Squashing the superbugs

Current antibiotics are becoming increasingly ineffective, not only at fighting common illnesses like pneumonia and urinary tract infections, but also at treating a range of infections, such as tuberculosis and malaria, which now risk again becoming incurable.

With the G-7 leaders having committed, in a recent joint declaration, to tackle “antimicrobial resistance” (AMR), it is time for the more inclusive G-20 — and China, as it chairs the group for the first time — to take the fight to the next level.

Failure to address AMR will affect everyone, regardless of their nationality or their country’s level of development.

Indeed, by 2050, 10 million people could be dying as a result of AMR, up from around 700,000 today, with China and India each housing about 1 million sufferers.

At that point, an estimated $100 trillion in global GDP will already have been lost.

No G-7 strategy, however well crafted, can succeed without the involvement of the rest of the international community.

After all, if infections travel with the people who carry them, so does resistance, meaning that the only solution to AMR is a shared one.

That is why members of the World Health Organisation have agreed to implement a “global action plan on AMR” and have called upon the United Nations to convene a high-level meeting of political leaders in 2016.

In this effort, the emerging economies — with their large populations, rising wealth and growing international clout — have a particularly important role to play, with China leading the way.

We at the Review on Antimicrobial Resistance have already recommended such a role for China, including in discussions with some Chinese policy makers.

Between now and 2016, the stage must be set for China to act. The G-7 countries should drive this effort forward by taking concrete steps to fulfil the commitments they made in their joint declaration.

One such commitment is to reduce the use of antibiotics in animal husbandry.

Some European governments have already made significant progress in regulating this practice. The United States has been slower to act, but has lately made some important policy moves.

But perhaps the best way to change the way livestock are raised is by putting pressure on major food companies — a feat that consumers could achieve most effectively.

Indeed, rising demand for healthier foods, including antibiotic-free meat, has already compelled major food industry players like McDonald’s, Costco and KFC to declare their intention to phase out antibiotic-laden meat.

Governments should capitalise on this trend by implementing a major social media campaign highlighting the smarter, healthier habits that all people should adopt — habits that would indirectly reduce demand for antimicrobials.

The low cost and potentially high payoff of such a campaign makes it all the more appealing.

A second commitment included in the joint declaration — to help ensure that medicines are used only when they are needed — may seem obvious, but in fact represents a major problem driving AMR.

The key to addressing this problem is, as the declaration recognises, to develop and improve access to rapid point-of-care diagnostic tools.

Improved diagnostic technologies are undoubtedly within the reach of the world’s top technology firms.

But they will invest only if they are confident that health systems will use their innovations. If governments, say, mandated that particular diagnostic tests must be conducted before antibiotics could be prescribed, companies would have the necessary incentive.

Such a requirement would face criticism, with some claiming that testing takes too long, and thus is not always possible before starting treatment. While this may be true in rare cases, there are many areas where fast and effective tests exist, but are not yet used widely — either in developing or developed countries.

Consider one of the most common infections: sore throats. Though they are often viral, rather than bacterial, they are frequently treated with antibiotics — an approach that not only is ineffective, but also fuels AMR.

A quick and easy swab test could solve this problem — and, indeed, one already exists.

In a trial by a British pharmacy chain (which, admittedly, used a small sample), the test reduced the number of antibiotics consumed by nearly 60 per cent.

Investment in the development and deployment of this technology could lead to a substantial decline in unnecessary antibiotic treatments for sore throats, not to mention ease pressure on health systems and save doctors’ time.

A third imperative, recommended by the Review and recognised by the G-7, is improved surveillance of the spread of drug-resistant infections, particularly in developing countries, where such data is most sparse.

On this front, our own government is leading the way, with Chancellor George Osborne pledging in March to allocate £195 million ($307 million) to help emerging countries finance the fight against AMR.

Foundations are likely to pledge their own funds to this initiative. Meanwhile, the US government is focusing on supporting the development of new drugs via the Biomedical Advanced Research and Development Authority.

The world faces many challenges and crises, virtually all of which will demand strong political commitment and significant investment to resolve. But the fact is that, when it comes to AMR, governments have a rare opportunity to preempt a major crisis, at a fraction of the cost of responding to the crisis once it has escalated.

In the scramble to address the recent Ebola outbreak in West Africa, for example, the US alone had to contribute $5.4 billion in public funds. Add to that the savings to health systems and even employers, and concerted action to combat AMR becomes even more cost-effective.

That is why the G-7 governments should intensify their efforts to address AMR. And it is why China and the other emerging economies should join the fight. Together, we can safeguard the curative powers of our medicines.

The writer, a former chairman of Goldman Sachs Asset Management, is commercial secretary to the UK Treasury and chair of the British government’s Review on Antimicrobial Resistance. ©Project Syndicate, 2015.
www.project-syndicate.org