The White House on Friday announced a new initiative to fight the growing threat posed by antibiotic-resistant bacteria, with a series of measures that will crack down on over-use and over-prescription of antibiotics at farms and hospitals.
The five-year, $1.2 billion plan is aimed at combating drug resistance, which is responsible for an estimated 23,000 deaths and two million illnesses a year in the United States. Included in the five-step plan is a call to end the widespread over-use of antibiotics in medicine and in animals raised for food, which is partially to blame for growing antibiotic resistance in the U.S. and elsewhere.
Drug resistance occurs when bacteria acquire genetic changes that give them the ability to withstand antibiotics. The World Health Organization said last year that bacteria resistant to antibiotics have spread to every part of the world, and if left unchecked, will take us back to a “pre-antibiotic era” in which minor infections like strep throat could kill.
Antibiotic resistance also threatens animal health, agriculture and the economy. The CDC estimates that antibiotic-resistant infections account for at least $20 billion in excess direct health care costs and up to $35 billion in lost productivity due to hospitalizations and sick days each year.
“The rise of drug resistance in bacteria is undermining the efficiency of current antibiotics and our capability to treat and prevent disease,” the White House said. “Antibiotic resistance also restricts our capability to perform a range of contemporary medical strategies, for example, chemotherapy, surgery, and organ transplants.”
The National Action Plan for Combating Antibiotic Resistant Bacteria (NAP) lays out a five-point approach to combating drug resistance:
- Slow the emergence of resistant bacteria and prevent the spread of resistant infections: The CDC estimates that up to half of all human antibiotic use is unnecessary or inappropriate. The new White House plan includes activities to foster improvements in the appropriate use of antibiotics (i.e., antibiotic stewardship) by improving prescribing practices across all healthcare settings, preventing the spread of drug-resistant threats in healthcare facilities and communities, and continuing to eliminate the use of medically-important antibiotics for growth promotion in animals. The plan also includes increased funding to support USDA development of alternatives to antibiotics, including improved management and animal care practices and other tools.
- Strengthen national One-Health surveillance efforts to combat resistance: Improved detection and control of antibiotic resistance in human and animal pathogens will be achieved through a “One-Health” approach to disease surveillance that integrates data from multiple monitoring networks, the White House says. This will include enhancing, expanding, and linking existing systems that monitor human and animal pathogens, including the National Healthcare Safety Network (NHSN), the Emerging Infections Program (EIP), the National Antimicrobial Resistance Monitoring System (NARMS), the National Animal Health Monitoring System (NAHMS), and animal health laboratories. “This approach will significantly increase the currently very limited data and provide high-quality information, including detailed genomic data, necessary to track resistant bacteria in diverse settings in a timely fashion,” the plan states.
- Advance development and use of rapid and innovative diagnostic tests for identification and characterization of resistant bacteria: The plan calls for more funding to go towards the development of new, rapid “point-of-need” diagnostic tests that can be used during a healthcare visit to distinguish between viral and bacterial infections and identify bacterial drug susceptibilities — an innovation that could significantly reduce unnecessary antibiotic use. “The availability of new rapid diagnostic tests, combined with ongoing use of culture-based assays to identify new resistance mechanisms, will advance the detection and control of resistant bacteria,” the plan says. The plan also establishes a “Detect Network of Antibiotic Resistance Regional Laboratories,” which will help to characterize emerging resistance patterns in real time and rapidly identify outbreaks of antibiotic-resistant organisms. Additionally, a new “Antibiotic Resistance Isolate Bank” will provide a complete collection of current antibiotic-resistant bacteria, help keep pace with mutations, and provide information to guide FDA approval of new tests, antibiotics, and related products.
- Accelerate basic and applied research and development for new antibiotics, other therapeutics, and vaccines: Antibiotics that lose their effectiveness for treating human disease through antibiotic resistance must be replaced with new drugs; alternatives to antibiotics are also needed in veterinary medicine. Despite the urgent need for new antibacterial drugs, the pipeline of antibiotics in development is inadequate, and commercial interest in antibiotic development remains limited. The plan addresses this need by investing more in basic and applied scientific research, fostering public-private partnerships, and facilitating clinical trials, with the goal of “advancing the discovery and development of new antibiotics and alternative therapies to combat resistance.”
- Improve international collaboration and capacities for antibiotic-resistance prevention, surveillance, control, and antibiotic research and development: “Antibiotic resistance is a global problem that requires global solutions,” the White House says. As such, the plan specifies that the United States will engage with international ministries and institutions to strengthen national and international capacities to detect, monitor, analyze, and report antibiotic resistance; provide resources and incentives to spur the development of therapeutics and diagnostics for use in humans and animals; and strengthen regional networks and global partnerships that help prevent and control the emergence and spread of resistance.
The plan is the result of an order Obama signed in September forming a task force on the issue. Obama also has asked Congress to nearly double its funding to fight antibiotic resistance to $1.2 billion.
“It is the boldest move against antibiotic resistance by any U.S. government ever,” Kevin Outterson, a Boston University law professor, researcher and author on antibiotic resistance, told The Wall Street Journal.