Without drastic changes to the way antibiotics are used and prescribed, the world is in danger of entering a “post-antibiotic era” where small infections now easily cured can become once again become deadly, the top Centers for Disease Control and Prevention official said in Atlanta.
“I’m an infectious disease physician by training. I have cared for patients who have organisms that are resistant to all antibiotics. Unfortunately that situation is becoming more and more common,” said Tom Frieden, the CDC president.
The growth of drug-resistant organisms was one of three major global health threats cited by Dr. Frieden at the World Affairs Council of Atlanta’s annual global health forum, which this year focused on Latin America and the Caribbean.
Dr. Frieden authored a Wall Street Journal commentary on the topic on June 2, the same day he went to the White House to discuss what he called one of the world’s most dire public health issues.
In opening remarks at the conference, he also warned against emerging infectious diseases like Ebola and dengue, noting that at least one organism completely new to science is discovered every year. “Intentionally created organisms,” either by lab mishaps or by malicious intent, also present grave dangers.
Isolated, they wouldn’t be so bad, but the world is interconnected in such a way that a disease like Ebola in West Africa is “a plane ride away,” he said.
“We are only as strong as the weakest link in the chain, and West Africa was a very weak link with regard to global health,” he said of last year’s Ebola outbreak, which has since subsided.
That’s an example of the paradox the world faces today.
“The paradox is that we’re better prepared than ever … and at the same time we are more vulnerable than ever before,” he said.
With that in view, the best way to prepare is to build capacity in the countries that need it most — both in human capital and physical resources — to detect diseases early and treat them effectively. Governments, he said, must invest in this public health infrastructure even when outbreaks fade from the headlines.
“Until something bad happens it may not be apparent how important those systems are,” Dr. Frieden said.
He gave the example of Nigeria, which was able to quickly detect and contain Ebola partly thanks to protocols introduced by the CDC for the elimination of polio. But on top of that, the global health system needs to have the capability to “surge” when the national health system is overwhelmed, as was the case in West Africa.
“Ebola was a reminder that the next thing we face is probably not going to be the thing we’re preparing, and that’s why it’s so important that we prepare the system,” he said.
He cited progress in China, where the response to the H7N9 bird flu in recent years was drastically different than during the 2001 SARS outbreak, when the country’s public health system was slower to react and less transparent with the international community. Posting the sequence publicly allowed CDC staffers to get to work on a vaccine immediately.
“That is not something that is available everywhere in the world. We don’t yet have the core things that we need, which are fundamentally the early warning systems, the detection systems — that means laboratories, epidemiologists, surveillance systems, information systems,” he said. “We don’t have the response capacity — emergency operations centers, trained epidemiologists. And we don’t have the capacity to prevent wherever possible through vaccinations, safe food, safe water.”
He also added that targeting specific diseases as a preventative measure is key. Haiti, often seen as a public-health nightmare has actually seen public health gains through immunization programs, medicines for tuberculosis, filariasis and HIV, plus a concerted effort that could eradicate malaria from the island of Hispaniola and the Caribbean by 2020, contrary to what Dr. Frieden expected when the initiative was announced.
“I didn’t believe that a year ago, but my staff has convinced me, based on rigorous data, that it is possible to make tremendous progress and indeed eliminate malaria from the Caribbean,” he said.
It’s not just infectious diseases that the world needs to attack. Particularly in Latin America and the Caribbean, the greatest impact on health could be tackling noncommunicable diseases like strokes, cancers and hypertension, the “silent killer” that takes down people than tobacco, he said.
Dr. Frieden also discussed the Global Health Security Agenda, an effort by governments around the world to collaborate on these global public health issues.
The day after he warned of the dangers of antibiotics, chicken farmer Foster Farms said it would eliminate the use of antibiotics used to treat humans in its chicken production and ramp up production of completely antibiotic-free chicken. That move follows other companies like McDonald’s curb antibiotics in chicken, responding to demands from consumers and warnings by public health leaders like Dr. Frieden.