By Kirsi Goldynia
On Sept. 21, the U.N. General Assembly convened a high-level meeting to discuss a critical issue in world health: the growing prevalence of antimicrobial resistance, or “superbugs.” After hours of discussing how resistance has developed and how it can be controlled, one takeaway was abundantly clear: Superbugs are every bit as ominous as their sci-fi-esque name suggests.
The rise of antimicrobial resistance (AMR) was the result of an inevitable evolutionary phenomenon—natural selection—which foretold that with the introduction of antimicrobial drugs in the 1940s would come the evolution of microbes immune to those drugs. Over time, the microbes’ immunity led to the development of new drugs, in turn giving rise to further evolved generations of resistant microbes, and the vicious cycle continues today.
AMR would have developed even if antimicrobial drug use had been reserved solely for the treatment of human ailments, but resistance was accelerated in the 1950s and 60s, when the U.S. and European countries formally approved the use of antibiotics as growth promoters (more blatantly, plumping agents) in livestock. This allowed drug-resistant bacteria to thrive in animals treated with antibiotics and subsequently spread to human consumers.
In 2012, less than a century after the commercialization of prescription drugs, the growing prevalence of AMR could no longer be ignored, prompting the U.S. Food and Drug Administration to reevaluate the efficacy and consequences of antimicrobial use in agriculture. It issued a statement providing voluntary guidelines aimed at eschewing antimicrobial use in animals for all but “judicious” purposes. The request was twofold: “[limit] medically important antimicrobial drugs to uses in food-producing animals that are considered necessary for assuring animal health,” and “[limit] such drugs to uses in food-producing animals that include veterinary oversight or consultation.”
Still, in the last four years, the problem has escalated and it now casts a foreboding shadow on the future of global health. “We see the resistance to common conditions increasing greatly,” says Dr. Liz Tayler, senior technical adviser on antimicrobial resistance with the World Health Organization. “In many countries, resistance levels to penicillin, quinolones—antibiotics that you and I get when we’re sick—are now so high that we can no longer use [them].” In light of this, third generation drugs are being designed, which, as Tayler explains, are not only expensive, but will leave physicians with few treatment options once bacteria develop resistance.
While the danger is not acute enough to require preparation for a bacteria-laden Armageddon, it is time for concern. Economist Lord Jim O’Neill estimated that, if left unaddressed, annual deaths from AMR will have risen from 700,000 in 2014 to 10 million by 2050, and will lead to a $100.2 trillion world GDP loss. These statistics are not surprising; the generation time for microbes is on the order of minutes, making it difficult for human innovation, however ingenious, to keep pace with the circumvention of drug therapies.
To prevent the future that O’Neill predicts, AMR must be combated immediately, and to do so, we must identify those responsible for its spread. But as Juan Lubroth points out, ascribing blame is neither productive nor clear-cut, as it is not confined to a single industry. Lubroth, the U.N. Food and Agriculture Organization’s chief veterinary officer, says that to some extent, policymakers, human and animal health care workers, the agricultural industry, pharmaceutical companies, and consumers all had a hand in creating the problem that we face today.
Consequently, coming up with a plan of attack has fallen upon the tripartite coalition best fit to bridge the gaps between these groups: the Food and Agriculture Organization, the World Health Organization, and the World Organization for Animal Health. Lubroth and Tayler, both intricately involved in developing the strategy to tackle AMR, feel that if appropriate measures are taken, resistance to new drugs can be avoided.
The first step in achieving this goal, says Tayler, is educating physicians on the efficacy of the drugs they are prescribing and raising public awareness of the long-term health consequences of misusing prescriptions and over-the-counter drugs. In addition, better data must be acquired worldwide so that clinicians are aware of regional resistance patterns in order to limit the prescription of costly third generation drugs to cases in which they are truly necessary. Next, preventative measures must be improved to drive down infection rates, and subsequently antibiotic usage, while maintaining a focus on drug innovation.
Reduction of antibiotic use must also extend to agriculture, says Lubroth. Over the last 60 years, the myopic goal of short-term gains has taken precedence over long-term health implications of antibiotic use for growth promotion in livestock. Policy must be re-written to mandate the discontinuation of such use—an authoritative extension of the suggested guidelines set forth by the FDA in 2012.
With the public discussion and news coverage of AMR in the weeks surrounding the General Assembly’s conference, it seems that the meeting did just what it was intended to—create awareness of the global unity and cooperation required to overcome superbugs. AMR is not an “every country for itself” type of problem, but a trans-boundary problem. “It can be an issue in one part of the world, and 12 hours later have spread to New York,” says Lubroth. This makes global cooperation imperative; poor and developing countries in particular must be supported to acquire the resources they need to protect and treat their citizens. The General Assembly’s meeting was the first step in this process, but the world still has a long road ahead.
Kirsi Goldynia is an editorial assistant at World Policy Journal.
[Photo courtesy of Pixabay]