Carbapenem-resistant Acinetobacter baumannii tops the the World Health Organization's 'priority pathogens' list.
The World Health Organization (WHO) has for the first time released a list of drug-resistant bacteria that pose the greatest threat to human health — and for which new antibiotics are desperately needed. The agency's aim in listing these 'priority pathogens' is to steer funds towards development of the most crucial antimicrobials. Researchers say the list is a useful reminder of the danger of bacteria that are becoming resistant to antibiotics.
The list ranks 12 bacteria or bacterial families and is topped by carbapenem-resistant Acinetobacter baumannii. This obscure bacterium causes a severe infection for which almost no treatments exist, and mainly affects people who are already critically ill. (It is resistant to carbapenem antibiotics, a ‘last resort’ antibiotic used only when all other treatments have failed.) The ranking also includes well-known bacteria, such as those that cause pneumonia and gonorrhoea (see 'Threat list').
Antibiotic resistance kills an estimated 700,000 people each year worldwide, and some experts predict that number to reach 10 million by 2050 if efforts are not made to curtail resistance or develop new antibiotics. Despite an urgent need for these drugs, the once-robust development pipeline for antibiotics now produces little more than a trickle of compounds. As of September 2016, about 40 new antibiotics were in clinical development for the US market, compared with hundreds of cancer drugs.
Many pharmaceutical companies see antibiotics as a losing proposition. “Most infections are still sensitive to existing drugs,” says Allan Coukell, who oversees an antibiotic-resistance initiative at the Pew Charitable Trusts in Washington DC. “And if you have a new antibiotic, you do really want to hold it in reserve for those resistant infections.” That means the market for new antibiotics is relatively small, and companies might not sell enough of the medicine to recoup their costs.
Khalid Abu Bakar, Malaysia’s national police chief, speaking to reporters in Kuala Lumpur on Thursday.CreditAssociated Press
KUALA LUMPUR, Malaysia — The poison used to kill Kim Jong-nam, the half brother of the North Korean leader Kim Jong-un, was VX nerve agent, which is listed as a chemical weapon, the Malaysian police announced Friday.
In a brief statement, Khalid Abu Bakar, the national police chief, said the substance was listed as a chemical weapon under the Chemical Weapons Conventions of 1997 and 2005, to which North Korea is not a party.
South Korea has suggested that the killing was the work of the North Korean government. The revelation that a banned weapon was used in such a high-profile killing raises the stakes over how Malaysia and the international community will respond.
VX nerve agent can be delivered in two compounds that are mixed at the last moment to create a lethal dose. The police say that two women approached Mr. Kim at the airport with the poison on their hands and rubbed it on his face one after the other.
Samples were taken from Mr. Kim’s skin and eyes. The poison was identified in a preliminary analysis by the Center for Chemical Weapons Analysis of the Chemistry Department of Malaysia, Mr. Khalid said.
The Chemical Weapons Convention bans the use and stockpiling of chemical weapons, and North Korea is among the world’s largest possessors of such weapons. In 2014, the South Korean Defense Ministry said the North had stockpiled 2,500 to 5,000 tons of chemical weapons and had a capacity to produce a variety of biological weapons. (The North has conducted five nuclear tests since 2006.)
VX is part of a family of nerve agents created decades ago during research into pesticides. It is tasteless and odorless and kills by causing uncontrollable muscle contractions, which eventually stop the victim from breathing. A dose of about 10 milligrams is enough to kill by skin contact, according to the Federation of American Scientists.
Several world powers, including the United States and the former Soviet Union, once had large stockpiles of the nerve agent. American stores of VX were destroyed under the Chemical Weapons Convention of 1997, with incineration completed in 2012.
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Kim Jong-nam gesturing toward his face while talking to airport security and officials at Kuala Lumpur’s international airport on Feb. 13. He died shortly afterward.CreditFootage from Kuala Lumpur airport security cameras obtained by Fuji TV, via Associated Press
In 1994 and 1995, the Japanese cult Aum Shinrikyo used homemade VX to attack three people, one of whom died.
North Korea is estimated to have a chemical weapons production capability of up to 4,500 metric tons during a typical year and 12,000 tons during a period of extended crisis. It is widely reported to possess a large arsenal of chemical weapons, including mustard, phosgene and sarin gas, a United States Congressional Research Service report said last year.
The announcement by Malaysia’s police chief came just a day after North Korea denied any responsibility for Mr. Kim’s death, accusing the Malaysian authorities of fabricating evidence of Pyongyang’s involvement under the influence of South Korea.
With the North’s reclusive government on the defensive about the Feb. 13 killing of Mr. Kim, the estranged half brother of Kim Jong-un, at the airport for the Malaysian capital, Kuala Lumpur, a statement attributed to the North Korean Jurists Committee said the greatest share of responsibility for the death “rests with the government of Malaysia” because Kim Jong-nam died there. And in what could be seen as a threat to Malaysia, the statement noted that North Korea is a “nuclear weapons state.”
But in a case that has been filled with mysteries and odd plot twists, North Korea still would not acknowledge that the man killed was indeed Kim Jong-nam. And it gave no indication that it would agree to Malaysia’s demands to question a senior staff member at the North Korean Embassy in Kuala Lumpur in the investigation into Mr. Kim’s death.
Relatives and acquaintances of the two women Malaysia has accused of carrying out the killing, by applying poison to Kim-Jong-nam’s face as North Korean agents looked on, insisted they must have been duped into doing so, though the Malaysian authorities say otherwise.
“I don’t believe Huong did such a thing,” said Doan Van Thanh, father of Doan Thi Huong, 28, a Vietnamese woman being held in Malaysia. “She was a very timid girl. When she saw a rat or frog, she would scream.”
Mr. Thanh, 63, said he had seen little of his daughter recently. He said she left the family’s home, in a village south of Hanoi, at 17 to attend community college, where she studied to be a pharmacist.
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Mr. Kim, the estranged half brother of North Korea’s leader, Kim Jong-un, in 2010.CreditShin In-Seop/JoongAng Ilbo, via Associated Press
She later left Vietnam to work in Malaysia without telling her family and rarely visited, Mr. Thanh said. When she returned home in January for the Tet holiday, he said, she stayed only a few days.
On Thursday in Nghia Binh, Ms. Huong’s hometown, her brother, Doan Van Binh, said that she posted on Facebook under the alias Ruby Ruby. Her Facebook photographs and the attached location information appear to show that she had visited Malaysia twice since January, and her Facebook friends include several people who write in Korean.
Mr. Binh said that Ms. Huong had also appeared in a singing contest on the television show “Vietnam Idol” in 2016. In a short video clip, a panel of judges rejected Ms. Huong after she sang just one line: “I want to stop breathing gloriously so that the loving memory will not fade.”
North Korea has called for the release of Ms. Huong, an Indonesian woman and a North Korean man who are being held by Malaysia in connection with the death of Mr. Kim.
The statement on Thursday from the Jurists Committee was cited by the state-run Korean Central News Agency, in the first comment on the killing from the North’s official news media. The statement accused the Malaysian authorities of pursuing a case “full of loopholes and contradictions” that proved that its investigators “intended to frame us.” It said Malaysia had done so under South Korean influence.
The statement said Malaysia’s Foreign Ministry and the local hospital first told the North Korean Embassy in Kuala Lumpur that Mr. Kim had died of “heart stroke,” asking North Korea to take the body and cremate it.
But Malaysian officials’ attitude began changing after the South Korean news media, citing anonymous sources, reported that Mr. Kim had been poisoned, according to the North Korean statement.
“The Malaysian secret police got involved in the case and recklessly made it an established fact” that the death had been a poisoning, according to the North Korean statement, which did not refer to Mr. Kim by name.
The statement questioned how Ms. Huong and the Indonesian suspect in the killing, Siti Aisyah, 25, had survived if, as Malaysian officials said, they had used their hands to apply a deadly poison.
MANILA — Only five people had turned up dead. It was a slow evening.
The journalists on the night shift say Fridays are like that. A predictable rhythm has developed to the killings in this dense metropolis of nearly 13 million. Weekdays are busier, often producing a dozen bodies before morning. One reporter told me the record was 27 one night. Weekends are more tranquil, which is when those who cover this beat attend wakes and funerals of victims, or follow up with witnesses and other sources.
In the eight months of Rodrigo Duterte’s presidency, reports on the drug war have caused concern around the world and in the Philippines, though the president’s supporters cast the news as biased and the killings as necessary.
Alarmed by the daily death tolls and tales of systemic abuse, I spent a weekend on the front lines with some of the journalists who track the mass death.
The media can hardly keep up. “The night shift used to be boring,” one reporter told me outside the press office of a police precinct. “Fires and domestic abuse and car accidents,” he said. Now their stories on daily deaths, crooked cops and the exploitations of the powerful no longer shock.
Filipinos were forewarned. As a candidate, Mr. Duterte vowed to rid the country of drugs and crime in six months. As president, he has guaranteed a pardon to any police officer who killed people in the line of duty, and said that human rights do not apply to drug addicts because they’re not human. To set a good example, Mr. Duterte boasted of shooting suspects dead himself.
His rhetoric and policies have yielded dramatic results. More than 7,000 people have been killed, while the police point to over 43,000 arrests and the surrender of nearly 80,000 drug pushers and more than 1.1 million users. Crimes like theft, carjacking and cattle rustling have collectively dropped 42 percent. But murder has spiked 51 percent — the consequence, according to a recent report by Amnesty International, of an “economy of death,” resulting from corruption, police abuse and pressure for results that have victimized society’s poorest.
A nightly vigil is kept by a group of local and international reporters, documentary filmmakers and photographers. They call themselves “night crawlers,” and they shadow the police who are armed with lists of alleged users and the mandate of door-to-door visits.
These night crawlers wait for word from radio reports, text messages from funeral homes, calls from colleagues and tips from sources within the police force (though tips have become rare since the media brought international attention to the killings). Authorities are now more guarded, and often the only tip-off reporters receive is the departure from the precinct of “scene of crime” officers. As soon as their van leaves, a convoy of journalists gives chase, lights flashing and horns blaring, on a white-knuckle race through the streets of Manila as calls are made to sources in the area in an effort to find the location and beat investigators to it. Crime scenes have reportedly been altered, official statements often contradict witnesses, and the families of victims have accused police of intimidation.
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A suspected drug dealer killed in October in the San Francisco del Monte neighborhood of Quezon City, Philippines.CreditDaniel Berehulak for The New York Times
Media scrutiny has changed the way both murders and investigations are conducted. In recent months, killings have gone from the streets and into the privacy of homes. Police cordons are now established farther out from the scene, to ensure distance from photojournalists’ cameras. Witnesses fear reprisals from authorities. Police officers hasten bodies to hospitals, which journalists cannot enter, clearing away crime scenes before they can be documented.
On the Saturday night, I arrived early at one location to find a 22-year-old man on the ground with a bullet through his head. Witnesses said the police had earlier picked him up nearby. Authorities, however, reported that he was gunned down by vigilantes after he committed theft. In his pocket, the police found two tiny rocks — about $4 worth of “shabu,” the form of crystal meth at the heart of this drug war. The officers took hardly 15 minutes to investigate, document and haul away the body.
As I examined the pool of blood that remained after police left, a teenager on a scooter rode up to have a look. I asked if he knew the victim. “He was my cousin,” he said. I told him I was sorry. He shrugged. “It was expected.”
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Polls show that the drug war remains immensely popular, but a similar majority say they are against all the killings. Critics of Mr. Duterte’s methods say this is a war against the poor, because no drug lords, or politicians alleged to be protecting them, have been punished. After months of reports of poor Filipinos being brutalized, the situation changed only recently thanks to a high-profile death.
On Jan. 30, authorities announced a temporary suspension of the drug war after a South Korean businessman living here was found to have been kidnapped by antidrug officers, strangled at the national Police Headquarters, cremated at a funeral parlor and flushed down a toilet — all while his wife was being extorted for a ransom of $100,000. Under pressure from South Korea, Mr. Duterte called the case an “embarrassment” and focused his rhetoric on “cleansing” the national police force, though he vowed to continue his crackdown on drugs until the end of his term.
The killings, though, continue. The Duterte administration is accountable for sanctioning, condoning or being unable to prevent them, and for failing to bring the perpetrators to justice. What was once a dispute about facts surrounding such deaths has turned to public acceptance. It is now a moral question — to which there is no answer, only opinion and conjecture.
“It’s the new normal,” a photojournalist told me. “It’s easier and cheaper to kill them. We can only document it, for a time when Filipinos have regained their sanity.”
More are now speaking out. A rally on Saturday against the killings, led by the Catholic Church, drew at least 10,000 people, and lawyers have volunteered to file cases for the families of four men allegedly killed by police. This week, a high-level officer linked Mr. Duterte to multiple crimes. These voices of protest echo what journalists have been saying for months.
The work is taking a toll on the night crawlers. Some of the journalists suffer health problems or nervous tics from the hours they keep and the things they see. Many cover the beat in their spare time, their publications having moved on from the now-commonplace killings. For their trouble, the media have been called “presstitutes” by Mr. Duterte’s followers; some receive threats of rape, violence and death. I asked some journalists what keeps them going. “Guilt,” one said. “Anger,” added another. “The widows, whose pain I know well,” said a third. “The families of all the victims,” said a fourth.
When the dawn broke that Sunday morning, most of us left the press office, with its badminton tournament trophies and pantheon of portraits of long-passed reporters who covered martial law and revolutions and coups d’etats. Tomorrow the night crawlers will return to do what journalists have always done, and what they’ll always do. Long after Mr. Duterte has gone and his most vociferous followers are footnotes in history, we will write about this terrible era of avarice, injustice and death.
Stacey with her son in the yard of their home in Florida. “In moderation, it’s O.K.,” she said of marijuana use during pregnancy.CreditJennifer Sens for The New York Times
During her pregnancy, she never drank alcohol or had a cigarette. But nearly every day, Stacey, then 24, smoked marijuana.
With her fiancé’s blessing, she began taking a few puffs in her first trimester to quell morning sickness before going to work at a sandwich shop. When sciatica made it unbearable to stand during her 12-hour shifts, she discreetly vaped marijuana oil on her lunch break.
“I wouldn’t necessarily say, ‘Go smoke a pound of pot when you’re pregnant,’” said Stacey, now a stay-at-home mother in Deltona, Fla., who asked that her full name be withheld because street-bought marijuana is illegal in Florida. “In moderation, it’s O.K.”
Many pregnant women, particularly younger ones, seem to agree, a recent federal survey shows. As states legalize marijuana or its medical use, expectant mothers are taking it up in increasing numbers — another example of the many ways in which acceptance of marijuana has outstripped scientific understanding of its effects on human health.
Often pregnant women presume that cannabis has no consequences for developing infants. But preliminary research suggests otherwise: Marijuana’s main psychoactive ingredient — tetrahydrocannabinol, or THC — can cross the placenta to reach the fetus, experts say, potentially harming brain development, cognition and birth weight. THC can also be present in breast milk.
A Balm When You’re Expecting: Sometimes Pot Does the Trick
Hundreds of readers wrote in; most had smoked, while a few vaped or ate marijuana-laced edibles. Roughly half said they had used pot for a medical reason. Most felt marijuana use had not affected their children, or were not sure; just a handful worried the children might have suffered cognitive deficits.
The Times followed up with a few of these women in greater depth. Where they wished to protect their privacy or avoid legal consequences, only first names are used.
