Photo Credit WHO
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The World Health Organization’s Director General Margaret Chan, addressing the Credit Suisse Asian investment conference in Hong Kong yesterday, warned that - despite the fact that the world was better equipped to deal with infectious disease outbreaks than ever before - dangerous new diseases will continue to emerge, and that the pace of new emerging health threats was accelerating.
A full transcript of Director Chan’s remarks can be found at:
WHO Director-General addresses the Asian Investment Conference
Dr Margaret Chan
Director-General of the World Health Organization
Keynote address at the 2014 Credit Suisse
Asian Investment Conference: Are we winning the fight against infectious diseases?
Hong Kong, the People's Republic of China
24 March 2014
In this address, Director Chan addresses numerous topics, including the industrialization of food production, the threat of growing antibiotic resistance, and the potential for climate change to exacerbate the emergence of new disease threats . . . to name just a few.
Her address is well worth reading in its entirety, but I’ve excerpted a few passages:
Today, the biggest threat from infectious diseases comes from the unknown: the next new virus lurking in the jungles of sub-Saharan Africa or in the wet markets and teeming cities of Asia.
These two geographical areas have traditionally been regarded as the breeding ground for new diseases. Around 75% of new diseases emerge following close contact between humans and domestic or wild animals. Africa and Asia offer multiple opportunities for these contacts to occur.
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A strong preference for freshly slaughtered poultry keeps the wet markets open in several parts of Asia. Most scientists view wet markets as hotspots for the emergence of new viruses that could spark the next influenza pandemic.
The practice or raising chickens near homes has been the source of numerous human cases of H5N1 infection, also among very young children who play or crawl near birds or their droppings.
All of these trends, like unprecedented population density, incursions into previously uninhabited areas, people crowded together with domestic animals, a changing climate, and the industrialization of food production, put our world on a dangerous trajectory, with new diseases just one of many prices to pay.
Local media coverage, as provided below by the Hong Kong Standard, understandably focused primarily on her remarks regarding the importation and sale of live poultry in the wake of the year-long outbreak of H7N9 in China.
Although a temporary ban is in place, the long-term policy regarding live poultry imports remains uncertain, with many top scientists urging that the ban not be lifted.
This from the Hong Kong Standard.
WHO chief urges end to sale of live poultry
Mary Ann Benitez
Tuesday, March 25, 2014
The World Health Organization director- general Margaret Chan Fung Fu-chun is urging Hong Kong to consider banning the sale of live poultry to stop bird flu.
Speaking at a conference in the territory, Chan said that wet markets are a breeding ground for the deadly new diseases. But Chan, the territory's former director of health, said that it would be difficult to impose a ban because of the local preference for fresh chicken.
The evidence that closing live-bird markets reduces the spread of avian flu viruses is pretty solid (see The Lancet: Poultry Market Closure Effect On H7N9 Transmission), making it an obvious mitigation strategy. But old habits die hard; purchasing live market birds is deeply ingrained in the Chinese culture, and there has been much public resistance to closing these markets.
Which illustrates the fact that public health policies cannot be made in a scientific vacuum; that economic, political, and societal factors (which vary widely around the world) will always influence what can – and what cannot – be readily accomplished.
While outbreaks of exotic diseases, or the specter of a pandemic, typically garners the biggest headlines, the bulk of Director Chan’s remarks were related to the growing antibiotic resistance crisis - which, if it continues – truly threatens a dark future for all aspects of medicine. A few excerpts:
We are losing our first-line antibiotics, our miracle cures. Replacement treatments are more costly, more toxic, need much longer durations of treatment, and may require treatment in intensive care units. For some diseases, the death rate doubles when drug resistance develops.
Many common bacteria have developed resistance to multiple drugs, some to nearly all. Hospitals have become hotbeds for highly-resistant superbugs, increasing the risk that hospitals kill rather than heal. These are end-of-the-road pathogens that are resistant to last-line drugs.
If current trends continue, the future is easy to predict. Some experts say we are moving back to the pre-antibiotic era. No. This will be a post-antibiotic era. In terms of new replacement antibiotics, the pipeline is virtually dry, the cupboard is nearly bare.
A post-antibiotic era means, in effect, an end to modern medicine as we know it. Common infections will once again kill. Some sophisticated interventions, like hip replacements, organ transplants, cancer chemotherapy, and care of preterm infants, will become far more difficult or even too dangerous to undertake.
Even simple interventions, like surgery to treat myopia, will become too dangerous to perform.
While a stark prediction, in some places in the world – and with some bacterial infections – we are already there (see ECDC/WHO: World TB Day - Focus On MDR & XDR Treatment Outcomes).
In EU, only 1 in every 3 MDR TB patients has a successful treatment outcome; more than half either die, fail treatment or default (stop taking treatment). XDR TB has even worse treatment outcomes: only 1 in 4 patients finishes treatment successfully
For more on the spread of antibiotic resistance around the globe, you may wish to revisit:
EID Journal: Acquisition of Drug Resistant Genes Through International Travel
UK CMO: Antimicrobial Resistance Poses `Catastrophic Threat’
MMWR Vital Signs: Carbapenem-Resistant Enterobacteriaceae (CRE)
Chan: World Faces A `Post-Antibiotic Era’
