The 2014 Atlanta Summit - - Race We Can't Afford to Lose: Outsmarting Superbugs

Global Health Threat Statistics:

• Approximately 48 million people globally contract food-borne diseases annually, resulting in roughly 3,000 deaths.
• Antimicrobial resistance (AMR) causes an estimated 2 million infections and 23,000 deaths annually in the U.S.
• Healthcare-associated infections affect 1 in 20 hospitalized patients, leading to 99,000 deaths and $45 billion in excess medical costs yearly.
• The total societal cost of food-borne illness is estimated at up to $77 billion annually.
• Businesses incur $10 billion annually in costs associated with flu infections among employees.

Technological Imperatives and Capabilities (Advanced Molecular Detection - AMD):

• Current CDC laboratory technology is cited as being over 10 years outdated, with some junior colleges possessing more advanced equipment.
• AMD enables the sequencing and interpretation of microbial genomes in hours, a process that previously took months.
• The cost of whole-genome sequencing has dropped from approximately $500,000 seven years ago to roughly $50 per sample today.
• AMD facilitates the rapid identification of infectious disease clusters, allowing for faster resource allocation and targeted public health responses.
• Victoria Nahum notes that AMD will potentially save lives like that of her son, Joshua, who died from a treatable Gram-negative infection that could have been identified earlier with modern tools.

Strategic Challenges and Root Causes:

• Antibiotic Misuse: Overuse and misuse in human medicine and agricultural animal production are primary drivers of superbug emergence.
• Supply Chain Risks: Globalized food trade requires year-round produce (e.g., cantaloupes grown in Central America), creating contamination risks through rapid temperature changes that split rinds and trap fecal bacteria.
• Bioterrorism and Bio-error: Risks include state-sponsored creation of chimeric pathogens (referenced as a potential Cold War-era decision by a former Soviet leader) and accidental laboratory releases.
• Infrastructure: While CDC facilities have improved, the lack of cutting-edge technology renders current diagnostic capabilities obsolete, likened by Beth Bell to the transition from payphones to smartphones.

Organizational Roles and Collaborative Frameworks:

• CDC: Leads in disease surveillance, outbreak detection, and training global scientists; advocates for AMD to maintain a competitive edge.
• FDA: Focuses on regulatory oversight, food safety, and international expansion ("FDA Beyond Our Borders") to inspect and certify quality at points of global production.
• NIH/Academia (e.g., George Washington University): Acts as an early adopter for new technologies, validating methods (like whole-genome sequencing) before they are scaled by federal agencies.
• Safe Care Campaign: A non-profit initiative born from Victoria Nahum's personal tragedy to humanize infection prevention data and drive hospital safety improvements.

Decisions, Recommendations, and Forward-Looking Statements:

• Immediate Action Required: The panel declares inaction on updating CDC technology as the most significant current risk, emphasizing that delays will result in preventable deaths.
• Standardization: Future success depends on developing common testing standards to ensure interoperability between hospitals and jurisdictions.
• Medical Diplomacy: The U.S. must export its scientific excellence and infrastructure to build global capacity, particularly in food safety and disease control, rather than relying solely on border inspections.
• Policy Leadership: The U.S. is urged to enact mandatory laws regarding antibiotic stewardship in agriculture and lead global efforts to curb antibiotic overuse.
• Public Education: Citizens are called upon to demand responsible antibiotic use, practice strict hand hygiene in healthcare settings, and avoid demanding antibiotics for viral infections.
• Cost Reality: Victoria Nahum highlights that while official reports may cite lower figures (e.g., $6 billion), the actual annual cost of healthcare-associated infections likely exceeds $40–$100 billion.

Panelist Highlights and Anecdotes:

• Beth Bell (CDC): Recalled the 1993 E. coli O157:H7 Jack-in-the-Box outbreak, where 100+ people were ill and 4 children died before the source was found, leading to the development of Pulse Field Gel Electrophoresis (PFGE), now viewed as obsolete compared to AMD.
• Victoria Nahum (Safe Care Campaign): Shared her family's loss of three generations to hospital-acquired infections, emphasizing the need to "attach a face and a name" to public health data to drive change.
• Lance Price (GWU): Cited a specific instance where an impersonator claiming to be Mikhail Gorbachev discussed the creation of a superbug chimera (smallpox/Ebola), illustrating the gravity of bioweapon risks.
• Andy von Eschenbach (Former FDA/NCI Director): Discussed the complexity of balancing consumer expectations for year-round fresh produce with the scientific necessity of preventing contamination in the supply chain.