The growing threat of drug resistance, which will increasingly leave more and more people vulnerable to diseases that were
once easier to treat, like malaria, HIV and tuberculosis (TB), requires a systematic global response, says a new report from the
Center for Global Development (CGD).
Unfortunately, it appears that the faster we try to improve the health of poor people by making more and more drugs available in developing countries, the faster an undesired side effect emerges, that of drug-resistant strains of diseases, which results in higher treatment costs and lives lost, said the expert Working Group that wrote the report "The Race Against Drug Resistance".
The report warns that around the world we are rapidly losing the ability to treat serious diseases like malaria, HIV, TB, dysentery and respiratory infections that can lead to pneumonia.
The chair of the Working Group, Dr Rachel Nugent, deputy director of global health at the CGD, a Washington-based independent, nonprofit policy research organization dedicated to reducing global poverty, told the press that:
"Drug resistance is a natural occurrence, but careless practices in drug supply and use are hastening it unnecessarily."
Diseases become drug resistant because the pathogens, eg bacteria, viruses, evolve into new strains that no longer respond to the drug. Many reasons are given for this, including over-use of drugs (the more exposure pathogens have to a drug the more opportunity for drug resistant mutations to succeed), incomplete dosage or poor adherence to treatment (leaving remnant pools of pathogen that should have been killed off, these then contain the potentially successful mutant strains), and counterfeit drugs with the wrong ingredient or too low a concentration of the key ingredient (which also makes it more likely that a new resistant mutation will emerge).
Thus the key to slowing down the emergence of drug resistance, is to manage the use of drugs carefully, eg only give them when absolutely necessary, and ensure appropriate and complete dosage and administration. So what the CGD report is alluding to is that it is not so much the drugs themselves, but the way they are being managed that is causing the rapid acceleration of drug resistance.
The problem is not restricted to developing countries: westernized nations are also seeing a rapid increase in drug resistance. For example, superbugs like MRSA (methicillin-resistant Staphylococcus aureus) have increased from 2 to more than 50 per cent of staph infections in the US between 1974 and 2004, so much so, that now more Americans die every year from MRSA than from HIV/AIDS.
In the developing world, where over the last 4 years more than 1.5 billion donor dollars have been spent on advanced drugs to treat resistant diseases, millions of children die every year from drug resistant diseases.
However, the report points to a direct relationship between increasing volume of drug use and the emergence of drug resistance, particularly where safeguards and monitoring of correct use are weak. For example, it says that in countries that consume the most antibiotics, 75 to 90 per cent of strep pneumoniae strains are already drug-resistant.
Malaria kills two million children a year, and bacterial respiratory infections kill more than three million children every year: many of these deaths are to strains that are resistant to common drugs, say the report authors.
In developing countries, common childhood diseases such as malaria, pneumonia, other respiratory infections and dysentery, can no longer be cured by the older types of antibiotics and other drugs available in the poorer nations.
In Latin America, 60 to 80 per cent of dysentery cases in children are due to drug-resistant strains.
The cost of curing patients is also beginning to spiral. In many poor countries, spend on drugs ranges from betwee 20 to 60 per cent of total healthcare costs. Also, when first line, more traditional drugs fail, the alternatives are more expensive and need more skills and medical supervision to administer and monitor.
The report gives an example: the cost to cure one patient with the extensively drug-resistant strain of TB (XDR-TB) is equal to the cost of curing 200 patients with ordinary TB.
Unfortunately, the attempts to tackle the problem have been piecemeal: either focusing on single diseases, or country by country. Some have been successful, said Nugent, but none has addressed the problem on a global scale.
The CGD Working Group says that unless we take action now, the stage is set for more deaths and higher costs. The authors urge the World Health Organization (WHO) to take the lead, and spur a wide range of stakeholders including pharmaceutical companies, governments, philanthropists, hospitals, healthcare providers, buyers and sellers of medicines, and patients themselves.
CGD President Nancy Birdsall said we know how to fix the problems, what actions are needed but:
"We just lack the incentives, institutions, and global leadership to get on with it."
"The growing threat of drug resistance demands a more extensive and systematic global response," she added.
The CGD report makes four recommendations, which they say taken together, with private and public sectors working in unison, should make a significant impact in containing and reducing drug resistance around the world:
- Track Resistance in Real Time: establish a network of surveillance labs and quickly share information with those who need it.
- Secure the Supply Chain: establish standards to maintain quality from manufacturing shop floor to final delivery to the patient and to promote best practice in prescribing and dispensing.
- Tighten Regulation: bring in new networks of national drug regulators, tighten existing ones, and enforce laws to ensure drug quality.
- Accelerate Research and Development of New Drugs: create a web-based marketplace for research to demonstrate and facilitate innovation and broker technical help, bring together researchers and match ideas with investment.
"The Race Against Drug Resistance ."
Rachel Nugent, Emma Back, and Alexandra Beith
Center for Global Development, Washington, USA, published 14 June 2010.
Written by: Catharine Paddock, PhD