U.N. officials on Thursday marked World Health Day with a warning that “the misuse and irrational use of antibiotics has undermined the global fight against tuberculosis and malaria, warning of a possible return to the days before the drugs were developed,” and called for urgent action to control the spread of drug resistance, Reuters reports. In addition to growing resistance to TB and malaria treatments, “treatment for gonorrhea was threatened by growing resistance to the last-line treatment, and the WHO said hospital-acquired superbugs, resistant to major antibiotics, were becoming increasingly frequent,” the news service writes (Mogato, 4/7).

Drug resistance “kills hundreds of thousands of people every year,” and jeopardizes the “care and control of infectious diseases that in the past were curable,” WHO Stop TB Department Director Mario Raviglione said, according to VOA News (Schlein, 4/6).

The issue of drug resistance is complicated by the fact that “[i]n the vast majority of the countries – there are no plans, no budgets, there are no accountability lines for this extremely serious problem,” Raviglione added, according to Agence France-Presse. Weak surveillance systems, low-quality antibiotics and the use of antibiotics in animals fuel the spread of drug-resistant microbes (4/6).

“The message is loud and clear … The world is on the brink of losing these miracle cures,” WHO Director-General Margaret Chan said, according to a WHO press release. “The emergence and spread of drug-resistant pathogens has accelerated. More and more essential medicines are failing. The therapeutic arsenal is shrinking,” she added (4/6).

The WHO on Thursday released a policy package to guide countries in their actions to prevent antimicrobial resistance, BMJ News reports. “The package calls for governments to draw up comprehensive national plans, with accountability and civil society engagement; strengthen surveillance and laboratory capacity to detect resistant micro-organisms and to follow their spread; and ensure uninterrupted access to essential drugs of assured quality,” the publication writes. “It also urges governments to regulate and promote rational use of medicines, and ensure proper patient care; enhance infection prevention and control practices; and foster innovations and research and development for new products” (Zarocostas, 4/7).

In a statement, USAID Administrator Rajiv Shah described antimicrobial drug resistance as “a growing problem with implications for both national and global security. … On this World Health Day, we pledge to contain the emergence and spread of antimicrobial resistance through the continued development of innovative tools and approaches that improve medicine use, assure medicine quality and strengthen health systems,” he said (4/6).

Antibiotic Development Slow Due To Lack Of Financial Incentives

“Over the past three decades only two new classes of antibacterial medicines have been discovered, compared to 11 in the previous 50 years,” the Wall Street Journal writes in an article examining why pharmaceutical companies have been slow to invest in antibiotic development. “One underlying problem is a lack of financial incentives,” the newspaper writes (Stovall, 4/7).

“Today, only two large companies – GlaxoSmithKline Plc and AstraZeneca Plc – still have strong and active antibiotic research and development programs, according to the Infectious Diseases Society of America,” Reuters reports, adding that there were close to 20 in 1990. The news service notes there are limited financial incentives for drug manufacturers to develop new classes of antibiotics because patients who take them generally are cured and no longer need the drug, and when the drugs are developed, regulatory agencies ask them to be held for serious infections.

“Fixing the system, experts argue, will require a mixture of ‘push’ and ‘pull’ incentives – ‘push’ measures to lower the cost of developing new antibiotics, and ‘pull’ factors to increase the commercial rewards for successful products,” according to Reuters (Kelland/Hirschler, 4/7).  

“Governments and partners need to work closely with industry to encourage greater investment in research and development of new diagnostics that can help improve decision making as well as drugs to replace those that are being lost to resistance,” the WHO release states. The release also outlines ways civil society groups and health and agricultural professionals can contribute to slowing the emergence or spread of antimicrobial resistance (4/6).

Scientists Report NDM-1 Found In New Delhi Water Supply

Researchers on Thursday reported in a study published in Lancet Infectious Diseases that they had detected the gene that produces NDM-1, an enzyme that can be incorporated into bacteria and inactivate a wide range of antibiotics, in New Delhi, India, water supplies used for drinking, washing and cooking, Reuters reports (Kelland, 4/7).

Out of 50 tap-water and 171 sewage-seepage samples, two and 51 tested positive for NDM-1, respectively, according to Nature News. The researchers reported finding 11 bacterial species with the gene “that had not previously been known to carry it,” according to the news service.

“NDM-1-positive bacteria have already turned up in the United Kingdom and elsewhere in patients, some of whom had previously been in hospitals in India and Pakistan, but this is the first report to find NDM-1 in environmental samples unconnected to hospitals or infected patients,” Nature News reports (Lubick, 4/7). Researchers say the study suggests NDM-1 “is widely circulating in the environment – and could potentially spread to the rest of the world,” Associated Press/Seattle Times reports (Cheng, 4/6).

Poor sanitation, lack of access to clean water, high temperatures, crowded populations, antibiotic misuse and poor infectious disease control measures provide a beneficial environment for the gene to spread, according to the Guardian (Boseley, 4/7).

In an accompanying commentary in Lancet Infectious Diseases, “Mohd Shahid from Jawaharlal Nehru Medical College and Hospital in Uttar Pradesh, India, said global action was needed” to respond to the threat of NDM-1, Reuters states. “The potential for wider international spread of … NDM-1 is real and should not be ignored,” Shahid wrote (4/7).