THE RACE AGAINST
DRUG RESISTANCE
Media Coverage July 2010
Compiled by The Hatcher Group
Table of Contents
Reuters, ―Drug-Resistant Bugs on Rise Globally: Report‖ pg. 4
Agence France Presse (AFP), ―Drug-Resistant Diseases on the Rise: Study‖ pg. 6
Guardian – Sarah Boseley’s Global Health Blog, ―Fears Grow Over Global Drug
Resistance‖ pg. 8
NPR Shots Blog, ―Increase in Drug Resistant Infections Sparks Call for Global Action‖
pg. 10
British Medical Journal, ―Better Access to Drugs in Developing Countries is
Accelerating Resistance‖ pg. 11
Kaiser Daily Global Health Policy Report, ―Global Drug Distribution Programs One
Factor in Hastening Drug Resistance, Report Says‖ pg. 13
Nature Network, ―‘Hidden Tuberculosis Raises Drug-Resistance Fears‖ pg. 15
Australian Broadcasting Corporation – ABC, ―Diseases Defying Flood of Life-Saving
Drugs‖ pg. 17
NEXT (Nigeria), ―Global Drug Resistance Raises Fear, Says Report‖ pg. 19
Health Leaders Media, ―Holding the Ground on Super Bugs‖ pg. 21
Hindustan Times, ―Drug-Resistance Diseases Rising Globally: Report‖ pg. 23
The Body – The Complete HIV/AIDS Resource, ―Global Drug Distribution Programs
One Factor in Hastening Drug Resistance, Report Says‖ pg. 24
Top News, ―Are They Life Saving Drugs or Life Taking Drugs?‖ pg. 26
PharmTech, ―Pharmaceutical Industry Urged to Fight Drug Resistance‖ pg. 27
CIDRAP, ―Report Says Fight Against Drug Resistance Must Go Global‖ pg. 28
ScienceBlogs: Superbug, ―News Break: Developing World Drug Resistance‖ pg. 30
OzarksFirst.com, ―Poverty Group Raises Flag Over WHO Drug Distribution‖ pg. 31
WCTV, ―Health Matters: Drug Resistance May be a Big Problem in Developing
Countries‖ pg. 32
Video
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TendersInfo.com, ―United States : Report Says Fight Against Drug Resistance Must Go
Global‖ pg. 33
Isaúde.net (Brazil), ―World Loses Capacity to Treat Diseases Like Malaria, HIV and
Tuberculosis‖ pg. 34
Emerging Health Threats, ―WHO Should Lead Drug-Resistance Fight, Experts Say‖
pg. 36
FiercePharma Manufacturing, ―Drug Resistance Complicates Supply Efforts to Poor‖
pg. 38
Le Monde, ―Bactéries résistantes‖ pg. 39
Homeland Security Digital Library, ―The Race Against Drug Resistance: Can it be
Won?‖ pg. 40
TDR: WHO Publication, ―The Race Against Drug Resistance‖ pg. 41
Malaria Policy Center, ―The Race Against Drug Resistance Must Go Global‖ pg. 43
C&EN – Chemical & Engineering News, ―Fighting Drug Resistance‖ pg. 44
End the Neglect, ―NTDs and Drug Resistance‖ pg. 46
The Pink Sheet, ―Industry Should Monitor Quality Outside Factory to Fight Drug
Resistance‖ pg. 48
Pharmiweb.com – Ran the press release. Read here
Manufacturing Chemist – Ran the press release. Read here
Madata (Greece) – http://www.madata.gr/diafora/science/66349.html
Africa News Service – Subscription Required
E-Drug, ―The Race Against Drug Resistance.‖ Read here
Africa Fighting Malaria, ―Drug Resistance – a global-scale failure.‖ Read here
3
Drug-resistant bugs on rise globally: report
(Reuters) - The World Health Organization, governments and nonprofit groups are
saving lives by distributing drugs to developing countries, but they are not paying
enough attention to the dangers of drug-resistant bugs, according to a report
released on Tuesday.
HEALTH
Many such drug distribution programs may be driving drug resistance and endangering
the lives they are meant to save, according to the report from the Center for Global
Development.
"Drug resistance is a natural occurrence, but careless practices in drug supply and use are
hastening it unnecessarily," the Center's Rachel Nugent, who led the group writing the
report, said in a statement.
Millions of children in the developing world die every year from drug-resistant strains of
malaria, tuberculosis, AIDS and other diseases, the report found.
Since 2006 donors have spent more than $1.5 billion on specialized drugs to treat
resistant bacteria and viruses, and this could worsen, the report cautions.
So-called "superbugs" such as methicillin-resistant Staphylococcus aureas, or MRSA,
now cause more than 50 percent of staph infections in U.S. hospitals.
Bacteria and viruses begin to evolve resistance to drugs almost as soon as they first
encounter them. If drug treatment leaves even one microbe alive, it will reproduce and
whatever genetic attributes helped it survive will be multiplied in the next generation.
Last week, experts told a Congressional panel that U.S. regulators need to provide a clear
path for drug companies to develop new antibiotics and should consider offering financial
incentives.
The Center's report looks for even broader action, urging WHO to lead others, including
pharmaceutical companies, governments, philanthropies that buy and distribute
medicines, hospitals, healthcare providers, pharmacies and patients.
The report finds clear links between increased drug availability and resistance. For
instance, in countries with the highest use of antibiotics, 75 to 90 percent of
Streptococcus pneumoniae strains are drug-resistant, it found.
4
Poor quality drugs, counterfeit drugs, incomplete use of drugs and other factors all
contribute to the problem, the report found. And this problem will worsen as drug access
programs succeed, it cautions.
"The number of people being treated for HIV/AIDS, for example, increased 10-fold
between 2002 and 2007; there was an 8-fold rise in deliveries of (drugs) for malaria
treatment between 2005 and 2006, and the Stop TB Partnership's Global Drug Facility
has expanded access to drugs for TB patients, offering nearly 14 million patient
treatments in 93 countries since 2001," the report reads.
"While increased access to necessary drugs is clearly desirable, it brings challenges in
preserving the efficacy of these drugs and ensuring they are used appropriately."
For instance, in 2008, an estimated 440,000 cases of multi-drug resistant tuberculosis
emerged.
The Center for Global Development, an independent, nonprofit group, specializes in
research on global poverty and inequality.
(Reporting by Maggie Fox; Editing by Paul Simao)
http://www.reuters.com/article/idUSTRE65E0NL20100615
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5
Drug-resistant diseases on the rise: study
(AFP)
WASHINGTON — Efforts by rich countries to provide drugs to help fight diseases in
poor countries has accelerated disease resistance to antibiotics, a report out Tuesday said.
The result is that more people are dying from diseases that used to be curable because
they are being treated with older-generation drugs, said the Center for Global
Development (CGD), a non-governmental organization based in Washington.
Over the past years developed countries and private aid groups have given poor countries
increased access to drugs to treat diseases such as malaria, HIV, and tuberculosis,
according to the report.
The result: strains of those diseases are increasingly resistant to antibiotics, and the world
is losing its ability to treat these and more common diseases such as dysentery and
respiratory infections.
In recent years poor countries have had a 10-fold increase in access to anti-retroviral
drugs for HIV/AIDS patients, a more than eight-fold increase in deliveries of anti-malaria
drugs, and a large increase in access to anti-tuberculosis drugs, the report said.
These "laudable" efforts have saved many lives, "but they are hindered by drug resistance
that could be avoided," said a statement announcing the report.
"Until now, surprisingly little effort has gone into ensuring that life-saving drugs will
continue to work."
Millions of children die in developing countries each year from drug resistant diseases -and since 2006 donors have spent more than 1.5 billion dollars on advanced drugs to treat
resistant diseases, the report said.
"Unless action is taken, the stage is set for both the death toll and the dollar cost to rise,"
a statement said. "Donors are already budgeting for increased purchases of expensive
specialized drugs needed to treat resistant diseases."
The report called on the World Health Organization (WHO) "to reverse a decade of
neglect of drug resistance and to take the lead in getting others involved.
6
"Action is needed from a wide variety of stakeholders -- pharmaceutical companies,
national governments, philanthropies that buy and distribute medicines, hospitals,
healthcare providers, pharmacies, and even patients."
Drug resistance "is a natural occurrence, but careless practices in drug supply and use are
hastening it unnecessarily", said Rachel Nugent, chair of the expert Working Group that
prepared the report, "The Race Against Drug Resistance."
Developed countries have similar problems: "superbugs" like methicillin-resistant
Staphylococcus aureas (MRSA) "increased from roughly two percent to more than 50
percent of staph infections in many US hospitals between 1974 and 2004. More people in
the United States die each year from MRSA than HIV/AIDS," the statement said.
More than three million children each year die of bacterial acute respiratory infections,
for example, while malaria kills two million.
"Many of these cases involve strains resistant to common drugs," the statement said.
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Fears grow over global drug resistance
Too little attention has been paid to the dangers that drugs will become resistant to diseases in the
developing world, report warns.
Unprecedented efforts are being made to get medicines to people in poor countries to treat killer
diseases such as Aids, tuberculosis and malaria. But too little attention is being paid to the real
danger that these drugs will run out of impact. A report today from the Center for Global
Development in Washington says we need to wake up - there are measures that can be taken to stop
drug resistance building.
It's always been a scourge of Europe and the USA. Penicillin long ago stopped being the miracle
cure it once appeared to be. Bacteria and viruses are smart organisms that will mutate, given the
slightest weakness in the drugs being used against them - which is why it is vital that we finish a
course of antibiotics.
But when drugs are precious, money is short and diseases all too often kill, as in the developing
world, a failure to guard against drug resistance has powerful potential consequences. We have had
MDR TB (multidrug-resistant tuberculosis) for some years. More recently came the first reports of
XDR TB, extremely drug resistant tuberculosis, in South Africa. The drugs to treat it would not
have been affordable even if they had been available.
Nancy Birdsall, president of CGD, put it this way:
Drug resistance is a serious problem that doesn't get serious attention. It is hard to see that people
are dying from drug resistance - but they are. We know what actions are needed to fix the problem.
We just lack the incentives, institutions and global leadership to get on with it.
The report has recommendations for a range of bodies: for instance, drug companies must help
ensure their products are safe and effective even after they are sold, governments must properly
regulate licensing and manufacturing and set up proper surveillance systems and global health
institutions like the WHO must make drug resistance a priority.
Meanwhile, a paper from the London School of Hygiene and Tropical Medicine in the Lancet says
that a cheap drug to prevent blood clots could save the lives of thousands of accident victims
worldwide. Haemorrhage is responsible for a third of hospital deaths following accidental injuries,
8
such as those caused by car crashes and violence. A trial of more than 20,000 patients in 40
countries found the use of tranexamic acid (TXA) prevented 10% of deaths.
And Medecins Sans Frontieres warns that while the world is watching football in South Africa,
there is a malnutrition crisis among children in the north of the continent. In Chad alone, it says,
3,000 children were admitted to its nutrition programmes in May. Erratic rainfalls, failed harvests,
soaring food prices, early depletion of food stocks and poor access to healthcare are all playing a
part, says MSF, which wants more and faster help sent to the area.
http://www.guardian.co.uk/society/sarah-boseley-global-health/2010/jun/15/international-aid-anddevelopment-pharmaceuticals-industry
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Increase In Drug-Resistant Infections Sparks Call For Global
Action
by Jaclyn Schiff
Infectious diseases resistant to treatment could become increasingly common and severe without a
coordinated international effort to thwart them.
Medicines against microbes tend to become less effective over time. But a report from the Center
for Global Development finds that resistance to the drugs is hastened in many countries by drug
misuse, weak health systems and overuse of the medicines in agriculture.
Drug-resistant strains of major infectious diseases, such as malaria, pneumonia and tuberculosis
have already emerged. And in some cases, drug-resistant mutations have become the dominant
strain. Some examples:
60 to 80 percent of dysentery strains in children in Latin America are resistant to recommended
drugs, according to the report.
10 years ago drug-resistant HIV strains made up between 1 and 5 percent of cases, but now
make up between 5 and 10 percent of cases worldwide, the Associated Press reported in January
as part of a series of articles looking at drug-resistance.
Earlier this year, Reuters reported on the ongoing story of malaria along the Thai-Cambodian
border that is showing resistance to the most effective drugs on the market.
The problem isn't restricted to poor countries. In the United States, the "superbug" methicillinresistant Staphylococcus aureas (MRSA) went from accounting for 2 percent of hospital staph
infections in 1974 to more than 50 percent in 2004.
The report also says that international donors' efforts to improve access to drugs in the developing
has helped fuel drug resistance.
Work to curb the problem has mostly been disease- or country-specific, according to Rachel
Nugent, CGD's deputy director for global health and chair of the group that prepared the report.
―Some have been more successful than others, but none have addressed the problem on a global
scale and across diseases," she says, adding that a "systemic global response" is missing.
http://www.npr.org/blogs/health/2010/06/14/127841428/growing-threat-of-drug-resistant-diseases
10
News
Better access to drugs in developing countries is accelerating
resistance
Susan Mayor
Published 17 June 2010
1 London
Improving access to drugs to treat serious diseases common in developing countries, including
malaria, HIV, and tuberculosis, is having the unintended effect of speeding up the development of
microbial resistance to drugs, warns a new report.
The report, published on 15 June by the Center for Global Development, shows a close link
between the volume of drug use and the emergence of resistant strains, particularly in settings
without adequate systems for ensuring appropriate use of drugs. For example, in countries with the
highest use of antibiotics, 75% to 90% of strains of Streptococcus pneumoniae are resistant to
commonly used drugs. Lack of systems to monitor resistance is adding to the problem: figures in
the report show that fewer than 10% of cases of resistant tuberculosis are currently detected and that
even fewer are treated.
Growing resistance will lead to a rapid loss of effective treatments for a range of diseases and
growing costs associated with providing new drugs in developing countries, the report¹s authors
argue.
Nancy Birdsall, president of the Center for Global Development, an independent think tank working
to reduce global poverty, said, "Drug resistance is a serious problem that doesn¹t get serious
attention.
"It is hard to see that people are dying from drug resistance, but they are. We know what actions are
needed to fix the problem, but we lack the incentives, institutions, and global leadership to get on
with it."
Research conducted for the report shows that several factors have increased the prevalence of drug
resistance in developing countries. These include insufficient technology, inappropriate use of
drugs, a lack of procedures in healthcare systems to ensure the best use of drugs and to monitor drug
resistance, poor quality of drugs, and excessive use of antibiotics in agriculture.
The World Health Organization should urgently take a lead in introducing measures to reduce the
risk of drug resistance, the authors say, and should encourage the key stakeholders involved,
11
including drug companies, national governments, aid agencies that buy and distribute drugs,
healthcare providers, and patients, to take action.
They suggest that a unified and multifaceted approach is needed across public and private sectors
to reduce the increase in drug resistance, including:
*Tracking resistance in real time<global health donors and agencies such as WHO should work
with developing countries to set up a network of surveillance laboratories to track the emergence
and spread of resistant strains and quickly share the information
*Securing the supply chain<the drug industry should set voluntary standards to maintain the quality
of products from manufacturing through to final delivery to patients, and organizations providing
drugs should promote best practices in prescribing and dispensing
*Strengthening regulation<donors should work with regional economic commissions to support
new and existing regional networks of national drug regulators to monitor drug quality, and
*Accelerating development of new drugs<research funders should set up a system for encouraging
information exchange and research.
Cite this as: BMJ 2010;340:c3234
12
Kaiser Daily Global Health Policy Report
Global Drug Distribution Programs One Factor In Hastening Drug Resistance,
Report Says
Tuesday, June 15, 2010
A Center for Global Development (CGD) report released Tuesday details factors leading to
increased drug resistance worldwide, including drug distribution programs in developing countries,
Reuters reports. Expanded access to medicines is "clearly desirable," but it creates "challenges in
preserving the efficacy of these drugs and ensuring they are used properly," the report says, noting
that program operators – such as the WHO, foreign government and nonprofit groups – are "not
paying enough attention" to the seriousness of drug resistance, according to the news service.
"Drug resistance is a natural occurrence, but careless practices in drug supply and use are hastening
it unnecessarily," said CGD's Rachel Nugent, the report's lead author (Fox, 6/15).
According to a CGD press release (.pdf), other drivers of drug resistance include: technology gaps,
weak health systems, inconsistent drug quality and the overuse of antibiotics in agriculture. The
report notes how drug resistance increases the overall cost of treatment as well as the effect on
children, who are particularly susceptible to infectious diseases. The press release says that 60 to 80
percent of dysentary cases among children in Latin America are "resistant to the drugs
recommended to treat it."
"In many poor countries, drug expenditures range from 20 to 60 percent of total expenditure on
health," according to the release, which adds that "alternatives [to first-line drugs] are more costly
and require greater medical oversight. Curing one patient of extensively drug-resistant TB costs the
same as curing 200 patients with ordinary TB" (6/15).
According to Reuters, "[s]ince 2006 donors have spent more than $1.5 billion on specialized drugs
to treat resistant bacteria and viruses, and this could worsen" as drug access continues to
increase. "The number of people being treated for HIV/AIDS, for example, increased 10-fold
between 2002 and 2007; there was an 8-fold rise in deliveries of (drugs) for malaria treatment
between 2005 and 2006, and the Stop TB Partnership's Global Drug Facility has expanded access to
drugs for TB patients, offering nearly 14 million patient treatments in 93 countries since 2001," the
news service writes.
In countries with the highest use of antibiotics, the report found that between 75 percent and 90
percent of Streptococcus pneumoniae strains have become drug-resistant. In addition, "methicillinresistant Staphylococcus aureas, or MRSA, now cause more than 50 percent of staph infections in
U.S. hospitals," the news service writes (6/15).
To address the problem, "the report calls for collective action by a variety of players in a shared
global push to fight drug resistance," according to the CGD press release. Recommendations
13
include: creating a "network of multi-disease surveillance laboratories to track the emergence and
spread of resistant strains" and share information; establishing stronger drug quality control
measures; strengthening regional networks to regulate drugs; and expanding research and
development about drug resistance (6/15).
http://globalhealth.kff.org/Daily-Reports/2010/June/15/GH-061510-Drug-ResistanceReport.aspx?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+kff%2Fkdgh
pr+%28Kaiser+Daily+Global+Health+Policy+Report%29
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'Hidden' tuberculosis raises drug-resistance fears
New study doubles known rate of infection at a South African hospital.
Amy Maxmen
Published online 23 June 2010 | Nature |
Huge and hidden levels of tuberculosis discovered in a South African province devastated by HIV
are increasing concerns about the prevalence of drug-resistant tuberculosis in Africa.
As reported in PLoS Medicine1, when researchers examined newly deceased patients at Edendale
hospital in the province of KwaZulu-Natal, they discovered that 50% were infected with the
bacterium M. tuberculosis, the causal agent of tuberculosis, with 17% of the infected individuals
carrying a multi-drug resistant (MDR) strain.
Among those with TB, only 58% had been diagnosed and started on treatment before their death. A
previous study had found that only 28% of patients admitted to the same hospital were diagnosed
with active tuberculosis.
In the new study, 96% of those positive for M. tuberculosis were also HIV positive, and the
alarming prevalence of tuberculosis may reflect the situation in other low-income countries plagued
by HIV. With weakened immunity, HIV-positive individuals are extremely vulnerable to other
infections.
"This report is extremely serious," says Mario Raviglione, director of the WHO Stop TB
Department in Geneva, Switzerland. "It confirms that over the last few years, multidrug-resistant
tuberculosis has become rampant in people living with HIV [in Africa]".
According to the World Health Organization, South Africa ranks fifth among countries with the
highest tuberculosis burden. Infection rates in KwaZulu-Natal may be especially high as 39% of
adults are HIV-positive, according to a 2008 UNAIDS report2.
Douglas Wilson, head of medicine at Edendale and an author on the PLoS Medicine paper, hadn't
expected such staggering rates of tuberculosis. "When you drive to my hospital, you see a number
of funeral parlours along the road," he says. "At least we now know why they are in business."
The new study looked at 240 adults aged between 20 and 45 who died from any cause excluding
trauma or childbirth. Many of these patients might have survived had their tuberculosis been
detected earlier, as 42% of them were not being treated for it.
15
Tuberculosis slips under the radar because many patients admitted to hospitals never get tested.
Even if they do, the cheapest and most commonly used diagnostic tests, which involve examining
sputum under a microscope, often miss cases. In particular, HIV-positive people typically suffer
from forms of tuberculosis that sputum tests don't detect.
By culturing samples drawn from organs and the respiratory tract, this team diagnosed the presence
of MDR M. tuberculosis with greater accuracy than less invasive tests can.
Drug-resistant danger
Although too little information exists to tell if MDR tuberculosis is on the rise globally, Peter
Cegielski, at the US Center for Disease Control's Division of Tuberculosis Elimination in Atlanta,
Georgia, predicts that the epidemic will worsen because of inadequate capability for diagnosis and
treatment.
"As drugs are used more and more, they will create new cases of MDR TB as predictably as the sun
will rise tomorrow," he says. "That's the nature of evolution. When we put tremendous selective
pressure on those bacteria, the drug-resistant mutants are going to survive."
Poor-quality drugs or incomplete drug regimens also give resistant TB bacteria time to arise,
multiply, and infect others.
On June 15, the non-profit Center for Global Development in Washington DC warned that drug
quality must be more carefully monitored and diagnostic capabilities improved so that drugresistant tuberculosis can be stopped before it spreads further.
Rachel Nugent, deputy director of global health at the organization, says long-term savings from
such moves will vastly exceed up-front costs, as standard tuberculosis treatments cost US$20
whereas those for the drug-resistant form of the disease start at $3,500.
Yet Wilson says Edendale lacks the expertise and resources required to run faster, more accurate
tests on a large scale.
In the meantime he's turned to HIV prevention as a means to slow the tuberculosis epidemic. "You
can chose to have safe sex," he says, "but you can't chose not to breathe."
http://www.nature.com/news/2010/100623/full/news.2010.311.html
16
Diseases defying flood of life-saving drugs
By David Mark
We may be living at the end of a golden age - one where drugs actually worked.
A report from the Centre for Global Development says the increased availability of drugs to treat
diseases like HIV, tuberculosis and malaria is in fact causing more people to die.
According to Rachel Nugent, who wrote the report, drug resistance is a growing and deadly
problem that is getting rapidly worse.
"It's a lot bigger problem for two reasons," she said.
"One is that as people use more and more drugs, resistance grows faster and faster. The pathogens
respond to the amount of drugs that they're faced with. So resistance is accelerating.
"The other reason is we are not producing new drugs anywhere near as quickly as we used to, so the
pipeline is running dry."
The problem is particularly bad in developing countries, which have been flooded with drugs
through the goodwill of aid groups and donors.
Dr Nugent calls HIV, malaria and tuberculosis (TB) the big three because they are the ones that get
the most funding for treatment.
Yet all three diseases are showing resistance to the main drugs used to fight them.
"Sometimes to the level that there are some pathogens that are untreatable. Some forms of those
diseases that are untreatable," she said.
"Malaria, for instance - there is only one effective drug that remains to treat malaria. TB - we're
seeing strains of TB for which we have no effective drug treatment."
Then there are the major childhood diseases like diarrhoea and pneumonia that kill five million
children a year.
Dr Nugent says the cheap available antibiotics used to treat these diseases simply do not work and
the problem is made worse by sloppy supply practices.
17
"They may get repeated treatment with the same drug," she said.
"Then perhaps the dispenser, the doctor, will switch drugs and they'll get treated with another drug
and there are a couple of common antibiotics that will be recommended for diarrhoea again.
"There are parts of the world where all three major antibiotics for diarrhoea are not working on
children anymore and then they don't have anything.
"Or perhaps they don't have a good lab that can tell them exactly what the strain will be sensitive to
and so they just keep getting treatments that don't work and the child dies."
The report has offered four solutions: the collection and sharing of information about drug
resistance, better quality products and practices, new drugs and regional networks to monitor the
drugs that are doled out.
"In developing countries the drug regulators are notoriously weak and often corrupt and so we're
proposing that there be regional networks of regulators," she said.
"We want them to work together ... bringing them together will create some peer accountability,
some check on that corruption."
The report condemns the lack of leadership, saying no effort has gone into ensuring drugs continue
to work.
Dr Nugent says much of the blame lies with the World Health Organisation, which has failed to
coordinate all the players in the drugs chain: pharmaceutical companies, governments, aid groups,
hospitals, doctors, pharmacies and patients.
"One of the things that we've lacked, aside from WHO leadership, which certainly has not been
what it should be, but we have lacked a coordinated effort on this," she said.
"That's one of the things that we're calling for, leadership - but [also] more coordination among
those that lead."
At risk are future generations who could die from diseases that until a few years ago were easily
cured.
http://www.abc.net.au/news/stories/2010/06/16/2928711.htm
18
Global drug resistance raises fear, says report
By Ifedayo Adebayo
June 16, 2010 01:22AM
The World Health Organisation, governments, and non-profit groups are not paying enough
attention to the dangers of drug-resistant drugs, a report from the Centre for Global Development
has warned.
According to the report, laudable efforts to increase access to drugs in the developing world are
hardly accompanied by measures to protect the continued effectiveness of drug treatment.
It called on the distributing agency to ―strenuously enforce quality standards throughout the supply
chain, ensure that adequate knowledge is gathered about the effectiveness of the medicines they are
providing, and use their purchasing power to drive drug quality standards throughout the supply
chain.‖
The report, which was released on Tuesday, added that children in the developing world die every
year from drug-resistant strains of malaria, tuberculosis, AIDS, and other diseases.
It also revealed that more than 40 percent of children worldwide live in malaria endemic countries,
while malaria kills almost 1 million children under the age of five in sub-Saharan Africa alone
annually.
Many of the drug distribution programmes may be driving drug resistance and endangering the lives
they are meant to save, according to the report from the Centre for Global Development.
―We are rapidly losing our ability to cure an alarming number of the most serious and common
diseases of the developing world because of an invisible adversary: drug resistance. Resistance is
inevitable - but careless practices in drug supply and use are hastening it unnecessarily.
―Without an immediate global effort to safeguard lasting treatment effectiveness, drug resistance
will quickly become a widespread threat, claiming lives, raising the cost of curing patients, and
making future generations increasingly vulnerable to deadly diseases that were easily cured in the
past, ‖ said the Centre‘s Rachel Nugent, who led the group that wrote the report.
High cost
Since 2006, donors have spent more than 1.5 billion dollars on specialised drugs to treat resistant
bacteria and viruses, and this could worsen the report cautions.
The Centre‘s report looks for even broader action, urging WHO to lead others, including
pharmaceutical companies, governments, philanthropies that buy and distribute medicines,
hospitals, healthcare providers, pharmacies and patients.
19
The report finds clear links between increased drug availability and resistance. For instance, in
countries with the highest use of antibiotics, 75 to 90 percent of Streptococcus pneumoniae strains
are drug-resistant, it found.
―Poor quality drugs, counterfeit drugs, incomplete use of drugs, and other factors all contribute to
the problem, and this problem will worsen as drug access programs succeed,‖ it cautions.
―The number of people being treated for HIV/AIDS, for example, increased 10-fold between 2002
and 2007; there was an 8-fold rise in deliveries of (drugs) for malaria treatment between 2005 and
2006.
―And the Stop TB Partnership‘s Global Drug Facility has expanded access to drugs for TB patients,
offering nearly 14 million patient treatments in 93 countries since 2001,‖ it added.
Child’s health impact
The long-term effects of malaria on a child‘s health and development are often insufficiently
recognised and poorly managed, the report identifies.
―A severe form of the disease, cerebral malaria, kills 10-20 percent of those children it affects,
while an additional 7 percent are left with permanent neurological problems, including blindness,
epilepsy, and speech and learning difficulties.
―Chloroquine was an effective first-line malaria treatment for more than 50 years, but when
resistance rates became unacceptably high in the mid-1990s, SP became the only affordable,
effective alternative with limited side effects,‖ it stated.
Mrs. Nugent, who is also the deputy director of global health, while commenting on drug resistance
and the administering of bad malaria pills in some Africa countries, told journalists in February
2010, that, ―there are many cases of malaria that are being only partially treated, and that just
guarantees acceleration of artemisinin drug resistance.‖
The result of a study conducted in Africa then revealed that high rates of the most effective type of
malaria-fighting drugs sold in three African countries are poor quality - including nearly half the
pills sampled in Senegal.
The group, however, highlighted the need for governments to ―have a responsibility to provide
regulation and oversight of drug licensing, manufacturing distribution, and use, as well as to
properly support laboratory facilities and surveillance systems, in order to detect and monitor drug
efficacy.‖
Patients, prescribers, and dispensers were all advised to gain greater awareness of the personal and
social costs of drug resistance, and employ far greater diligence in appropriately using drugs.
http://234next.com/csp/cms/sites/Next/Home/5581274146/global_drug_resistance_raises_fear_says.csp
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Holding the Ground on Super Bugs
Janice Simmons, for HealthLeaders Media, June 17, 2010
Antibiotic-resistant organisms—the so-called "super bugs"—may be gaining an upper hand if action
is not taken very soon on the healthcare front.
At a hearing last week on antibiotic development, Rep. Henry Waxman (D-CA), chair of the House
Energy and Commerce Committee, said that the goal both in the United States and abroad is that
individuals keep on benefitting from life-saving treatments.
Providing that, though, can be tough. "By definition, this is an inherently difficult goal to achieve—
after all, the very use of antibiotics leads to the development of pathogens that can no longer be
treated by those antibiotics," Waxman said. In this case, rather than "use it or lose it," with
antibiotics it is "use it and lose it."
The impact of these super bugs is being felt worldwide. In a report released Tuesday by the
Washington, DC-based Center for Global Development, many international drug distribution
programs were found to be creating drug resistance themselves—and endangering the lives they
should be saving.
For instance, in nations with the highest use of antibiotics, 75% to 90% percent of Streptococcus
pneumoniae strains were already drug resistant.
In many poorer countries, drug expenditures can range from 20% to 60% of total expenditure on
health. When first line drugs fail, alternatives were more costly and require greater medical
oversight: Curing one patient of extensively drug resistant tuberculosis costs the same as curing 200
patients with ordinary TB, the report notes.
"Drug resistance is a natural occurrence, but careless practices in drug supply and use are hastening
it unnecessarily," the Center's Rachel Nugent, who led the group writing the report, said in a
statement.
Back in the U.S., antibiotic resistance can be considered an economic burden on the healthcare
system, too, Centers for Disease Control and Prevention Director Thomas Frieden, MD, told the
House panel earlier this spring.
Resistant infections not only cost more to treat—but also can prolong healthcare use, Frieden said.
For instance, in a 2008 study of medical costs for antibiotic resistant infections, it was estimated
that infections in 188 patients at a single healthcare institution cost between $13.35 million and
$18.75 million.
Unfortunately, as Frieden points out, infections caused by antibiotic-resistant bacteria—despite
precautions taken—still remain an everyday occurrence in healthcare settings.
21
Antimicrobial resistance is a complex issue and addressing it will require "creativity and
persistence," said Janet Woodcock, MD, director of the Food and Drug Administration's Center for
Drug Evaluation Research, at the House hearing.
This will include, she said, developing new vaccines—"diminishing the need for antimicrobial
treatment in the first place," Woodcock said. Prevention of infections through the use of vaccines
has virtually eliminated or markedly decreased the problem of resistance in organisms such as
Haemophilus influenzae type b, virtually eliminated in the U.S., but still a problem in other parts of
the world, and Streptococcus pneumoniae, also known as pneumococcus.
Also, improved diagnostics will help curb overuse of antibiotics, she said, by allowing physicians to
determine whether a patient has a bacterial infection and, if so, whether it is resistant to
conventional antibiotics.
Educating providers—and patients—about the overuse of antibiotics has been important, said
Sandra Fryhofer, MD, a member of the American Medical Association's Council on Science and
Public Health. However, the use of antibiotics for the treatment of pediatric acute otitis media has
not subsided despite the issuance of a watchful waiting guidance from the American Academy of
Family Physicians and the American Academy of Pediatrics six years ago.
Unfortunately, the issue that will not go away is that new drugs that battle antibiotic resistance need
to be created. Many pharmaceutical manufacturers, though, have been increasingly reluctant to
move in such a direction because of high costs and low returns on investment.
Thus, "innovative incentives" must be developed, Fryhofer said, to foster ―continued research and
development of novel antibiotics to make sure that these important tools that combat infectious
diseases remain available for future generations of physicians."
One AMA proposal, announced Wednesday at its annual meeting, is to educate the public about
antibiotic resistance and to create incentives for manufacturers to develop 10 new antibiotics by
2020.
But will that be soon enough? Take the case of the new antibiotic linezolid—considered one of the
few effective antibiotics to fight severe MRSA infections. However, in new research reported this
month in the Journal of the American Medical Association, new cases have been reported already of
linezolid resistant Staphylococcus aureus (LRSA) in Spain, Germany, Brazil, and even the U.S.
As far as super bugs are concerned, the fight continues.
Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media
Online. She can be reached at jsimmons@healthleadersmedia.com.
http://www.healthleadersmedia.com/content/QUA-252624/Holding-the-Ground-on-Super-Bugs##
22
Drug-resistance diseases rising globally: Report
Press Trust Of India
Washington, June 15, 2010
The world is rapidly losing its ability to treat more common diseases such as dysentery, malaria and
tuberculosis as they are increasingly becoming drug resistant, a new report said today.
Although World Health Organisation and other NGOs have increased their efforts to improve health
care in poor and developing countries, they have not paid much attention to the dangers of growing
drug-resistance, said the report from the Centre for Global Development (CGD), a US-based
research institute.
"Drug resistance is a natural occurrence, but careless practices in drug supply and use are hastening
it unnecessarily," said Rachel Nugent, who led expert group that prepared the report.
Millions of children in developing countries die annually from drug resistant strains of malaria,
tuberculosis, AIDS and other diseases, found the report titled "The Race Against Drug Resistance".
And since 2006, donors have spent more than $1.5 billion on advanced drugs to treat resistant
diseases, it said.
"Unless action is taken, the stage is set for both the death toll and the dollar cost to rise. Donors are
already budgeting for increased purchases of expensive specialised drugs needed to treat resistant
diseases," it warned.
In recent years, it said, governments and private funders have worked to increase developingcountry access to drugs, particularly for malaria, HIV, and tuberculosis.
Access to anti-retroviral drugs for HIV/AIDS patients rose more than 10-fold, deliveries of the most
effective anti-malarial drugs increased more than eight-fold, and access to TB drugs rose
dramatically.
"These are laudable efforts that have saved many lives, but they are hindered by drug resistance that
could be avoided," the CGD report said. "Until now, surprisingly little effort has gone into ensuring
that life-saving drugs will continue to work."
The report claimed that there is a strong link between the volume of drug use and emergence of
drug resistance, particularly in settings with weak safeguards for appropriate use and monitoring of
effectiveness.
http://www.hindustantimes.com/Drug-resistance-diseases-rising-globally-Report/Article1558059.aspx
23
INTERNATIONAL NEWS
Global Drug Distribution Programs One Factor in Hastening
Drug Resistance, Report Says
June 15, 2010
A Center for Global Development (CGD) report released Tuesday details factors leading to
increased drug resistance worldwide, including drug distribution programs in developing countries,
Reuters reports. Expanded access to medicines is "clearly desirable," but it creates "challenges in
preserving the efficacy of these drugs and ensuring they are used properly," the report says, noting
that program operators -- such as the WHO, foreign government and nonprofit groups -- are "not
paying enough attention" to the seriousness of drug resistance, according to the news service.
"Drug resistance is a natural occurrence, but careless practices in drug supply and use are hastening
it unnecessarily," said CGD's Rachel Nugent, the report's lead author (Fox, 6/15).
According to a CGD press release (.pdf), other drivers of drug resistance include: technology gaps,
weak health systems, inconsistent drug quality and the overuse of antibiotics in agriculture. The
report notes how drug resistance increases the overall cost of treatment as well as the effect on
children, who are particularly susceptible to infectious diseases. The press release says that 60 to 80
percent of dysentary cases among children in Latin America are "resistant to the drugs
recommended to treat it."
"In many poor countries, drug expenditures range from 20 to 60 percent of total expenditure on
health," according to the release, which adds that "alternatives [to first-line drugs] are more costly
and require greater medical oversight. Curing one patient of extensively drug-resistant TB costs the
same as curing 200 patients with ordinary TB" (6/15).
According to Reuters, "[s]ince 2006 donors have spent more than $1.5 billion on specialized drugs
to treat resistant bacteria and viruses, and this could worsen" as drug access continues to increase.
"The number of people being treated for HIV/AIDS, for example, increased 10-fold between 2002
and 2007; there was an 8-fold rise in deliveries of (drugs) for malaria treatment between 2005 and
2006, and the Stop TB Partnership's Global Drug Facility has expanded access to drugs for TB
patients, offering nearly 14 million patient treatments in 93 countries since 2001," the news service
writes.
In countries with the highest use of antibiotics, the report found that between 75 percent and 90
percent of Streptococcus pneumoniae strains have become drug-resistant. In addition, "methicillinresistant Staphylococcus aureas, or MRSA, now cause more than 50 percent of staph infections in
U.S. hospitals," the news service writes (6/15).
To address the problem, "the report calls for collective action by a variety of players in a shared
global push to fight drug resistance," according to the CGD press release. Recommendations
include: creating a "network of multi-disease surveillance laboratories to track the emergence and
24
spread of resistant strains" and share information; establishing stronger drug quality control
measures; strengthening regional networks to regulate drugs; and expanding research and
development about drug resistance (6/15).
http://www.thebody.com/content/news/art57044.html
25
Are They Life Saving-Drugs or Life Taking-Drugs?
Submitted by Olivia Conroy on Wed, 06/16/2010 - 11:35
It is a clear dilemma whether the drugs that are available with us in this golden age are actually lifesaving or life-taking drugs.
An account from the Centre for Global Development says that the amplified accessibility of drugs,
in order to treat diseases such as HIV, tuberculosis and malaria, is in reality causing more people to
die.
According to Rachel Nugent, who wrote the account said that drug resistance is a growing and fatal
crisis that is getting worse real quickly.
The real problem underlying is that people tend to make extreme use of these drugs and the body
system becomes more resistant towards the effects of the drugs, which are taken.
The pathogens respond to the level of drugs that they have to face and therefore, the resistance
becomes all the more rapid in its process.
Probably, talking of the current time, the drugs that are produced now are being manufactured real
rapidly, so the pipeline is running dry.
The actual trouble seems to have been faced by all the developing nations, which have seen a gush
of drugs that are made available to the nationals by goodwill aid groups and donors and on top of
that, such nations cannot even do without the drugs, which are offered by the more developed
countries.
http://topnews.us/content/222278-are-they-life-saving-drugs-or-life-taking-drugs
26
Pharmaceutical Industry Urged to Fight Drug Resistance
Jun 17, 2010
By: Stephanie Sutton
ePT--the Electronic Newsletter of Pharmaceutical Technology
The world is rapidly losing its ability to treat malaria, HIV, and tuberculosis, as well as more
common diseases such as dysentery and respiratory infections because of drug resistance, according
to a report from the Center for Global Development (CGD).
Drug resistance is a natural occurrence, but the report claims it is being accelerated by careless
practices in medicine supplies. The issue is particularly prominent in developing countries, but
developed areas are also experiencing increasing instances of drug resistance; for example, in the
US, the occurrence of drug resistant ‗superbugs‘ increased from approximately 2% to more than
50% between 1974 and 2004.
―Over the past decade, the global community has responded to the rise in drug-resistant organisms
with a number of disease- or country-specific initiatives,‖ Rachel Nugent, chair of the working
group that prepared the report, explained in a press statement. ―Some have been more successful
than others, but none have addressed the problem on a global scale and across diseases. The
situation demands a more extensive and systematic global response.‖
According to the report, the common drivers of drug resistance across diseases are a mix of
technology gaps, behavior that leads to inappropriate use of medicines, weak health systems, poor
drug quality, and excessive use of antibiotics in agriculture. Because so many different factors are
involved, the report says collective action will be required, and is urging the World Health
Organization (WHO) to take the lead in getting other stakeholders involved, including, among
others, pharmaceutical companies, national governments, hospitals, and healthcare providers.
The report includes a variety of recommendations for different stakeholders. In the case of the
pharmaceutical industry, the report says that drug companies must help ensure that products are safe
and effective even after they are sold. As such, it recommends that voluntary standards be set to
maintain the quality of products from manufacturing to the end-user. Additionally, global and
national partnership of medicine providers is needed to promote best practices in drug prescribing
and dispensing.
http://pharmtech.findpharma.com/pharmtech/Manufacturing/Pharmaceutical-Industry-Urged-toFight-Drug-Resist/ArticleStandard/Article/detail/674492?contextCategoryId=40939
27
Report says fight against drug resistance must go global
Robert Roos News Editor
Jun 16, 2010 (CIDRAP News) – Efforts to battle major diseases in the developing world are leading
to increased drug resistance, creating a need for a coordinated global campaign to maintain the
effectiveness of antimicrobial drugs, a US nonprofit policy research group said in a report released
this week.
The Center for Global Development (CGD) in Washington, DC, said millions of children in the
developing world die each year from resistant strains of common diseases such as malaria,
pneumonia, other respiratory infections, and dysentery.
In the report, The Race Against Drug Resistance, the group urges the World Health Organization
(WHO) to take the lead in reversing what it calls "a decade of neglect of drug resistance" and calls
on drug companies, governments, philanthropies, and healthcare providers to get involved.
"Drug resistance is a natural occurrence, but careless practices in drug supply and use are hastening
it unnecessarily," Rachel Nugent, chair of the CGD working group that prepared the report, said in a
news release.
In recent years governments and private funders have succeeded in improving poor countries' access
to drugs for malaria, HIV, tuberculosis, and other diseases, the CGD said. It praised these efforts,
but said they are hindered by drug resistance that could be avoided, adding that "surprisingly little
effort" has been made to prevent resistance.
The report says there is a strong association between the volume of drug use and emergence of
resistance, especially where safeguards for appropriate use are weak. For example, in countries
where antibiotic use is highest, 75% to 90% of Streptococcus pneumoniae strains are resistant.
The CGD said the report identifies the common drivers of resistance as "a mix of technology gaps,
behavior that leads to inappropriate use of medicines, weak health systems, poor drug quality, and
excessive use of antibiotics in agriculture."
Drug resistance is a problem in developed as well as developing countries, the report acknowledges.
For example, it says that methicillin-resistant Staphylococcus aureus (MRSA) increased from about
2% to more than 50% of staph infections in many US hospitals between 1974 and 2004 and that
MRSA kills more people in the United States than HIV/AIDS.
The CGD makes four broad recommendations for combating drug resistance.
28
The first is to improve monitoring of the problem. To this end, the CGD suggests that donor
organizations and agencies such as the WHO work with developing countries to set up a network of
surveillance laboratories to track the emergence and spread of resistant strains and quickly share the
information. The group suggests that this network should produce a global drug resistance report
every 2 years and establish a Web-based resource center to collect and share data.
The second recommendation is two-pronged. First, the pharmaceutical industry should "set
voluntary standards to maintain the quality of its products from manufacturing through final
delivery to the patient." Second, global and national partnerships of medicine providers should
collect and promote best practices in drug prescribing and dispensing, share evaluations of what
works, and adapt tested models to individual countries.
The third recommendation is for stronger regulation. Many national regulatory authorities lack the
ability to enforce drug quality standards, which permits poor-quality and counterfeit drugs to reach
patients. To address this, the CGD suggests that donor groups partner with regional economic
commissions "to support new regional networks of national drug regulators and enhance existing
ones to monitor drug quality and enforce laws."
Finally, the CGD calls for boosting research and innovation to speed the development of resistancefighting technologies. One way to do this, it says, is to set up "a Web-based marketplace" to show
off relevant research and innovation. "It would offer a brokerage facility to provide technical
assistance, connect researchers with one another, and match good ideas with investors," the report
states.
http://www.cidrap.umn.edu/cidrap/content/other/news/jun1610resist.html
29
News break: Developing-world drug resistance
Posted on: June 15, 2010 1:00 PM, by Maryn McKenna
The Center for Global Development, a DC think-tank, is releasing what looks like a thoughtful
report aimed at refocusing policy debates over drug resistance toward the epidemic's global impact,
with particular attention to the the developing world.
From the report's preface:
Problems with drug resistance have moved from the patient's bedside to threaten global public
health. Drug resistance has dramatically increased the costs of fighting tuberculosis (TB) and
malaria, has slowed gains against childhood dysentery and pneumonia, and threatens to undermine
the push to treat people living with HIV/AIDS effectively. Global health funders and development
agencies have cause to worry about whether their investments in access to drugs, and global health
programming more broadly, are being undone by the relentless advance of drug resistance.
It calls out a sustained lack of leadership:
Past efforts to energize global action to more comprehensively address drug resistance have been
sidetracked by poor timing or over-stretched budgets... In an unfortunate coincidence of timing, a
WHO Strategy on Antimicrobial Resistance was launched on September 11, 2001. As a result, the
action plan prepared for the Strategy did not get carried out, and over time the interest in crosscutting drug resistance at WHO withered, even while disease-specific attention grew. For many
years, the U.S. Government provided support for research, technical support, surveillance, and
policy development on drug resistance in developing countries through an annual budget
appropriation to the U.S. Agency for International Development (USAID). That support has become
narrowed to programming in only a few areas.
It recommends 4 specific steps:
1. Improve surveillance by collecting and sharing resistance information across networks of
laboratories
2. Secure the drug supply chain to ensure quality products and practices
3. Strengthen national drug regulatory authorities in developing countries
4. Catalyze research and innovation to speed the development of resistance-fighting
technologies
A policy brief is here and the full report is here.
http://scienceblogs.com/superbug/2010/06/news_break_developing-world_dr.php
30
Poverty Group Raises Flag Over WHO Drug Distribution
Tuesday, June 15 2010
KOLR/KSFX – Springfield, MO
The Center for Global Development says groups that distribute drugs to developing nations need to
pay more attention to drug-resistant viruses.
The report issued Tuesday says drug distribution programs run by the World Health Organization,
governments and non-profit groups are saving lives.
However, they are also driving up drug resistance and endangering the lives they are meant to save.
A Center spokesperson says drug resistance is a natural occurrence, but careless practices in drug
supply and use are speeding up the process.
Millions of children die in underdeveloped nations every year from drug-resistant strains of malaria,
tuberculosis, aids and other diseases.
The report finds clear links between increased drug availability and resistance.
They caution poor quality drugs, counterfeit drugs and incomplete use of drugs contribute to the
problem, which they believe will worsen as drug access programs succeed.
The Center for Global Development is an independent, non-profit group, that specializes in research
on global poverty and inequality.
http://ozarksfirst.com/fulltext?nxd_id=281885
31
Health Matters: Drug Resistance May be a Big Problem in
Developing Countries
The drugs meant to save lives may actually be destroying them.
Reporter: Triston Sanders-Medical Anchor
Email Address: triston.sanders@wctv.tv
June 17, 2010
The Center for Global Development says groups who distribute drugs to developing nations need to
pay more attention to drug-resistant viruses.
The report issued recently says drug distribution programs run by the World Health Organization,
governments and non-profit groups are saving lives.
However, they are also driving up drug resistance and endangering the lives they are meant to save.
A center spokesperson says drug resistance is a natural occurrence, but careless practices in drug
supply and use are speeding up the process.
Millions of children die in underdeveloped nations every year from drug-resistant strains of
Malaria, Tuberculosis, AIDS and other diseases.
The report finds clear links between increased drug availability and resistance.
They caution poor quality drugs, counterfeit drugs and incomplete use of drugs contribute to the
problem, which they believe will worsen as drug access programs succeed.
http://www.wctv.tv/healthmatters/headlines/96594939.html
To view the video click here.
32
TendersInfo
June 17, 2010 Thursday
United States : Report says fight against drug resistance must go global
BYLINE: datasource03
Efforts to battle major diseases in the developing world are leading to increased drug resistance,
creating a need for a coordinated global campaign to maintain the effectiveness of antimicrobial
drugs, a US nonprofit policy research group said in a report released this week.
The Center for Global Development (CGD) in Washington, DC, said millions of children in the
developing world die each year from resistant strains of common diseases such as malaria,
pneumonia, other respiratory infections, and dysentery.
In the report, The Race Against Drug Resistance, the group urges the World Health Organization
(WHO) to take the lead in reversing what it calls "a decade of neglect of drug resistance" and calls
on drug companies, governments, philanthropies, and healthcare providers to get involved.
"Drug resistance is a natural occurrence, but careless practices in drug supply and use are hastening
it unnecessarily," Rachel Nugent, chair of the CGD working group that prepared the report, said in a
news release.
In recent years governments and private funders have succeeded in improving poor countries' access
to drugs for malaria, HIV, tuberculosis, and other diseases, the CGD said. It praised these efforts,
but said they are hindered by drug resistance that could be avoided, adding that "surprisingly little
effort" has been made to prevent resistance.
The report says there is a strong association between the volume of drug use and emergence of
resistance, especially where safeguards for appropriate use are weak. For example, in countries
where antibiotic use is highest, 75% to 90% of Streptococcus pneumoniae strains are resistant.
The CGD said the report identifies the common drivers of resistance as "a mix of technology gaps,
behavior that leads to inappropriate use of medicines, weak health systems, poor drug quality, and
excessive use of antibiotics in agriculture."
Drug resistance is a problem in developed as well as developing countries, the report acknowledges.
For example, it says that methicillin-resistant Staphylococcus aureus (MRSA) increased from about
2% to more than 50% of staph infections in many US hospitals between 1974 and 2004 and that
MRSA kills more people in the United States than HIV/AIDS.
The CGD makes four broad recommendations for combating drug resistance.
Ltd.
33
16/06/2010
World loses the capacity to treat diseases like
malaria, HIV and tuberculosis 1
The warning from the Center for Global Development shows that
excessive use of drugs increases resistance to bacteria and viruses
lethal
Rachel Nugent, Chairman of the Working Group of Experts
which prepared the report, The Race Against Drug Resistance
A new report by the Center for Global Development
(CGD), disclosed yesterday (15), warns that the
world is rapidly losing its ability to treat diseases
like malaria, HIV and tuberculosis as well as more
common diseases like dysentery and respiratory
infections that can lead the deadly pneumonia.
"Drug resistance is a natural occurrence, but the
sloppy practices in the supply of drugs and are
speeding unnecessarily," said Rachel Nugent,
Chairman of the Working Group of Experts which
prepared the report, "The Race Against Drugs
Resistance."
Rich countries also suffer from problems of resistance. "Superbug" as aureas aureus, methicillin
resistant, had an increase of about 2% more than half of staph infections in many hospitals.
The report shows that there is a strong link between the volume of drug use and the emergence of
drug resistance, particularly in environments with weak guarantees for the proper use and
monitoring of effectiveness. In countries where people consume larger quantities of antibiotics, 7590 percent of the strains of streptococcus pneumonia and are already resistant to drugs.
Still, the report says action is needed from a wide range of stakeholders - the pharmaceutical
companies, governments, philanthropic organizations that buy and distribute drugs, hospitals, health
care providers, pharmacies and even patients.
The consequences may be more dramatic for children who are especially susceptible to infectious
diseases. Common childhood diseases in developing countries - malaria, pneumonia and other
respiratory infections and dysentery - it can not be cured by antibiotics or other drugs more
available in poor countries.
1
Translated from Portuguese
34
Acute respiratory infections, for example, kill more than three million children every year and
malaria kills two million. Many of these cases involve strains resistant to common drugs.
"Drug resistance is a serious problem that does not receive serious attention," said CGD president
Nancy Birdsall. "It's hard to see that people are dying of drug resistance - but they are. We know
what actions are necessary to correct the problem," she said. "We're just a lack of incentives,
institutions and global leadership for that."
Drug resistance can have a dramatic impact on the cost of curing patients. In many poor countries,
spending on medicines ranges from 20% to 60% of total health expenditure. When the first line
drugs do not, the alternatives are more expensive and require more medical supervision. Curing a
patient of extensively drug-resistant TB costs the same as curing 200 patients with ordinary TB.
"During the last decade, the global community has responded to the increase in drug-resistant
organisms with a number of diseases or specific initiatives in each country," said Nugent. "Some
were more successful than others, but none of them addressed the problem on a global scale and in
disease."
http://www.isaude.net/pt-BR/noticia/8252/saude-publica/mundo-perde-capacidade-para-tratardoencas-como-malaria-hiv-e-tuberculose
35
WHO should lead drug-resistance fight, experts say
Progress in treating malaria, TB, could be undone by soaring levels of drug resistance
Friday 18 June 2010
Current efforts to control drug resistance are ―laudable but completely insufficient‖, according to a
report published this week by the Center for Global Development (CGD), an independent, nonprofit policy research organization based in Washington DC, USA.
The authors call on the World Health Organization (WHO) to take a leading role in implementing a
coordinated international response to stem the rising tide of drug resistance.
Antimicrobial resistance is not the global priority that it should be, says Ian Gould, from the
Department of Medical Microbiology at the Aberdeen Royal Infirmary, UK. ―Antibiotic resistance
is the single most important threat to modern medicine that we know.‖
The authors of the report say that without action, there is a risk that the costly public health
advances that have given millions in the developing world access to drugs against malaria, HIV and
tuberculosis (TB) could be undone.
Pathogens can naturally evolve to resist antimicrobial drugs, but human actions have hastened this
process. The regulation of drugs is weak, according to the report, and this means that poor-quality
drugs can go unnoticed. Together with often unregulated prescribing and dispensing practices, such
as selling drugs to people who do not have a prescription, this can encourage resistance to develop.
The report recommends that drug regulatory authorities should be bolstered to combat these
problems.
Global monitoring of resistance is inadequate, says the CGD, leaving gaps in scientists‘ knowledge
about where resistance lurks and how it spreads. There are also few incentives for pharmaceutical
companies to develop new drugs to replace those that have become less effective. In response to
these problems the CGD says that surveillance systems to monitor drug resistance should be
improved, and the information collected about resistance shared across networks of laboratories
worldwide.
Research and development of new resistance-fighting technologies should also be encouraged, they
say.
36
Until now, initiatives against drug resistance have centred on specific diseases or countries, but
these strategies have had mixed successes, explains the CGD in the report. But the growing threat
posed by drug resistance demands a global response, they say.
―Global health institutions must make drug resistance a priority—across all treatable diseases—by
providing financial and technical support to developing nations to meet and maintain standards,‖
write the authors. ―WHO must clearly articulate countries‘ responsibilities regarding resistance
under the global health legal framework.‖
Gould believes that the WHO is well placed to take the lead in the battle against drug-resistant bugs.
But he notes that some previous efforts by the Organization have stalled. Antimicrobial resistance is
set to be the WHO‘s third Global Patient Safety Challenge, an international campaign promoting
recommendations to ensure that patients are receiving the safest possible care.
The campaign tackling antimicrobial resistance will follow two earlier successful initiatives, says
the WHO. The first, in 2008, promoted the importance of hand washing by healthcare workers, and
the second, in 2009, launched a universal checklist to enhance safety in surgery.
According to the WHO website, the third campaign‘s workplan was to be published in the first half
of 2010, but the expert group behind the project last met in March 2009. Funding for this project
has been pulled by the UK government, according to Gould. ―Lack of funding has been a key
issue,‖ he adds.
Gould says that the CGD report presents a novel approach to improve problems in the antimicrobial
drug-supply chain, which is another area targeted in the report. Delays in the manufacturing of some
antibiotics, including long-acting penicillin, can lead to drug shortages, he explains. Patients not
receiving a full course of antibiotics is one factor that can encourage the infecting bug to develop
resistance to the drug.
Increasing the pool of available drugs can overcome these problems, as well as provide a wider
choice of treatment options for infections that are resistant to some drugs.
Medics could turn to older drugs that have been taken off shelves over the years to be replaced by
newer alternatives, suggests Gould. In many cases, these older drugs are still licensed for use, and
demand for them is increasing, he says, but medics have no access to them in some countries.
http://www.eht-forum.org/news.html?fileId=news100618065626&from=home&id=0
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Drug resistance complicates supply efforts to poor
June 22, 2010 — 5:58am ET | By George Miller
It turns out that overcoming manufacturing and supply chain cost constraints to provide low-cost
drugs is not the way to improve the health of citizens in developing nations. In fact, the medicines
being provided may be doing more harm than good.
A push to fight drug resistance is under way by the Center for Global Development's Drug
Resistance Working Group. Researchers find the problem in abundance in developing nations, with
millions of child deaths each year from diseases that have outsmarted the drugs intended to thwart
them. And when first-line drugs fail, the alternatives are expensive: Curing one drug-resistant TB
patient costs the same as curing 200 patients that have ordinary TB, according to the researchers.
The working group's 116-page report identifies common drivers of resistance--"a mix of technology
gaps, behavior that leads to inappropriate use of medicines, weak health systems, poor drug quality,
and excessive use of antibiotics in agriculture."
The role of pharma manufacturers in stemming the growth of disease-resistant strains is to do what
conscientious drugmakers already do: Ensure that their products are safe and effective, even after
they are sold. Governments must properly regulate drug licensing, manufacturing, distribution and
use, the report says.
The drug industry also should set voluntary standards to maintain product quality from
manufacturing through final delivery to the patient, according to the working group. And medicineprovider partnerships should work to promote best practices in drug prescribing and dispensing.
http://www.fiercepharmamanufacturing.com/story/drug-resistance-complicates-supply-effortspoor/2010-06-22
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Le Monde
17 juin 2010 jeudi
Bactéries résistantes
RUBRIQUE: PLANETE; Pg. 4
En fournissant sans contrôle aux pays pauvres des traitements contre les maladies infectieuses
(paludisme, sida, tuberculose), les pays développés accélèrent la résistance bactérienne aux
antibiotiques, notamment chez les enfants, met en garde l'ONG Center for Global Development.
LANGUE: FRENCH; FRANÇAIS
Google Translation:
Bacteria resistant
ITEM: PLANET, Pg 4
By providing poor countries with no control treatments against infectious diseases (malaria, AIDS,
tuberculosis), developed countries expedite bacterial resistance to antibiotics, especially in children,
warns the NGO Center for Global Development.
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The Race Against Drug Resistance: Can It Be Won?
Submitted by eicarlso on Wed, 06/16/2010 - 09:29
―In an increasingly interconnected world, drug resistance does not stop at a patient‘s
bedside—it threatens global health. It has slowed gains against the fatal ravages of
childhood dysentery and pneumonia, drastically increased the costs of fighting
tuberculosis and malaria, and imperiled efforts to effectively treat people living with
HIV/AIDS. Tens of millions of lives are at stake; quality of life for scores of millions
more is under threat.‖ So concludes the Center for Global Development‘s Drug
Resistance Working Group in their new report released on June 14. The report, entitled
The Race against Drug Resistance, calls for urgent action to combat this threat, in the
form of ―achievable steps […] which the health community, governments, donors, and
the pharmaceutical industry can and must take to slow the spread of drug resistance.‖ The
report outlines four key recommendations for these stakeholders:
1. Collect and share drug resistance information across disease networks
2. Secure the drug supply chain to ensure quality products and practices
3. Strengthen national drug regulatory authorities in developing countries
4. Catalyze research and innovation to speed the development of resistance-fighting
technologies
If these steps are not taken, the working group warns that drug resistance ―will quickly
become a widespread threat—claiming lives, raising the cost of curing patients, and
making future generations increasingly vulnerable to deadly diseases […] that were
easily cured in the past.‖
http://www.hsdl.org/hslog/?q=node/5589
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TDR news item
The Race Against Drug Resistance
A new report from the Center for Global Development says there is a need for urgent
action to tackle the growing crisis of drug resistance.
The ability to cure a wide range of serious and common diseases is under threat from
drug resistance. Resistance is inevitable, but careless practices in drug supply and use are
hastening it unnecessarily. Without an immediate global effort to safeguard lasting
treatment effectiveness, drug resistance will quickly become a widespread threat,
claiming lives, raising the cost of curing patients, and making future generations
increasingly vulnerable to deadly diseases that were easily cured in the past.
Already, drug resistance has slowed gains against the fatal ravages of childhood
dysentery and pneumonia, drastically increased the costs of fighting tuberculosis and
malaria, and imperiled efforts to effectively treat people living with HIV/AIDS. Millions
of children die annually from drug resistant disease strains and since 2006 donors have
spent more than $1.5 billion on advanced drugs to treat resistant diseases. Unless action is
taken, the stage is set for both the death toll and the dollar cost to rise.
A new report and accompanying film from the Center for Global Development‘s Drug
Resistance Working Group says that drug resistance testing and surveillance capabilities
are inadequate; weak points in the supply chain and inappropriate dispensing facilities
help drug resistance; drug regulation is weak and uncertain.
The Race Against Drug Resistance says there is no simple solution to solve the crisis but
there are achievable steps to slow its spread. It says the World Health Organization
should play a leading role.
The report urges pharmaceutical companies, governments, donors, global health
institutions, health providers, and patients to collectively and immediately tackle this
global health threat by implementing four key recommendations:
Collect and share drug resistance information across disease networks.
Secure the drug supply chain to ensure quality products and practices.
Strengthen national drug regulatory authorities in developing countries.
Catalyze research and innovation to speed the development of resistance-fighting
technologies.
The report was produced by a working group set up in 2007 and comprising
representatives of governments, foundations, charities, health institutions, the
41
pharmaceutical industry and academia to develop concrete, achievable steps that could
make a difference.
Dr Paul Nunn, coordinator TB Operations and Coordination at WHO's Stop TB
department was a member of the working group, as was TDR scientist Dr Andrew
Ramsay, who provided guidance on laboratories and diagnostics and their roles in
detecting and preventing resistance. TDR convened a seminar about the draft report at
WHO in January.
The working group was chaired by Dr Rachel Nugent, deputy director of global health at
the Center for Global Development, which is an independent, nonprofit policy research
organization dedicated to reducing global poverty and inequality and to making
globalization work for the poor.
http://www.youtube.com/watch?v=3KggflMCx24&feature=player_embedded
http://www.cgdev.org/content/publications/detail/1424207
TDR contact:
Dr Andrew Ramsay
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The Race Against Drug Resistance must go Global
June 18th, 2010 | Posted by Meghan Murphy
In recent years governments and private funders have improved developing countries‘
access to drugs for malaria, HIV, TB, and other diseases, but surprisingly little effort has
been made to guard against the development of resistance to these drugs that could easily
be avoided. Resistance develops where safeguards for appropriate use are weak. For
example, in many rural areas of Africa clinics that are understaffed and undersupplied are
dealing with a high volume of sick patients and, under pressure to diagnose and treat
these people quickly, will misdiagnose and prescribe medicine for malaria when patients
have a fever caused by other ailments. This trend slows or even reverses gains made on
the global health front, drastically increasing the costs of fighting malaria and other
diseases.
According to the Center for Global Development in Washington, DC, millions of
children in the developing world die each year from resistant strains of common diseases
such as malaria, pneumonia, other respiratory infections, and dysentery. The CGD in
their report The Race Against Drug Resistance urges the WHO to take the lead in
reversing what it calls ―a decade of neglect of drug resistance‖ and calls on drug
companies, governments, philanthropies and healthcare providers to get involved.
―Drug resistance is a natural occurrence, but careless practices in drug supply and use are
hastening it unnecessarily,‖ says Rachel Nugent, chair of the CGD working group that
prepared the report.
The CGD makes four broad recommendations for combatting drug resistance, which
include improved monitoring of the issue, stronger regulation of drug standards,
increased research and development of resistance-fighting technologies, and promotion of
best practices for drug prescribing and dispensing and sharing of evaluations throughout a
global network of medical providers. Access the CGD‘s full report here, under ―Related
Content‖.
http://www.malariapolicycenter.org/blog/?tag=race-against-drug-resistance
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Fighting Drug Resistance
Britt E. Erickson
June 21, 2010
Volume 88, Number 25
p. 21
Drug-resistant diseases are on the rise globally, and action is needed now to ensure that
lifesaving drugs continue to work, a report by the Center for Global Development (CGD)
concludes. To combat the problem, the report recommends that the World Health
Organization take the lead and establish a network of laboratories dedicated to tracking
the emergence and spread of drug-resistant microorganisms. The report also calls on
pharmaceutical companies to provide a secure supply chain and ensure that high-quality
medicines reach patients, particularly those in developing countries where counterfeit and
substandard drugs are prevalent. Worldwide drug safety laws and enforcement of those
laws should also be strengthened. Lastly, the report calls for research-funding agencies to
create a Web-based network for researchers to share data that can accelerate the
discovery of new drugs and diagnostics. ―We know what actions are needed to fix the
problem,‖ Nancy Birdsall, president of CGD, said in a statement. ―We just lack the
incentives, institutions, and global leadership to get on with it.‖
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NTDs and Drug Resistance
by: Alanna Shaikh
June 16, 2010
The Center for Global Development (CGD) released a new report on drug resistance this
week, and it‘s sobering. Counterfeiting, poor production, and misuse have eroded the
power of many of our lifesaving drugs. In response to the problem, they call for
cooperative action from governments, drug companies, donors, and health care providers.
While the report doesn‘t specifically refer to neglected tropical diseases, the drugs we use
to treat them are highly at risk for resistance. Many of the NTD drugs are old, which
means there has been plenty of time to develop resistance. They are also provided
through mass administration, another vehicle for resistance, and there is very little
research going on right now on new drug alternatives.
In other words, NTDs are primed for a serious resistance problem in the near future.
Scaling up treatment is going to save lives but it‘s also going to increase resistance and
we don‘t have any other drugs lined up to take the place of current treatments.
So, how can we apply the CGD recommendations to neglected tropical diseases?
1) Collect and share drug resistance information across disease networks.
The world of neglected tropical diseases is pretty well connected. The major
organizations working on NTDs already share information and coordinate efforts.
Expending that coordination to include information on resistance will not be all that
difficult. I do wonder what form would be most useful for that information sharing – I
would love to see an online database with shared inputs and the data free for everyone to
access.
2) Secure the drug supply chain to ensure quality products and practices.
This is one of those recommendations that is a whole lot more complex than it sounds.
Securing a drug supply chain while maintaining access to those drugs is not an easy task.
Especially when you want to keep prices down while keeping drugs moving to both the
government and the private sector. You need multiple suppliers to maintain lowest prices,
which means more companies to regulate. You also need to make sure drugs aren‘t
45
diverted for the wrong purpose at the pharmacy level. That‘s challenging in the public
sector, and in the private sector – in totally different ways.
There are a lot of initiatives to secure drug supply chains for everything from antimalarial to ARVs. So far we‘re still struggling, especially in Africa where NTDs are most
prevalent. So this recommendation isn‘t going to come into practice any time soon.
3) Strengthen national drug regulatory authorities in developing countries.
I like this recommendation. It‘s going to have an impact on pharmaceutical supply well
beyond just reducing resistance; it also strengthens the health system as a whole. The
trick is how you do it – you can train regulators, and that‘s important, but what you really
need in this situation is regulators with the authority to take action and impose penalties.
That authority comes from a government with the will and the capacity to support it, and
not every government has a sufficiently powerful Ministry of Health to make that happen.
4) Catalyze research and innovation to speed the development of resistance-fighting
technologies.
In the case of NTDs, I think the focus should be on new drugs. They‘re the tech we need
most right now. Other resistance-fighting technologies, like cheaper faster bacterial
cultures can wait. The NTD drugs are old. We need new ones before we exhaust the
effectiveness of what we have.
Alanna Shaikh is an expert in health consulting, writing about global health for UN
Dispatch and about international relief and development at Blood & Milk. She
also serves as a frequently contributing blogger to ‘End the Neglect.”
http://endtheneglect.org/2010/06/1627/
46
“The Pink Sheet”
Prescription Pharmaceuticals & Biotechnology
Industry Should Monitor Quality Outside Factory To
Fight Drug Resistance
June 28, 2010 Volume 72 Number 26 Page 23
Pharmaceutical manufacturers have to better ensure the quality and security of their
supply chains, as well as develop new drugs, to win the fight against antibiotic resistance,
according to the Center for Global Development.
New standards for post-market testing and quality after products exit the factory would
reduce the prevalence of counterfeit and poor-quality drugs, which can hasten resistance
problems, the group said in its report ―The Race Against Drug Resistance,‖ released June
15.
The Center for Global Development is an independent non-profit policy research
organization working against global poverty and inequality.
There is little incentive for manufacturers to reveal information about factors, like where
their drugs are sold, that could lead to resistance, the group said in the report. There also
is no incentive to reveal information about drug resistance because it would put that
manufacturer at a disadvantage.
Voluntary Testing Standards Sought
New standards for manufacturers would change that. Periodic quality and integrity
sampling at distribution and point-of-sale and supply chain security monitoring as well as
eliminating marketing incentives for prescribers and dispensers to choose certain brands,
creating labels that are easily understood and in local languages, and supporting
independent associations dedicated to improving prescribing and dispensing practices
were among the new standards recommended for industry.
Reviews and sampling reports would be made available to regulators, providers and the
public to better monitor the industry.
The International Organization of Standardization would develop the voluntary standards
that manufacturers would follow. The group argued those companies that receive ISO
certification would hold an advantage over competition and ultimately force more
industry to better preserve drug quality.
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―ISO certification should become a procurement requirement of all donor organizations
and national
governments making drug purchases with donor funds,‖ the group stated in the report.
Regulation needs strengthening in developing countries, the report stated, but policing
drug quality is a much bigger problem now because many of the widely used antibiotics
are off-patent.
Cases of antibiotics being produced without the proper amount of active ingredient and
counterfeited are becoming more common. Gail Cassell, Eli Lilly and Co. vice president,
scientific affairs, said the counterfeit drug industry is worth more than $200 billion
worldwide.
―We could have almost a new TB drug a month if you will, and if you don‘t correct this
drug supply chain issue, you‘re going to have resistance and all of our efforts will be for
naught,‖ Cassell said during a panel discussion about the report.
Web Can Improve R&D
The report also calls for the creation of a web-based marketplace to help researchers
improve collaboration and speed development and potentially connect them with
investors.
The website would include a place to market new resistance-related discoveries and a
brokerage to facilitate the marketplace and offer advice as partnerships form.
Rachel Nugent, chair of the Center for Global Development‘s Drug Resistance Working
Group, which produced the report, said the scientists tend to be isolated in terms of their
work.
―Scientists working on very good ideas, but not going to the same conferences, not
participating in the same networks, not publishing in the same journals, prevents them
from sharing the ideas that they have and synergizing these ideas for faster discovery,‖
Nugent said.
In the United States, the antibiotic development pipeline is drying up and needs
incentives to boost research (―The Pink Sheet‖ DAILY, June 9, 2010). FDA officials also
are working to issue new draft guidance to better define the approval path for new
antibiotics.
In addition to new treatments, the group also wants the web marketplace to facilitate
development of point-ofcare diagnostics, rapid drug susceptibility tests and technologies
that can enhance drug potency or prolong efficacy.
– Derrick Gingery (d.gingery@elsevier.com)
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