04/06/19 SOMETIMES THE ANSWERS ARE SIMPLE

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SOMETIMES THE ANSWERS ARE SIMPLE

The prospect of a microbial resurgence is chilling not only in terms of human suffering but in its cost to the economy. As late as 1938, one study estimated malaria was robbing the South of one-third of its industrial output. Today, an epidemic of staphylococcus resistant to Vancomycin--often considered the antibiotic of last resort--would disrupt the most common medical practices. ''Surgery as we know it would have to change,'' warns Barry R. Bloom, an infectious disease expert at Albert Einstein College of Medicine.
Public-health experts already know how to prevent such disasters. The first step is global vigilance. It's far better to snuff out or prevent a small outbreak than fight an epidemic. With last year's Hong Kong flu, once the avian strain was spotted in humans, microbe hunters around the world speedily unlocked its genetic secrets. Local officials ordered millions of chickens slaughtered. A potential nightmare was averted--demonstrating the power of a swift response.
But the public-health defenses are not impregnable. The Centers for Disease Control, says the Institute of Medicine's Dr. Polly F. Harrison, ''wouldn't be able to simultaneously deal with cholera in India, ebola in Africa, and avian flu in Hong Kong.''
And prevention efforts are riddled with holes. Controversial needle-exchange programs, which slow the spread of HIV, aren't being funded. Syphilis cases in Baltimore have tripled since 1993, in part because agencies don't have the resources to track down and treat patients' sexual contacts. Then there's sloppy hygiene. In the Mar. 12 issue of the New England Journal of Medicine, researchers reported the cause of a potentially fatal yeast infection striking newborns at a Lebanon (N.H.) hospital: workers who didn't wash their hands after playing with their dogs.
Medical authorities must also address the misuse of drugs. In 1954, the U.S. produced 2 million pounds of antibiotics; today the total is more than 50 million. Almost half is used to boost livestock growth--a practice that horrifies many disease experts. ''It is the perfect formula for selecting increasing numbers of antibiotic-resistant bacteria,'' says Tufts University microbiologist Stuart B. Levy.
Doctors and patients are at fault, too. Levy figures half of all antibiotic prescriptions are unnecessary: ''It's a major public-health crisis.'' Antibiotics are powerless against viruses yet are given routinely to patients with viral infections--spurring resistance. Plus, many patients don't take the full antibiotic course, also spurring resistance. ''If we released 10 new life-saving antibiotics tomorrow, in 10 years we'd have resistance problems with them, too, unless we change our practices,'' says Dr. John D. Siegfried of Pharmaceutical Research & Manufacturers of America.
The CDC has kicked off a campaign to convince doctors and patients to rein in antibiotic prescriptions and use drugs properly. So we know how to beat back the microbial hordes. But do we have the will?
By John Carey in Washington, with Amy Barrett in Philadelphia

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