OR: If this faltering of political will continues, what will be the short- and medium-term consequences?
Garrett: We are already seeing them. Let me give you an example. When I was a child, some of the diseases that are common we didn't have vaccines for. When I was a kid antibiotics were considered really miraculous substances that were used as indicated by doctors. But they were very well aware of the miracle of penicillin and tetracycline. They used them when there was a really good reason to believe you had strep throat as opposed to a virus. I never had an antibiotic -- no doctor felt the need to prescribe it -- until I had tonsillitis at the age of six. Somehow I, and most of my generation, managed to get all the way into elementary school before we ever had to have an antibiotic.
Today it's almost impossible in the United States to find a two-year-old who hasn't already had two, three, or even four giant rounds of broad-spectrum, very powerful antibiotic treatment. In most cases it's for ear infection. That kind of ear infection was almost unheard of 40 years ago; now it's routine. Hardly any kid makes it to first grade without having gone through bouts of antibiotic treatment for ear infections. On the first round, the doctor may give the parent these droplets that the children hate; the parent has to go into combat with their 18-month-old to get them to swallow the stuff. And it seems to work. They stop taking them perhaps prematurely, and the kid's fine. But they didn't kill off all the bacteria, they just brought the worst symptoms under control -- and meanwhile the remaining bacteria acquired resistance to that first round of treatment.
Six months later the kid's back, the ear infection's worse, the kid is screaming. There's concern about it getting into the brain and leading to encephalitis. So they go to a higher, broader-spectrum, more powerful antibiotic formulation. Now the child is two years old and is flailing around and screaming and doesn't want to take these drops. Mom and dad go into combat every night with child. Finally they think they've got it under control. Maybe the pediatrician said, "You have to really, really do it right this time." But once again a resistant strain arises.
Pediatricians will tell you they see more hearing loss in children now. Eight, 10, 11-year-olds showing hearing loss that's a result of bouts of bacterial infection when they were toddlers. That's just one example. Consider urinary tract infections. About 15 to 18 million Americans every year get a urinary tract infection, most of them women, and an increasing percentage of those infections are drug-resistant. Some are so drug-resistant that basically nothing works. You just wait it out in pain and hope -- if you're lucky, you're young, and you're healthy -- that your immune system goes into combat mode and you defeat the microbes. Or maybe not.
There was a woman who died in 2016. She had been traveling in India. She got a broken leg and was treated in India for her broken leg. She came home to Las Vegas and there was an infection associated with her broken leg and the treatment. It looked like it had just been a little scratch that perhaps one of the medical instruments had made when they were fixing her bone. But it became so drug-resistant she went through 26 different rounds of completely different formulations of antibiotics. She died. Nothing worked. We're seeing this more and more. There are people trying to keep tally of all of this and there are various interactive trackers you can see online that will show you trends in drug resistance around the world.
The bottom line is that it's just getting harder to keep hospitals clean, because it now turns out that some of the disinfectants we use actually select for resistant bacteria and promote resistance. The chlorine we use for water-waste treatments, so that we don't dump antibiotic-resistant factors into our oceans and our rivers, turns out to select for resistant microbes and actually enhances the amount of resistance we're dumping into our environment.
We need an all-hands-on-deck approach that where the world takes the U.N. resolution seriously and the pharmaceutical community steps up to the plate and the biotech community steps up to the plate. We need an all-out push by NIH and all its counterparts around the world. The World Health Organization underscored this. For the first time in the history of the organization they released a list of 12 of the most dangerous pathogens -- non-viral -- on earth. All of them because they've become so drug-resistant that people are dying in record numbers. You can see that list on their website. So the sense of urgency is there in the public health community, but it's not yet there at all in higher tiers of policy making, on Wall Street, and in the pharmaceutical industry where it needs to be.
OR: Where do you rank AMR on the scale of global health threats?
Garrett: Let me provide an example that is not bacterial, but is illustrative of how complicated trying to answer that question can be. Yellow fever has been around as long as we know in human history. It's carried by mosquitoes; it's a virus. It's a nasty virus. If you are unvaccinated, I believe the mortality rate is 30 percent. I've seen people with yellow fever. You hemorrhage. The individual looks like an Ebola victim, which is why a lot of yellow fever is misdiagnosed. But then we developed a vaccine that really, really works. And not only does it really work, it only costs 27 cents and it confers lifetime immunity. There was good reason to believe when this vaccine rolled out in the 1960's that we could effectively stop yellow fever on the whole planet. The World Health organization and everybody else issued these special yellow papers you had to carry anywhere you traveled in the world that stipulated when and where you'd been vaccinated. Many countries would not allow you in, especially in Africa, without a valid yellow fever vaccination slip certified by the World Health Organization.