April 7, 2011
World Health Day, 2011
Dr. Tony Fauci
National Institute of Allergy and Infectious Diseases
U.S. National Institutes of Health
Combat Drug Resistance – No Action today, No Cure Tomorrow
High Level Panel Discussion
World Health Organization
Greetings. My name is Dr. Tony Fauci, Director of the National Institute of Allergy and Infectious Diseases at the U.S. National Institutes of Health.
First, let me express my appreciation to the World Health Organization for inviting me to speak to you on World Health Day 2011. As you know, this year, WHO has taken the opportunity offered by World Health Day to highlight an issue of major importance to health professionals and the public around the globe, the problem of antimicrobial resistance.
The Institute that I direct, NIAID, is the lead institute at NIH for research relating to infectious diseases, including research on antimicrobial resistance. Today, I want to describe to you the role that NIH plays in supporting research to better understand, prevent and treat antimicrobial resistance, as well as to share with you my thoughts on key issues that we need to address together to meet the challenge of antimicrobial resistance. In carrying out this research mandate, NIAID addresses scientific priorities that will benefit both U.S. domestic and global public health. In this regard, we are firmly committed to helping implement the new WHO sixpoint policy on antimicrobial resistance.
The success of antimicrobial drugs directed at disease-causing microbes is among the greatest achievements of modern medicine. Yet, for all of this success against microbial pathogens, microbes continuously develop ways to circumvent these powerful medicines. There are multiple examples of drug-resistant bacteria, parasites, and viruses that illustrate this point. Unfortunately, drug resistance has become a key stumbling block in our efforts to control many infectious diseases of global public health concern, including tuberculosis, malaria, HIV/AIDS, and influenza. WHO estimates that 3.3 percent of all tuberculosis cases are multidrug-resistant, or resistant to at least two first-line TB drugs. In addition, there is a disturbing increase in the number of cases of extensively drug-resistant TB. The 2011 WHO Progress Report indicates that 69 countries have reported at least one case of extensively drug-resistant TB, with an estimated 25,000 cases emerging each year.
Also, of great concern is the growing evidence of resistance to newer malaria drugs, notably artemisinin-based combination therapies. While the development and use of these medicines was a breakthrough for malaria control programs, the recent emergence of drug resistance threatens to erode our hard-earned progress.
Important viruses also have demonstrated a remarkable ability to develop drug resistance.
Antiretroviral therapy—or ART—revolutionized our ability to successfully treat people with HIV infection. However, as ART becomes accessible to millions of people around the world, there are increasing concerns regarding the widespread emergence of drug-resistant HIV. Antivirals also are an important weapon against another major viral disease – influenza; however, health care workers have only a short list of effective drugs to give to patients with influenza and this list has been made even shorter by drug resistance.
In addition to these examples with which global health leaders are all familiar, the emergence of drug-resistant organisms makes it increasingly challenging to treat infections with hospitaland /or community-acquired pathogens such as methicillin-resistant Staphylococcus aureus or MRSA; Enterococci; C. difficile; and foodborne pathogens such as E. coli, Salmonella and Campylobacter; among others.
I applaud WHO for refocusing attention on the problem of drug resistance in its multifaceted new policy. Antimicrobial resistance has been a long-standing research focus at NIH and we hope others will help expand research internationally to meet this critical challenge. Our research activities support the six-point policy package released today to combat antimicrobial resistance, especially with regard to fostering innovative research and the development of new tools.
NIH oversees a major effort built upon a foundation of basic research to understand the biology of microbial pathogens and their interactions with human hosts, as well as the mechanisms by which pathogens develop resistance. The availability of extremely efficient high-throughput genomic sequencing of microbial pathogens is playing an important role in this effort. In addition, NIH is committed to scientific inquiry that will help identify new antimicrobial targets through sequence data and to translational research that will apply these findings to the development of therapeutics. We are working to advance the development of new and improved diagnostic tools and to create safe and effective vaccines that prevent infectious diseases—thereby limiting the need for antimicrobial drugs. Finally, NIH is conducting studies to inform the rational use of existing antimicrobial drugs or other therapies to help limit the development of resistance.
Important partnerships are underway to address antimicrobial resistance, including NIH participation in the US government’s Interagency Task Force on Antimicrobial Resistance and the International Transatlantic Task Force on Antimicrobial Resistance. We welcome such multilateral efforts and we will continue to be fully engaged.
Today, World Health Day 2011, WHO is focusing our attention on a critical issue that increasingly challenges global health. With our international and national partners from the public health, research, medical, and pharmaceutical communities, the US National Institutes of Health is committed to supporting WHO in its efforts to address the challenge of antimicrobial resistance through research, international training, and the development of new vaccines, therapeutics, and diagnostics, which will ultimately strengthen our capacity to prevent, identify, control, and treat these perpetually emerging and re-emerging pathogens.