Needed at the G20 Summit: A Global Assault on Drug-Resistant TB

Ever since Alexander Fleming’s discovery of penicillin, the mass production of antibiotics has been a vast boon to humanity, curing untold numbers of infections that were once a death sentence.

But bacteria are increasingly becoming resistant to our antibiotic stockpile, rendering treatments against disease ineffective. Antibiotic overuse, misuse, and abuse have all exacerbated the problem. To put it simply, there aren’t enough new drugs to treat diseases, and the drugs that we do have don’t always work.

When I saw the impact of AIDS firsthand in the early 1980s, I had an overwhelming feeling we were facing a tremendous catastrophe. Today I’m similarly convinced that drug-resistant infection — known as AMR, for antimicrobial resistance — is one of the most significant health challenges we face. That’s why last year the London School of Hygiene & Tropical Medicine launched its own AMR Center to support innovative high-quality research across a range of disciplines. Without urgent action, we risk undermining the medical progress we have relied on for 80 years.

Thankfully, interest in AMR has surged in recent years, with headlines in every major news outlet about superbugs being on track to cause more deaths than cancer.

But this has not been by accident. In keeping with Britain’s historic leadership in medical science, the U.K. government has championed the once obscure issue of drug resistance and helped secure its place on the international political agenda. In 2014, the government commissioned a review of the issue, led by the renowned economist Lord Jim O’Neill; the review found that drug-resistant infections could cause 10 million deaths per year by 2050, costing the global economy $100 trillion. The U.K.-based Wellcome Trust, one of the world’s largest health charities, has been a strong advocate for research on drug-resistant infections.

But while we may think of drug resistance as a new emergency, at its heart lies an age-old disease: tuberculosis. The review’s final report stated that TB — already the world’s leading infectious killer, claiming 1.8 million lives a year — accounts for a third of all deaths from resistance and that if left unaddressed it will have cumulative economic costs of almost $17 trillion by 2050, an unacceptable toll in lives and treasure.

A major driver of the epidemic of drug-resistant tuberculosis is a lack of effective treatment: Standard TB treatment is an arduous six months; for drug-resistant TB, 18 months, with 14,000 pills plus daily injections. This cocktail can cause serious side effects, including permanent deafness. Little wonder that the treatment is completed by only half of those who start it.

Alarmingly, there is an increasing number of cases of extensively drug-resistant TB, which has developed resistance to almost all drugs available. TB is the only major airborne drug-resistant infection, and it doesn’t respect borders.

Bedaquiline, a new drug to combat drug-resistant TB, was brought to the market a few years ago. That was welcome, but it is not a first-line treatment — that is, the first choice for treating a given disease. In fact, there have been no new first-line drugs for TB in more than 50 years. Ironically, as the problem has grown ever greater, investments in TB research and development have fallen.

It is time to think outside the box. Drug resistance is complex and requires a multifaceted response. A key component of such a response is international agreement on a new approach to research and development, one that does not depend on market incentives.

Last year, alongside the O’Neill review and a U.N. high-level meeting on AMR, the G20 nations asked a number of international organizations to produce a road map for encouraging research and development on new antibiotics. This weekend, when the leaders of those 20 major economies meet in Hamburg, Germany, for their annual summit, research and development to tackle drug resistance will be among the many pressing topics they discuss.

With broad international support, the G20 has a key opportunity to agree on a mechanism to develop new antibiotics to tackle drug-resistant infections, overcoming present market failures and supercharging the antibiotics pipeline.

In the words of the U.K.’s review, “TB must be at the heart of any international action against AMR.” These leaders have an added incentive: Around half of all TB and drug-resistant TB cases, as well as TB deaths, occur in G20 countries.

World leaders should specifically include TB in their G20 outcome document this weekend. While it may not be headline-grabbing, it could be lifesaving: helping protect millions from the world’s leading infectious killer and encouraging innovation to address one of the world’s largest challenges. Without global action, we will hurtle toward a post-antibiotic era. New drugs are needed for now and for the future.

Dr. Peter Piot, director of the London School of Hygiene & Tropical Medicine, was a co-discoverer of the Ebola virus.