The global outlook

Multidrug-resistant TB, extremely drug-resistant TB, and totally drug-resistant TB are emerging the fastest in places where antibiotic access is the least controlled. It’s the combination of the ability to transfer bugs around the world with the greater pressures in many parts of the world for these bacteria to evolve that’s going to create much more of a problem in years to come. The scenarios that scare me the most are the ones that I think are likely. Explosive outbreak could always occur, but what we’re already seeing are situations in which we have really dangerous organisms like tuberculosis that are very, very difficult to treat. And we know they are spreading.

I was visiting South Africa on a recent trip, and I went to the specific hospital where they housed the XDR patients with TB. XDR stands for Extremely Drug Resistant. And what it essentially means is these tuberculosis bacteria are resistant to everything. So there is no drug that is susceptible. And you use all kinds of combinations and different drugs to try to treat these patients. And I went to the ward that housed the children with XDR TB. And I think that seeing these kids in a room– most of them happily playing, because they are kids– knowing that they have this bacteria that is resistant to everything that we have was a really eye opening experience for me.

And I mean, I think it makes you think about a lot of things. But it certainly makes you think about these helpless kids who have gotten a resistant bacteria that essentially was created by our use, and misuse, maybe, of some of these antibiotics. Now as we see more antibiotic consumption in the developing world just as people can afford them, that’s going to undoubtedly place much more selection pressure on resistant bacteria to evolve. And if enough drug is given, and for enough time, these resistant forms take over that environment, and you change completely the kinds of bacteria that are living in that farm, that house, that hospital.