July 24, 2015
A roundup of news on drug resistance and other topics in global health.
The Global Antibiotic Resistance Partnership (GARP)-Tanzania Working Group has released its Situation Analysis and Recommendations on Antibiotic Use and Resistance in Tanzania. The Acting Chief Medical Officer in the Ministry of Health officially launched the report at a high-level meeting at the Ministry in Dar es Salaam on July 21. The situation analysis is available on the CDDEP website. It details the current state of antibiotic use and resistance in Tanzania and culminates in a series of recommendations for combating antibiotic resistance in the country, laying the groundwork for development of a national strategic plan, as called for by the World Health Organization in its Global Action Plan for Antimicrobial Resistance. [CDDEP, WHO]
The 21st Century Cures Act isn’t a cure—and if passed, it could set back progress in the fight against antibiotic resistance, according to CDDEP Associate Director Hellen Gelband, writing in a CDDEP blogpost. Gelband points out recent commentary in The New York Times, the New England Journal of Medicine and the Annals of Internal Medicine, explaining why the legislation will not help solve problems in drug development, incentivizes overuse of antibiotics and could put patients at risk of harm. Gelband further comments that on the topic of antibiotic development, the bill is predicated on the myth of an “empty pipeline”—an overhyped crisis that neglects the need for conservation of antibiotic effectiveness. [CDDEP, The New York Times, NEJM, Annals of Internal Medicine]
What are fiscal instruments, and how can they influence population health? CDDEP Senior Research Analyst Ashvin Ashok explores this question in a post on the CDDEP blog, with fiscal policies for behaviors from smoking to the use of fossil fuels. Ashok explains how taxes, tariffs and subsidies are used to incentivize positive health behaviors and reduce mortality, and CDDEP’s recent work investigating fiscal policies in India and South Africa. [CDDEP]
Ten percent of healthcare providers write an antibiotic prescription for almost every patient with a cold, bronchitis or acute respiratory infection (ARI). Research published in the Annals of Internal Medicine reviewed over one million patient visits at Veterans Affairs Medical Centers and found tremendous variation in prescribing rates. Ten percent of providers prescribed antibiotics to about 40 percent of patients. The study’s authors found that 59 percent of variation in prescribing rates could be attributed to individual differences in prescribing practices. [University of Utah, Annals of Internal Medicine]
A major study claiming that school-based deworming campaigns led to increased school attendance in Kenya has been called into question. Researchers commissioned by the International Initiative for Impact Evaluation re-analyzed the original data from these studies carried out in the 1990s. Using the same analytical methods as the original study, but correcting some errors, they found no evidence that deworming programs increased school attendance, though it did decrease worm infections. They also re-analyzed the original data with standard epidemiologic methods and found inconsistent results, missing data and a high risk of bias in the study. In a commentary article on the studies, Professor Paul Garner writes, “Our view is that current promotion of community deworming [as] a single solution to multiple problems in low and middle income countries…seems delusional when you look at the results of reliable controlled trials.” Professor Garner is a co-author of an updated Cochrane Collaboration systematic review of all relevant deworming studies, released simultaneously. [International Journal of Epidemiology, International Journal of Epidemiology, Cochrane Reviews]
“The recent progress report on neglected tropical diseases confirms what all development actors know yet few do: country ownership leads to success and sustainability.” An article in The Guardian chronicles the story of a Malawian civil servant who received donations of millions of dollars of necessary neglected tropical disease (NTD) medicines in 2008 but had no way to distribute them. The official, Square Mkwanda, worked with Malawi’s Ministry of Health to fund and create an internal distribution system that reached all 26 districts in the country, and in 2009 Malawi became the second African country to interrupt transmission of lymphatic filariasis, an NTD. The article notes that though there is variation in how countries run their own programs, the most successful ones take an integrated, multi-sectoral approach to development issues. [The Guardian]
As of today, polio is no longer endemic in Nigeria. July 24 marks exactly 12 months since the country has seen a case of wild poliomyelitis—meaning the virus is no longer endemic to Nigeria. The disease can be declared eradicated from a country (as opposed to non-endemic) when three years has gone by without a case. Nigeria’s polio eradication campaigns also likely helped keep Ebola from spreading within its borders: Contact tracing through its existing polio surveillance system helped contain the virus when a traveler arrived in Nigeria carrying Ebola in July 2014. [Quartz, Voice of America]
Synthetic sugar is the latest hopeful source of new antibiotics. A research team based at the University of Queensland reported discovery of a new anti-bacterial technique that uses a modified version of sugar that is produced by bacteria and exhibits low potential for bacterial resistance. The unmodified sugar molecules typically serve as a medium for bacterial cell walls to link up; the modified molecules disarm bacteria by destroying the linking of the cell walls. [University of Queensland, Nature Communications]
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Image courtesy Wikimedia Commons.
