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The growth and global spread of infections resistant to almost all known antibiotics is a huge looming threat. A recent study estimates up to 10 million lives could be lost each year by 2050, with enormous economic impact. Antimicrobial resistance could reverse progress made against big global killers such as HIV, malaria and tuberculosis. Even common surgery could carry a lethal risk of infection. CGD work examines the incentives, innovation, and impetus needed to ensure collective action to produce a new generation of antibiotics, and encourage their widespread development and use.
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.
The Center for Global Development presents a seminar and discussion on
Prices, Diagnostic Tests and the Demand for Malaria Treatment: Evidence from a Randomized Trial
Harvard School of Public Health & Brookings Institution
With discussantRachel Nugent
Center for Global Development
Moderated by Mead Over
Center for Global Development Tuesday, June 29, 201012:00pm--1:30pmA light lunch will be served
atCenter for Global Development Lobby-level Conference Center1800 Massachusetts Avenue, NW, Washington, DC
Summary: CGD recently issued a major report on global drug resistance. CGD’s working group pointed to inappropriate use of medicines as a major driver of drug resistance across all major developing country diseases. This seminar will present results of new research on how to reduce the overuse and misuse of anti-malarials through better diagnosis of malaria. Due to widespread parasite resistance and high costs of Artemisinin Combination Therapies (ACTs), fewer than 15% of children with malaria are treated with effective medicines. The Affordable Medicines Facility for malaria (AMFm) is an initiative to subsidize the bulk of the cost of ACTs to suppliers, in part by dramatically reducing the final price of ACTs to consumers in the retail sector, or drug shops (where malaria treatment is most commonly sought). However, because the majority of people seeking malaria treatment in drug shops have received no formal diagnosis, substantial increases in access to ACTs may lead to inappropriate utilization of the drug. A high rate of overtreatment with ACTs is problematic, wasting subsidy funds and potentially stimulating the evolution of resistance. This paper reports on a field experiment from Western Kenya in which subsidized ACTs, along with subsidized Rapid Diagnostic Tests (RDTs), were made available in drug shops. We explore whether the targeting of the ACT subsidy to people with confirmed malaria could be improved by creating financial incentives for individuals to be tested before purchasing ACTs.
The Center for Global Development’s Drug Resistance Working Group urges pharmaceutical companies, governments, donors, global health institutions, health providers, and patients to collectively and immediately tackle this global health threat by implementing four key recommendations.
In an increasingly interconnected world, drug resistance does not stop at a patient’s bedside—it threatens global health. The conclusions of the Center for Global Development’s Drug Resistance Working Group make clear the need for urgent action to address this growing crisis.
Since Charles, Janeen, and I last wrote about the links between drug-resistant superbugs and antibiotic use in livestock, there has been a slew of new interesting, terrifying, and informative things to read on the topic. And they all underscore the need for a global approach to reduce agricultural use of antibiotics to promote animal growth and prevent disease in large, concentrated feeding operations. We offered initial ideas on the essential elements of a global treaty here. You can also read more about the problem, and the steps taken thus far to address it, in my new CGD book, Global Agriculture and the American Farmer: Opportunities for US Leadership.
Most antibiotics around the world today are fed to farm animals to promote growth and prevent diseases fostered by crowded conditions on factory farms. There is an urgent need to find alternatives to keep animals healthy, and preserve crucial antibiotics for human health. One way to do that would be to create an international treaty not to use antibiotics in livestock feed — and probiotics, like those found in yogurt, may be a stepping stone toward that goal.
Without global action, by 2050 there could be as many as 10 million antimicrobial resistance-related deaths each year. An important—and often overlooked—part of the problem is the overuse of antibiotics in farm animals. CGD recently convened a roundtable discussion with technical experts to discuss possible ways to strengthen global cooperation to address livestock’s contribution to AMR. Drawing on that productive discussion, we outline steps that could help make inroads into the problem.