For decades, public health experts have warned of the dangers of “superbugs,” microbes that can’t be stopped with drugs. Now, for the first time, world leaders are tackling the problem at a high-level summit Wednesday at the United Nations in New York.
The meeting underscores the growing awareness by governments as well as disease experts that drug resistance is not just a health problem but also an enormous economic and security threat. It’s also an international threat, because drug resistance spreads easily across species and throughout the world, observing no political boundaries.
“There’s a recognition now by different people, different sectors and different organizations that we are, in fact, dealing with an enormous challenge beyond a health issue alone,” said Keiji Fukuda, who oversees antimicrobial resistance at the World Health Organization. “It doesn’t happen very often for health issues.”
This is only the fourth time that the world’s decision-makers have addressed a health issue at the U.N. General Assembly. The others were the HIV/AIDS crisis (in 2001); chronic illnesses, such as heart attacks, stroke, diabetes and cancers (in 2011); and the Ebola epidemic (in 2014).
On Monday, the World Bank said drug-resistant infections could cause global economic damage comparable to the 2008 financial crisis. Under a worst-case scenario, the bank projects that low-income countries could lose more than 5 percent of their GDP and that up to 28 million people, mostly in developing countries, could be pushed into poverty by 2050.
Without changes in policies to combat drug resistance, an estimated $100 trillion in economic output could be put at risk by 2050, according to a separate analysis by an independent British commission chaired by Jim O’Neill, a former Goldman Sachs chief economist.
On Tuesday, in a rare case of collaboration among competitors, 13 leading pharmaceutical companies, including Johnson & Johnson, Novartis and Pfizer, presented a road map laying out several commitments they pledge to deliver by 2020 to reduce drug resistance.
The companies said they will work with their manufacturers and suppliers to cut the environmental footprint from antibiotic production; monitor company promotional activities and share surveillance data as a way to reduce unnecessary antibiotic use; improve access to current and future antibiotics, vaccines and diagnostics; and explore new public-private collaborations for research and development.
Antimicrobial resistance refers to infections that have evolved the ability to withstand drugs that ought to stop them. The medicines include antibiotics, which act on bacteria, as well as drugs to fight fungal, viral or parasitic infections. If these lifesaving medicines are rendered ineffective by multidrug-resistant superbugs, even the most minor infections would be untreatable, bringing back a level of danger not seen since the 19th century.
An estimated 700,000 people die every year from drug-resistant infections, according to the British commission review. Without policies to halt the spread of this resistance, the toll could soar to 10 million additional deaths annually by 2050, or one person every three seconds, according to the commission review. That’s more than the number of people now killed each year by cancer.
At the summit, world leaders are expected to issue a call to action to reduce inappropriate use of antimicrobial medicines in humans, restrict the routine use of antibiotics to boost growth in farm animals, improve access to better diagnostics, and jump-start the development of new drugs.
In the United States, for example, nearly a third of antibiotics prescribed in doctor’s offices, emergency rooms and hospital-based clinics are not needed and not effective, according to a recent in-depth study.
The widespread use of antibiotics in animals encourages development of resistant microbes that can spread to humans and then withstand drug treatments. Many of the same drugs are used in people and livestock, with more than 70 percent (by weight) of those antibiotics going to animals.
Some experts want the United Nations to set global targets for reducing the use of antibiotics to encourage livestock to grow faster, a sensitive topic. Banning the use of such drugs would drive up meat costs when the world demand for protein is growing.
“If you want to solve these problems, you need targets and a kind of accountability mechanism to make sure countries do what they say,” said Ramanan Laxminarayan, an infectious-disease researcher who directs the Center for Disease Dynamics, Economics & Policy.
The draft resolution being considered at the U.N. this week, however, does not include such specifics, a weakness that Laxminarayan called “disappointing.”
Still, he and other experts said they are encouraged that the issue is getting high-level attention.
The hope is that public agreement by senior leaders will help trigger action among officials and researchers in their home countries, said Allan Coukell, senior director for health programs at the Pew Charitable Trusts, which has a project tracking antibiotic resistance.
Experts say the political momentum for the meeting has been developing in recent years. After hospitals were forced to close in Ghana because of superbug threats, Ghana’s health minister co-sponsored a forum on antimicrobial resistance four years ago. The Obama administration announced a national action plan to combat superbugs last year and established a presidential council to combat antibiotic-resistant bacteria.
At the World Economic Forum in Davos in January, more than 80 international drug and biotech firms urged governments to work with industry to cut unnecessary use of antimicrobial drugs and to support development of new antibiotics and invest in research. Earlier this summer, leaders of the G-7 industrialized countries said resistance is an international priority.
The problem of pathogens becoming drug-resistant has been recognized since shortly after the discovery of penicillin in 1928. The problem has worsened drastically because drug companies have cut their investment in new drugs, so microbes have had plenty of time to evolve resistance to the old ones. It has been more than 30 years since a new class of antibiotics has been introduced. Experts point to scientific barriers to discovery, regulatory hurdles and diminishing returns on investment for drug companies.
In a bluntly worded report, the O’Neill commission suggests a “pay or play” strategy as one way to give drug companies incentives to develop new antibiotics. Companies should be subject to a surcharge if they decide not to invest in research and development. Those that decide to "play” should get a reward of between $1 billion and $1.5 billion for any successful new antimicrobial medicine brought to market, the commission says.
Meanwhile, superbug outbreaks are spreading around the world. The newest superbug, resistant to an antibiotic called colistin, has been detected in nearly 30 countries since its discovery was reported in China a year ago. Colistin is known as the antibiotic of last resort because many infections that are resistant to every other drug do still respond to colistin.
The gene for colistin resistance, known as mcr-1, has been found in at least four people in the United States, including a Connecticut toddler. The worst-case scenario would be if the gene, which spreads easily, jumps into other bacteria that can already evade most antibiotics, creating a kind of uber-superbug.
Experts say the biggest challenge will be to raise awareness and spur action from government leaders down to individuals. But that’s difficult. Many people don’t think their individual actions are adding to the problem.
“If you talk to any individual physician around the world, they all definitely agree that drug resistance is a big problem,” Laxminarayan said. “But they are not the ones who overprescribe. It’s always someone else.”