The eco­nomic con­se­quences of drug re­sis­tance

Financial Mirror (Cyprus) - - FRONT PAGE -

When Bri­tish Prime Min­is­ter David Cameron asked me in July to lead an ef­fort to find so­lu­tions to the grow­ing global prob­lem of an­timi­cro­bial re­sis­tance, my first ques­tion was: “What is that?” I soon learned that, as bac­te­ria and par­a­sites de­velop re­sis­tance to ex­ist­ing drugs, like an­tibi­otics and an­ti­malar­ial med­i­ca­tions, the world is at risk of los­ing its bat­tle against in­fec­tious dis­eases. So my next ques­tion was: “Why me? Don’t you need a sci­en­tist?”

It turns out that the prob­lem of ris­ing an­timi­cro­bial re­sis­tance is as much about eco­nomics as it is about sci­ence or medicine. Left unchecked, it will kill mil­lions of peo­ple ev­ery year, and have se­ri­ous ad­verse eco­nomic con­se­quences for the world. For de­vel­op­ing economies, in­clud­ing most of the BRIC (Brazil, Rus­sia, In­dia, and China) and MINT (Mex­ico, In­done­sia, Nige­ria, and Turkey) coun­tries, the risk is par­tic­u­larly large.

Re­cent re­search, by an in­de­pen­dent re­view on an­timi­cro­bial re­sis­tance, which I chair, has mod­eled the phe­nom­e­non’s likely im­pact on the world econ­omy. It sug­gests that if we fail to ad­dress an­timi­cro­bial re­sis­tance, the prob­lem will grow worse.

By 2020, if we al­low re­sis­tance to rise by 40%, global GDP will be 0.5% smaller than it oth­er­wise would have been. By 2030, it will be 1.4% smaller. By 2050, the eco­nomic short­fall will reach 3%. The ac­cu­mu­lated loss of global out­put over the next 35 years will to­tal $100 tril­lion – more than one and a half times an­nual world GDP to­day.

Al­ready, 60,000 peo­ple die ev­ery year from causes re­lated to an­timi­cro­bial re­sis­tance in the United States and Europe – some ten times the world­wide death toll from the on­go­ing Ebola cri­sis. By 2050, if the prob­lem is al­lowed to con­tinue to grow, an­timi­cro­bial re­sis­tance will kill more than ten mil­lion peo­ple per year. That is more than the num­ber of peo­ple who cur­rently die of can­cer, di­a­betes, lung can­cer, road traf­fic ac­ci­dents, di­ar­rhoeal dis­ease, and HIV/AIDS com­bined. The eco­nomic costs from the re­sult­ing panic, in­clud­ing a col­lapse of travel and trade, could be dev­as­tat­ing.

Ris­ing rates of an­timi­cro­bial re­sis­tance will have a par­tic­u­larly se­vere im­pact on In­dia, In­done­sia, and Nige­ria (as well as the rest of Sub-Sa­ha­ran Africa). Coun­tries like China and Brazil, which have been suc­cess­ful in re­duc­ing malaria rates, could see their hard work un­der­mined by an in­crease in re­sis­tance to an­ti­malar­ial drugs.

The re­search we com­mis­sioned was based on the limited data avail­able. It does not take into ac­count the dam­age from drug-resistant ill­nesses out­side of hos­pi­tals or the im­pact of es­ca­lat­ing health­care costs. Nor does it in­clude the drop in liv­ing stan­dards from the loss of life-en­hanc­ing treat­ments – for ex­am­ple, knee or hip re­place­ments, can­cer treat­ment, and cae­sarean sec­tions – that rely on an­tibi­otics to pre­vent in­fec­tions. The broad-brush re­search we con­ducted shows that such treat­ments – many of which would not be pos­si­ble with­out ef­fec­tive an­tibi­otics – add around 4% of ben­e­fit in terms of GDP.

One of my goals is to per­suade pol­i­cy­mak­ers at the United Na­tions to agree to a set of rules and poli­cies to stop the growth of an­timi­cro­bial re­sis­tance. In ad­di­tion to high­light­ing the scale of the prob­lem, the re­view is seek­ing to find ways to re­duce drug re­sis­tance and to stim­u­late the pro­duc­tion of new an­tibi­otics to com­pen­sate for the loss of those that are now or will be­come in­ef­fec­tive.

Some so­lu­tions to re­duce re­sis­tance will re­quire cut­tingedge tech­nol­ogy. We must en­cour­age pol­i­cy­mak­ers to support the de­vel­op­ment of the best di­ag­nos­tics. Quicker, more ac­cu­rate di­ag­noses will curb the cur­rent over­re­liance on an­tibi­otics – a key re­quire­ment for com­bat­ing re­sis­tance. We also must de­velop tools to iden­tify and halt out­breaks of resistant dis­eases at an early stage. Data pro­vided by di­ag­nos­tic de­vices could be a po­tent weapon in con­tain­ing th­ese out­breaks.

Other so­lu­tions are low tech, re­quir­ing lit­tle more than common sense. We need to start wash­ing our hands thor­oughly and of­ten. We need to stop de­mand­ing an­tibi­otics from our doc­tors. And, when an­tibi­otics are called for, we need to fin­ish the pre­scribed course. As we try to pre­vent re­sis­tance to ex­ist­ing drugs, we will also need to ex­am­ine the im­pact of an­tibi­otics in agri­cul­ture.

De­vel­op­ing new an­tibi­otics is a chal­lenge, be­cause phar­ma­ceu­ti­cal com­pa­nies seem to need in­cen­tives to con­duct the re­quired re­search. The re­view will study whether mar­ket in­cen­tives can be changed. If they can­not, more dra­matic al­ter­na­tives to boost early in­no­va­tion by univer­sity labs and small com­pa­nies could be sought, per­haps through a tar­geted fund.

As the re­view re­search shows, the stakes of in­ac­tion on an­timi­cro­bial re­sis­tance are high. Now is the time to search for bold, clear, and prac­ti­cal long-term so­lu­tions.

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