Antimicrobial resistance takes center stage

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Forum explores global and diverse causes, challenges, impacts, of dwindling treatments for infectious diseases

NEW YORK — On the eve of the first gathering of world leaders confronting the worldwide and growing threat of infections resistant to existing medicines, Professor Ramanan Laxminarayan of the Center for Disease Dynamics, Economics & Policy emphasized the opportunity the moment offered.

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Professor Ramanan Laxminarayan at the Yale Club Tuesday

“We only get one crack at the United Nations,” he said. “Health issues don’t come back to the UN repeatedly.” This “high-level” meeting will be only the fourth of its kind focused on a health challenge, he noted.

For that reason, a unifying message on the danger to personal and public health that a dwindling supply of effective antimicrobial medicines poses would be critical to spurring action from the meeting this week on antimicrobial resistance.

“It all comes down to access, sustainable access to effective antimicrobials,” he said. “There’s a threat to access.”

Laxminarayan was speaking at a gathering of experts, in health, economy, and development from nations around the world at the Yale Club Tuesday, and his message wouldn’t be hard to remember; the event, organized by CDDEP and other organizations including the Infectious Diseases Society of America (which produces this blog) was titled a Forum on Sustainable Access to Effective Antibiotics.

But that apparently unifying title and issue also highlighted the diversity of challenges that has slowed both recognition of and responses to infections resistant to available treatment, as discussions that followed underscored.

“At the end of the day, if there are no new antibiotics, there can be no access,” Dr. Julie Gerberding of Merck pharmaceutical company reasoned.

What happens then, who can afford the medicines, whether they are appropriately prescribed, reliably accessed, and used correctly are all questions decided by resources and capacities, were some of the issues reiterated by speakers, though.

In prosperous countries, in fact, among the greatest threat to the effectiveness of existing antimicrobial medicines is excessive access to them, speakers noted.

“We had the problem of too much resources,” Gabriel Wickstrom, Sweden’s Health Ministry representative said, “of trying to persuade people that something abundant was actually scarce.”

That abundance can be quantified, as Dr. Martin Blaser of the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria, pointed out, with more than 300,000 tons of antibiotics, which are administered in milligrams, produced each year. “That is ten doses for every man, woman and child,” he said.

But harder to quantify are the impacts of resource limitations.

Martin Khor, of the South Centre intergovernmental organization of 53 developing countries’s governments offered one, however. Of the 10 million people that analyses have said will die as a result of antimicrobial resistance by 2050, he said, nine million will die in resource limited countries, he said. Lack of awareness of the issue, competing challenges that include terrorism, the impacts of climate change as well as insufficient funds, equipment and capacities to measure and address antimicrobial resistance will all slow action in response to the threat he said, while in reality, those countries are experiencing the greatest impacts. Effectively, he said, resource-limited countries already are in an the era projected to loom in the futures of prosperous countries: “We are in a post antibiotic era.”

With limited access to effective medicines, vaccines are a key to reducing antimicrobial resistance in the developing world, Dr. Keith Klugman of the Bill and Melinda Gates Foundation said.

Access to reliable diagnostics to avert inappropriate, ineffective treatment is another, Dr. Mark Miller of biotechnology company bioMerieux said.

With only one shot at the United Nations, and an array of puzzle pieces to assemble, meeting the challenge of antimicrobial resistance will largely be up to governments of developed and developing countries alike, speakers agreed.

But as that includes countries like India, where, one commenter from that country noted, “Health care is in a state of permanent chaos,” it also will call for a unified response to a threat that ultimately will be without borders, they concluded.

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