Microbiologists estimate that approximately 700,000 people per year die from drug-resistant infections, or “superbugs.” That number could rise to 10 million deaths annually—more people than currently die each year from cancer—by 2050 if nothing is done. Just last month, the transnational spread of a superbug strain of malaria through Southeast Asia was reported in the Lancet Infectious Diseases journal. Ominously, the Lancet reports that the main malaria parasite along the border of Cambodia and Thailand has become resistant to almost all cures. Financial incentives and leadership from rich country governments and philanthropic organizations are urgently needed to catalyze collective action, including improving international monitoring to catch clusters of resistant strains early, limiting the use of antibiotics as growth supplements in livestock, decreasing provider overprescribing of drugs, improving patient adherence to treatment regimens, and increasing the development of new drugs. However, as long as global leaders continue to do nothing, the world remains dangerously unprepared for the rise of superbugs.
Low-income countries experience the most serious threat from superbugs, which are usually drug-resistant strains of malaria, bacterial infections, and tuberculosis. These countries are already constrained by generally weak health infrastructure, a critical shortage in health workforce numbers, and inadequate health funding. They offer a fertile environment for drug resistance to emerge and strengthen. This has international consequences, since microbes don’t recognize borders. One of the most chilling dangers of the unchecked proliferation of drug resistance is the loss of antibiotics to treat bacterial infections in anyone, in any country. For example, routine surgery becomes incredibly dangerous without antibiotics, and common infections like gonorrhea (which the World Health Organization warns may soon be untreatable) spiral into serious and permanent health problems.
Rich countries not only equally experience the effects of drug resistance, but are just as culpable for the rise of superbugs. The governments and philanthropies with the resources and leadership capacity to address harmful practices at home and abroad must invest in action. For instance, one of the driving factors of antibiotic resistance is the overprescribing of antibiotics. In the United States, 50 percent of antibiotic use in humans is estimated to be unnecessary. Research in developing countries has found that up to a third of drug prescriptions are inappropriate or unnecessary, and drugs to treat infectious disease are among the most frequently prescribed medicines. Cracking down on over-prescription of drugs is therefore one critical way to fight back against the emergence of superbug strains.
One of the best ways to limit overprescribing drugs is to expand educational programs for prescribers. Standard treatment guidelines help address the problem of inappropriate prescription, dispensing, and selling of drugs. Studies in both the United States and developing countries have shown that educational programs for prescribers have reduced unjustified prescribing for infectious disease by 5 to 20 percent.
Another solution ripe for global action is research and development of new drugs. Researchers have not identified a new class of antibiotic medicine since 1987. The primary reason is that infectious diseases with resistant strains have a poor return on investment for pharmaceutical companies. Malaria and tuberculosis predominantly affect developing countries and do not offer a strong financial incentive for drug development because patients are usually too poor to pay for them. Additionally, compared to drugs with long-term treatment times for chronic illnesses, antibiotics are only taken for a short period of time until they cure their target disease.
Rich country governments and philanthropies can do much more to address this market failure through push and pull incentive programs. “Push” incentives provide direct financing for the development of new drugs, while “pull” incentives create a financial prize for successful new drug development, unlinking profits from sales. Funders can use these mechanisms to lower the cost of and de-risk drug development and reward successful development of desired drug families.
As the startlingly rapid spread of an almost totally drug-resistant strain of malaria in Southeast Asia illustrates, the threat of superbugs is already here and will continue to worsen in the face of inaction. We have no fast fixes for drug resistance. Solutions like developing new drugs, constructing global surveillance systems, and educating providers will take years. It’s imperative we invest in them now.
About the author: Emily Foecke Munden is the International Development Fellow at Young Professionals in Foreign Policy (YPFP). She is also a Research Assistant with the Center for Global Development in Washington, DC. Emily earned her Master of International Affairs in 2016 from the University of California-San Diego, where she concentrated on international development policy.