HEALTH: Life-Saving Drugs Increasingly Ineffective

By Jim Lobe Reprint | | Print |

Jim Lobe

WASHINGTON, Jun 12 2000 (IPS) - Antibiotic drugs, which since the invention of penicillin 70 years ago, have greatly expanded life expectancy around the globe, are becoming increasingly ineffective, as deadly microbes develop resistance to their curative effects, according to a new report by the World Health Organisation (WHO) released here Monday.

“Virtually all of the world’s infectious diseases are “slowly but surely becoming resistant to existing medicines,” says David Heymann, WHO’s executive director for Communicable Diseases. “We are literally in a race against time to bring levels of infectious disease down worldwide before the diseases wear the drugs down.

Already, penicillin has become useless for treating gonorrhoea in most parts of the world, while in the Baltic states, Russia and parts of China, more than 10 percent of tuberculosis (TB) cases are resistant to two of the most powerful anti-TB medications.

Similar setbacks have been reported in parts of the world for drugs used against typhoid, shigella, malaria and hepatitis B, according to the 67-page report, “Overcoming Microbial Resistance,” billed by the WHO as the first comprehensive effort to lay out the magnitude of the threat.

Resistance to front-line antibiotics is also growing for other major killers, including pneumonia, diarrhoeal diseases, AIDS, hepatitis C, and leishmaniasis, according to the report, which noted that newer, more effective drugs to combat these diseases often are out of the financial reach of most of their victims in developing countries.

Before the invention of antibiotics, vast numbers of people fell victim to outbreaks of deadly diseases which are easily curable through the proper use of antibiotics today. After World War One, some 30 million people – more than the death toll of the entire war – died in a flu epidemic, usually from infections like pneumonia, which were treated routinely just 30 years later.

Modern medicine now has an arsenal of some 150 drugs to fight infectious diseases, although the cost has been huge. Pharmaceutical companies ordinarily spend about 500 million dollars and up to 20 years for every new compound it takes to market.

But drug resistance is increasingly nibbling away at the effectiveness of these same medications, according to the report which blames the under-use and misuse of antibiotics, combined with the natural process of evolution.

Under-use occurs mostly in developing countries where many, if not most, inhabitants, suffer poverty and inadequate access to drugs and health care. As a result, patients often must resort to poor- quality or counterfeit drugs or can afford only one or two doses of a drug whose effectiveness depends on a longer treatment.

In such circumstances, the weakest microbes in the body may be killed, while the more resistant microbes survive and multiply, passing on their resistance genes to their offspring or to other bacteria. The result is the evolution through natural selection of microbes ever more capable of resisting the drug.

In developed countries, antibiotics often are over-used. Doctors there may be too inclined to prescribe antibiotics when they are not needed, as in cases of the common cold or flu. But administering the drug will have the same effect as in under-use. More vulnerable microbes are killed off; hardier and more resistant ones survive and multiply.

In addition, antibiotics are increasingly used in food production where they both kill destructive organisms in animals and plants, but also promote quick growth, especially of livestock and poultry. The result of this mostly low-level dosing is the development of resistance in bacteria in or near livestock and even the possibility of new resistant strains, like Vancomycin- resistant Enterococcus Fuecium (VRE), “jumping” between species.

Currently, half of all the antibiotics produced in the world are used in food production, according to the report.

Hospitals in both developed and developing countries are also important purveyor of drug-resistant microbes, according to the report. Around the world, as many as 60 percent of hospital- acquired infections are caused by drug-resistant microbes which kill some 14,000 people a year in the United States alone.

Regardless of where more-resistant microbes are developed, they can travel quickly from country to country, particularly given globalisation and the increasing international travel and trade which it has promoted.

In the United States, for example, a majority of multi-drug- resistant typhoid cases in recent years originated in six developing countries. “Diseases don’t stop at geo-political boundaries,” says Jeffrey Koblan, director of the Atlanta-based Centers for Disease Control (CDC), the major US public-health research agency.

The WHO is highlighting the problem in advance of next month’s Group of Eight summit meeting in Okinawa, Japan, where the leaders of the world’s wealthiest nations are expected to make the fight against infectious diseases a top agenda item.

The WHO estimates the cost of cutting by half the more than 11 million people who die each year of the five major preventable or curable infectious diseases – pneumonia, diarrhoeal diseases, HIV/AIDS, tuberculosis, and malaria – at 15 billion dollars over 10 years. All of them are treated with antibiotics.

The administration of US President Bill Clinton has proposed major increases in US aid for fighting infectious diseases in developing countries, including a 10-year, 1-billion-dollar tax-incentive programme for pharmaceutical countries to develop vaccines for these diseases.

But the costs of treating drug-resistant strains of infectious diseases are rising all the time. For example, the cost of treating one person with multi-drug resistant TB is 100 times more expensive than the cost of treating non-resistant TB, according to Heymann.

In the early 1990s, New York City by itself spent almost 1 billion dollars to control an outbreak of the multi-resistant strain; more than the total health budget of many poor countries.

Moreover, “there currently are no new drugs or vaccines ready to quickly emerge from the research and development pipeline” of pharmaceutical companies which for the last 20 years have focused more of their efforts on developing medicine for non-infectious illnesses, like heart disease and depression, which afflict more people in wealthy developed countries.