The increased availability of life-saving medicines worldwide is having a serious unintended side-effect: a wide array of diseases -- from malaria, TB and HIV/AIDS to pneumonia and acute diarrhea -- is becoming resistant to the drugs we rely on to overcome them. To address this critical challenge, the Center for Global Development organized the Drug Resistance Working Group late last year to discover ways that the international community can prevent or contain the emergence of drug resistance in developing countries. Rachel Nugent, CGD senior program associate for global health, chairs the group. In this Q&A, she explains the group’s goals and the main points of its recently released concept paper, Drug Resistance as a Global Health Policy Priority.
Q: Developing countries already face many technical and financial challenges in meeting the health-care needs of their people. Why does CGD see drug resistance as a major issue?
A: Over the long term, much of the health care progress in developing countries may be for naught if we can’t overcome drug resistance. In the United States, it costs several thousand dollars extra to treat an infection that is resistant to common antimicrobials; hospital-acquired infections alone are estimated to cost $17-$29 billion per year. But the cost of improper management of medicines and health care in the developing world will be measured not only in terms of wasted money but also in lives needlessly lost. Resistance has arisen against all major drugs for treating Malaria and TB -- sometimes making them untreatable. Resistance is growing rapidly to antibiotics for Staph and Strep, and for common diarrheal and respiratory infections. Resistance to drugs for treating AIDS is beginning to emerge in developing countries where treatment has been available, and it is expected to grow as treatment expands. It also limits treatment options for serious illnesses such as respiratory infections.
Q: What are the causes of drug resistance?
A: The past 50 years have been a golden age for human dominance over microbes. Since the discovery of penicillin in the mid-20th century, antibiotics -- and more recently antivirals (and antiretrovirals) -- have been a mainstay of the public health arsenal deployed against communicable disease, alongside vaccines. But over time, genetic mutations have occurred, rendering microbes less susceptible to these drugs, and resistant microbes are being passed from host to host. The resistance of pathogens to drugs is a naturally occurring biological phenomenon, but the process may be stimulated or accelerated in response to human actions, which may in turn stem from health system weaknesses. The challenge presented by these conditions has become more apparent with the increasing burden of disease and greater resources dedicated to treatment.
Q: How will the working group tackle this problem?
A: Our work will be conducted in several stages. Beginning with an initial mapping of the resistance problem, we plan to describe the patterns, causes, and key characteristics of resistance to illuminate the global aspects of the issue. Second, we will analyze the costs of drug resistance at different levels of society and how they might change under different scenarios. From that work, we hope to develop models of action for public and private donors and international organizations that could create incentives to slow drug resistance. Ultimately, we hope our efforts will identify informational and regulatory actions to reduce the risk of resistance.
The main product of the working group will be a policy report identifying practical actions. The report, which we hope to release by the end of this year, will include recommendations for the global donor community. It will outline the responsibilities different actors should bear while pointing out opportunities and needs at the local, national, and intra-institutional levels.
Q: Who are the members of the working group?
A: Like many other development issues, drug resistance requires a coordinated response from a wide variety of policymakers and experts. CGD has been very fortunate to recruit more than 30 talented individuals who will contribute their experience and insight to tackle a complex problem with truly global implications. Because this issue requires action on a number of different fronts, our working group has experts from the public health sectors in developing and developed countries, technical and funding agencies, product development partnerships, the pharmaceutical industry, advocacy organizations and academia. All of these individuals work in communities that have an interest in this issue, but rarely have an opportunity to forge joint solutions. We are especially fortunate to have a number of working group members from developing countries who are dealing with this problem every day, and can provide essential knowledge about what responses are needed to support effective health improvements in different developing country settings. (You can see a list of the working group members here).