By JOHN LUMPKIN AND RAMANAN LAXMINARAYAN
How reimagining data – and reframing a problem – can help avert a looming public health crisis
For the first time, researchers and policymakers can visually track the rise in “superbug” infections over time and identify regions of the country with rapidly spreading rates of resistance.
Researchers at Extending the Cure, a nonprofit project funded by the Robert Wood Johnson Foundation’s Pioneer Portfolio, have developed ResistanceMap—an online tool that tracks changes in resistance levels. These maps show us how the problem of antibiotic resistance has gotten worse, with some regions of the country experiencing a significant and worrying increase in drug-resistant microbes.
Infections like those caused by MRSA (methicillin-resistant Staphylococcus aureus) kill an estimated 100,000 people in the United States each year. Progress toward solving this emerging public health crisis has been slow, an important reason why the Robert Wood Johnson Foundation has funded this research through its Pioneer Portfolio. We share a common view that the best way to prevent an epidemic from occurring may lie in dramatically reframing how we approach the problem.
This is exactly what Extending the Cure has done with ResistanceMap, a web tool that presents scientific data in a user-friendly way, allowing policymakers and researchers to quickly identify regions in urgent need of better infection control, enhanced surveillance, more vigilant antibiotic stewardship, and comprehensive methods to curtail the spread of resistant microbes.
At the core of these maps are data on more than 5 million individual patient samples tested for resistance, or the ability to survive a treatment course with an antibiotic. The resulting maps show that resistance has risen sharply during the first decade of the 21st century.
They also highlight additional significant trends. Each year, tens of thousands of people are killed by Acinetobacter baumannii, which causes pneumonia and other health problems. This microbe now has the ability to evade a last-resort class of antibiotics called carbapenems. The map shows resistance rates in the U.S. have risen from under 5 percent in 2000 to nearly 40 percent in 2009, an eight-fold increase. In some cases, infections caused by this superbug are unstoppable.
That’s why tackling a superbug like Acinetobacter requires new thinking on an old problem. The Extending the Cure project started with a 2008 report that examined antibiotic resistance in a fundamentally different light. By approaching the problem as a natural resources economist might, the report argued that we could help turn the tide on superbugs by optimizing the effectiveness of a scarce societal good (antibiotics). Taking such a perspective leads researchers to look upstream from the point of antibiotic use and consider issues related to the development, production, regulation and management of these drugs. This is a dramatic break from usual approaches to drug resistance which emphasize infection control and greater government investment in new antibiotics to replace older, ineffective ones without altering incentives for how antibiotics are utilized.
At the time, this concept was well outside the established research paradigm. And, in fact, the concept emerged from a completely different field of study. However, through its Pioneer Portfolio, the Robert Wood Johnson Foundation serves as an incubator for ideas – like ResistanceMap — that have the ability to drive lasting change in health and health care.
With the launch of ResistanceMap, we have the ability not just to study the past but to peer into the future of resistance, accelerating our progress against superbugs—a crucial step if we are to stave off a major public health crisis.
John Lumpkin, M.D., M.P.H., is senior vice president and director of the Health Care Group at the Robert Wood Johnson Foundation in Princeton, N.J.
Ramanan Laxminarayan, Ph.D., is the director of Extending the Cure, a project that studies the growing problem of antibiotic resistance. Extending the Cure is funded in part by the Robert Wood Johnson Foundation’s Pioneer Portfolio.