By Tracey Guise and Laura Piddock, Special to CNN
Editor’s note: Tracey Guise is CEO of the British Society for Antimicrobial Chemotherapy. Laura J.V. Piddock is Director of Antibiotic Action and Professor of Microbiology at the University of Birmingham. The views expressed are their own.
It’s not surprising that international attention has been focused on the ongoing outbreak of Ebola that has struck West Africa. After all, there are few treatment options for the disease, which has a case fatality rate of up to 90 percent, and the current outbreak has been described as the deadliest outbreak in history. Indeed, Britain’s government recently held an emergency meeting to discuss the possible threat to the country, although the foreign secretary said he believes Britain has the expertise to deal with the threat.
But while Ebola is getting the headlines, another health threat has been growing across the globe, one with implications every bit as serious: the rapid rise of antibiotic resistant bacteria.
There are few of us alive in developed countries that can remember living without the unprecedented health benefits that antibiotics bring. Within a few decades of Alexander Fleming’s discovery of the antibacterial powers of Penicillium, back in 1928, healthcare had progressed more than it had in the two millennia prior to their discovery. Fast forward to today, and antibiotics are a mainstay of human health – lifesaving, life enhancing, life extending and enabling agents without which medicine as most of us know it would not exist.
As consumers, we have high expectations for our well-being, including life extending treatments for those with chronic conditions such as cystic fibrosis, successful cancer chemotherapy regimens, and organ transplant and joint replacement surgeries – we expect to receive these treatments when required and without exception. But imagine a world in which a simple scratch could prove fatal? Or even minor surgery became risky to perform? One recent study, reviewing 43,000 patients undergoing abdominal surgeries, showed that about 40 percent of patients having operations on the large intestine suffered an abdominal wound infection if they were not given antibiotics.
Sadly, these once inconceivable scenarios are edging closer to reality as health professionals across the globe grapple with a dual crisis of antibiotic resistance and a depleted antibiotic discovery and development pipeline. Together, they pose a global crisis to human health as critical as the AIDS pandemic in the 1980s and 1990s. This is not a crisis pending – it is already here.
Yet none of this should come as a surprise. Physicians and scientists have been warning of the relentless rise in the numbers of antibiotic resistant bacteria for half a century. But while dozens of reports and recommendations, including by the World Health Organization, have been published on the issue, there has been a noticeable absence of political will, which in turn has meant the public has remained largely unaware of the problem.
Meanwhile, an increasingly complex, and in turn expensive, regulatory environment for the pharmaceutical industry has meant that the development of antibiotics has become a high-risk activity with diminished returns for shareholders. As the number of pharmaceutical companies producing new antibiotics have declined, so have the number of new antibiotics reaching the market – only two systemic antibacterial agents were approved for use in humans from 2008-2012, compared to the 16 discovered from 1983-1987.
It is difficult to imagine how loud the outcry would be if there were so few new cancer treatments in the pipeline, yet the potential size of the antibiotic arsenal available to defeat a growing number of multidrug-resistant bacterial infections is troublingly small despite the efforts of organizations such as the Alliance for Prudent Antibiotic Use, CDDEP and the Pew Trust in the United States, and ReAct and Antibiotic Action in Europe. All are aware of the enormity of the task ahead, and hope that their collective messages will be received.
And their voices might finally be being heard.
The Transatlantic Taskforce on Antimicrobial Resistance (TATFAR) was established by U.S. presidential declaration in 2009 and issued its first report in September 2012, identifying the need for intensified cooperation between the United States and Europe. In the European Union, the European Medicines Agency has been reviewing the requirements for clinical trials of antibacterial treatments. In India, meanwhile, the publication of the Chennai Declaration led to changes in Indian law aimed at ending the sale of over the counter antibiotics. And here in the U.K., the government last year published a five-year strategy on antimicrobial resistance, while in July, Prime Minister David Cameron declared the need for urgent and global action as he announced the launch of a commission on antibiotic resistance.
But while this increased interest is welcome, policymakers must match words with the kind of action that has been seen on challenges such as Alzheimer’s and obesity by ensuring similar levels of funding is in place to further our scientific base for understanding the biology, clinical and social impact of antibiotic resistance.
Governments must also do more to encourage drug development. One way of underpinning such efforts would be to assist academic and small and medium-sized enterprises (SMEs) to work together and with “big pharma” to accelerate the discovery of new ways to prevent and treat bacterial infections.
Finally, it is imperative that everyone has a clear understanding of the importance of ensuring antibiotics are used appropriately, especially as they are so commonplace – discouraging their use other than to treat bacterial infection is essential. With this in mind, education on appropriate use must include placing restrictions on the purchase of antibiotics by the general public, a widespread problem in some countries.
Former U.S. Secretary of State Henry Kissinger once famously said, “The absence of alternatives clears the mind marvellously.” This perfectly encapsulates the importance of antibiotics to health today, and we must now be bold enough to invest in the infrastructure and innovation needed to protect and replenish the antibiotic treasure trove.
We are at a crossroads, and inaction is not an option – a reality that must be acknowledged by politicians, scientists, healthcare professionals and the public alike. If we can ensure that it is, then we will give ourselves a fighting chance to make the future of global health a brighter one.
Instead of all this senseless military spending, this government would do far better to use that money in combating not only Ebola, but a host of other diseases such as ALS and Alzheimer's. Need I say more?
Very well put. I also think that as well as new anti-biotics,; we would do well to eat to boost our immune systems.
Agree @ George Patton...and yet the last act the romper room misfits did before leaving on their lengthy vacation...was approve $225 million to be given to Israel to strengthen their Iron Dome! How DARE they!
They act as if our hard earned tax dollars are their own personal spending money!
How does the FDA justify giving two doctors an experimental serum who have contracted the Ebola virus when it had only been tested on monkeys but denies experimental medication to terminally ill children?
Maybe because they werent in the US when they were given it?
Clever, @ chrissy.
Sarah Palin gives me the heebie-jeebies !
if you call yourself a twit, you must be a twit. all of us know that you are indeed a twit. do you know that you are a twit??? a palintwit is still a twit. Don't you have anything else do do with your life other than talk rubbish on blogs that get erased every week??? I guess not. Think about it, please............. :)
Are you still embarrassed that you voted for Palin?
dude, Sarah Palin destroyed her own rocket ship long ago. The only thing she has is her pretty face. She came across, to the entire world, as a low intellectual lame brain, white trash from a trailer park in Wasilla, Alaska, who should have stayed to cheer leading at the Iditarod. don't worry, she will never make it to the big ball game, and no, I did not vote for her.
What's it like being stuck in 2008? You should invest in the stock market. I believe by 2014 it will reach record highs...
How come Palin is still spouting her ignorance TODAY then?
she is still spouting rubbish because white trash tea baggers, just like herself, love her. but the rest of us Americans know now, not to let even those white trash tea baggers take charge of this country, because they don't deserve to steer a ship as diverse and as powerful as ours. If they take over, their racist ignorance will cause them to crash our country into the first trailer park along the freeway, within months....... we know that..........
Nothing will be done of any consequence until there is money to be made
@ Colt Hunter:
Thank you. That's a good motto to live by.
Trust me. I dedicated myself to mastering an art.
Is there a vaccine for the Heebie= jeebies ?
Oh but @ fun stuff....they DONT get erased dont you know! Proving that you should be very careful what you say on the internet cuz once there always there!
"there has been a noticeable absence of political will, which in turn has meant the public has remained largely unaware of the problem."
That's because celebrities and politicians haven't been directly affected yet. Apparently, that's what it takes to get the public's attention these days.
Or @ Yakobi...it could be because people are now realising that the big "fear frensy" was orchestrated to drive up certain Pharmecutical stock prices! And in fact it did just that very thing until....it was leaked that those Pharmacutical companies were NOT the ones that provided the cure!!! Go read for yourself in the money section of CNNs homepage!
It costs 1/2 billion dollars and takes 10 years to get a treatment approved by the FDA. Then, with a small molecule drug like an antibiotic, you only have 5 to 7 years to recoup your investment before patent protection runs out. Why would any company get involved in that business? Only exotic, hard-to-copy treatments are being developed, and antibiotics don't fit in that model.
And yet @ Ray, they are! Three of them in fact! And i guess you havent anyone in your family with a serious illness recently huh? My daughter has to have an injection every other week that costs 30k ea time! On top of all meds to balance that shot! Let me tell you...they make a fortune!
I kissed my way up to CEO at a health insurance company. Now I take over $1,000,000 of your health care dollars for NO VALUE ADDED to your health care. And that’s just me. Now think about how many other CEOs, VPs, Directors, Managers, etc. are at my company alone. Now multiply that by thousands of others at hundreds of other health insurance companies. From 10 to 25% of your health care dollars go towards administration that adds NO VALUE to your health care. But my company’s PAC dollars will continue to fool you little people into thinking that a single payer system will be bad. Little people like you are so easy to fool. Little people also don’t realize that a single payer system is the ONLY system that would allow little people (as an entire country) to negotiate better health care prices. Little people don’t realize that the Medical Cartels already know that. And that is the reason why the Medical Cartels spend so much PAC money from the hospitals and doctors lobbying against a single payer system. Some little people say that a single payer system would cost you little people more. But if that were true, then wouldn’t the hospitals and doctors WANT that extra money? Yes they would. So why do the Medical Cartels lobby against a single payer system? It’s because the Medical Cartels know it would allow little people to negotiate better health care prices. And that’s what the Medical Cartels are afraid of. Period.
But us big wigs at insurance companies, hospitals, and pharmacy companies don’t ever need to worry about health care no matter what it costs. We get our health care paid for one way or another by you little people. And we get the little people that work at our companies to contribute to our PACs. And us big wigs say it’s to protect the little peoples’ jobs. But in reality it would be in the little peoples’ best interest to NOT contribute to the PAC. Again, little people are so easily fooled. I won’t ever have to worry about losing my job with so many little people being brain washed by the Medical Cartels’ PAC money. Not only that, the Medical Cartels’ PAC money is used to elect so many republicans that will never allow a single payer system. Republicans have always fought against any meaningful health care reform. But that’s what our Medical Cartels’ PACs pay them for. Politicians can be bought so easily.
Pretty soon the only people that will be able to afford health care is us big wigs. And that’s the way it should be. We don’t want you little people using up the resources when we need them. And once again, I thank you little people for capping my SS tax at the $117,000 level. Now I only pay 1.17% SS tax and you little people pay 6.2%. Also, thank you for extending my tax breaks. I’m using the extra money on my vacation houses.
YOU SIR ARE EITHER SARCASTIC OR A FOOL. OR MAYBE CYNICAL BEYOND BELIEF.
What happens when your daughter can't afford her health care? Go to Mexico? Can't argue with the truth.
Medical costs in the USA are so out of control, that people are actually scared to get sick because they are sure it will wipe out their life savings. Just hearing what you are going to have to pay for your medication, these days, is enough to give you a heart attack! There are some real stories of 80 year old American women, driving south of the border, to Mexico, just to buy a medication that is one tenth of the price here in the US. Many Americans are flying to Asia to get surgery because the cost difference is so huge!
My daughter goes to Mexico for her dental care!
When we think of healthcare in America when it's a single mother raising her two young daughters who are attending school, as we all know the economy is slow coming back to normal with great paying jobs that can sort of cover our rising cost of healthcare, most of us are kept awake at night looking at the expensive medical bills and wondering should I use the retirement savings or mortgage the house again to pay for the bills. Well America I think we have reached a point where our healthcare system is run like a Mexican Cartel if you can afford then you deserve treatment if you don't have the money well the street is the best place to lie down and die because your healthcare coverage well not pay for your treatment. Our healthcare system in America should not be run like a McDonalds restaurant if you can pay for medical treatment, like most other countries like Cuba and the rest of North America and the world healthcare is a right not a privilege. Speaking to most Americans when I traveled this great land by bus I was talking to a nurse in Panama Beach Florida, she had worked at the local hospital for over twenty years and she had double the amount of healthcare coverage and was still not enough to pay for her medical bills it sadden me, to hear that a frontline nurse worker who cares for patients her entire life is now a patient and the healthcare system in America is denying her coverage that's not right atall in our great nation. As Americans we have a choice in our great land between private hospital's and universal health care which should be right for all Americans, because we are the only nation that pay's more for our drugs and get's screwed when it comes to the medical bills we have to pay for if for cast on our arm after a night of drunken biking down a path or something else in life which requires medical treatment. So America here is our choices we can have universal health care which covers all of our bills, and let's us keep our houses, or we can be depending on our children and great grandchildren to cover our medical expensive for years to come.
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