When I saw the headlines earlier this week about the toll of drug-resistant staph infection - Staph Fatalities May Exceed AIDS Deaths - I started thinking about global warming. This wasn't some anxiety-inducing exercise to tote up all the possible things that might wipe us off the planet, but rather a musing on how a big problem that's on the minds of scientists finally makes it onto the public policy agenda - and how important it is to make sure that the "rich world" orientation of both the scientific and the policy communities doesn't obscure the important "poor world" issues.
Here's how drug resistance writ large (not related only to staph, but also to TB, AIDS and malaria) is a little bit like global warming:
- Both are a result of profligate overuse of a precious resource (fossil fuels, the ability to kill harmful bugs) without mindfulness about long-term consequences.
- For both, we've created a situation in which the commercial interests are largely lined up against better resource management and mitigation measures. The power of markets and the private sector is not yet marshaled toward making the situation better. The energy sector makes money on oil not conservation; the pharmaceutical industry may see few gains from taking steps to ensure the long-term effectiveness of low-margin, first-line drugs.
- For both, the government has a crucial role to play in regulation and in providing incentives for better resource management - and in both cases governments have been slow to take on those tasks. Particularly in low-income countries, public officials may also see that actions to mitigate long-term damage have a near-term cost for economic development (if energy conservation is required) and improvements in health conditions (if it's necessary to slow drug access until stronger systems to ensure adherence are in place).
- Both can be ameliorated only with a combination of significant behavior changes (by consumers, health care workers, patients) and technological developments (energy-efficient cars, solar power, new diagnostics and drugs).
- For both, understanding the severity and causes of the problem, and the feasible solutions is only possible if we think about the planet as one world, with global goods - and bads - that call for collective action.
The threat of drug resistance has not yet broken through in a big way into public policy circles, despite the worrisome signs - the recent research on deaths from staph infection, the emergence of extensively drug-resistant TB, new findings about the high rates of ARV failure in Africa. If the global warming analogy is right, scientists will fret over this for many more years and will see their warnings dismissed in favor of more "convenient truths." And the contributing factors and potential solutions in developing countries will be largely ignored. By the time the policy makers start feeling the heat, alternative paths will be much more challenging to find and it will be still more difficult to bring on board decision makers in the developing world.
Maybe we can learn a bit from the global warming story, though, and figure out ways to focus attention on the issue of drug resistance earlier than would otherwise be the case, and to ensure that the issues from the perspective of developing countries is well integrated into the policy discussions. Certainly some excellent efforts toward raising awareness about antibiotic drug resistance in the US have been made by our friends at Resources for the Future and elsewhere - see, for example, Extending the Cure. Now it's time to work on understanding the breadth of this and other types of drug resistance in low-income countries - particularly where donors are having a strong hand in expanding access to drugs - and to identify measures to address the problem.
Note: CGD is hoping to contribute to that process through a new Drug Resistance Working Group, to be led by my colleague Rachel Nugent.