The Spread of Antibiotic-Resistant Bacteria through Medical Tourism and Transmission Prevention Under the International Health Regulations

Abstract Medical tourism-travel by healthcare patients to a foreign location for medical treatment-is a growing industry. Healthcare is nationally regulated in every country, and difficulties arise where legal remedies and standards vary between a medical tourist's resident and destination country. Antibiotic-resistant bacteria, which are typically limited to healthcare settings and close community quarters, have predictable risk factors. These predictable risk factors generally reduce concern regarding healthcare-associated strains in the medical community because hospitals can set admission and contact policies to reduce the spread of healthcare-associated strains. As medical tourism increases, however, the spread of healthcare-associated antibiotic-resistant bacteria infections is also likely to increase because patients are more likely to be exposed to hospitals and healthcare settings in different countries. Patients may thus spread their infections to facilities around the world. One recently discovered antibiotic-resistant strain of bacteria has shown evidence of fast international spread due to connections with medical tourism. There are a number of possible solutions to the public health and economic implications of the rapid spread of existing and potential antibiotic-resistant bacteria. These solutions include: containment strategies implemented by the World Health Organisation (WHO) under the International Health Regulatins 2005 (IHR); race-to-the-top strategies that do not require state intervention at any level, where patients seek out hospitals that best manage infectious disease; containment procedures utilized by individual countries to prevent incoming infections, similar to the classical IHR regime; and information-forcing regimes at either national or international levels, which can supplement any of the other three regulatory and economic solutions by instituting reporting requirements on individual states. To date, the WHO has never used the IHR to make recommendations regarding antibiotic-resistant bacteria. This Comment discusses the growth and practices of medical tourism, the development and spread of antibiotic-resistant bacteria, and compares the attributes of antibiotic-resistant bacteria to the attributes of previously declared pandemic diseases. This Comment proposes that the application of the IHR to antibiotic-resistant bacteria spread though medical tourism is consistent with the language of the IHR and concludes that the IHR offers the most efficient and potentially effective method of combating transmission of antibiotic-resistant bacteria. Table of Contents I. Introduction 275 II. Medical Tourism 278 A. Current and Projected State of die Medical Tourism Industry 279 B. Accreditation and Odier Current Regulatory Methods 281 III. Antibiotic-Resistant Bacteria 282 A. Attributes and Examples of Antibiotic-Resistant Bacteria 282 1. Emergence, spread and economic costs of MRSA 283 2. Recent emergence of NDM-I and its spread through medical tourism 286 B. Attributes of Antibiotic-Resistant Bacteria Compared to Attributes of Other Pandemic Infectious Diseases 288 1. Risk factors for infection and transmission of antibiotic-resistant bacteria compared to other infectious diseases 288 2. …