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As the avian influenza H5N1 strain is marching westwards towards Europe, the world is bracing itself with the need to set up national and local preparedness planning for the next human influenza pandemic which could arise at any time from recombination of avian and human viruses. The WHO and world political leaders are calling for all governments to stockpile antiviral drugs and personal protective equipment that could be deployed in coordinated fashion as soon as the pandemic strikes. To prepare for the emergence of the new virus, public-private partnerships between national health authorities and the pharmaceutical industry have been established to speed up influenza vaccine development schemes and upgrade production capacity to try and meet the challenge of rapid use of vaccination. In response to this threat, the European CDC is developing a protocol for crisis co-ordination at the EU level and a self-assessment tool for checking the quality of national pandemic response plans. Disaster anticipation is thus high on the global political agenda and these timely efforts for public health protection should be applauded. It remains to be seen how much international coordination and solidarity can be achieved in practice. In contrast to the media attention focussed on this potential epidemic of catastrophic consequences, other pandemics are already creeping up with less public notice. These include the international dissemination of hyper-virulent antibiotic resistant clones of opportunistic pathogens, such as Clostridium difficile ribotype 027 and VanA Enterococcus faecium clonal complex 17. Both of these strains are now reported in European hospitals after causing major outbreaks with high mortality in the USA and Canada. They also call for laboratory and infection control preparedness across the health care system. ESCMID has played and will continue to play a significant role in the dissemination of microbiological and epidemiological expertise to improve surveillance and hospital infection control programmes. In ESCMID News 3-2005, which can be downloaded from the link below, Jacques Fabry presents a new EU-supported project named Improving Patient Safety in Europe (IPSE), which does address professional training issues and transfer of technological advances in the prevention of nosocomial infection. ESCMID Study Groups will be associated in this project. This European project is supportive of the goals of the World Alliance for Patient Safety that was launched this fall by WHO. As explained by Andreas Voss in this issue, this initiative will stimulate health authorities, experts, clinicians and patients to work together in combating healthcare-related infections. As pointed out by Francis Mégraud in his commentary, the awarding of the 2005 Nobel Prize for Physiology and Medicine to Warren and Marshall for their discovery of the role of Helicobacter pylori in causing gastric ulcer disease is the wonderful demonstration of the power of open-minded examination of the facts to challenge common wisdom. Microbiology and immunology of infectious diseases have been rewarded by a quarter of the Nobel Prizes in Medicine to this day. One can predict that astute clinicians and microbiologists will hold this rank to our disciplines by making further discoveries of curable infectious causes of human disease in the coming years. Marc Struelens
Message from the President
As noted in a position paper published last year (1) ESCMID is seriously concerned about the fact that although we have known for many years that antibiotic resistance is becoming an increasing problem, there are very few new antibiotics under development. Some new drugs have been added for treatment of resistant Gram-positive organisms, e.g. linezolid, teicoplanin, the combination of quinopristin and dalfopristin and some of the new quinolone derivatives. However, with the possible exception of tigecycline there are virtually no new drugs under development which have increased activity against resistant strains of Gram-negative bacteria such as Pseudomonas spp., Burkholderia spp, Acinetobacter spp. and Enterobacteriaceae producing extended spectrum β-lactamases. In fact, due to these organisms there is a considerable risk that in the near future we will see patients with infections caused by bacteria resistant to all licensed antibiotics. Another problem is that the costs for treatment of infections caused by resistant bacteria, e.g. multi-resistant tuberculosis, exceed available resources in poor countries. This concern for a possible return to the pre-penicillin era is shared by many organisations and at the 2005 World Health Assembly in Geneva the Member States of the World Health Organisation (WHO) adopted a resolution, which pointed out the problem and called for increased efforts to combat it both by the Member States and by the Director General of WHO. This should lead to an increased political awareness of the importance of the issue. Hopefully it will also result in better resources for research as well as discussions of how to bring the pharmaceutical industry back to developing new antibiotics. In the US the Infectious Diseases Society of America (IDSA) has taken an initiative called Bad Bugs, No Drugs (www.idsociety.org). This has increased the awareness of the problem in the US Congress but not yet the resources available for research. Another organisation working actively in this field is Alliance for the Prudent Use of Antibiotics (APUA). A new and interesting initiative, actively supported by ESCMID, is React, a truly international network for organisations tackling the problem of antimicrobial resistance. In September 2005 React held a meeting in Uppsala, Sweden sponsored by the Dag Hammarsküld Foundation and the Swedish International Development Cooperation Agency, to fully identify the problem of antimicrobial resistance and to discuss means for increasing the awareness of it among decision-makers all over the world. The meeting was attended by about 50 delegates from more than 25 countries and all continents, including several middle- and poor-income countries. They represented scientific, governmental and non-governmental organisations as well as pharmaceutical companies. Importantly, React aims at an evidence-based approach to the problem of resistance. Among the important issues for further evaluation, defined at the Uppsala meeting, was the urgent need for more and better studies of the burden of antibiotic resistance in terms of increased morbidity and mortality and costs. It is quite obvious that a weakness when we argue for more prudent use of antibiotics in order to reduce the resistance problem is that we can put forward rather few systematic studies in that field. ESCMID hopes to be able to provide continuous support for React. One way of doing so is to offer space at the ECCMID Nice in April next year for React to present itself to a larger international audience. It is quite clear that we need a more efficient lobbying organisation with the task to increase the international awareness of the serious threat posed by antimicrobial resistance. Reference: (1) Norrby SR, Nord CE, Finch R, European Society of Clinical Microbiology and Infectious Diseases. Lack of development of new antimicrobial drugs: a potential serious threat to public health. Lancet Infect Dis 2004;5:115-9 S. Ragnar Norrby |
