Beth BellUS Centers for Diseases Control and Prevention
Dr. Beth Bell is Director of the National Center for Emerging and Zoonotic Infectious Diseases at the US Centers for Disease Control and Prevention.
In this guest post, Beth P. Bell, MD MPH—director of the National Center for Emerging and Zoonotic Infectious Diseases at the US Centers for Disease Control and Prevention (CDC)—discusses the growing problem of antibiotic drug resistance and what we can do to address this challenge.
I am pleased to have the opportunity to write about what is perhaps today’s most vexing public health challenge—the growing threat of antibiotic resistance.
Super-resistant bacteria have become a worldwide crisis. In India, 58,000 babies died in 2013 of an infection with resistant bacteria usually passed on from the mother during childbirth. In Thailand, 38,000 people die each year from “superbug” infections. And the numbers are only slightly better in the European Union, which loses 25,000 people each year, or in the United States, which annually attributes 23,000 deaths and two million illnesses to antibiotic-resistant infections.
Currently, global health faces enormous challenges from both well-established epidemics like HIV and AIDS and malaria and new epidemics like Ebola and pandemic influenza. But antibiotic-resistant infections are steadily spreading across the globe and could soon eclipse them all. Unfortunately, this is not an apocalyptic fantasy but a real and growing threat.
But the good news is that we can do something about antibiotic resistance and, like most public health problems, the more we collaborate today, the more we mitigate the threat tomorrow. Turning the tide on the “superbugs” requires a coordinated international response from all sectors. It will be especially critical for international non-governmental organizations and global foundations to build and support portfolios of work in this area and to collaborate with the World Health Organization (WHO), CDC, and other international partners to stop this threat.
The threat of antibiotic resistance is two-fold: it creates infections that are untreatable, and it undermines the progress that we have made in other areas of public health and healthcare improvement. Not surprisingly, drug-resistant infections result in costlier treatments, extended hospital stays, and higher mortality. They also can dismantle some of our most significant public health achievements. For example, the benefits of antiretroviral therapies, which have saved countless lives of people with HIV and AIDS across the globe, may be negated by the burden of drug-resistant tuberculosis, gonorrhea, and other resistant infections to which people with HIV and AIDS are more vulnerable.
Increasing global travel further compounds the problem by making it easy for drug-resistant germs to spread across borders and oceans. The new reality is that all countries, regardless of the sophistication of their medical care, have become vulnerable to these infections. The United States has both imported and exported drug-resistant threats. The first outbreak of carbapenem-resistant Enterobacteriaceae (CRE)—the “nightmare bacteria” that are resistant to most available antibiotics—occurred in New York City. From there, the infection migrated to France by way of an infected US traveler. Another type of CRE known as New Delhi Metallo-beta-lactamase (NDM) was first identified in South Asia, then introduced to other parts of the world, including the United States, by infected travelers. Once established in a new country, these resistant bacteria often become endemic in communities and healthcare environments. Many current NDM infections are in patients with no travel history.
Developed countries have been working to define the scope and address antibiotic-resistant threats inside their borders. In many developing countries, the ability to accurately estimate the burden of antibiotic resistance or know what forms of resistance are evolving is even more limited.
The CDC is working globally to increase investments in combatting antibiotic-resistance bacteria through bilateral partnerships, such as the Global Health Security Agenda, as well as via multilateral efforts in partnering with WHO. But we need your help. We need your partnership to help us reduce antibiotic resistance around the world. A top priority is ensuring that countries everywhere have sustainable healthcare infrastructures, because the lesson of Ebola is that a vulnerability in one country can become a vulnerability in our country.
Now it’s time to join together and focus on how we can help countries strengthen basic capacities and provide the tools they will need to defeat antibiotic resistance. This includes: