So, antibiotic resistance: We care about it, right? The World Health Organization does: It made antimicrobial resistance the theme of this year’s World Health Day. The Centers for Disease Control and Prevention does. The journal Lancet Infectious Diseases says it’s a “global health concern.” The major association for infectious disease physicians has pleaded for attention. Two separate sets of legislators have introduced two bills in Congress.
You’d think, with all those calls for attention, that combating antibiotic resistance would be a priority in the United States. But if we can take how much we spend to research a problem as a gauge of how much we care about it, then antibiotic resistance is no priority at all.
As in: For every death from AIDS, the US federal research establishment awards approximately $69,000 in grant funds. And for every death from MRSA, it awards $570.
The numbers come from an analysis presented at the World HAI Forum by Dr. Eli Perencevich of the University of Iowa (and the blog Controversies in Hospital Infection Prevention) and co-authors S. Kwon and M.L. Schweizer. (As far as I can tell, their poster is not online; perhaps they’ll post on it?)
As researchers competing for grants, they noted that the research budget at the National Institutes of Health has been rising, from $13.1 billion in 1998 to $28.7 billion in 2008; within that, so has the research budget at NIH’s National Institute of Allergy and Infectious Diseases (NIAID), from $1.4 billion to $4.6 billion over that same decade. They wondered how much of that research funding was going to this resistance problem that health authorities nationally and globally have pronounced a crisis. MRSA, let’s remember, kills an estimated 19,000 Americans a year: more than HIV, and more than pneumococcal disease, meningococcal disease, H. influenzae and group A Streptococcus combined.
They found the answer to be: Not very much.
To derive that answer, they drilled down into NIH’s Research Portfolio Online Reporting Tools database, RePORT for short, looking for all the grants awarded by NIAID that went to antibiotic resistance, antimicrobial resistance or hospital-associated infections. They especially looked for grants aimed at the seven most important resistant pathogens, the ones that cause the most illness and death and for which there are few remaining drugs that work: the Enterobacter species, MRSA and other resistant staph, C. difficile, Acinetobacter baumanii, Klebsiella pneumoniae, Pseudomonas aeruginosa and Enterococcus faecium, collectively known as ESCKAPE.
What they found looked, at first, to be encouraging: From 2007 to 2009, the amount per grant and the total amount awarded for those topics and pathogens had gone up. In 2007, the total was $180 million; in 2009, it was $398 million. But then they looked at what NIH awards for other infectious diseases, and at that point the picture was much less positive. In 2007, NIAID funding for HIV/AIDS was $1.24 billion.
Plotted against the 18,000 AIDS deaths that year, that came to $69,000 per death. Breaking the antibiotic resistance funding apart by pathogen, they compared the 2007 funding for MRSA and for C. diff, and for the 18,650 deaths from invasive MRSA and 6,372 deaths from C. diff. Per death, the funding for those organisms was $570 and $560.
I asked Perencevich to help me make sense of these numbers. He replied by pointing to the utter dearth of new drugs for resistant pathogens — and to the fact that, because HIV has been a research priority for most of the 30 years of its existence, research has brought forth thousands of antiviral compounds and drug combinations for treatment.
“That’s what funding can do,” he said. “We need a renewed focus on antibacterial drug discovery and infection prevention. Our take-home point is that we ought to bring to this the same vigor that we’ve brought to HIV.”
- Not Enough Antibiotics: Just an Incentives Problem?
- New antibiotics: Not many and fewer all the time
- Running out of antibiotics — and other drugs too
- Antibiotics Breed Superbugs Faster Than Expected
- World Health Day update: Use an antibiotic, pay a fee?
Cite: Perencevich E et al. Modeling the Future of Antimicrobial Resistance: USA Perspective. Presented at the World HAI Forum on Healthcare-Associated Infections, Annecy, France, June 28, 2011.