Last spring, Arjun Srinivasan, an associate director of the Centers for Disease Control and Prevention, delivered a presentation to state health officials with some alarming information. Before the year 2000, he said, it was rare to find cases of bacteria resistant to carbapenems, a class of powerful, last-resort antibiotics. But by February 2013 they had been seen in almost every state. Srinivasan also briefed Thomas Frieden, director of the CDC. On March 5, Frieden issued a public warning about “nightmare” bacteria, a family of germs known as CREs. They can kill up to half the patients who get bloodstream infections from them, resist most or all antibiotics and spread resistance to other strains.
Last month, Frieden released a report estimating that at least 2 million Americans get infections each year that are resistant to antibiotics and that at least 23,000 people die as a result. Margaret Chan, director general of the World Health Organization, warned last year: "A post-antibiotic era means, in effect, an end to modern medicine as we know it. Things as common as strep throat or a child's scratched knee could once again kill."
President Obama ought to shake us out of this lethargy and appoint someone to tackle antimicrobial resistance across all fronts. The goals are clear: far more detailed, national data reporting; improved stewardship of existing antibiotics; and a major antibiotic drug discovery and development effort. We shouldn't expect government to do it all. This crisis will require truly broad collaboration, including scientists, clinicians, hospitals, regulators and the pharmaceutical industry. But government can light a spark and galvanize people toward a result that each could not achieve acting alone in the face of a real threat.
Antimicrobial resistance is driven by evolution, a relentless process. But we shouldn't throw up our hands. We do not have to return to the pre-antibiotic age. To sustain the wonder in wonder drugs, to find a way forward, a little leadership would go a long way.