Research Roundup: discoveries in malaria research, remaining barriers to the development of an Ebola vaccine, and a diagnostic for maternal survival

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. The spread of drug-resistant tuberculosis could undermine advancements in HIV and AIDS prevention. Photo: CDC. 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: Laboratory detection of antimicrobial resistance—Countries need medical laboratory infrastructure to diagnose the cause of infections and to identify the best drugs for treatment. We also need to invest in rapid diagnostics to guide appropriate antibiotic use and identify which antibiotics will be effective. We need rapid and easy-to-use diagnostic tests that can distinguish between infections that do or do not require antibiotics. This will reduce unnecessary antibiotic use. National antibiotic resistance tracking programs—Countries need the infrastructure to collect resistance data from hospital laboratories and report these data in national and global surveillance reports. These data are necessary to: Drive appropriate prevention interventions. Develop policies that support prevention efforts. Measure the impact of prevention efforts. Antibiotic stewardship programs—We need to work collaboratively globally to ensure that antibiotics are available to treat infections, while at the same time making certain that antibiotic use is appropriate to limit the development of new forms of resistance. Infection control programs—Improving hygiene and infection control practices in healthcare settings is critical for preventing the transmission of antibiotic-resistant pathogens between patients and between hospitals, and the benefits extend to other global infectious disease threats such as Ebola, Middle East Respiratory Syndrome (MERS), and emerging infectious diseases. Healthcare environments and poor infection control are major drivers of antibiotic resistance. Technologies that improve infection control have the potential to significantly reduce infection rates. This is especially important in low resource environments—how to best support hand washing where there is a lack of clean water and how to best deploy rapid diagnostics that can work, like dipsticks and other technologies that don’t require electricity.

The US Agency for International Development (USAID) announced last week that Ariel Pabos-Mendez, the assistant administrator for Global Health, will serve as the coordinator for Child and Maternal Survival. USAID stated that his "dual role" will ensure that maternal and child health remains a “central priority” of the Bureau of Global Health. Katie Taylor, who served as the interim coordinator, was named deputy coordinator, and will continue to serve as deputy assistant administrator for Global Health. Researchers at Johns Hopkins University made a groundbreaking discovery about the pathogen that causes tuberculosis, which could ultimately lead to the development of more effective drugs and vaccines. The bacteria generates pieces of DNA that—to the immune cells—resemble and behave like a virus, and thus the immune system responds to the bacteria as though it were a virus. That virus-like piece of DNA, known as c-di-AMP, elicits the production of INF-beta proteins as part of the immune response. The scientists infected mice with tuberculosis bacterium that was manipulated to release elevated numbers of c-di-AMP molecules, and the mice survived twice as long as those infected with normal tuberculosis bacterium. Last week, the US Food and Drug Administration approved LILETTA™, a hormonal intrauterine device developed by Medicines360, a nonprofit biotech company focused on women’s health. Medicines360 is partnering with Actavis to market and lead sales for the device. While the article notes the paucity of nonprofit pharmaceutical companies, it highlights OneWorld Health, which recently merged with PATH and whose founder also founded Medicines360. The organization, which relied on donors throughout the research and development (R&D) of LILETTA™, intends to sustain itself on sales moving forward. The Council on Foreign Relations took an in-depth look at the history of artemisinin, the leading agent used to treat malaria, from discovery through R&D for effective drugs. The search began when the Plasmodium falciparum parasite, which is responsible for the vast majority of malaria cases, developed resistance to existing treatments. In 1967, the Chinese government established a team of nearly 500 scientists, who identified and researched an extensive list of herbs and traditional medicines, ultimately confirming the efficacy of artemisinin in treating malaria. The article is part of a series, the next of which will focus on the market landscape and dynamics for artemisinin-based products.