When Dr. Tom Frieden starts using phrases such as “urgent health threat” and “potentially catastrophic consequences,” it is a good idea to pay attention. Frieden is director of the Centers for Disease Control and Prevention, and with those words Monday he introduced a new report that documents the growing threat of antimicrobial resistance, in which bacteria are becoming untreatable by known antibiotics. The report says 2 million people in the United States are sickened every year with antibiotic-resistant infections, with at least 23,000 dying as a result. The global toll is certainly much higher.
Frieden has taken the lead in sounding the alarm in the United States about this problem, and he made a very potent observation. “Many people may see antimicrobial resistance as a problem that happens somewhere else, to other medical practices, to other farms, other patients and other people,” he said. The report shows “antimicrobial resistance is happening here, in every community, in every health care facility, in medical practices throughout the country.”
This raises a natural question: What is being done about that? Similar warnings have been issued for at least three decades, yet the public has largely shrugged. Antibiotic resistance never got traction as a major health issue on the scale of cancer or HIV/AIDS. Why? Perhaps because the crisis is rooted in so many different quarters. It is a problem of science (the bacteria are evolving to evade antibiotics); of human medicine (resistance has been driven by our overuse of antibiotics); of food animals (which consume a large share of antibiotics) and of the pharmaceutical industry (the antibiotic drug pipeline is running dry).
Big Pharma turned away from antibiotic development in recent years because of economic factors; put simply, drugs for chronic diseases offered higher returns. Legislation to give companies modest incentives to develop new antibiotics has become law, but that might not be enough. There is a crying public need for more drug development in antibiotics. If the pharmaceutical industry can’t do it, more government involvement may be required.
Laudable efforts are being made everywhere to improve hospital procedures — more hand-washing has a big impact — and to educate clinicians on better stewardship and avoiding antibiotic overuse. The Food and Drug Administration has laid out draft guidelines under which drug companies would voluntarily phase out antibiotics used for growth promotion in food animals and veterinarians would have a greater role in oversight, both vital steps. The CDC is trying to expand the knowledge base by collecting more information about antibiotic use and resistance, especially in hospitals.
All of this seems worthy but incremental and gradual. The question raised by Frieden’s alarm is whether the responses measure up to a problem described as potentially catastrophic. Frieden said it is not too late. Yet some bacteria are becoming resistant to multiple antibiotics. Some of the most effective drugs are losing their punch. Let’s hope we won’t look back on the latest CDC report as just another warning that was forgotten.