Last week, the United Nations General Assembly met to discuss the growing global issue of antimicrobial resistance. This marked only the fourth time a UN high-level meeting convened about a health topic, putting the issue on par with the AIDS pandemic and Ebola as threats to the health and economies of nations around the world.
Drug-resistant infections—in which illness-causing bacteria, viruses, or parasites no longer respond to medications—kill an estimated 700,000 people around the world each year and could cause 300 million premature deaths by 2050. Those numbers have caught the attention of world leaders, who used the meeting to call for improved prevention efforts and better systems to monitor overuse of antibiotics in medicine and agriculture. The member nations also noted pharmaceutical companies’ failure to deliver new affordable antibiotics and asked governments to create incentives to promote research and development.
While the United Nations’ consideration of the issue is groundbreaking, antibiotic resistance is not new. Almost as soon as scientists discovered ways to kill them, bacteria began to adapt. In fact, Alexander Fleming, who is credited with discovering penicillin, warned of resistance when he accepted a Nobel Prize in 1945: “There is the danger that the ignorant man may easily underdose himself and by exposing his microbes to nonlethal quantities of the drug make them resistant,” Fleming said. In recent years, the number of bacteria that has become resistant to the drugs commonly used to cure infections has increased, and the threat of untreatable infections looms large.
The threat, however, goes beyond just health. The World Bank recently released a report suggesting that if antibiotic resistance is not curbed soon, the crisis would make it impossible to reach the UN’s sustainable development goals for 2030. At the meeting, World Bank President Jim Yong Kim said: “The scale and nature of this economic threat could wipe out hard-fought development gains and take us away from our goals of ending extreme poverty. We must urgently change course to avert this potential crisis.”
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Simply using antibiotics inevitably leads to resistance, but this crisis could be stemmed if we limited our use of these life-saving drugs. Antibiotics should only be used to fight diagnosed bacterial infections, but patients often demand antibiotics when they are not necessary and frequently stop those that are necessary too soon. When antibiotics are used, doctors need to prescribe the right medication in the right dose. But, unfortunately, doctors are limited by a lack of diagnostic testing that can determine which bacteria are causing infection. The result is that, according to the Centers for Disease Control and Prevention (CDC), 50 percent of the time antibiotics are not optimally prescribed.
Overuse of antibiotics in patients, however, may not be the main source of resistant germs. For decades, farmers have been using antibiotics in animals to fatten cows, pigs, and chickens faster and prevent infections from spreading among the animals. These antibiotics kill or suppress those bacteria that still respond to the drugs while resistant bacteria are allowed to thrive.
Some of the bacteria that are most resistant to existing drugs cause food-borne illnesses such as salmonella or sexually transmitted infections. Other bacteria of concern include methicillin-resistant Staphylococcus aureus (MRSA), which can live on medical equipment and is common in hospital settings. And, as Rewire has been reporting for many years, Neisseria gonorrhoeae, the bacteria which causes gonorrhea, is also becoming rapidly immune to existing treatments. In fact, at a meeting held in Atlanta at the same time the UN was meeting in New York, the CDC announced that seven men in Hawaii were infected with strains of gonorrhea that were showing resistance to the only two drugs we have left to treat it.
The lack of antibiotics in our arsenal is a large part of the problem the UN is attempting to address. Indeed a new report in the Journal of the American Medical Association (JAMA) points out that the FDA approved only two new antibiotics in the United States between 2008 and 2012. In contrast, it approved 16 new drugs between 1983 and 1987.
To be sure, a U.S. government incentive program—which speeds up the regulatory process—does seem to be working. As of March of this year, 37 new drugs were reportedly in development.
But for the pharmaceutical industry’s part, the JAMA report notes that it has not invested in antibiotic development primarily due to financial reasons. These drugs are expensive to produce and difficult to test because infections are sporadic and patients are usually exposed to existing antibiotics before being given an experimental drug. The profit motive is also not there; antibiotics are relatively inexpensive per dose and only taken for a short period of time as opposed to drugs designed to treat chronic conditions. Moreover, because the threat of resistance looms over any new antibiotic, the longevity of these drugs in the market is never certain.
At the conclusion of the UN meeting, all 193 member countries signed a declaration in which they promised, among other things, to encourage innovation and the development of new antibiotics. The declaration does not set targets but instead requires each country to submit a plan to the UN Secretary General within two years. This was done in part to acknowledge the disparities between signatory nations; in some countries, access to antibiotics when needed is a bigger problem than overuse and the UN does not want to stigmatize or impede necessary use of these drugs.
Ramanan Laxminarayan, director of the nonprofit Center for Disease Dynamics, Economics and Policy and a speaker at the meeting, told National Geographic that the road forward will not be easy and the stakes are high: “This is a multisector problem, which means the U.N has to quickly make friends outside of governments. We’ve got to get doctors, the whole medical practice community, the pharmacists, manufacturing, the whole agricultural sector …. We only get one crack at this. If we fail to do this, the world will only have checked off a box that says, ‘We have dealt with antimicrobial resistance, it went to the U.N., it is done.’”