Drug resistance is, as we know, one of my pet areas of fascination. Public health matters to me, and health care justice is an important issue — the people who stand to hurt the most from the development of drug-resistant bacteria are those who can least afford to cope with it. But a World Bank report earlier this year made me think about an aspect of the issue I hadn’t been considering: The economic ramifications. I’m not the World Bank’s number one fan, and I tend to read through its reports carefully because they often contain some troubling assumptions or other issues, but this one makes a point that’s really important and inescapable.
Using various financial projections, the organization explored the economic impacts of drug resistance and found that the result could rival the 2008 financial crisis, which was a hot mess, as some of us may recall. The report found that low-income countries could lose five percent or more of their GDP, and that nearly 30 million people would be pressured into poverty by financial shifts related to drug resistance. Unlike 2008, though, things wouldn’t necessarily pull up, because drug resistance keeps hammering away. That means the potential for permanent structural changes in the global economy.
Some of the costs are probably pretty obvious, if you think about it, the big one being health care expenses. You’re talking direct costs for caring for people with complex prolonged illnesses that do not respond to treatment. Expenses associated with drug research and development. Public health endeavors designed to limit the spread of drug resistant infections while identifying new infectious disease threats. This all costs money, and low-income people are least likely to have the ability to pay their own way, or to contribute in a significant way to their treatment.
There are also the secondary expenses associated with human health issues. Time off work is a big one, and could become a real suck when it comes to productivity levels — people who aren’t participating in an economy are unable to contribute to growth and development, and can at times even drag things down. That gets really complicated with health care workers exposed to infections, because they’re not just losing out financially, but also depriving people of needed health care services.
But it’s farming where things get particularly interesting. As we know, antibiotics are heavily used in a prophylactic sense on farms, both to promote growth and deal with the inevitable infections caused by crowding too many animals too tightly together in unhygienic conditions. Even the cleanest and most spotless and thoughtfully administered factory farm (if there is such a thing) just can’t keep pace with the sheer amount of waste generated, the stress and subsequent susceptibility to infection, and host of other issues that farm animals face.
There’s a lot of pressure to stop with the unnecessary antibiotics already, which is a positive step. But the development of drug resistance means that when animals actually really do need antibiotics, they’re less effective. In cramped herds where infections can spread like wildfire, that means the possibility of losing a substantial part of a herd or flock to a rampant infection that cannot be managed, which is horrifically expensive. It costs money to raise animals, and you hope to recoup that money at slaughter or through the sale of animal products like milk and eggs. Losing a substantial percentage of your animals can be economically devastating — especially with animals like milk cows and goats, which require substantial investment. It takes time to build up a herd, and small farmers especially may not be able to cope with the financial fallout of an outbreak.
Getting proactive about antibiotic resistance isn’t just about trying to shore up human health options or reducing the use of drugs in livestock. This report also highlights that it’s really necessary to consider the ramifications for animal health, including the need for more comprehensive vaccination, better hygiene, and better training for vets, especially in low-income nations where access to veterinary care can be poor.
I like it when I encounter a report or body of research on a subject that introduces a new issue for me. This is something that I could probably have thought about in the abstract, but I’d never actually connected the dots, which makes me feel kind of silly. But it also highlights the importance of the report. Lots of laypeople are interested in antibiotic resistance, and many of us have approached it from the perspective of concern about public health, including in low-income nations where it’s difficult to get adequate health care and the stakes are so much higher. Some of us are likely already thinking about economic impacts, but this report really lays them out in detail and encourages some deeper thinking.
If you haven’t read it and you’re interested in the economics of drug resistance, I definitely recommend checking it out. If you haven’t historically been interested in, or thought about, the economic factors at work here, you should really take a look, because I found it to be eye-opening and rather insightful when it comes to framing the issue from another important perspective. As a bonus, those who don’t think public health is their problem may perhaps be convinced that antibiotic resistance is their problem when they learn about the economic impacts.
Image: Klebsiella pneumoniae, Nathan Reading, Flickr