President Obama and Gov. Romney: What Will You Do About Superbugs?

Orignally appeared in Kolleen Bouchane's Huffington Post Impact blog.

On Monday, President Obama and Gov. Romney squared off in their third and final debate before the election. After debating domestic policy and fielding questions from undecided voters, their last debate focused on foreign policy.

Amongst the bayonets and bravado, there was no discussion about how either of them would use the office of the president to address the top global health challenges of our time. Among these challenges is the rise of superbugs -- killer germs against which antibiotics are failing. This is an issue that affects everyone, and neglecting to head off threats now will lead to calamitous consequences later.

The research and development of new antibiotics to fight disease has been falling steadily since the 1980s. In the meantime, bacteria that cause a range of illnesses -- from MRSA to tuberculosis -- are mutating, breeding new strains that resist our aging antibiotics, and killing people in large numbers. According to the FDA, antibiotic resistance "has become a serious issue of global concern."

Last week, the World Health Organization released its annual report on global tuberculosis (TB). TB is an age-old disease that kills more people today than it did a hundred years ago. It's also a leading killer of women worldwide. The disease has orphaned 10 million children as it strikes people down in the prime of their lives.

There was little new in the data this year compared to last year, but the report still managed to make headlines around the world (see here, here and here) due to one finding in particular: Drug-resistant TB is spreading worldwide, and the resistance itself is growing stronger, eliminating the effectiveness of more drugs.

Less than one in five people with multidrug resistant TB -- defined as TB that's resistant to two of the most powerful TB drugs -- are ever diagnosed. In India and China, which together have 60 percent of the world's people living and dying of MDR-TB, a mere 6 percent and 3 percent of people with MDR-TB receive a diagnosis, respectively.

XDR-TB, defined as TB that has mutated beyond MDR-TB to be resistant to at least two "second-line" drugs (drugs used to treat TB that's resistant to "first-line drugs"), was first reported in 2008 when it killed 52 out of 53 people infected in a South African hospital. Since then, WHO reported last week that XDR-TB has been discovered in 84 countries.

While standard TB can be cured virtually anywhere at low cost, treating MDR-TB and XDR-TB is exorbitantly expensive.

According to news reports last week, after a few isolated cases, Australia is now facing the impending spread of XDR-TB within the general population. "XDR-TB is estimated to cost between $500,000 and $1 million a patient, with a low cure rate and a very high death rate," according to local news reports.

According to WHO, people with TB spread the infection -- it transmits through the air like the common cold -- to 10 to 15 additional people per year.

Combine the rate of disease spread with the cost of public health response, and you can quickly understand that the math is not on our side.

Last week The Wall Street Journal reported that TB drugs are about 50 years old (Lyndon Johnson was president when the latest drug was introduced), so researchers are now in a race to develop new drugs before it's too late. But WHO also reports this week that globally, research and development for needed TB drugs, diagnostics and a vaccine falls short by some $1.4 billion each year.

We can pay now, or we can pay later. The longer we wait we wait, the higher the cost.

Humanity's war against germs is a constant arms race. The trick is to stay in front of the germs by researching and developing new treatments as the old ones start to fail.

But we're behind. The germs are winning.

President Obama and Gov. Romney: What will you do about it?