Drug resistance usually emerges in parts of the world where antibiotic use in people and food animals is rampant, poorly regulated and largely untracked.
IN 2012, the director-general of the World Health Organization painted a stark picture of a post-antibiotic era where “things as common as strep throat or a child’s scratched knee could once again kill” and “hip replacements, organ transplants, cancer chemotherapy, and care of preterm infants would become far more difficult or even too dangerous to undertake.”
The recent appearance of a drug-resistant “superbug” in the U.S. is a wake-up call. It is the latest sign we need a different approach to protecting the efficacy of the antibiotics that modern medicine relies on.
Washington state is home to 168 nonprofits, businesses and other entities working on global health projects throughout the world and is well-positioned to help address this emerging crisis. Earlier this year, many of us came together to chart a new path.
Unlike other global health crises, this threat will directly impact many American lives and our sense of safety. The U.S. Centers for Disease Control and Prevention attributes 23,000 deaths to drug-resistant bacterial infections in the U.S. annually. Globally the number is as high as 700,000 deaths, and that number could rise to 10 million by 2050.
National action in response to superbugs is growing. In 2015, the White House released the National Action Plan for Combating Antimicrobial-Resistant Bacteria.
While we applaud this effort, these domestic steps need to be accompanied by a much stronger global approach. The reality is drug resistance usually emerges in parts of the world where antibiotic use in people and animals is rampant, poorly regulated and largely untracked.
What happens overseas in hospitals and communities (especially those with a high burden of disease) and on farms increasingly affects us. This is a function of both drug resistance and international travel and trade. In 2015, U.S. citizens made nearly 33 million overseas trips, and U.S. hospitals are increasingly dealing with situations in which citizens return home, seek treatment for illnesses, and introduce drug-resistant bacteria to hospital settings.
When superbugs hit the headlines, some experts call for reducing antibiotic use. That is a rational response in the developed world, but it is a more complicated story in poor countries.
While problematic, the high use of antibiotics in developing nations is often an understandable response to serious human health and economic problems. Factors driving human antibiotic use include low vaccination rates, poor urban sanitation, and lack of clean water, all resulting in a high disease levels. For livestock, the lack of vaccination and biosecurity combined with a growing demand for animal source proteins results in high use of antibiotics, many of which are medically important. In this context, urging less antibiotic use without addressing underlying problems is a strategy destined for failure.
Significant progress is possible with the right approach. We need to start by better understanding how drug resistance emerges and spreads from different global settings into U.S. communities and hospitals. Comprehensive surveillance at locations with the greatest risk will help us identify and test intervention strategies that reduce the emergence and spread of drug-resistant bacteria. Carrying out this approach will require resources and cooperation between federal agencies, Congress, international global health organizations, U.S. hospitals, research universities, and others.
Our organizations and others recently formed the Washington State Antimicrobial Resistance Coalition. The coalition brings together a broad cross-section of organizations based in our state that can help make a global impact on this public health priority. We have been impressed with the bipartisan interest shown by our state’s congressional delegation and others in government.
It is only a matter of time before superbugs shake the foundation of modern medicine. To confront this challenge, we must deploy resources in a smarter way across the globe, making the connections that the bugs themselves make. We can minimize the effects, but only if we identify the problem and intervene. That’s where our coalition and others can help. Let’s get started.