The Economist summarized part of the CGD Antibiotic Resistance Working Group Report in a recent article on drug resistance efforts.
From the Article
ON DECEMBER 11th 1945, at the end of his Nobel lecture, Alexander Fleming sounded a warning. Fleming’s chance observation of the antibiotic effects of a mould called Penicillium on one of his bacterial cultures had inspired his co-laureates, Howard Florey and Ernst Chain, two researchers based in Oxford, to extract the mould’s active principal and turn it into the miracle cure now known as penicillin. But Fleming could already see the future of antibiotic misuse. “There is the danger”, he said, “that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”
Penicillin and the other antibiotics that its discovery prompted stand alongside vaccination as the greatest inventions of medical science. Yet Fleming’s warning has always haunted them. Antibiotic resistance has now become a costly and dangerous problem. Some people fear there may be worse to come: that a strain of resistant bacterium might start an epidemic for which no treatment was available. Yet despite Fleming’s warning and despite a fair understanding of the causes of resistance and how they could be dealt with, dealing with them has proved elusive. Convenience, laziness, perverse financial incentives and sheer bad luck have conspired to nullify almost every attempt to stop the emergence of resistance.
There are good reasons to hope that the extreme threat of a resistant epidemic will never come to pass—not least that 65 years of routine antibiotic use have failed to prompt one. Even so, the lesser problems of resistance continue to gnaw away at medicine, hurting people and diverting resources from more productive uses, often in the countries that can least afford it.
Irresistible
Convenience and laziness top the list of causes of antibiotic resistance. That is because those who misuse these drugs mostly do not pay the cost. Antibiotics work against bacteria, not viruses, yet patients who press their doctors to prescribe them for viral infections such as colds or influenza are seldom harmed by their self-indulgence. Nor are the doctors who write useless prescriptions in order to rid their surgeries of such hypochondriacs. The hypochondriacs can, though, act as breeding grounds for resistant bacteria that may infect others. Even when the drug has been correctly prescribed, those who fail to finish the course are similarly guilty of promoting resistance. In some parts of the world, even prescription is unnecessary. Many antibiotics are bought over the counter, with neither diagnosis nor proper recommendations for use, multiplying still further the number of human reaction vessels from which resistance can emerge.
Nor is the problem confined to people. Analysing official figures, Louise Slaughter, an American congresswoman who is also a microbiologist, calculates that four-fifths of the antibiotics used in America are given to livestock, often to get perfectly healthy animals to grow faster. That is convenient, because it produces cheaper meat, but it creates yet more opportunities for bugs to evolve resistance.
All this matters because antibiotic resistance has both medical and financial costs. It causes longer and more serious illnesses, lengthening people’s stays in hospital and complicating their treatment. Sometimes people die unnecessarily. In one study, which sampled almost 1,400 patients at Cook County hospital in Chicago, researchers found resistant strains of bacteria infecting 188 people, 12 of whom died because they could not be treated adequately. At the moment, resistant bacteria threaten mostly children, the old, cancer patients and the chronically ill (especially those infected with HIV). However, there could be worse to come. Nearly 450,000 new cases of multidrug-resistant tuberculosis are recorded each year; one-third of these people die from the disease. More than a quarter of new cases of TB identified recently in parts of Russia were of this troublesome kind.
The price in money, too, is high. On the basis of the Cook County study the Alliance for the Prudent Use of Antibiotics, a non-profit group, calculates that resistance to antibiotics costs America alone between $17 billion and $26 billion a year—perhaps 1% of the country’s vast spending on health care.
America is rich, and can afford this. Poor countries are not as lucky. And a perverse calculus puts them at a particular disadvantage. The poorer the country, the larger the share of its health-care budget typically absorbed by the cost of drugs. As a report last year by the Centre for Global Development, an American think-tank, pointed out, resistance often increases the drug bill, because patients are forced to turn from cheap, widely used drugs (whose very ubiquity encourages the evolution of resistant strains) to dearer alternatives. That imposes a disproportionate burden on poor countries. For the cost of treating one person with extensively drug-resistant TB, for example, a hospital could treat 200 with the less lethal variety.