PAHO Director, in Beijing, Calls for Global Responses to Global Health Challenges

Washington, Sept. 2, 2000—Global health challenges such as the "time bomb" of resistance to antibiotics, the movement of potentially harmful products and foods, and information that induces health-damaging behaviors, must be faced at the global level, according to Dr. George Alleyne, Director of the Pan American Health Organization.

In a speech prepared for delivery at the World Federation of Public Health Associations meeting in China today, Dr. Alleyne said, "The prospect for spread of disease among all countries is enormous with this intensity of travel. The movement of people is particularly critical for the emergence of one of the time bombs of public health -the spread of antimicrobial resistance," which deserves more attention.

Antimicrobial resistance, Dr. Alleyne said, "is a natural biological phenomenon that is really unstoppable. Microbes usually acquire resistance through the normal process of mutation, or by the transfer of genetic material from one to another. When microbes are exposed to antibiotics, the phenomenon known as selection pressure encourages the development of resistance-perhaps a particular application of the old saying that only the strong survive. Antimicrobial resistance has become a major public health problem because of our own arrogance and carelessness in the use of antibiotics."

"We are now well past the euphoria of a half century ago when the first antibiotics came into common use, and raised the possibility of victory over the microbes," Dr. Alleyne told the global public health group. "It has been claimed that antibiotics have had very little to do with global improvements in health, that have really been due to advances in nutrition and social and environmental engineering that occurred in what some would say were the golden days of public health. That view cannot be sustained, and the world of the pre-antibiotic era was very different from this when the phenomenon of globalization brings us all together in ways that were not imagined."

He said antimicrobial resistance develops because of misdiagnosis and inappropriate therapy, "inappropriate in the sense of applying antibiotics when they are not needed or applying them in insufficient quantity and in courses that are too short. The problem of counterfeit drugs and the dispensing by unqualified personnel also contribute. The global spread of antibiotic resistant gonococci is a classic example, since we now find that in some parts of the world up to 98% of these organisms are multidrug resistant, whereas initially -at least when I was a medical student, they were all sensitive to penicillin."

The problem of antibiotic resistance "has been felt very keenly in the case of tuberculosis," he said. "The inadequate local treatment leads to the development of multidrug resistance and an increase in cost of treatment by several orders of magnitude. The global nature of this problem is shown by the fact that antimicrobial resistant organisms are found in all countries. In one of the poorest countries of our Region, Bolivia, apparently healthy children from urban areas carried E-coli of which 97% were insensitive to amipicillin."

Dr. Alleyne noted that half of all antibiotics produced are used in animal farming, where they are applied prophylactically, to treat sick animals, and to promote the growth of healthy ones. "The action of European governments to ban growth-promoting antibiotics in animal feed results from the real possibility of antibiotic resistant pathogens passing from animals to humans," he said.

"We are faced already with the global spread of communicable diseases through the two principal vectors mentioned above -humans and food, and I believe that those communicable diseases of greatest concern for us in the context of global health are -HIV/AIDS, malaria, and tuberculosis. I am sure you know the data, -over 34 million persons living with AIDS, and sub-Saharan Africa facing a plague of biblical proportions, -the Caribbean with a prevalence rate second only to that in Sub-Saharan Africa; 3,000 persons dying every day from malaria -mostly children- and 1.5 million dying every year from tuberculosis," Dr. Alleyne said.

"But grim as the global picture may seem for the transfer of infections by human and other vectors, it is perhaps potentially worse as a result of the propaganda that knows no frontiers and induces others to adopt health-damaging practices. The most egregious example is the one of tobacco, which is estimated to have killed 4 million in 1998, with the possibility of that figure rising to 10 million by 2030," he added.

Citing possible global responses to these global challenges, Dr. Alleyne said "The first, and perhaps most important, is the ability to detect changes at a global level -that we should know what is upon the people where they live and the possibility of its transfer. This means the presence of some global surveillance system. International health regulations represent a reactive system so we need to have a more agile one that provides information on a systematic basis on disease trends worldwide." An important and "painstakingly prosaic" task is that of strengthening the capacity of laboratories to diagnose accurately some of the most common pathogens, he said.

"Another part of the response to the global challenge is the establishment of global mechanisms based on shared interests and responsibilities," Dr. Alleyne said. "International organizations such as WHO have, as part of their mandate, the coordination of a global response, and the existence of these organizations is an indication of the willingness of nations to work together for common causes. Indeed, in many instances, there have been outstanding successes in this joint work. The eradication of smallpox, the imminent eradication of poliomyelitis, the possible eradication of measles -following a successful effort in the Americas- the strong movement to develop a framework convention for tobacco control -these are all excellent examples, " he added.

"Transnational companies will appreciate that their success will increasingly depend on the stability of global conditions and the health of persons where they do business," he said. "Once again, self-interest will drive the concern for attention to global health. It is not farfetched to imagine these codes of social responsibility embracing efforts to address global health issues. It will be a challenge for people like us to find ways of merging these business interests with those of the international intergovernmental organizations.

PAHO, which also serves as the Regional Office for the Americas of the World Health Organization, works with all the countries of the Americas to improve the health and raise the living standards of their peoples.

For more information contact Daniel Epstein, Tel (202) 974-3459, Fax (202) 974-3143, PAHO Office of Public Information, 525 Twenty-Third Street, N.W. Washington, DC 20037, USA; e-mail: epsteind@paho.org