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‘Silent Pandemic’ Threatens to Turn Back Century of Medical Progress

Antimicrobial resistance could ‘undermine … care as we know it,’ a leading infectious disease doctor tells TheStreet.

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Antimicrobial resistance could 'undermine ... care as we know it,' a leading infectious disease doctor tells TheStreet.

Spring was just arriving in 1942 when a woman in her early 30s came down with a bad infection with a common type of bacteria: Strep. She was admitted to a hospital in Connecticut, but her illness grew worse and her shot at surviving eventually appeared hopeless. Her temperature hit nearly 107 degrees Fahrenheit as she became distraught and slipped in and out of consciousness. 

Growing desperate, her doctors tried everything – commonly used medications, blood transfusions, even surgery – but nothing helped her, according to a Centers for Disease Control and Prevention description of the patient.

There was, however, one last hope: an experimental drug known as penicillin. 

Discovered by accident by a Scottish microbiologist named Sir Alexander Fleming years earlier, the drug was all the doctors had to offer. They injected the woman with the unproven medicine, and it worked. Within hours her fever disappeared, and then her other symptoms improved. The woman, Anne Miller, became the first American civilian to use the antibiotic treatment and went on to live to age 90. 

While it’s hard to appreciate today the role of such a seemingly simple drug, penicillin and its development helped spur the creation of more and more life-saving antibiotics. The world saw a boom in the drugs spanning from the 1950s to the 1970s, and it changed the course of health care dramatically. The drugs diminished the dangers once posed by common bacterial infections that had plagued the U.S. and the rest of the world before the mid-1900s, when people were lucky to make it past their late 40s. Illnesses such as bacterial pneumonia and diarrhea that were previously the main causes of death in developed nations were suddenly cured within days of taking the new medicines. 

“Before antibiotics, a simple skin infection had a 10% chance of killing you. People never think about that today, because we have antibiotics that cure all bacterial skin infections. We don’t think about skin infections as being a problem at all,” says Dr. Helen W. Boucher of the Levy Center for Integrated Management of Antimicrobial Resistance at Tufts University School of Medicine in Boston. 

But now, warns Boucher and other experts, time for many of these drugs is running out. Antimicrobial resistance is turning back nearly a century of work to prevent deaths from bacterial and fungal infections. In the U.S. alone, nearly 3 million people annually are believed to fall ill to antibiotic-resistant bacterial infections, and more than 35,000 of the patients perish from the germs. 

Dr. Helen W. Boucher of the Center for Integrated Management of Antimicrobial Resistance at Tufts University School of Medicine in Boston.

Boucher and others who are advocating for national initiativeslegislation and global efforts to stave off the threat of resistance, say the world is now facing a “silent pandemic” that could make many routine surgeries too risky, transform common and curable illnesses into the fatal ones they once were, and turn back the clock of health care by many decades.

As part of an occasional series on how to prevent the next pandemic, TheStreet spoke with Boucher by phone recently about this emerging disease threat. In addition to her other roles, Boucher is the interim Dean of Tufts University School of Medicine, Chief Academic Officer at Wellforce, and an infectious disease physician at Tufts Medical Center. The following has been edited for clarity and brevity. 

TheStreet: Everyone has had COVID on their minds for the past year and a half, and everyone has been surprised at the ways in which the disease can affect our bodies. But a common bacterium – Staphylococcus aureus – that you have studied can also affect the heart, lungs, even joints. Could you talk a little bit about that in the context of antibacterial resistance?

Boucher: Before COVID and today, we have been faced with patients who have infections caused by resistant bacteria – everyday. It limits our ability more and more to care for people. We are seeing people who have infections caused by bacteria that are so resistant that we can’t treat them. I’ve had to put people on hospice, because we couldn’t treat their infection. The threat that this poses is really limiting health care, including limiting our ability to perform surgeries, to give people chemotherapy to treat their cancer, to give them organ transplants. The problem of antibiotic resistance is steadily getting worse, despite the efforts that we’re making. That’s why sometimes people call it the “silent pandemic.”

People like me, and our professional society, the Infectious Diseases Society of America, and others, are working hard to get buy-in from a lot of stakeholders, including the government, to make investments that will allow us to slow down, or stop, antibiotic resistance.

TheStreet: Tell me if I’m overstating the threat – but it sounds as if these drugs that we now depend on lose their effectiveness to resistant bacteria, that we will eventually increase the risk of any type of basic surgery, or even getting a cut, or even a respiratory infection….

Boucher: That’s exactly the concern – that we could undermine medical care as we know it. If you think about our aging population and how cancer is tremendously common – you can’t treat cancer if you don’t have antibiotics, full stop. You can’t do it. This could be a very serious – well it is a very serious problem – but it could become worse. 

TheStreet: It seems like a big part of the this problem is … the lack of financial incentive for creating new antibiotic drugs, right? Most antibiotics are used over a few days and are expected to be affordable and some call the business model “broken.”

Boucher: One of the problems is the broken antibiotic market. So, one of the tools, one of the ways to address resistance, is to develop more antibiotics. But there are a number of other ways – antibiotic stewardship, having better diagnostics, and infection prevention in our hospitals. But new antibiotics are a very important part of combating the problem of resistance, and our market is broken. Even longer than 10 years ago, big pharma kind of left the space and then these little companies tried to move in and pick that up, and unfortunately the market has only gotten worse. We’ve seen the bankruptcy of several companies. A number of measures have been taken to try to fix this: so-called push incentives – things that would help the process before Food and Drug Administration approvals. Carb-X, for example, is a public-private partnership that gives money to these small companies. Those have been pretty successful. 

But the bad news is that the post-FDA-approval world is still quite broken. Companies have been going bankrupt, because they’re not selling enough to stay afloat. Now, there’s movement for so-called pull-incentives to come into play at or after FDA approval. One is (legislation called) the Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (Pasteur) Act, which is a subscription model that is a contract with the government that would provide a guaranteed return on investment to a company that would produce a much-needed antibiotic that meets certain criteria for up to 10 years. It’s linked to rigorous antibiotic stewardship and reporting use to the CDC and some other things that are measures that would provide the best chance for that antibiotic to last as long as possible. 

Over 40 big stakeholder groups have signed on in support of the Pasteur Act, and we are very hopeful that will move forward as one step toward reinvigorating the pipeline. 

TheStreet: A lot of people when they go to the doctor, they don’t always get a test to diagnose a particular viral or bacterial or other infection (especially before the pandemic). … Does more diagnostic testing make sense, so that doctors can accurately determine what’s causing symptoms? Patients have no idea whether the antibiotics they are taking are appropriate.

Boucher: The whole area of diagnostics is a big focus here. It’s clear that if we could diagnose whether a person has a virus -- or bacterial infection -- upfront, we would save a lot of inappropriate antibiotic use. There is a lot of focus on diagnostic testing and a lot of work going into that. This is a so-called wicked problem and it requires a really multifaceted approach and solutions. There are several international prizes being awarded for innovative strategies for testing, and the COVID epidemic has really shown us – again – the importance of having good diagnostic testing. I know that this fall we’re all going to be very focused on the importance of diagnostic testing. When people come in with respiratory symptoms – we'll be asking, Is it COVID? Is it the flu? Is it bacterial? That is a big, big issue.

 

TheStreet: How much should we be looking at vaccines for bacterial infections?

Boucher: Vaccines are very important. You perhaps think of vaccines as treating viral infections, but many bacterial infections are so-called super infections. So a person comes in with influenza, and they get a bacterial pneumonia because of Staph – Staphylococcus aureus – if you prevent the flu in the first place, they will never get the staph pneumonia. So, vaccination is vitally important. Not just the flu vaccine and COVID vaccine, but there are pneumonia vaccines – very, very effective.  They are hugely important. But if we think the economic argument for antibiotics is difficult, the economic argument for vaccines is even more difficult… .

TheStreet: But you’re talking about the argument for producing and selling vaccines, and yet aren’t they highly cost-effective from a public health standpoint?

Boucher: Correct. But, someone still has to do the developing, somebody has to buy them and distribute them and all that. Investment is still required.

TheStreet: Is there a disconnect ... between global warming and emergence of these diseases?

Boucher: We know that it fits into this picture. This is a one-health problem. Antibiotic resistance involves humans, animals and the environment and all the interactions among them. With global warming, we’ve already seen a spread of resistance and changing resistance patterns, so we know that there is a relationship.

TheStreet: What about antifungal resistance?

Boucher: Antifungal resistance is very real. It’s definitely associated with global warming. There are some fungi that grow better in warmer climates, in warmer temperatures, and we are seeing that. You might have seen the outbreaks of mucormycosis in people with COVID in India. That’s related to the environment. The problem of resistance in antifungals is getting worse. We’re seeing a resistant Aspergillosis in this country, and things we hadn’t seen previously. There is a real need to address antifungal resistance. It’s a particular problem in immunocompromised people. So, those cancer patients, transplant patients – special groups. But then you see something like the horrible thing we see in India with the mucormycosis, and that’s happening not in immunocompromised patients, but in (all kinds of) patients. That is very disturbing and just a sign of what many people believe is to come. 

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Spread & Containment

Addressing the HIV epidemic in Eastern Europe and Central Asia

Working in partnership will be key, says Alex Kalomparis, vice president, public affairs, international at Gilead Sciences. 2021
The post Addressing the HIV epidemic in Eastern Europe and Central Asia appeared first on .

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Working in partnership will be key, says Alex Kalomparis, vice president, public affairs, international at Gilead Sciences.

2021 marks 40 years since the first cases of HIV were reported. In that time, over 79 million people have been diagnosed with HIV, with more than 36 million dying from AIDS-related illnesses, more than any other infectious disease.

While there has been incredible progress in the HIV response, nearly 38 million people are living with HIV, with more than a million new cases every year, jeopardising the goal to end AIDS as a public health threat by 2030.

HIV places enormous burdens on the communities it affects most, straining health systems and government budgets. In the era of the global COVID-19 pandemic, where health systems are already stretched to breaking, it is tempting to cut costs in other areas, including HIV. If commitment to the HIV response wanes, the progress we have made is at risk, leading to increases in new infections in regions that can least afford to tackle them.

“An epidemic somewhere is an epidemic everywhere”

Throughout the COVID-19 pandemic, we have seen the temptation to focus on one’s own backyard, isolate oneself from the rest of the world, and believe one is safe and protected. We know now that this protection is an illusion. Regardless of the protections we erect in our own countries, allowing public health crises to persist in other parts of the world threatens our own progress and safety.

The message is clear: an epidemic somewhere is an epidemic everywhere. To find our way out of a pandemic, we must broaden our ideas of how to respond, and address the problems and inequities that allow diseases to thrive in other parts of the world. To be effective, our response must be global.

The same is true for HIV. HIV has persisted for 40 years, and is still here because root problems continue to drive the epidemic: stigma and discrimination, poverty, lack of access to services and treatments, lack of access to education, and the marginalisation of the people and communities most at risk of HIV. These are not issues that can be addressed by any one government, group, or company. They can be addressed only in partnership with one another, and by engaging those key marginalised communities in our effort to end the HIV epidemic.

Whilst the global community has the tools it needs to meaningfully address new HIV infections, HIV is on the rise in Eastern Europe and Central Asia (EECA). Unlike other regions in the world, rates of HIV in EECA have increased, with infections up by 72 per cent, and AIDS-related deaths up by 24 per cent since 2010.

Working with the Elton John AIDS Foundation

However, across EECA, a range of community partners are making significant contributions in the fight against HIV, such as the first wave of the RADIAN ‘Unmet Need’ fund and Model City grantees, previously announced in 2020. In the first nine months of the programme, these partners have already reached more than 12,000 people from vulnerable communities directly with services, initiating life-saving care in over 2,000 people living with HIV.

RADIAN, a ground-breaking partnership between Gilead Sciences and the Elton John AIDS Foundation, works with local experts to target new HIV infections and deaths from AIDS-related illnesses in EECA in the communities most vulnerable to HIV.

Focusing on the groups most affected by HIV in EECA (eg men who have sex with men, transgender people, sex workers, and people who use drugs), RADIAN engages with groups led by these communities and are sensitive to the difficulties unique to the region.

“We all have one common goal: ending HIV”

Anne Aslett, CEO of the Elton John AIDS Foundation, is clear that for the partnership to reach its goals, it’s crucial to listen to and amplify the voices of people for whom HIV is a tangible, daily reality.

“They understand better than anyone the challenges associated with the virus, and what works to stop it. No matter where we are in the world, we must partner with them, and follow their leadership. We are proud of our RADIAN partnership with Gilead, to champion the vital work of communities to bring an end to the AIDS epidemic in Eastern Europe and Central Asia.”

Companies like Gilead Sciences provide industry leading expertise, while Governments bring an understanding of health systems and funding, developing an infrastructure that enables access.

However, these efforts need community leadership because they know best how to ensure people can access those systems to get tested, and adhere to medication. They understand the fears and sensitivities, the strengths and stigma within those communities, the nuances that make the difference in linking their members to the care they need. No two regions of the world experience the ‘same’ HIV epidemic. People living with HIV are critical to the success of any HIV response.

This autumn, RADIAN will launch a campaign telling the inspirational stories of ordinary, yet remarkable, community members who are taking action to turn the tide of the HIV epidemic in EECA.

We all have one common goal: ending HIV. It is crucial that we all understand the role we can play to achieve this. Our access to global networks of public health expertise, government funding, and innovative HIV treatments are meaningless unless they are used in service of people living with, and at risk of, HIV. They are the core of any successful response, regardless of country or region. Working in partnership with them is the key to ending HIV. By respecting them as leaders and giving them the seat at the head of the table, we make our work more effective and responsive to local needs, bringing us closer to the end of the HIV epidemic globally.

About the author 

Alex Kalomparis is vice president, public affairs, international at Gilead Sciences. He joined the company in January 2017 and is responsible for all communications and patient advocacy activities across Africa, Asia, Australia, Canada, Europe, Latin America and the Middle East. Prior to that Alex held senior communication roles with a number of consumer and pharmaceutical companies, including Unilever, Rolls Royce, Novartis, Roche, AstraZeneca and GlaxoSmithKline.

The post Addressing the HIV epidemic in Eastern Europe and Central Asia appeared first on .

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Science

Your immune system is as unique as your fingerprint – new study

New discovery could help scientists develop more targeted drugs and vaccines.

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Christoph Burgstedt/Shutterstock

Every person appears to have a unique immune system. My colleagues and I discovered this immune diversity after charting antibodies in the blood from healthy and sick people. The discovery could help explain why, for example, COVID vaccines appear to be less effective for some people. At the same time, it points to the possibility of identifying and retrieving particularly effective antibodies from individuals and using them to cure others.

In our daily life, our body is confronted and attacked by many germs that use clever tricks to enter our body, aiming to take control. Luckily, we have a powerful defence: our immune system.

With a well-functioning immune system, we can combat most of the germs that continuously and aggressively approach us. Part of our arsenal of weapons to neutralise invading germs are protein molecules called antibodies. These antibodies are abundant in the blood, streaming throughout our body, forming the first line of defence when a new nasty germ appears.

Each different germ requires a different arsenal of weapons (antibodies) to combat them most efficiently. Luckily, our body has provided us with a means to make millions to even billions of different antibodies, but they cannot all be made at the same time. Often, specific antibodies are only made as a response to a particular germ.

If we are infected by bacteria, we start to make antibodies to attack and kill those bacteria. If we are infected by the coronavirus, we start to make antibodies to neutralise that virus. When infected with the flu virus, we again make other ones.

How antibodies fight coronavirus.

How many different antibodies are made at a given moment and are thus present in our blood, was not known. Many scientists estimated it to be over several billion and hence almost immeasurable. Using a few droplets of blood and a technique called mass spectrometry, my colleagues and I were able to capture and measure the number of different antibodies in the blood and also assess the exact concentration of each of them.

Two surprises

Although theoretically, our body has the capacity to make trillions of different antibodies, a first surprise came when we noted that in the bloodstream of both healthy and diseased people just a few tens to hundreds of distinct antibodies were present at high concentrations.

Monitoring these profiles from just a few droplets of blood, we were surprised for a second time when we noticed that the way the immune system responds to germs varies highly from person to person, with each person’s antibody profile being unique. And the concentrations of these antibodies change in a unique way during illness or after a vaccination. The results may explain why some people are more prone to becoming ill from flu or COVID, or why they recover faster from some illnesses than others do.

Until now, scientists considered it impossible to accurately map the highly complex mixture of antibodies in the blood. But mass spectrometry separates substances based on their molecular composition, and since each specific antibody has a distinct molecular composition, we were able to use a refinement of the technique to measure all antibodies individually.

The method has been used to measure antibody profiles in about 100 people, including COVID patients and people vaccinated with different COVID vaccines. Not once did we encounter the same antibodies in two different people, even if they had received the same vaccine. It’s safe to say that everyone’s antibody profile is as unique as their fingerprint.

Even though the differences in antibodies are small, they greatly influence the course of a disease. If someone makes fewer antibodies against a certain germ, or only antibodies that are less effective at killing the germ, then a disease might strike harder or several times. On the other hand, if people produce antibodies that are excellent at neutralising the germ, that antibody could be produced therapeutically and used to vaccinate or treat patients.

Our research creates opportunities to make optimal vaccinations and drugs tailored to an individual’s immune system. By mapping someone’s antibody profile, you can track how their body responds to a vaccine or infection – or even a drug treatment. This way, you can also check whether the body produces enough of the desired antibodies, for example, those against the coronavirus. If they don’t produce enough, you can consider offering booster shots or antibodies that worked for other people.

Albert Heck receives funding from the Netherlands Organization fro Scientific Research

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Government

The Bloc’s Secrets of Success: 5 Ways The Health Creative Agency Won 200 Awards

As a global pandemic has reshaped society, The Bloc has been at the forefront of changing not just what stories get told about healthcare, but how they are told. In doing so, the health creative agency has won more than 200 film and advertising awards…

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The Bloc’s Secrets of Success: 5 Ways The Health Creative Agency Won 200 Awards

The Bloc achieved unprecedented levels of acclaim and recognition by embracing creativity, racial justice, technology, new practices, and people

New York, NY, September 22 – Over the past two years, The Bloc has redefined health creative to become one of America’s most talked about agencies. As a global pandemic has reshaped society, The Bloc has been at the forefront of changing not just what stories get told about healthcare, but how they’re told. In doing so, they’ve won over 200 film and advertising awards in 2020 and 2021. Recently, The Bloc became the first ever health agency listed on the “Of The Year” ranking for the entire Cannes Lions International Festival of Creativity. In addition, The Bloc is a founding member of The BlocPartners, the acclaimed global network of independent health creative agencies. The BlocPartners recently placed second in the “Health Network of the Festival” category at the Cannes Lions Health Festival.

The Bloc CEO Jennifer Matthews (PRNewsfoto/The Bloc)

“The work we’ve been so awarded for lately has been a natural extension of our motto ‘Be Great to Do Good,’” said Jennifer Matthews, CEO at The Bloc. “Health is life. It deserves the very best in creative excellence.”

  1. Invest in Hollywood Level Filmmaking 

A man walks through a futuristic train station, suffering from a cough, and decides to seek help from an automated doctor. That’s the premise of The Bloc’s award-winning short film Instant Doctor. Made so as to give thanks to doctors and released on National Doctor’s Day (March 30, 2020), the film highlighted the importance of the human element in healthcare by showing a world where medicine is done via machines.  

Instant Doctor won the Grand Jury Award for Best Short at the New York International Film Awards and was declared the Best Sci-fi Short Film at the 2020 Rhode Island International Film Festival.

“Instant Doctor has shown the industry that healthcare advertising can have not just the production quality but also the storytelling excellence of Hollywood movies,” said Bernardo Romero, Chief Creative Officer at The Bloc. “Healthcare has never been more important, which means health creative should be of the same quality as what you would see in a movie theatre or stream on Netflix.”

  1. Tackle the Biggest Issues – Including Racism and Racial Bias in Healthcare

Some of The Bloc’s most acclaimed recent work has centered around racial justice, both in healthcare and in the broader world. 

In early 2020, The Bloc, in partnership with acclaimed ballet dancer Ingrid Silva’s EmpowHer New York, released “The Call,” a short film where an actress went undercover on nursing advice hotlines to expose racial disparities in healthcare treatment. 

The Bloc went on to work with Ingrid on two more films. First came Skindeep, an animated story about racial trauma told through watercolor frames by Black women illustrators. Skindeep was followed by Making Space, a documentary about Ingrid’s life journey which premiered at Cannes Lions. 

In partnership with the National Black Child Development Institute, The Bloc created ABC’s of Survival, a tear-apart book for black children and their parents. The book aims to support mental health and change laws by including postcards that can be sent to congress. The ebook can be found at abcsofsurvival.com.

  1. Hire and Promote the Best People

The Bloc continues to grow rapidly and has recently hired Stuart Goldstein as COO and promoted Antoinette Bobbitt to EVP, strategy director. Stuart will be The Bloc’s first COO, and he’ll oversee the management for over 4,500 projects a year, with the goal of increasing efficiency and profitability. Meanwhile, Antoinette will ensure that The Bloc’s competitive differentiation is present in all client work.

The Bloc’s commitment to its employees was underscored this summer when Fortune magazine listed it as one of the best workplaces in New York for 2021. The Bloc is one of three advertising agencies on the list, and the only health creative agency focused exclusively on health.

  1. Get High Tech

More and more agencies are realizing that their creative skills can be used to power tech innovations, and The Bloc has focused on the development of tech to address pressing health needs. At the beginning of the pandemic, The Bloc pioneered SafeCode, a device concept which combined a bar-code scanner with UV light to help stop the spread of disease on delivery packages. 

The Bloc has also created a tool to aid mental health. At the end of 2020, they worked with Rockwell Ventures to create Scrollaby, an app which takes the habit of “doomscrolling” and turns it into a sleep aid, with over 1,000 pieces of custom content that support rest and relaxation.

  1. Rethink Agency Practices

To expand upon the capabilities it has developed, The Bloc has established new practice areas that distinguish it in the healthcare agency space.

One new practice area is The Bloc Science Foundry, which applies behavioral science and scientific expertise to medical communications. The other is The Bloc Storytellers

And this year, The Bloc announced its Storytellers department, which is dedicated to bringing unsurpassed production and narrative quality to healthcare creative. Storytellers seeks to replicate the success The Bloc has had with The Call, Skindeep, and Instant Doctor. The Bloc is currently searching for the best creative minds from the film, theater, and TV industries to join their team. Resumes can be sent to storytellers@thebloc.com.

 

About The Bloc

The Bloc is a leading independent health creative agency in the United States. Celebrating 21 years in 2021, The Bloc delivers comprehensive omnichannel communications for audiences across the health spectrum and partners with innovative clients who are doing some of the most meaningful and exciting work in health today. A founding member of The BlocPartners, the leading global network of independent health creative agencies, The Bloc’s work has been globally recognized for creativity and innovation. For more information, visit www.thebloc.com.

 

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