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Blair Horner: Another Looming Public Health Catastrophe, “Superbugs”

State lawmakers return from their Presidents’ Week “mini-break” and begin to seriously debate the next state budget.  New York’s fiscal year starts on April first, thus giving Albany 5 weeks to negotiate the proposed $178 billion state budget.

Contained in that budget are many important policies – from Medicaid spending to higher education to the environment to education financing.  Most of the budget’s “top line” items are publicly debated; sometime equally important items are not.  One under-debated issue is the rising threat from infections that are increasingly resistant to antibiotics, also known as “superbugs.”

According to the U.S. Centers for Disease Control and Prevention (CDC), antibiotic-resistant bacteria are most prevalent in environments associated with high antibiotic use: healthcare settings, the general community, and in livestock production.  Antibiotic resistance can spread from person to person, from animal to person, via the natural environment or contaminated food and from bacteria to bacteria.  Some bacteria have developed resistance to multiple antibiotics, making them especially difficult to treat, and thus very dangerous and sometimes deadly.  Common infectious diseases such as tuberculosis, pneumonia, blood poisoning, food poisoning, and gonorrhea have already become harder and sometimes impossible to treat due to multidrug-resistant bacteria.

The problem of antibiotics-resistance is not just one found in the United States, it is a worldwide problem.  And worldwide problems demand global responses.

Antibiotic resistance happens when bacteria develop the ability to defeat the drugs designed to kill them.  Each year in the United States, more than 2.8 million infections from bacteria that are resistant to antibiotics occur and more than 35,000 people die as a direct result.  Many more die from complications from antibiotic-resistant infections.

A study commissioned by the U.K. government predicts that if action is not taken now to combat antibiotic resistance, by 2050 the annual death toll will have risen to 10 million globally.

The situation is getting worse with the emergence of new bacterial strains resistant to several antibiotics at the same time (known as multidrug-resistant bacteria). Such bacteria may eventually become resistant to all existing antibiotics. Without antibiotics, the world could return to the “pre-antibiotic era”, when organ transplants, cancer chemotherapy, intensive care and other medical procedures would no longer be possible.  Bacterial diseases would spread and could no longer be treated, causing death.

There is hope.  Data from European agencies show that interventions can work.  Medical data shows that Scandinavian countries and the Netherlands have low rates of superbugs, but that there are higher rates in Southern Europe.  Countries with lower resistance rates have generally lower use of antibiotics, while countries with higher antibiotic resistance rates use more antibiotics.

Buried in the governor’s proposed health budget is an item to begin to address the rise of antibiotics resistant superbugs.  In his budget, the governor proposed that every general hospital and nursing home must establish an antibiotic stewardship program that meets or exceeds federal conditions of participation for antimicrobial stewardship programs in health care facilities. Additionally, such program shall incorporate an ongoing process to measure the impact of the program.  While vague, the governor’s program leaves the details up to the state’s Health Commissioner.

Yet, the governor’s plan leaves out an important area of antibiotics overuse and misuse: use on farms.  Nearly two-thirds of antibiotics that are important for human medicine are currently sold for use in livestock, not people. These drugs are routinely given as poor compensation for inappropriate diets and the stressful, crowded and unsanitary conditions on industrial feedlots. This practice hastens the spread of antibiotic resistance in bacteria and increases the risk of drug-resistant infections in people.

When antibiotics are given to food-producing animals, they kill most of the bacteria in them. The resistant bacteria, however, survive and can contaminate animal products during slaughtering and processing. They can also contaminate fruits and vegetables via contaminated soil or water, especially when animal manure is used as fertilizer. Antibiotic-resistant bacteria can contaminate food prepared on germ-filled surfaces and the environment via animal feces. According to the CDC, approximately 1 in 5 antibiotic-resistant infections are caused by germs from food and animals.

Thus, the governor’s plan ignores 20 percent of the problem – and in dealing with the growing menace of superbugs, comprehensive approaches are the only ones that will work.

It is clear from the Scandinavian experiences that policies can significantly reduce the rise of “superbugs”: policies that focus on cleanliness in health care settings, a reliance on antibiotic use in humans only when medically necessary, and a drastic reduction in use on farm animals.  The most obvious way to reduce use among farm animals is for veterinarians to stop the use of antibiotics on healthy livestock.

This is a worldwide problem, unless the rise of “superbugs” can be stopped, the next generation will be faced with a world without effective antibiotics, one in which illnesses like urinary tract infections will be untreatable, leaving people to suffer and perhaps die, from infections easily treatable today.

Blair Horner is executive director of the New York Public Interest Research Group.

The views expressed by commentators are solely those of the authors.They do not necessarily reflect the views of this station or its management.

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