Friday, June 29, 2018

2954. Join the International Campaign to Free Khalida Jarrar, Palestinian Political Prisoner

By Samidoun, June 29, 2018

Palestinian leader Khalida Jarrar, a leftist, feminist parliamentarian imprisoned by the Israeli occupation, has been jailed without charge or trial since 2 July 2017. As her friends, family and comrades awaited her release, they were instead informed on 14 June that her administrative detention had been renewed for the third time for an additional four months. Take action to demand the immediate release of Khalida Jarrar and her fellow Palestinian prisoners!
As Palestinians march in Gaza in the Great Return March, and as they take to the streets in the West Bank in the Lift the Sanctions movement, the Israeli occupation is extending Khalida Jarrar’s detention without charge or trial to keep this strong, powerful leader off the streets and away from her people.
Khalida’s administrative detention renewal is scheduled to be approved by an Israeli military court on 2 July. Before this approval happens, it is important that international solidarity is heard, loudly and clearly, demanding her freedom!
Khalida Jarrar is a longtime advocate for the freedom of Palestinian prisoners, the Vice-Chair of Addameer Prisoner Support and Human Rights Association and its former Executive Director. A member of the Palestinian Legislative Council elected as part of the leftist Abu Ali Mustafa Bloc, associated with the Popular Front for the Liberation of Palestine, she chairs the PLC’s Prisoners Committee.
She is also an outspoken leader in the fight to hold Israeli officials accountable for war crimes in the International Criminal Court. She is a member of a Palestinian commission charged with bringing complaints and files before the international court about ongoing Israeli crimes against the Palestinian people, from attacks on Gaza to land confiscation and settlement construction to mass arrests and imprisonment.
This is not the first time she has faced arrest and persecution. In 2014, she resisted – and defeated – an Israeli attempt to forcibly displace her from her family home in el-Bireh to Jericho. Only nine months later, in April 2015, she was seized by Israeli occupation forces and ordered to administrative detention, imprisonment without charge or trial. After a global outcry, she was brought before Israeli military courts and faced 12 charges based on her political activity, from giving speeches to attending events in support of Palestinian prisoners.
After she was released in June 2016, she resumed her leading role in the Palestinian liberation movement, only to be seized once more on 2 July 2017 and once again thrown in prison with no charges and no trial. Her administrative detention was already renewed for another six months in December 2017, and it is clear that the Israeli occupation has no intention of releasing Khalida, one of the leaders among the 6,200 Palestinian prisoners (including nearly 500 administrative detainees) in Israeli jails.
She, along with her fellow administrative detainees, boycotts the Israeli military courts that rubber-stamp their military detention orders. They are demanding an end to the practice of administrative detention, first brought to Palestine by the British colonial mandate before being adopted by the Zionist occupation. Administrative detention orders can be issued for up to six months at a time, and they are indefinitely renewable. Palestinians have spent years at a time jailed without charge or trial under administrative detention.
Within the Israeli occupation prison, she has played a leading role in supporting the education of the minor girls held there, organizing classes on human rights and in review for mandatory high school examinations when the prison authority denied the girls a teacher. 

We know that the Israeli military court hearing is a sham. But it is more important than ever that our voices are heard and our actions are visible throughout the next week to demand freedom for Khalida Jarrar. Protests are already being organized in New York and elsewhere around the world. Join us and take action!
1. Sign the petition: Denounce Khalida’s imprisonment without charge or trial. Sign the petition at to add your name.
2. Organize a protest, demonstration or other gathering or event to Free Khalida Jarrar- especially on June 30, July 1 or July 2. Bring posters and flyers about Khalida’s case and hold a protest, or join a protest with this important information. Hold a community event or discussion, or include Khalida’s case in your next event about Palestine and social justice.  Find your nearest Israeli embassy here: to us at or contact us on Facebook to let us know about your action! 
3. Contact your Member of Parliament, Representative, or Member of European Parliament. The attack on Khalida is an attack on Palestinian parliamentary legitimacy and political expression. Parliamentarians have a responsibility to pressure Israel to cancel this order.
4. Boycott, Divest, and Sanction. Hold Israel accountable for its violations of international law. Don’t buy Israeli goods, and campaign to end investments in corporations that profit from the occupation. Learn more at
Campaign Materials
Download the posters/flyers:
Campaign Flyer/Factsheet
Download PDF (A4/ 8.5 X 11)Campaign Poster

Thursday, June 28, 2018

2953. 2017 Was the Second Worst Year on Record for Tropical Forests

By Eliza Barcley, Vox, June 28, 2018
The principal driver of deforestation in tropical countries like Ecuador, pictured here, is agriculture. Photo: Ministry of Agriculture.

The current rate that we’re clearing the Amazon and other tropical forests in Southeast Asia and Central and West Africa
is putting us on a course for rapid, irreversible, and catastrophic climate change, with an intensifying cycle of extreme droughts, more heat, and more forest fires. All told, deforestation accounts for an estimated 15 percent of total greenhouse gas emissions.OSLO, Norway — Tropical forests are essential for keeping carbon in the ground and maintaining the climate. When Amazonian forests are converted into savannah, there’s less rainfall and more drought.

Given forests’ importance, new data from the University of Maryland released on Global Forest Watch, a forest monitoring site, is alarming: 2017 was the second-worst year on record for tropical forest loss. Some 39 million acres of trees, an area the size of Bangladesh, were destroyed. That’s about 40 football fields of trees lost every single minute.

2017 turned out to be only slightly better than 2016, which was the worst deforestation year to date due mainly to an El Niño-related drought and the major spike in fires it caused in Brazil.
“This is a crisis of existential proportions,” Ola Elvestuen, Norway’s minister of climate and environment, said Wednesday at the Oslo Tropical Forest Forum where the data was released. “We either deal with it or we leave future generations in ecological collapse.

What caused deforestation in 2017?
As the chart shows, deforestation in the tropics has been accelerating. Which means we are not keeping up with — much less reversing — the growing pressures on forests from people clearing and burning them for agriculture, livestock, and timber.

Governments, corporations, and local communities are taking the issue more seriously. But many factors contributed to the extraordinary destruction of forests last year.

Deforestation increased significantly in a few countries in 2017, most notably Colombia and the Democratic Republic of Congo. In Colombia, the peace process and the demobilization of the Revolutionary Armed Forces of Colombia (FARC) left a power vacuum in vast, remote forest regions. With the rebel group no longer controlling the forest areas (and the lack of any other government entity to regulate them), opportunists moved in to log and clear land to plant coca and other crops.

Overall in 2017, Colombia lost 1 million acres — 46 percent more than the previous year. In the DRC, some 3.4 million acres of forest were lost to agriculture, artisanal logging, and charcoal production.

Brazil had success slowing deforestation between 2004 and 2012 through better monitoring and crackdowns on illegal activity, incentives for farmers to not clear forests, and programs to cut off illegal soy and cattle producers from markets.

But in a dramatic turnaround, tree cover loss doubled there from 2015 to 2017. As the World Resource Institute’s Frances Seymour writes, this is “in part due to unprecedented forest fires in the Amazon ... [and] to a relaxation of law enforcement efforts in the midst of the country’s ongoing political turmoil and fiscal crisis.”

According to Carlos Nobre, a Brazilian scientist and expert on climate change, we’ve already deforested about 18 percent of the Amazon. Reaching 20 to 25 percent deforestation would cause the “system to flip to non-forest ecosystems in eastern, southern and central Amazonia,” he wrote with Thomas Lovejoy in a recent paper in Science Advances.
“We are very close to 20 percent,” he said Wednesday at the Oslo Tropical Forest Forum. “We need to stop completely Amazonian deforestation. We do not want the Amazon to become a global cattle ranch.”

In most tropical regions, demand for soy, beef, palm oil, and other commodities — as well as fires — is driving the bulk of deforestation. In Brazil, which lost 11 million acres of forest cover in 2017, the main use for cleared land is cattle pasture.

In the Caribbean, the total forest lost during the 2017 Atlantic hurricane season was small compared to Brazil and DRC. But the Category 4 hurricanes that pummeled the region still did a number on forests there. The island of Dominica lost 32 percent of its tree cover in 2017, while Puerto Rico lost 10 percent.

Why stopping deforestation is so difficult
So what to do about it?

In the past 10 years, we’ve seen more and more ambitious international commitments on forests and climate change, including the Paris climate agreement, REDD+, and the Sustainable Development Goals. Better satellite images, remote sensing, and other technologies are helping law enforcement respond to illegal deforestation far quicker. More and more companies are committing to only buying from producers who can certify they are improving the environment.

“It comes down to regulation, enforcement, and incentives,” said Norway Environment Minister Elvestuen.

Some countries actually saw a drop in tree cover loss in 2017. Indonesia achieved a decrease because of a moratorium on converting peatland, better education of farmers, and enforcement around burning forests, according to the new report.

But it’s not enough. According to Seymour, who spoke Wednesday in Oslo, “We know what it takes. And we’re not doing enough of it, and we don’t have enough help to do it.”
The list of things we need to do is very long and very challenging, especially given the growing appetite for meat and other commodities like palm oil, timber, and cocoa. We need to shift global diets and lower meat consumption. We need to persuade farmers not to burn forests.

In the case of Brazil, cattle pasture is the main use of cleared land. And farmers “have grown weary of being vilified as criminals, of unmet promises of positive incentives for shifting to sustainable production systems...” write Daniel Nepstad and João Shimada of the Earth Innovation Institute for Mongabay. “To gain the support of conservation-minded, responsible farmers for the deforestation agenda, a new narrative and set of actions is needed that recognizes, applauds and rewards them for their efforts as it effectively includes them in dialogues.”

Increasingly, forest advocates are talking about connecting people who live in or near remaining tropical forests with opportunities to restore them. The Nature Conservancy, for instance, has been heavily involved in a new initiative with 7 other institutions called Nature4Climate, that will try to engage farmers and others around reforestation and conservation agriculture.

“We can’t have self-righteous NGOs just telling people ‘you can’t cut down your forests,’ anymore,” Justin Adams, TNC’s managing director of global lands, told Vox. “We want to help countries manage land and trade carbon as an asset. There has to be an economic opportunity for tropical forest countries in restoring ecosystems.”

On the bright side, there seems to be more dialogue across the board, around the world, than ever.

Tuesday, June 26, 2018

2952. Nigeria’s Farmers and Herders Fight a Deadly Battle for Scarce Resources

By Emmanuel Akinwoto, The New York Times, June 25, 2018 
Nigeria with over 195 million people is the seventh most populous county in the world and the largest economy in Africa. Its purchasing power parity per capita income was $5740 in 2016.
ABUJA, Nigeria — Clashes between armed herdsmen and farmers in Nigeria are escalating to increasingly violent episodes as a battle for scarce resources stirs long-held tensions over religion and ethnicity.

By some estimates, the clashes have taken more than 500 lives this year.
In recent days, at least 86 people were killed in several villages in Plateau State in the middle of the country, among the deadliest of the episodes.

On Friday and Saturday night dozens of suspected armed herders, who are Muslim and of the Fulani ethnicity, descended from surrounding hills into several villages, opening fire, burning homes and shooting to death some people, most of them Christian and of the Berom ethnicity, as they slept.

The killings immediately triggered reprisals as young people from the villages set up road blocks and killed anyone suspected of being Muslim and Fulani. One police commissioner in the area said at least five people died at checkpoints.

Conflict between herders and farmers over natural resources has a long history throughout sub-Saharan Africa. In Mali, officials on Sunday said more than 30 herders and their children were killed in an area where disputes have raged over competition for land.
The issue has particularly polarized Nigeria, especially in the Middle Belt, the agrarian bread basket that stretches across the country.

As the nation’s population has soared and available grazing land has shrunk, farmers have settled on land that herders have used for hundreds of years as grazing routes to move their cattle seasonally.

Many parts of the country have been affected by the conflicts, including in the north, where Muslims constitute most of the farmers. But much of the recent surge in violence has taken place in the Middle Belt, where the herders are typically ethnic Fulani and Muslim, and the farmers are mostly Christian.

Many of the herders near the site of last weekend’s violence farm in addition to taking care of livestock, creating all the more competition for land.

It appears that many of those killed this year have been farmers, but the pastoralists have also been attacked in reprisals.

In January, seven Fulani died after being set ablaze by a mob in Benue State. Fulani pastoralists, which include not only herders but older women who sell milk from the livestock, are often referred to disparagingly in local media reports from the nation’s mostly Christian urban centers.

The attacks are testing the government of President Muhammadu Buhari, who came to office in 2015 vowing to instill security. Many Nigerians say that promise has been unfulfilled on a number of fronts — including a war with Islamist militants as well as rampant banditry in some areas.

Mr. Buhari, a Muslim and Fulani, has been accused of allowing the attacks to continue, and his vice president, Yemi Osinbajo, a Christian, has been faulted for failing to speak out.
After the weekend attacks on villages, Mr. Buhari tweeted, “We will not rest until all murderers and criminal elements and their sponsors are incapacitated and brought to justice.”

In Benue State alone, in the heart of the Middle Belt, more than 300,000 people have been displaced by violence this year, most ending up in government-run camps, according to official statistics. More than 50 villages have been attacked by armed men, and about as many more have been deserted by residents fearful of attacks.

Though most of the uprooted residents were subsistence farmers, some had produced enough that their displacement has cut food production and driven up prices in the region.
In Plateau, one of the most ethnically diverse states in Nigeria, disputes between indigenous and settler groups over resources and representation exploded into deadly conflicts for more than a decade; more than 7,000 people died between 2001 and 2011.

More recently, violence has been rare in Plateau. Yet the city and surrounding towns remain partly segregated along religious lines, with Muslims and Christians living in divided communities, and so the conflict over land is particularly explosive.

The killings over the weekend appeared to be revenge for attacks on pastoralists earlier in the week. On Thursday, five cattle-rearers riding in a truck full of cattle were ambushed, their cows stolen and truck set ablaze. The five men are still missing.

One of the cattle breeders associations in Plateau complained to the state government and security forces that more than 400 of their cattle had been stolen with their herders attacked or killed in recent months.

In late April, about 30 nomadic Fulani herdsmen were blamed for storming St. Augustine’s Roman Catholic Church in the rural Middle Belt and killing at least 17 worshipers and two priests.

Paulina Shimakaha had just slipped into the front row for the 6 a.m. Mass, when the quiet was shattered by shouting and gunshots.

“Several men came in, some of them from the back entrance, some from the altar,” said Ms. Shimakaha, 60, who teaches nursery school in the farming village of Mbalom. “They started killing straight away.”

The April attack triggered protests as thousands gathered to decry the violence in Catholic Church-organized rallies across Nigeria. Other Christian groups have pointedly cited religion in faulting the government. Adebayo Oladeji, a spokesman for the Christian Association of Nigeria, said that Mr. Buhari had overseen a period in which the safety of Christians had deteriorated.

“The emergence of President Muhammadu Buhari has emboldened the Fulani herdsmen who have been invading Christian communities, killing, maiming and destroying with impunity,” he said. “These criminals are being treated with kid gloves.”
Abiodun Baiyewu, the director of Global Rights Nigeria, a human rights group, said the government’s failure to combat the violence has deepened ethnic and religious suspicions and widened divisions.

“The religious dimension is being seized on because the government has failed to provide security while so many have died,” Ms. Baiyewu said. “So people are explaining the failings with what reasons they can.”

Mr. Buhari has condemned the killings, and the military had deployed more than 1,000 troops in past weeks in a special operation intended to curb the violence, said Gen. John Agim, a spokesman.

Military officials have attributed the surge in killings, in part, to a migration of pastoralists from neighboring Chad, Niger and Cameroon that is being propelled by changing climate conditions and insecurity. Specifically, the war with Boko Haram has spilled into areas where nomadic herders typically roam, forcing them to find new terrain.

But they also note that criminals and militias are behind at least some of the recent attacks. Often, the Fulani are used as the scapegoat.

Many of the recent attacks attributed to pastoralists have been carried out by men armed with AK-47s, the police say, although herders have not traditionally carried such weapons.
Because many herders lead a nomadic culture, they have few advocates. One of them, Mohammed Bello, a former adviser to a local cattle breeders association, said pastoralists are routinely, and often wrongly, characterized as perpetrators.

“The conflict has become so politicized and driven by a specific narrative that the media no longer distinguish between banditry, other criminal factors and the traditional conflict,” Mr. Bello said.

An ineffective security structure in rural areas is fueling fears, said Sola Tayo, a fellow at the Chatham House research group.

“People in rural communities are incredibly exposed and response times to reports of attacks are poor,” Ms. Tayo said. “The police service in Nigeria is inadequate for the size of the population and is very much urbanized, leaving people in remote areas vulnerable.”

Wednesday, June 20, 2018

2951. The Bacteria Babies Need

By Kristin Lawless, The New York Times, June 17, 2018
B. Infantis
We may be missing the key to one of the biggest boons to public health since the introduction of iodine into the food supply in 1924.

Scientists at the University of California, Davis, have found that a strain of bacteria called B. infantis that is thought to have been the dominant bacterium in the infant gut for all of human history is disappearing from the Western world. According to their research, this was probably caused by the rise in cesarean births, the overuse of antibiotics and the use of infant formula in place of breast milk.

Indeed, nine out of 10 American babies don’t harbor this bacterium in their gut, while researchers suspect that the majority of infants in less industrialized countries do.
Bruce German, a professor of food science and technology and one of the U.C. Davis researchers, says, “The central benefits of having a microbiota dominated by B. infantis is that it crowds all the other guys out” — especially pathogenic bacteria, which can cause both acute illnesses and chronic inflammation that leads to disease.

Studies suggest that by the time babies without B. infantis are children, they are more likely to have allergies and Type 1 diabetes and more likely to be overweight. This change to the infant gut may be at the root of the rising prevalence of diseases and ailments, from allergies to certain cancers.

Dr. German and his colleagues learned about the missing bacterium by studying breast milk. They found that the milk contains an abundance of oligosaccharides, carbohydrates that babies are incapable of digesting. Why would they be there if babies can’t digest them?
They realized that these carbohydrates weren’t feeding the baby — they were feeding B. infantis.

What can new mothers do to ensure that their babies have this beneficial bacterium? At the moment, nothing.

If you live in the industrialized world, you probably can’t pass B. infantis on to your baby. Not even if you give birth vaginally, breast-feed exclusively and eat well.

B. infantis is not the only endangered bacterium in the West, and babies aren’t the only ones affected. By studying mice, researchers at Stanford have found that a lack of dietary fiber — which is missing from most processed foods — results in the loss of important bacterial strains.

Once these strains are gone, the only way to get them back will be to deliberately reintroduce them.

In a study funded by a company that plans to do just that, Dr. German and colleagues fed B. infantis to breast-fed babies. They found that it took over the entire lower intestine, crowding out pathogenic bacteria.

Although it’s too early to know if these babies will turn out to be healthier than their peers, the hope is that the presence of B. infantis for the first year or two of life will help prevent colic, allergies, asthma, obesity, diabetes, heart disease and cancers later in life.

Dr. German envisions a future when it will be common for us to add the bacterium to some of our foods, much as we did with iodine.

But just inoculating babies with B. infantis won’t be enough. We should also give their mothers the opportunity to breastfeed.

The bacterium can’t survive without the carbohydrates it depends on. While companies are trying to figure out how to add oligosaccharides into infant formula, it will be very difficult to replicate the complexity and concentration of the carbohydrates that are naturally present in breast milk.

While the decision to breastfeed is often framed as a personal choice, most women have no choice. Only 15 percent of workers and 4 percent of the lowest-paid workers in the United States have access to paid family leave, which means they often can’t afford to stay home with a newborn.

Many other nations — like Austria, Bulgaria, the Czech Republic, Hungary, Japan, Latvia, Lithuania, Norway and Slovakia — manage to provide working parents with more than a year’s worth of paid family leave.

We should do the same. It’s not just about better personal health, but about better public health, which has been in decline in this country for decades.

We’d also be wise to heed these findings on the microbiota as a harbinger of what’s to come. The promotion of infant formula in place of breast milk, and our reliance on processed foods into adulthood, have had some unforeseen and frightening repercussions for our health. The industrialization of our food supply is changing us from the inside out.

Kristin Lawless is the author of “Formerly Known as Food: How the Industrial Food System Is Changing Our Minds, Bodies, and Culture.”

Monday, June 18, 2018

2950. The Bugs Are Winning

By Jerome Groopman, The New York Review of Books, June 28, 2018
Penicillium Chrysogenum 3D model

I never knew my aunt, Pessimindle. As a teenager in the early 1900s, she developed appendicitis and rapidly succumbed to the infection. At the time, there were no antibiotics. When I was growing up, my father contrasted the loss of his sister with the advent of penicillin that saved many of his fellow soldiers in the waning days of World War II. I was taught that medicine could create miracles, which should never be taken for granted.
Penicillin was serendipitously discovered when the researcher Alexander Fleming went on vacation in the summer of 1928. He returned to his laboratory at St. Mary’s Hospital, London, to find that a petri dish with bacteria had been left open and had become contaminated by a relatively rare strain of airborne mold, Penicillium notatum, its spores likely drifting in through the window. The growth of the bacteria in the dish was inhibited by the mold. Its inhibitory substance, termed penicillin, was produced in scant quantities and was laborious to purify. A worldwide search was launched to find other strains of Penicillium that produced higher concentrations; promising samples were obtained in Cape Town, Mumbai, and Chongqing, but the best came from an overripe melon bought at a fruit market in Peoria. Pharmaceutical companies scaled up production of the antibiotic and, beginning with the D-Day landings in 1944, it was widely available to Allied troops.
Fleming recognized not only the opportunity afforded by the open petri dish, but also the peril from misusing the drug. In his speech accepting the 1945 Nobel Prize in Physiology or Medicine he said:
The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant. Here is a hypothetical illustration. Mr. X has a sore throat. He buys some penicillin and gives himself, not enough to kill the streptococci but enough to educate them to resist penicillin. He then infects his wife. Mrs. X gets pneumonia and is treated with penicillin. As the streptococci are now resistant to penicillin the treatment fails. Mrs. X dies. Who is primarily responsible for Mrs. X’s death? Why Mr. X, whose negligent use of penicillin changed the nature of the microbe. Moral: If you use penicillin, use enough.
Fleming’s advice to use the antibiotic properly was widely disregarded, not by “the ignorant man” but by “negligent” medical professionals. Prescriptions of penicillin in suboptimal dosages led to the emergence of bacteria resistant to it.
This is because bacteria reproduce at an astonishing rate. E. coli, commonly found in our colon, has a generational interval of about twenty minutes. Homo sapiens has an average generational interval of thirty years. So, over two and a half years, E. coli goes through the same number of generations as we do in two million years. As DNA is copied to spawn the next generation, random errors (mutations) occur, and the more copying, the more random mutations. If an antibiotic is used in suboptimal concentrations, then bacteria with random mutations that confer some level of resistance to the drug are more likely to survive and over many generations become impervious to it.
Researchers thus play leapfrog with bacteria that are resistant to one antibiotic by searching for a new one that is effective. William Hall, Anthony McDonnell, and Jim O’Neill in their lucid and thoughtful book Superbugs recount that for several decades, this strategy succeeded. But now we are running out of options. Potent antibiotics that were mainstays in the clinic over the four decades that I’ve practiced medicine, like ampicillin, ceftazidime, and imipenem, typically fail to eradicate many of the bacteria that currently cause infections.
Bacteria that have developed immunity to a large number of antibiotics are termed “superbugs.” The best known is methicillin-resistant Staphylococcus aureus, or MRSA. It originally appeared in intensive care units, among surgical patients. In this setting, MRSA primarily causes pneumonia and bloodstream infection from catheters. But over the past two decades, the resistant microbes have spread outside hospitals to the larger community. At the end of the 1990s this superbug infected children in North Dakota and Minnesota, then was found among men who have sex with men and in prisons among prisoners. A widely publicized outbreak occurred among the St. Louis Rams football team, transmitted by shared equipment. Other MRSA outbreaks were reported among religious groups in upstate New York, Hurricane Katrina evacuees, and people who have received tattoos without proper sanitary precautions. Resistant forms of so-called gram-negative bacteria—characterized by cell walls that protect them from many antibiotics—have also emerged, like Klebsiella and Acinetobacter, which often cause death. Recently, resistant strains of gonorrhea have been detected in Asia.1
Superbugs only briefly reviews the science of bacterial resistance; its focus is on the societal consequences. While there are no exact data on the total number of people dying each year from resistant microbes, the authors calculate it to be at least 1.5 million. This number outstrips deaths from road accidents (1.2 million) and approximates the number of deaths from diabetes (1.5 million).
The economic burden on our health care systems is considerable. People with resistant infections spend more time in the hospital, require more care from doctors and nurses, are treated with more expensive drugs, and often have to be isolated from other patients. In the United States, it costs an average of $16,000 to treat a patient with Staphylococcus aureus that is susceptible to the antibiotic methicillin, with an 11.5 percent chance of death; if the bacteria are resistant, the cost jumps to $35,000 and the chance of the patient dying more than doubles. A study from the European Medicines Agency in the European Union, which includes England, estimated the cost to EU healthcare  systems at €900 million ($1.06 billion)
The impact of bacterial resistance on economic productivity is also significant. The Centers for Disease Control and Prevention in the United States have estimated that resistance costs the American health care system about $20 billion per year, to which productivity losses add a further $35 billion. Using the American estimates, the authors of Superbugs extrapolate the total costs of antimicrobial resistance worldwide to about $57 billion for health systems, with the reduction in world productivity valued at $174 billion.
Based on these economic calculations, Superbugs provides a set of policy prescriptions, framed in pragmatic terms meant to motivate self-interested politicians:
Governments might not want to invest in solutions, but they will ultimately pay either way. Any money not spent now will result in substantial costs in the future—not to mention many lost lives. Serious damage to economic productivity (which by extension threatens governments’ tax incomes) coupled with the higher costs of health care (which is largely government funded) should provide the impetus to deal with this crisis now.
Investment to combat superbugs begins with identifying new antibiotics. Almost all antibiotics are still derived from natural compounds, like Fleming’s penicillin. Although researchers at the Rockefeller University have recently devised advanced methods to facilitate the search, it is unclear how many antibacterial agents are left to discover.2 The most prudent approach is to rely not on discovery but on conservation. “We need to think of our current antibiotics as nonrenewable natural resources,” Hall, McDonnell, and O’Neill write.
Long before we discovered the environmental damage caused by burning hydrocarbons, we were keenly aware that one day the world would run out of coal and oil and that not only should we not waste them, but we should develop renewable resources.
This in part has been the focus of Environmental Protection Agency (EPA) regulations:
Both government and industry plan for the exhaustion of rare earth metals that are needed in electronics and elsewhere. This is not to say that we will never find any new antibacterial compounds…. However as it is unclear how many more drugs can be found in the future, we should work hard to protect the ones we have, as well as new ones that we find.
They provide a concise overview of the logistics of new drug development. It normally takes ten to fifteen years to bring a new therapy to market, at a cost of more than a billion dollars. Intellectual property rights give the company a monopoly over the drug for some twenty years, depending on the country. After that, low-cost generic manufacturers typically jump in to sell it at a reduced price. Much of those twenty years is spent testing the drug in clinical trials, so investment costs are recouped over only about a decade. The company generally makes no significant profit after the patent expires. Still, high sales usually mean that patented drugs end up making a profit.
Antibiotics, the authors show, are paradoxically different in the marketplace when properly prescribed:
If an excellent new antibiotic is effective against infections caused by drug-resistant bacteria, most public health officials would want to protect it for use in the most extreme circumstances and would discourage it from being sold worldwide. To get the maximum benefit from the drug and prevent the development of resistance, it is important that people not use it frequently.
This makes eminent sense from a public health point of view, in effect safeguarding a precious social resource:
When asked what she would do with a useful new antibiotic, the chief medical officer for England, Sally Davis, said that the drug “would need a stewardship program”—that is, that systems would have to be in place to make sure that the antibiotic was only prescribed when absolutely necessary. Indeed, limiting unnecessary use is essential to keep bacteria from becoming resistant to new antibiotics, and thus essential for our continued health.
While this is a cogent strategy, it doesn’t coincide with the marketing goals of the drug industry: “When a really useful new antibiotic is found, the company that invests in it cannot rely on high sales for return on investment.”
Commercial imperatives also work against societal needs in the use of antibiotics in animal husbandry. This is partly a result of the sheer number of animals being reared yearly to feed the world’s seven billion–plus people. Antibiotics were introduced into agriculture in the 1950s, when it was discovered that regular low doses of them made farm animals grow faster and larger. Consumers could purchase meat at lower prices, since the drugs reduce production costs for farmers. Globally, more antibiotics are estimated to be used today for animals than for humans. For example, “over 70 percent of medically important antibiotics in the United States, by volume, are sold for use in farm animals.” Hall, McDonnell, and O’Neill note that
antibiotics are more effective growth promoters when used for animals kept in cramped, dirty, unregulated conditions than for animals living in cleaner, more open, more controlled environments. Under suboptimal conditions, the growth promoters are for all practical purposes a substitute for good infection prevention and control.
The effects of antibiotics on growth are not fully understood. They may alter the animal’s microbiome—the bacteria in the gut—as well as prevent infection, so less energy is expended on fighting microbes.
Our environment is becoming contaminated with antibiotics and their residues in several ways. The first is a result of body waste—from both animals and humans. According to Hall, McDonnell, and O’Neill, “Studies suggest that as much as 75 to 90 percent of antibiotics may be excreted from animals without being metabolized. This waste goes into the soil and is then washed into the water systems.” Second, when pharmaceutical factories dump their untreated waste that contains the active ingredients of antibiotics into the water supply, they save money on expensive disposal. Such practices encourage the development of antibiotic resistance, since we are thus exposed to low and varying amounts of the drugs, as Fleming warned.
Hall, McDonnell, and O’Neill argue that “antibiotics provide a backbone to the entire healthcare system,” essential in everything from hip surgery to cancer treatment to organ transplantation. Thus developing effective antibiotics should be recognized as a “public good.” This justifies governmental intervention with incentives for the creation of new drugs. But such incentives have not been forthcoming, partly, in the authors’ view, because “electoral cycles encourage short-term thinking.” This kind of thinking has become particularly acute with the economic and social upheavals of the recent elections in the United States and Europe:
If a prime minister or president invests government resources to curtail drug resistance, they are unlikely to get huge rewards from the electorate. People generally do not vote on how well the government is dealing with a future problem, and they do not have enough knowledge of the early stages of research to make judgments. As a result, the political incentives have not been sufficient to pressure governments into action.
To overcome these barriers, they recommend a public innovation fund that covers early-stage research, as well as “non-cutting edge research that has societal benefit but little commercial attractiveness”; enhanced collaboration among companies in conducting clinical trials; harmonization of new drug regulation to reduce the costs of development; and “market entry rewards” that will compensate a company for creating useful products.
In agriculture, the authors write, methods are needed to rear animals without antibiotics. But “progress on an international scale will be a challenge because many meat-producing countries have a financial interest to continue antibiotic use.” Still, farming practices can be profitably improved, as occurred in Denmark, where farmers significantly reduced use of antibiotics while sustaining productivity; the country is one of the largest exporters of pork in the world. This has been possible despite regulations to limit the use of antibiotics, in part because of improved infection control procedures, which lowered infection rates and reduced the need for drugs. Denmark also improved the monitoring of antibiotic sales and use, which enabled the government to intervene if farmers were disregarding the law. It did this through what was called a “‘yellow card system’—pig farmers using the most antibiotics were sent warnings that they might face penalties.”
Given this evidence of economic competitiveness despite the regulation of antibiotic use in livestock, Hall, McDonnell, and O’Neill propose international agreements as a first step toward remedying the urgent issue of superbugs. “A combination of taxation, regulation, and subsidies for alternatives to antibiotics should be developed.”
But regulation is needed not only in farming. When we are treated for bacterial infection, we excrete unmetabolized antibiotics that enter our water systems. As the authors write, “A wastewater system that eradicates all traces of antibiotics does not yet exist, partly due to the high cost of development.” This issue is especially prominent in hospital waste, since patients are more likely to have antibiotic residues in their feces, in addition to drug-resistant bacteria. “This combination has the potential to create hotspots of resistance.”
Yet another obstacle is found where antibiotics are often manufactured, in India and China, where production costs are minimal. There is often poor quality control of the content of the antibiotic pills manufactured in these countries. They also often contain less of the active drug than advertised.3 Again, as Fleming noted, undertreatment with suboptimal doses of antibiotics fosters bacterial resistance.
At the 2016 G7 meeting, chaired by Japan, world leaders recognized how market forces mitigate against new drug development and called on international institutions to rectify the problem. While these leaders recognized the importance of increased access to antibiotics for their underserved populations, they also highlighted the need for stewardship in use of the drugs for both patients and animal husbandry.
The authors assert that political will is needed to find the funds for implementing incentives. They estimate that an investment of $40 billion over ten years is required for the world to avoid a $100 trillion cost by 2050. They argue that “the potential to prevent an increase from 1.5 million to 10 million deaths per year should make every one of us stand up and take note.”
But I am not hopeful that such pragmatism will prevail. Superbugs was written before the sharp shift in our politics, notably Brexit and the election of Donald Trump. The withdrawal of the United States from both the Paris Climate Accord and the Trans-Pacific Partnership has been followed by a declaration of trade wars, which the president tweets are “good” and “easy to win.” This absurd delusion fits with his view that all deals are binary, with “winners and losers” rather than agreements that may benefit both parties in the negotiation.
Such brute nativist thinking undermines global cooperation, which is needed for the proposals of Hall, McDonnell, and O’Neill. If the recent lifting of salutary regulations by Trump’s EPA on the chemical and mining sectors are any indications of disregard for the environment, there is scant hope that measures to limit factory dumping of antibiotic waste will be pursued. Still, some within the administration are trying to address the threat of superbugs in the defense budget, where research on antibiotic resistance may be cloaked under the aegis of national security.4 But such singular measures will ultimately fall short without a comprehensive and coordinated plan of cooperation among nations.
  1. 1
    For greater detail on the science of bacterial resistance, see my “Superbugs: The New Generation of Resistant Infections Is Almost Impossible to Treat,” The New Yorker, August 11, 2008; and “Sex and the Superbug: The Rise of Drug-Resistant Gonorrhea,” The New Yorker, October 1, 2012. See also Ellie Kincaid, “New Study Raises Specter of More Bacteria Resistant to Last Line Antibiotics,” The Wall Street Journal, January 16, 2017. This April the Centers for Disease Control and Prevention released an update on multidrug-resistant microbes in the United States. Bacteria that were believed to be rare proved more common than previously thought, with unusual resistance making them impervious to most available antibiotics. See Kate Russell Woodworth et al., “Vital Signs: Containment of Novel Multidrug-Resistant Organisms and Resistance Mechanisms—United States, 2006–2017,” Morbidity and Mortality Weekly Report, Vol. 67, No. 13 (April 6, 2018). 
  2. 2
    Bradley M. Hover, Zachary Charlop-Powers, Sean F. Brady et al., “Culture-Independent Discovery of the Malacidins as Calcium-Dependent Antibiotics with Activity Against Multidrug-Resistant Gram-Positive Pathogens,” Nature Microbiology, February 12, 2018.  
  3. 3
    Patricia McGettigan, Peter Roderick, Abhay Kadam, and Allyson Pollock, “Threats to Global Antimicrobial Resistance Control: Centrally Approved and Unapproved Antibiotic Formulations Sold in India,” British Journal of Clinical Pharmacology, February 21, 2018.  
  4. 4
    Ike Swetlitz, “Drug Makers Lobby for Antibiotic Incentives in Pandemic Preparedness Bill,” STAT+, February 27, 2018.