Super Bugs Attacking!

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When Superbugs Attack

Antibiotic-resistant NDM-1 Is Undermining India's Medical Sector

Sonia Shah, Foreign Affairs, 28 March 2012

Taming the new drug-resistant pathogens requires ever more toxic, expensive, and time-consuming therapies, such as a class of last-resort antibiotics called carbapenems, which must be administered intravenously in hospitals. In the United States alone, fighting drug-resistant infections costs up to 8 million additional patient hospital days and up to $34 billion every year.

Now, the emergence in India of a particularly nasty form of antibiotic-resistant bacteria, which renders even the last-resort drugs obsolete, could bring about an era of unstoppable infections... But with the Indian political establishment prioritizing building up its lucrative private health sector over making costly public health reforms, and policies aimed at recalibrating drug research and development in the West stymied, the political will to accomplish the job is scarce.

There is almost no regulation of the use of antibiotics in India.  While this sounds like a Libertarians dream, it goes a long way towards illustrating the "plight of the commons"  problem.  In this case the "commons" that is a public property is the overall effectiveness of antibiotics.  Poor people scrape together a little money to buy some antibiotics when they are feeling sick.  When the symptoms abate, they stop taking the antibiotics: stopping before the infection is completely cleared.  The wealthy, much like their American counterparts take them for everything, even when not entirely appropriate.

So, it is no wonder that, even before the new super-resistant strain was first documented, over 50 percent of the bacterial infections that occurred in Indian hospitals were resistant to commonly used antibiotics.

Then, in 2010, a study of a New Delhi-area hospital found that 24 percent of bacterial infections there could resist the last-resort carbapenem antibiotics. Thirteen percent not only resisted carbapenem drugs, but overcame 14 other antibiotics, making treatment options exceedingly limited. The gene that conferred this extreme drug-resistance was dubbed "New Delhi metallo-beta-lactamase 1" or NDM-1. Scientists found that, unlike other drug-resistant bacteria, NDM-1 bacteria are able to quickly and prolifically spread their genes to other bacteria, easily jumping the barriers of species and genus. The pandemic potential of such a microbe is enormous. Indeed, according to Tim Walsh, a University of Cardiff medical microbiologist who has been chasing the dangerous gene, NDM-1 infections already turned up in more than 35 countries last year -- often in the bodies of medical tourists, who had traveled to India or Pakistan for cheap surgeries and other procedures. And NDM-1 bacteria have also been found in drinking water and in puddles around New Delhi....

It was in the bodies of medical tourists who had traveled to India and Pakistan that the new super-resistant gene was first discovered by British scientists in 2009. But when those scientists named it "NDM-1," after the city from which it seemed to originate, and warned that other medical tourists might be at risk, Indian politicians, news media, and physicians cried foul, suggesting a conspiracy to undermine the medical tourism sector. India's National Centre for Disease Control spent days openly denying the public health relevance of NDM-1. Government authorities sent letters to Indian researchers who had collaborated with British scientists on the NDM-1 studies, demanding that they disavow their research. They also tried to prevent scientists from taking samples of NDM-1 out of India for research purposes.

 For now, experts such as Walsh estimate that NDM-1 bacteria silently lurk in the guts of up to 200 million people in India alone, evolving, exchanging genes with other bacteria, and being shed into the environment. In an interconnected world, they will not remain quarantined there for long.

Ms. Shah notes that when India tried to curtail the usage of antibiotics, their pharmacists went on strike, and the legislature threw in the towel.

On a global scale, there is not enough money in antibiotics to make the drug companies much interested in discovering more of them.  The drug companies like special medications for chronic conditions: expensive, and taken for long periods of time.  Political pressures -understandably-  tend to keep the prices of antibiotics down.

As an aside, it is further evidence that the government of the United States has plenty of competition from abroad as to foolishness and poor governance.

Sonia Shah, Investigative Journalist