[Congressional Record (Bound Edition), Volume 159 (2013), Part 4]
[Extensions of Remarks]
[Page 5929]
[From the U.S. Government Publishing Office, www.gpo.gov]




    MEETING THE CHALLENGE OF DRUG-RESISTANT DISEASES IN DEVELOPING 
                               COUNTRIES

                                 ______
                                 

                       HON. CHRISTOPHER H. SMITH

                             of new jersey

                    in the house of representatives

                       Wednesday, April 24, 2013

  Mr. SMITH of New Jersey. Mr. Speaker, the Subcommittee on Africa, 
Global Health, Global Human Rights, and International Organizations 
held a hearing that examined a deadly phenomenon involving both natural 
and man-made elements--diseases that are resistant to most or all 
available methods of treatment. While this is a growing problem of 
increasing concern throughout the world, the subcommittee focused 
yesterday on the impact of such diseases--known as ``superbugs''--in 
developing countries and the challenges to preventing and treating 
these diseases in this part of the world.
  There is a family of germs that occur normally in everyone's 
digestive system. They can cause infections when they get into the 
bladder, blood or other areas where they don't belong. That is the 
natural part of this growing problem. Gut flora are absolutely 
essential for health and an effectively functioning immune response. 
There are about 100 trillion microorganisms in our digestive systems--
ten times the number of cells in our bodies. Most of them help break 
down the foods we eat. Those that are not helpful are usually can be 
treated with existing medicines, such as antibiotics.
  The man-made part is that antibiotics have been used increasingly to 
treat naturally occurring germs, but many of them have become resistant 
to such treatment. These so-called ``superbugs'' pose a threat because 
of overuse or misuse of antibiotics, but they also pose a threat 
because of what some call a ``drug discovery void,'' in which there has 
been insufficient research and development of new medicines to treat 
emerging mutating infections.
  This situation recently has become much more serious. In the last 10 
years, these drug-resistant diseases have been identified in patients 
in more than 200 hospitals in 42 states in this country. Over that 
period, their prevalence rate has increased from 1 percent of patients 
to 4 percent for those in short-term care, but for patients in long-
term care facilities, the rate is as high as 18 percent. Half of all 
patients who contract these diseases do not survive.
  Methicillin-resistant Staphylococcus aureus, or MRSA, one of the 
better known of these superbugs, now kills as many as 19,000 Americans 
each year and a similar number in Europe. That is higher than the 
annual rate of deaths from HIV and AIDS.
  Last year, the World Health Organization identified strains of 
gonorrhea and tuberculosis that are currently completely untreatable, 
as well as a new wave of what might be called ``super superbugs'' with 
the mutation known as NDM1. These frightening new strains were first 
seen in India, but they have now spread worldwide. The spread of the 
H7N9 bird flu in China is causing considerable concern--with more than 
100 confirmed cases and 22 deaths reported thus far. According to 
Agence France Presse, WHO said yesterday that there is still no 
evidence that H7N9 was spreading in a ``sustained'' way between people 
in China.
  According to WHO, artemesinin, when used in combination with other 
drugs, is now considered the world's best treatment against malaria, 
but malarial parasites resistant to artemesinin have emerged in western 
Cambodia, along the border with Thailand.
  In the developed world, we pride ourselves on having top-flight 
medical care widely available to patients. If we lose half of all 
patients who contract these drug-resistant diseases, what about 
patients in the developing world, where statistics are often scarce and 
effective medical care can be even scarcer? Using accepted protocols 
for treating these diseases, their rate of infection can be curbed.
  In Israel, infection rates in all 27 of its hospitals fell by more 
than 70 percent in one year with a coordinated prevention program. By 
following accepted protocols for handling these diseases, the Colorado 
Department of Public Health and Environment and the Florida Department 
of Health both have stopped outbreaks of these drug resistant diseases 
in recent years. But what about hospitals in developing countries?
  For example, the brain drain has sent trained medical personnel in 
Africa in search of better working conditions and pay in the developed 
world. The lack of equipment and supplies that partly led to this brain 
drain would facilitate the rapid spread of drug resistant diseases in 
these countries. What would be simple interventions, including removing 
temporary medical devices such as catheters or ventilators from 
patients as soon as possible, is less likely under current conditions 
in developing world hospitals. Adding to this problem is the presence 
of expired and counterfeit drugs. Patients whose lives could be saved 
may not be because of inadequate medical care. Unfortunately, because 
so many countries do not maintain and report statistics on medical 
issues, we have little idea how serious the situation is today in 
developing countries in Africa and elsewhere around the world.
  In our interconnected world, that means that infected people in the 
developing and developed countries pose a mutual threat.
  Last month, a Nepalese man was detained at the Texas border while 
trying to make an illegal crossing from Mexico. Officials found he was 
infected with an extensively drug resistant strain of tuberculosis and 
had carried this potentially deadly airborne disease through 13 
countries over three months--from his home country of Nepal through 
South Asia, Brazil, Mexico and finally the United States. Who can say 
how many people he infected during this long journey?
  Conversely, six years ago an American infected with multi-drug 
resistant tuberculosis traveled from this country to France, Greece and 
Italy before returning through the Czech Republic and Canada. Upon his 
return to the U.S., he became the first person subjected to a Centers 
for Disease Control and Prevention isolation order since 1963.
  Clearly, both developed and developing nations must work together to 
prevent and treat for these diseases and find a way to implement the 
new strategies in an era of constrained budgets and loosening control 
of authority in far too many countries. However, the Administration's 
proposed FY 2014 budget calls for a 19 percent cut in funding for 
tuberculosis programming at a time we need such capacity the most.

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