The UK's 'Review on Anti-Microbial Resistance'

An extremely important report has been published today. It talks of a possible 10 million deaths each year from drug-resistant diseases (mainly from resistant E. coli, malaria and TB) by 2050... -

..this amounts to 4 million deaths a year just in Africa - with the same again in Asia (which includes both India and China of course) with of 390,000 more in Europe and 317,000 in North America.. (see below)

These numbers actually makes our own assessments of the problem look conservative. (For those interested these were comprehensively presented in ‘Blowing in the Wind – Drug-Resistant TB and the Poor’). They also make the WHO’s abjectly slow response to the problem (even going so far as to promote the idea that rates of DR-TB are “not changing”) more baffling than ever.

We’d add a couple of our own observations in relation to two of these particular three diseases, however:

- One is that as far as we understand it the evidence of global resistance that’s been developing globally so far in the malaria parasite is a lot less advanced, less widespread and more limited than the extensive resistance that’s already developed in the tuberculosis mycobacterium.

- Another is that TB is the only drug-resistant disease which is infectious by being airborne.

- The other is that resistance in E. coli (the other of the diseases that this report focuses upon) is closely related to the industrialised farming practices which have been largely conducted in the developed world. These risks can and should be being far more effectively managed without any great huge economic consequences. Reducing the risk of resistance in this disease should be also more straightforward because E. coli is also thankfully not as genetically disposed to mutation as some strains of TB are now known to be.

We would therefore very strongly suggest that by far the hardest of these three manifestations of antimicrobial drug-resistance to contain is already with TB and is going to stay that way unless things change dramatically – and we should remind ourselves that those who consistently suffer most from this disease are the poor who often don’t get properly counted anyway.

Excerpts from today's BBC's report of the Survey follows in italics (along with our own comments in upright text):

The analysis, presented by the economist Jim O'Neill, said the costs would spiral to $100tn (£63tn). Mr O'Neill told the BBC: "To put that in context, the annual GDP [gross domestic product] of the UK is about $3tn, so this would be the equivalent of around 35 years without the UK contribution to the global economy."

These are astonishing costs which cannot possibly be proportionately met in low-income countries. One hundred trillion, incidentally, looks like this: 100,000,000,000,000...(i.e. one with fourteen noughts behind it). It also adds up to over US$14,000 per person alive on the planet today.

O'Neill was appointed by Prime Minister David Cameron in July to head a review of antimicrobial resistance. He is best known for his economic analysis of developing nations and their growing importance in global trade. He coined the acronyms BRIC (Brazil, Russia, India and China - before adding South Africa) and more recently MINT (Mexico, Indonesia, Nigeria and Turkey).

He said the impact of the would be mostly keenly felt in these countries.

This last observation in the BBC's report seems particularly revealing to us, given that the less developed nations ‘beneath’ them with far less anticipatable economic growth must surely be more vulnerable still.

Perhaps Jim O'Neill's perspective is as an economist who's been employed by a leader of a G-7 economy - he's also an economist briefed to have specific interests in the global economic importance of these self-same developing nations (ones which have for some years been having positive impact on the economic recovery of the wider world). In other words, the impact of this problem is being seen (as far as the Review is concerned) not simply in terms of its potential humanitarian devastation (which surely will be devastating and which will fall the most upon the world's poor) but rather in terms of the economic health of wider world. It might also explain the UK Prime Minister's self-evident interest in the problem - given that it may so directly impact on how his country benefits from world trade.

The Report suggests that the reduction in population and the impact on ill-health would reduce world economic output by between 2% and 3.5%.

Perhaps this observation underlines our concerns about the bias towards middle-income countries in the Report. Given that TB (in contrast to both E. coli and malaria) almost always takes its highest toll on people of wage-earning and child-bearing age, it's not difficult to suppose that the authors of the Review would have really recognised that the greatest direct economic consequence of anti-microbial resistance will fall on low-income countries - they chose to rather focus on its indirect effects on world trade (and therefore middle-income nations) because they were implicitly being directed to do so.

So is this Review in any case over-egged? Professor Dame Sally Davies, the UK's health czar, doesn't think so - and she's not alone.

Dr Jeremy Farrar, the director the Wellcome Trust, said: "By highlighting the vast financial and human costs that unchecked drug resistance will have, this important research underlines that this is not just a medical problem, but an economic and social one too."

We so very much agree with his view.

The review team concludes that solving the problem of drug resistance will be far cheaper than doing nothing and there was "cause for optimism" that the right steps could be taken.

We do seriously wonder, however, exactly what that this "cause for optimism" can really consist of be for those living in the poorer countries who are now already facing DR-TB with so little in the pipeline in the way of response and so little focus on their plight. Is their only hope that the interests of richer nations will somehow shed light on their plight and so promote an appropriate response for them as well? Or will they be forgotten in the process - as long as the richer world can enjoy the benefits of its existing trading treaties which poor countries aren't exactly known to benefit from anyway?

We're not sure. We do have a hunch, however, that there may be some "cause for optimism" for the major shareholders of Big Pharma companies who we think are likely to be able to hoover up some handsome research incentives in the next few years as a reward for their negligence in antibiotic research for the last forty...

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