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Drug
Resistance Threatens to Reverse Medical Progress- WHO Report
Dr. David Heymann, Executive Director for Communicable
Diseases at the World Health Organization, and Dr. Jeffrey Koplan,
Director of the US Centers for Disease Control and Prevention recently issued a press
release entitled "Drug Resistance Threatens to Reverse Medical
Progress."
WHO warns in its recent annual report on infectious diseases,
"Overcoming Antimicrobial Resistance," that the world is facing a dangerous
situation as once-effective medicines are becoming increasingly
ineffective. Dr. Gro Harlem Brundtland, Director-General of WHO, stated that, "We
risk losing these valuable drugs -- and our opportunity to eventually
control many infectious diseases -- because of increasing antimicrobial
resistance."
The report details how almost all major infectious diseases worldwide
are slowly but steadily becoming resistant to existing treatments: "In
Estonia, Latvia, and parts of Russia and China, over 10% of tuberculosis
(TB) patients have strains resistant to the two most powerful TB
medicines. Because of resistance, Thailand has completely lost the means of
using three of the most common anti-malaria drugs. Approximately 30%
of patients taking lamivudine -- a drug recently developed to treat
hepatitis B -- show resistance to therapy after the first year of
treatment.... A small but growing number of patients are already showing primary
resistance to AZT and other new therapies for HIV-infected persons....
In the United States alone, some 14,000 people are infected and die
each year as a result of drug-resistant microbes picked up in hospitals...
In many instances, poorly planned or haphazard use of medicines has
caused the world to lose these drugs as quickly as scientists have
discovered them."
Factors contributing to the resistance problem vary from country to
country, with underuse of drugs being the primary cause in less developed
countries, where patients may be unable to afford a full course of
treatment to be cured of an illness, for example, or can only afford
counterfeit drugs of questionable quality sold on the black market. In this
situation, the weakest microbes in the body may be killed by these
inadequate doses, leaving the more resistant microbes behind to multiply.
In wealthier countries, resistance is emerging from overuse of drugs in
human medicine, production of food animals and agriculture.
"Regardless of where drug resistance originates, globalization, increased travel
and trade ensure that these strains quickly travel elsewhere."
The economic consequences of antimicrobial resistance can be alarming.
The cost of treating one person with multi-drug resistant TB, for
example, is 100 times greater than the cost of treating a non-resistant
case. Another cause for concern, according to pharmaceutical companies, is
the slow development of new medicines to replace those that are losing
their effectiveness. While new versions of older drugs continue to be
developed, few new classes of drugs have emerged in recent years. On
average, research and development of anti-infective drugs takes between
15 and 20 years, and can cost over $500 million US dollars. Dr.
Rosamund Williams who leads WHO's team working on drug resistance cautions,
"If we fail to make full and proper use of medicines discovered in our
lifetime, many of these drugs will slip through our grasp. Before long,
we may have missed our opportunity to control the most dangerous
infectious diseases. Indeed, if we fail to make rapid progress during this
decade, it may become very difficult and expensive -- if not impossible
-- to do so later."
According to the WHO report, "the most effective strategy against
antimicrobial resistance is to get the job done right the first time -- to
unequivocally destroy microbes -- thereby defeating resistance before it
starts. The challenge is to get the right treatment to the patient,
each and every time." "Used wisely and widely," said Dr. Brundtland,
"the drugs we have today can be used to prevent the infections of today
and the antimicrobial-resistant catastrophes of tomorrow. However, if
the world fails to mount a more serious effort to fight infectious
diseases, antimicrobial resistance will increasingly threaten to send the
world back to a pre-antibiotic age..."
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