Antibiotic resistance (ABR) is now on the map in the United States. Last Thursday, President Obama issued an Executive Order giving the full force of law to a National Strategy on Combating Antibiotic Resistance. The Strategy adopted the report by the President’s Council of Advisors on Science and Technology (PCAST), Combating Antibiotic Resistance, which was unanimously and enthusiastically approved by its members at a public meeting July 11.
But why the need for a national strategy now; and, tellingly, why the rush to give it immediate legal effect by Executive Order?
Let’s begin in the frontlines of medicine: Doctors are flat-out scared – for their own health. They’re afraid to go to work at the hospital because they might catch an infectious disease which can’t be treated because antibiotics have become increasingly useless.
Dr. Barbara Murray: I'm scared. I don't want to go to the hospital.
Barbara Murray, MD, (who was not involved in the PCAST report), president of the Infectious Diseases Society of America, who practices in Houston, Texas, puts it this way: “I’ve been [treating infectious diseases] for years, and I’m scared,” she said. “I don’t want to go to the hospital. This is the first time I’ve felt this way.”
Eric Lander, PhD, founding director of the Broad Institute of MIT and Harvard, and co-chair of PCAST, agrees: “Members of PCAST have commented to me, ‘I now worry when I go to a hospital whether I might get an ABR infection.’” (Comments by Dr. Lander are from this Webcast, July 11, where he unveiled the PCAST report.)
The number of dead and wounded support Murray and Lander: At least 2 million people become severely infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections – half of those deaths due to MRSA alone. Many more people die from other conditions that were complicated by an antibiotic-resistant infection.
Second, ABR infections eviscerate the practice of medicine: “The safety of many modern medical procedures – including cancer chemotherapy, complex surgery, dialysis for renal disease, and organ transplantation – relies on effective antibiotics. These interventions become significantly more dangerous as bacterial resistance rises. Indeed, the World Health Organization recently warned that we risk entering a ‘post-antibiotic’ era unless we act now,” says Eric Lander.
Third, a post-antibiotic era would have devastating social consequences: “Bacteria for which there is no effective antibiotic pose a national security threat, says John Holdren, director of the White House Office of Science and Technology Policy. “What we see … is the potential for [a] runaway spread of infection, which ultimately, as they go to very large scale, undermines social stability.” (Emphasis mine.)
Disease resulting in social instability to the degree that it morphs into a national security threat is the thesis of the film “Contagion,” starring Matt Damon. According to this United Nations/World Bank public health expert, the filmmakers get it exactly right and therefore “you should rush to see [it]” and witness “how, in the new phase of globalization—large-scale movements of people, goods, and services, and shortened geographical distances due to the dramatic growth and improvement of air transportation—the rapid spread of viruses and bacteria is a clear and present danger.”
In fact, ABR already has a global footprint: “The yearly death toll from antibiotic-resistant infections is roughly equivalent to one jumbo jet crash every week,” says John Rex, a member of the PCAST Working Group. As Thomas Frieden, director of the Centers for Disease Control and Preventions, says, “A disease outbreak anywhere is a risk everywhere.”
Dr. Eric Lander: It's just plain scary.
The way to deal with this global and growing threat of ABR is “… sort of simple at some level,” according to Dr. Lander. “There are really 3 things that have to be done … If we can surveil and see what’s going on, and we can slow down the rate at which we lose antibiotics, through stewardship, and speed up the rate at which we create new antibiotics or equivalent therapies … we stay ahead; we win.
But Lander warns us: “There is no permanent victory against microbes. If you use antibiotics, whether in human health care or in agriculture, you will over time see resistance. If we fail, if we fall behind in our stewardship, in our creation [of new antibiotics or equivalent therapies], or if we fail to surveil to understand what’s going on, it’s a very real risk to see a resurgence of what life looked like a century ago when we had bugs we could not treat. It’s a terrifying prospect. Now … it doesn’t help to do scare tactics around these things but it’s just plain scary.”
The tag-line of the film Contagion is “Nothing Spreads Like Fear.” How, as bad as these outbreaks are in and of themselves, our human responses to these types of public health crises make matters even worse.
So we hope the Obama Strategy works. We don’t want to wake up one day to find ourselves cast in a real-life Contagion: we don’t want life to imitate art – not in this case.