Turning Recommendations into Reality: CGD's Impact on Drug Resistance Beginning to Take Shape

By Rachel Nugent

Deputy Director for Global Health

Since most readers of this newsletter are dedicated advocates of a stronger global response to drug resistance, you are well aware that efforts to curb resistance thus far have fallen woefully short. Across the spectrum – from R&D to supply chain, to patient adherence to drug resistance surveillance and lab capacity – people are making choices that increase the risk of stimulating or spreading drug resistance. Sometimes the implications are unknown, and sometimes they are simply ignored.

While I am grateful for the many organizations and programs that have been working on this problem for years – many of whom have been guests columnists in this space – I share their frustration and disbelief that the efforts remain largely piecemeal and fragmented, often focusing on one disease or one geographic area at a time. The result is a scatterplot of seemingly unconnected dots that tell us something about resistance to a specific drug in a specific time and place – yet these dots are rarely connected into a recognizable hologram, whether by public health authorities or by providers working directly with patients. Even relatively new programs that provide critical information about resistance such as WWARN, HIVResnet, and GARP suffer from those weaknesses, and are supported with temporary funding.

The recent report of CGD’s expert Drug Resistance Working Group provides a broad, comprehensive examination of drug resistance – across different diseases, geographies, and stakeholders. The working group, which included representatives from pharmaceutical manufacturers, global health institutions, foundations, and governments, expressed the need for a coherent, coordinated global response and presented four key recommendations that – implemented together – will go far to stop the spread of resistance. The steps proposed by the working group require strong global leadership to strengthen existing efforts in the field and emphasize the need to spur innovative solutions.

Specifically, the report recommends:

1. Collecting and sharing drug resistance information across disease networks.

2. Securing the entire drug supply chain to ensure quality products and practices.

3. Strengthening national drug regulatory authorities in developing countries.

4. Accelerating research and innovation to speed the development of resistance-fighting technologies.

Each of these objectives and the steps to achieve them are carefully described in the report. We are now working with a range of organizations to advance the ideas and see them implemented. It’s going to take time and money, but we and many others have concluded that the risk of not taking these steps is too high. As our report makes clear, we need a significant, broad-based and sustained new push to address drug resistance and ensure the lasting effectiveness of medicines. On a good day, I find myself believing that such a push may be possible with the combined efforts of global agencies and donors. It is glaringly obvious that it won’t happen without them. Here are a few of the reasons for my optimism:

In an encouraging step forward, a CGD-sponsored drug resistance stakeholder’s meeting in May attracted a number of key global and national organizations to endorse the recommendations of the CGD Drug Resistance Working Group, and produced a consensus for both greater priority and greater action to respond to drug resistance. Here are the major actions that are under active development so far as a result of that meeting and our discussions with implementing organizations and funders:

• A push to galvanize global awareness about drug resistance and raise the priority at major multilateral and donor institutions. There are encouraging signs from the WHO, World Bank, Global Fund, and Inter-American Development Bank to bring new attention to drug resistance.
• A new Global Partnership to Improve Drug Prescribing, Dispensing, and Use (DPDU). Learn more about this effort and an organizing meeting below.
• A coalition of drug resistance surveillance networks and private companies sharing information, methods and tools, and producing a biannual report of global drug resistance across diseases. More information will be shared as plans evolve.
• Establishment of a web-based drug resistance research marketplace to share innovation and attract R&D funding. Once again, more information will be shared as our work progresses.

In another very positive sign, WHO decided last spring to make drug resistance the topic of World Health Day 2011 (just a coincidence?). Plans are moving ahead rapidly in Geneva and in WHO regional offices, and CGD is working closely with WHO leaders to assure a cross-disease and multiple-stakeholder approach to how drug resistance is presented globally. But wait…there’s more.

International efforts – including new initiatives from the World Bank to strengthen laboratories worldwide, a new EU-US Task Force on Antimicrobial Resistance, and recent attention to antimicrobial drug development needs and agricultural antibiotic over-use from the House Energy and Commerce Health Subcommittee in the U.S. Congress – make me feel optimistic that the global health community won’t stand idly by while drug resistance overwhelms efforts to improve health in both poor and rich countries. And if those positive steps are not enough, the pan-drug resistant NDM-1 gene traveling around the world should attract more than passing attention to the empty medicine cabinet that could be our future.

For our part, as we work to advance all four recommendations of the CGD report, our next step is to convene a meeting in September with organizations interested in forming a Global Partnership to Improve Drug Prescribing, Dispensing, and Use (from the Ecumenical Pharmacy Network on up to WHO). Our challenge to them: create a partnership to guide, oversee, and improve how drugs are distributed and used that can engage with developing countries that are ready, willing, and able to address the problems of poor quality (and counterfeit) drugs and inappropriate use. Our promise to them: to do all we can to help bring on board technical and financial support for a viable effort to improve DPDU. We’ll report back from that meeting how the Global Partnership will work, and how you could be involved.