Dear Colleague:

A very warm welcome to the first issue of the Center for Global Development's latest e-newsletter, focusing on the important and often insufficiently-addressed topic of drug resistance as part of our Drug Resistance Working Group! No doubt that wherever you live, you've been reading lately about drug resistant disease--whether it's XDR-TB and MDR-TB in South Africa or London or Methicillin-resistant Staphylococcus aureus in your local school. Drug resistance is a problem that travels from person to person and country to country. Its pervasiveness threatens the health of each of us and our families, and urgently requires increased global action. Within this context, I am excited to lead a new CGD Working Group addressing such an important issue.

The purpose of the monthly Drug Resistance and Global Health Update is not only to provide an update on the Working Group's activities, but also to highlight recent drug resistance research and policy developments at the global level. The newsletter will include guest columns from Working Group members and other experts on specific sub-topics related to resistance concerns. We hope to inform and mobilize a community of people working on development and health issues to address the global problem of drug resistance.

I welcome your comments and suggestions (write us at [email protected]) and hope that you will forward this letter to your colleagues who may share our concern about growing problem of drug resistance.

Best wishes,

Rachel Nugent

Senior Program Associate for Global Health
Center for Global Development

Introduction to the Working Group

CGD's Drug Resistance Working Group was launched in November 2007 to bring together global drug resistance experts crossing geographic regions, disease areas and professional sectors (including academia, industry, national and international policy, NGO, and advocacy). Drawing on the strength of it diverse composition, the Working Group seeks to extend the problem-solving conversation around drug resistance into and among communities that all have an interest, but rarely have the opportunity to forge joint solutions. The group expects to conclude its work program in early 2009 with publication of a set of realistic, credible and actionable recommendations targeting key actors who can influence policy to slow drug resistance emergence and transmission. (See this Q&A for more details.)

Since its inception, the Working Group has begun work on several background papers, which will serve as inputs to the final policy document. The first paper, "Drug Resistance as a Global Health Policy Priority," provides a brief overview of the magnitude of drug resistance against AIDS, malaria, tuberculosis and other bacterial infections; discusses the rationale for global policy action; and identifies promising avenues for exploration.

For purposes of analysis, we have classified the drivers of drug resistance into the following "tripartite" framework:

• Drug and drug technology characteristics based on the ways that drugs are developed and manufactured, and how this can affect their propensity to drive resistance (through half-life and drug selection pressure, for example).
• Health system characteristics including the lack of high-quality services, high direct and indirect costs, etc.
• Behavioral characteristics such as stigma, length of treatment, patient-provider interaction, cultural and gender issues.

These three drivers are overlapping in some respects. We are using this framework to highlight opportunities for change that will reduce the risks of resistance. The Working Group's recommendations will most likely fall into and across these three categories. We will keep you updated on those emerging findings via this e-newsletter, and welcome your feedback on our thinking.

Drug Resistance News

• Misdiagnosis of TB as a driver of resistance in Kenya (Business Daily, Nairobi)
• The paucity of laboratory support in Asia (Antara News, Manila)
• TB and ethics (The Guardian)
• Evidence that the use of fluoroquinolones to treat pediatric MDR-TB has led to the emergence and spread of levofloxacin-resistant pneumonia (The Lancet)
• How much to screen for hospital-based MRSA? Recent findings supporting and opposing universal screening at hospital admission (Annals of Internal Medicine and The Journal of the American Medical Association)
• Hospital vs. community; human rights and infectious disease: the ongoing debate on how to best and most "justly" manage XDR- and MDR-TB. A view from current practice in South Africa and from Georgia-Abkhazia (New York Times and MSF International)
• New rapid diagnostic tool for MDR-TB reduces diagnostic time from 42 days down to 1-2 days (American Journal of Respiratory and Critical Care Medicine)
• Tea up: green tea as a weapon against drug resistant bugs (Newsweek

Employment and Consulting Opportunities

• CGD is seeking to hire a Program Coordinator to provide research and outreach to the Drug Resistance Working Group.

Upcoming Events

• The Global Health Council will be hosting a policy seminar addressing the intersection of drug resistance and access to medicines on May 30, 2008, featuring Rachel Nugent.
• The XVII International HIV Drug Resistance Workshop: basic principles & clinical implications will be held in Sitges, Spain on June 10-14, 2008

Call for Papers and Abstracts

• An official call is out for articles for the first volume of the 2008 International Pharmacy Journal Series. The theme of this issue will be "The Future of Medicines Use" and will include strides made in the Rational Use of Medicines and good pharmacy practice. Please email [email protected] for authors' instructions. The deadline for submission is May 1, 2008. Articles may be submitted to [email protected].
• The Journal of Law, Medicine & Ethics will host a thematic issue on Pharmaceuticals & Medical Devices in 2009. Articles may be submitted for any topic relating to pharmaceuticals and medical devices. Shorter papers (e.g. (3000--9000 words) are of primary interest, although longer papers will receive careful consideration. Please submit an abstract by June 15, 2008; papers are due by September 15, 2008, and should adhere to the JLME style sheet. All correspondence should be directed to guest editor Kevin Outterson at [email protected].

Grant Opportunities

• The Bill & Melinda Gates Foundation recently announced that it is now accepting grant proposals for the first round of Grand Challenges Explorations, which include a topic area devoted to drugs and delivery systems to limit drug resistance. Proposals will be accepted onlinethrough May 30, 2008; applicants must register their intent to submit a proposal by May 15, 2008.

Partner Resources

• Action on Antibiotic Resistance (ReAct) has sponsored SciDevNet's latest resource on antibiotic resistance highlighting the need to raise public awareness of the situation and provides expert views and information about the scale of the problem, drivers of resistance, the economic implications of growing resistance, diagnostics, and investment in new drugs. For additional updates on important antibiotic resistance issues, you can also subscribe to ReAct's e-newsletter.