President Obama Doubles Down on the Fight against Superbugs

Calling antibiotic resistance “one of the most pressing public health issues facing the world today,” the President’s FY 2016 Budget, announced Tuesday, proposes an historic investment – almost doubling the current budget to an unprecedented $1.2 billion – to combat antibiotic-resistant bacteria.

A meeting of PCAST members with President Obama, 2014

The Budget is Obama’s effort to pay for the game plan on antibiotic resistance, announced in September, drawn up by his eminently qualified President’s Council of Advisors on Science and Technology (PCAST).

Eric Lander, PhD, founding director of the Broad Institute of MIT and Harvard, and co-chair of PCAST, assessed the state of play at the time: “There is no permanent victory against microbes. If you use antibiotics, whether in human health care or in agriculture, you will over time see resistance. If we fail, if we fall behind in our stewardship, in our creation [of new antibiotics or equivalent therapies], or if we fail to surveil to understand what’s going on, it’s a very real risk to see a resurgence of what life looked like a century ago when we had bugs we could not treat. It’s a terrifying prospect. Now … it doesn’t help to do scare tactics around these things but it’s just plain scary.”

Since then, there have been two notable events.

One, the announcement in December by UK Prime Minister David Cameron’s working group on antimicrobial resistance that deaths caused by untreatable infection will overtake deaths caused by cancer by the year 2050.

Two, the report in the New York Times that India’s infants are born with bacterial infections that are resistant to most known antibiotics, and more than 58,000 died last year as a result. That if these “resistant infections keep growing … it would be a disaster for not only India but the entire world.”

Quoting health officials, the Times reports that the infections are in fact growing rapidly: “Five years ago, we almost never saw these kinds of infections. Now, close to 100 percent of the babies referred to us have multidrug resistant infections. It’s scary … And these resistant infections have already begun to migrate elsewhere … reaching just about every country in the world … including … the United States.”

Migrate here? The recent Ebola scare in the US is a useful reminder of a bedrock principle of infectious disease: “A disease outbreak anywhere is a disease risk everywhere,” says Tom Frieden, MD, Director of the Centers for Disease Control and Prevention.

Of course, there is a crucial difference between Ebola and antibiotic- resistant infections: Ebola is transferred only from the very sick through their body fluids. Most ABR infections, on the other hand, travel through the air and are therefore as easy to catch as the common cold. So imagine then, if Thomas Eric Duncan, the only person to die in the US from Ebola, was left wandering Dallas for 5 days with an undiagnosed case of MRSA, say, as he was with Ebola. What then?

That is just one scenario that would constitute Dr. Landers’ “terrifying prospect.” And that is why President Obama rightly calls antibiotic resistance one of the most pressing public health issues facing the world today.

The Day the Earth Stood Still

Last week we wrote about the new British report that said drug resistant infections will cause more deaths than cancer by 2050.

We focused on how untreatable infections will fundamentally change how we practice medicine, citing 3 examples: an increased inability to treat cancer; an increase in deaths during child birth – to mother and child; and how surgery will become too dangerous to perform in most cases.

There is, crucially, a whole other aspect to the global rise of drug resistant infection that is stressed in the report. It is summed up in one sentence by the lead author, former Goldman Sachs economist Jim Nill, in the video below, where he says:

“Something like this which is going to affect everybody; you know it could have a devastating impact on international trade and travel and globalization.

A devastating economic and social impact – what does he mean?

Remember the great American Ebola freakout of 2014? The one where, in the US, 1 person died and a half a dozen or so were sick but recovered. Well, what if the number of deaths in the US and Canada was not 1, but, as the report predicts concerning drug resistant infection, over 300,000? What if the number of infected people were several multiples of that? And what if these infections, unlike Ebola, are airborne – meaning you catch them easily, the way you catch the cold or the flu?

Deaths attributable to drug resistant infections every year, by 2050

A partial answer to these questions has been before our eyes for the past 6 months or so with Ebola virus disease in West Africa. As of yesterday, the US Centers for Disease Control and Prevention reported more than 8,000 deaths and over 21,000 cases.

As a consequence, life over there has stood comparatively still. Take just 2 brief examples.

The World Bank reported this month that in Liberia “The Ebola virus has tempered our economy. It has hurt our economic investments. Our businesses have been closed down and our country has been abandoned.”

And from the Financial Times in October: Airlines, hotels, tour operators and cruise businesses are resigned to a period of crisis management as investors retreat from their stocks on fears that the Ebola threat will blunt people’s willingness to travel.”

Now imagine that scenario playing out over here and in Europe and you have the kind of “devastating impact,” from the rise of drug resistant infections “which is going to affect everybody,” that the conservative, experienced, elite economist Jim Nill is warning us about.

In other words, closed businesses, truncated trade and travel, investment crises, and other globalization effects will be such that the world could virtually end up at a stand still — and don’t forget the fear that will accompany it all.

Here’s the brief video where Mr. Nill and a few others voice these stark concerns:

Drug-resistant infections are going to cause more deaths than cancer

Deaths caused by untreatable infection will overtake deaths caused by cancer by the year 2050. So says the first report produced by UK Prime Minister David Cameron’s working group on antimicrobial resistance, formed last July. As you look over the graphic keep this warning from the Cameron group in mind: “Despite the staggering size of the figures set out … they do not capture the full picture of what a world without antimicrobials would look like.”

The “full picture” of a world without these drugs means we will be forced to stop practicing medicine the way we do now. Stuff we have long taken for granted will be taken from us. The report gives us 3 concrete examples: surgery, cancer treatment, and child birth.

On surgery: “When most surgery is undertaken, patients are given prophylactic antibiotics to reduce the risk of bacterial infections. In a world where antibiotics do not work, this measure would become largely useless and surgery would become far more dangerous.”

On cancer treatment: “Modern cancer treatments often suppress patients’ immune systems, making them more susceptible to infections. Therefore without effective antibiotics to prevent or treat infection, chemotherapy would become a much riskier proposition.”

On childbirth: “Rising drug resistance would also have alarming secondary effects in terms of the safety of childbirth, including caesarean sections, with consequential increases in maternal and infant mortality. The 20th century saw childbirth in high income countries move from being something that carried significant risk to something that we take for granted as being safe: the world witnessed a 50-fold decrease in maternal deaths over the course of that century. Much of this progress could risk being undermined if AMR is allowed to continue rising significantly.”

Here’s the most important point: You and I have a role to play. We are are not meant to be mere bystanders. Since the problem is driven by the overuse of antibiotics our job is to lessen the demand. How so? Stop asking for antibiotics. That’s the message that people such as the Harvard School of Public Health are trying to get across. It’s well worth watching their presentation – meant for the public – by clicking on the preceding link.

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