Antibiotics have represented the primary line of defense for treating bacterial infections since 1935 when the first sulfur-containing compounds were introduced. Many antibiotic compounds are produced naturally by microorganisms while some more recently developed antibiotics are chemically designed based on a knowledge of susceptible biochemical pathways or physiological processes in pathogenic bacteria. Ciprofloxacin (“cipro”), a synthetic broad-spectrum antibiotic, functions by interfering with DNA replication.

Increased use and mis-use of antibiotics has led to increased numbers of pathogenic bacteria that are resistant to one or more antibiotics. Some resistant microbes possess mechanisms that allow continued growth in the presence of multiple antibiotics. These multiply drug-resistant pathogenic bacteria may also possess pathogenic properties that result in significantly more severe disease than their drug-sensitive cousins. Medical misuse of antibiotics – prescribing antibiotics for viral infections, failure of patients to complete treatment with the full regiment of antibiotics, or application of antibiotics based on inaccurate or incomplete tests can lead to selection of antibiotic resistant bacteria that can then cause infections that cannot be treated with the antibiotic(s) to which they are resistant. Multiple drug resistance can quickly reduce or eliminate all antibiotic-based treatment options. Infections caused by antibiotic resistant bacteria are very difficult to treat and can sometimes lead to death of the patient.

Antibiotic resistance can also result from selection based on exposure to antibiotics present in the environment. More than 70% of the antibiotics sold in the U.S. are used as supplements to animal feed. The intestinal bacteria in the animals provided with such feed often show resistance to the antibiotics in the feed and, in some documented cases, have transferred this resistance to pathogenic microbes with which they share the environment.

A brief of history of antibiotic use and the medical and public policy factors that are, in part, responsible for increased antibiotic resistance in pathogenic microbes and for a decrease in the development of new antibiotics will be presented. An introduction to new directions that are being taken to develop a next generation of antibiotic compounds will also be provided.

Speaker Biography:

Paul Jackson received his Bachelor's of Science degree from the University of Washington in Cellular Biology and his Ph.D. from the University of Utah in Molecular Biology. He became a CISAC Visiting Scholar in September 2011. He was previously a CISAC affiliate.

For the past 18 years he has been studying bacterial pathogens, first working to develop DNA-based methods of detecting these microbes and their remnants in environmental and laboratory samples, then developing methods to differentiate among different strains of the same pathogenic species. Research interests include the study of different methods of interrogating biological samples for detection and characterization of content, and development of bioforensic tools that provide detailed information about biothreat isolates including full interrogation of samples for strain content and other genetic traits.

Methods he developed have been applied to forensic analysis of samples and aid in identifying the source of disease outbreaks. He contributed to analysis of the Bacillus anthracis present in the 2001 Amerithrax letters and conducted detailed analyses of human tissue samples preserved from the 1979 Sverdlovsk anthrax outbreak, providing evidence that was inconsistent with Soviet government claims of a natural anthrax outbreak.

His current work continues to focus on development of assays that rapidly detect specific signatures including antibiotic resistance in threat agents and other pathogens. More recent activities include identification and characterization of new antimicrobial compounds that are based on the pathogens' own genes and the products they encode. These include development of such materials as therapeutic antimicrobials, their application to remediate high value contaminated sites and materials, and their use to destroy large cultures and preparations of different bacterial threat agents. Efforts to address issues of antibiotic resistance and treatment of resistant organisms have recently been expanded to look at non-threat agent pathogens that cause problematic nosocomial or community-acquired infections of particular interest to the military.

Paul spent 24 years as a Technical Staff Member at Los Alamos National Laboratory where he was heavily involved in development of the biological threat reduction efforts there. He was appointed a Laboratory Fellow at Los Alamos in recognition of his efforts. He moved to Lawrence Livermore National Laboratory in 2005 where he is presently Senior Scientist in the Global Security and Physical and Life Sciences Directorates. In addition to his work at the National Laboratories, he has served on the FBI's Scientific Working Group for Microbial Forensics, on NIH study sections and review panels, and continues to serve on steering and oversight committees for other federal agencies.

The production and distribution of counterfeit medications has become a significant global public health issue. Though not as rampant in the United States, the Food and Drug Administration (FDA) has seen a 10 fold increase in the number of cases investigated, particularly a rise in illegally imported and diverted medications entering our legitimate drug supply. In order to curb these illegal activities, California and the federal government have introduced various pieces of legislation to address this. In addition, international entities, State Boards of Pharmacy and the FDA have begun promoting utilization of radio frequency identification technology and other technology to effectively track the medication supply. In a recent California survey, pharmacists felt strongly that the presence of counterfeit medications poses a problem in their pharmacy practice, but they still face several challenges in identifying counterfeit medications, counseling their patients, and forging their role in implementing legislative requirements.

This presentation will aim to provide an introduction to the international and domestic counterfeit drugs situation, discuss possible factors facilitating patient exposure to counterfeit medications, examine potential sources for counterfeit medications in the United States, identifiy federal legislation issues, discuss various forms of technology being used to combat counterfeit medications, and recognize the role of pharmacists and the challenges they face in dealing with counterfeit medications.

Speaker Biography:

Dr. Elaine Law is currently a Clinical Pharmacist specializing in Adult General Surgery at UCSF Medical Center and an Assistant Clinical Professor in the UCSF School of Pharmacy. She received a B.S. in Molecular, Cell and Developmental Biology from UCLA, earned a Doctor in Pharmacy from UCSF School of Pharmacy and completed a General Practice Pharmacy Residency at UCSF Medical Center. She holds a Board Certification in Pharmacotherapy and her research interests include roles pharmacists can play in public health issues including counterfeit medications and pharmacist-based immunization programs. She is an advocate of patient care in underserved areas and reaches out regularly to the Tenderloin communities and elderly populations of San Francisco through pharmacy health outreach programs.

Rates of tuberculosis, a disease that thrives on poverty, malnutrition and interrupted medical care, are now among the highest in the world in the Democratic People's Republic of Korea (DPRK, North Korea), elevating the risk of an epidemic of drug-resistant strains and a spread into China. This project represents a unique historical opportunity to examine the relationship between food security, malnutrition and the epidemiology of tuberculosis in a present-day famine.

BIOGRAPHY OF VALI NASR

Vali Nasr is Professor of International Politics at the Fletcher School of Law and Diplomacy of Tufts University, Senior Advisor at Kissinger Associates, Senior Fellow at Foreign Policy at Brookings Institution, and a columnist at Bloomberg View. He served as Senior Advisor to U.S. Special Representative for Afghanistan and Pakistan, Ambassador Richard Holbrooke between 2009 and 2011. He has previously served as Senior Fellow at the Council on Foreign Relations and Senior Fellow at the Kennedy School of Government at Harvard University.

He is a specialist on political and social developments in the Muslim world and is the author of Forces of Fortune: The Rise of a New Middle Class and How it Will Change Our World (Free Press, 2009); The Shia Revival: How Conflicts within Islam will Shape the Future (W.W. Norton, 2006); and Democracy in Iran: History and the Quest for Liberty (Oxford University Press, 2006); as well as a number of other books and numerous articles in academic journals and encyclopedias.

He has advised senior American policy makers, world leaders, and businesses including the President, Secretary of State, senior members of the Congress, and presidential campaigns, and has written for New York Times, Foreign Affairs, The New Republic, Newsweek, Time, Christian Science Monitor, Financial Times, Foreign Policy, Los Angeles Times, Wall Street Journal, and The Washington Post, and has provided frequent expert commentary to CNN, BBC, National Public Radio, Newshour, ABC News, CBS News, NBC News, and has been a guest on the Charlie Rose Show and Meet the Press, the Daily Show with Jon Stewart, The Colbert Report, Real Time with Bill Maher, GPS with Fareed Zakaria, and This Week with Christiane Amanpour.

He is a member of Board of Trustees of the Rockefeller Brothers Fund and National Democratic Institute; and has been the recipient of grants from the John D. and Catherine T. MacArthur Foundation, The Harry Frank Guggenheim Foundation, and the Social Science Research Council. He is a Carnegie Scholar for 2006.

He received his BA from Tufts University in International Relations summa cum laude and was initiated into Phi Beta Kappa in 1983. He earned his masters from the Fletcher School of Law in and Diplomacy in international economics and Middle East studies in 1984, and his PhD from MIT in political science in 1991.

S.T. LEE LECTURE

The S.T. Lee Lecture was established by Seng Tee Lee, a businessman and philanthropist located in Singapore, with the dual objectives of raising public understanding of the complex policy issues facing the global community today and increasing public support for informed international cooperation.  The S.T. Lee Distinguished Lecturer is chosen for his or her international reputation as a leader in international political, economic, social and health issues, and strategic policy-making concerns.

Previous S.T. Lee Lecturers have included John Prendergast, author and human rights activist, the Honorable Robert Hormats, Under Secretary of State for Economic, Energy, and Agricultural Affairs, the Nobel Prize-winning author Orhan Pamuk, Joseph F. Nye, the Dean emeritus and Sultan of Oman Professor of International Relations, the John F. Kennedy School of Government, Harvard University, and Dr. Paul Farmer, Professor of Medicine and Medical Anthropology, Harvard University and Medical Director of the Clinique Bon Sauveur in Cange, Hait.

The Asia Pacific Observatory (APO) on Health Systems and Policies was established in June 2011. It is a collaborative partnership of interested governments, international agencies, foundations, civil society, and the research community. Modeled on the European Observatory of the same name, the APO has as its main function the collection and analysis of information and research evidence on health care systems, policies, and reforms, with the aim of making this knowledge widely available and easily accessible throughout the Asia Pacific Region; it will also draw cross-country lessons and disseminate these in formats that can be directly used for policymaking.

This presentation will trace the history underlying the creation of the Observatory and indicate its objectives, organizational structure, and proposed modes of operation. It will describe the challenges of attempting to bring a wide range of stakeholders together in support of a regional collaborative research effort. It will also touch on ways that research entities located outside the Asia Pacific region might interact with the APO.

L. Richard Meyers was employed by the World Bank for two decades managing teams that carried out World Bank health sector projects and analytical work in a number of countries in East Asia. He directed a team that produced the first comprehensive health sector review for Vietnam, as well as the first Vietnam National Health Survey.  He also led a team that produced the most comprehensive and empirically-based external analysis to date of the rural health sector in China. More recently he has worked with the European Health Observatory, the Asian Development Bank, the World Bank, the WHO Western Pacific and South Asia regional offices, and other stakeholders to facilitate the creation of the Asia Pacific Observatory.