On March 27, the Obama administration released an implementation plan for its Combating Antibiotic-Resistant Bacteria strategy, which was announced in September.
The plan contains five goals with action steps on key issues around antibiotics: stewardship, both in human health care and animal agriculture; surveillance and response; research and development; and international collaboration in all of these areas.
Goal 1: Slow the emergence of resistant bacteria and prevent the spread of resistant infections.
To improve patient outcomes and minimize the development of resistant bacteria, the administration recommends targeted health care policies and antibiotic stewardship programs that ensure patients are prescribed these drugs only when they need them and that the most appropriate drug, dosage, and duration are used for their specific infections. The plan will also phase out, over the next three years, antibiotics used to promote the growth of food animals.
The Pew Charitable Trusts advocated for such efforts in September, calling for “vigilant stewardship of existing drugs in humans and animals.” In a statement following the release of the blueprint, Pew praised the administration’s “rigorous plan” for reducing antibiotic misuse in hospitals and other medical facilities but also called for action to reduce the misuse of antibiotics in food production beyond the administration’s stated goals—such as reviewing the safety of approved preventive uses of antibiotics.
Goal 2: Strengthen national “One-Health” surveillance efforts to combat resistance.
The administration aims to optimize the surveillance of drug-resistant bacteria through a new network of public health laboratories with standardized techniques for monitoring resistance. Taking a “One-Health” approach, the administration also plans to increase the monitoring of antibiotic sales, usage, and management practices in food animal production, as well as the presence of drug-resistant bacteria in animals and meat. The administration’s plan aims to enhance surveillance of both antibiotic use and antibiotic resistance through increased reporting to the Centers for Disease Control and Prevention’s National Healthcare Safety Network.
In testimony before the President’s Council of Advisors on Science and Technology (PCAST), Pew encouraged the administration to undertake more comprehensive surveillance of infectious organisms to better inform efforts to curb antibiotic resistance in both health care settings and agriculture.
Goal 3: Advance the development and use of rapid, innovative diagnostic tests to identify and characterize resistant bacteria.
The administration’s plan calls for improved diagnostics, which play a critical role in informing antibiotic treatment, stewardship, surveillance, and innovation.
Pew recognized effective diagnostic testing as a fundamental component of the fight against drug resistance at a 2014 hearing of the House Committee on Energy and Commerce’s Health Subcommittee. When doctors know exactly what is infecting patients, they are better able to properly treat them and less likely to prescribe unnecessary or inappropriate antibiotics. Rapid diagnostics also optimize antibiotic innovation; if clinicians could more easily identify patients with the most serious infections, clinical trials for potential treatments could be smaller and less expensive.
The administration’s plan supports basic and applied research, scientific services for researchers, and the development of public-private partnerships to strengthen the infrastructure of clinical trials for the development of antibacterial products and increase the number of antibiotics in the drug-development pipeline.
Pew participated in a 2014 PCAST meeting on the barriers to drug development and called attention to the fundamental scientific questions impeding our ability to combat resistance. Pew’s antibiotic resistance project is now working to address key scientific bottlenecks, facilitate better collaboration across the private and public sectors, and rejuvenate antibiotic discovery.
Goal 5: Improve international collaboration and capacities for antibiotic resistance prevention, surveillance, control, and antibiotic research and development.
Antibiotic resistance is a global issue, and the administration recommends combating it with a global approach. By coordinating with ministries of health and agriculture, the World Health Organization, and other international groups to monitor antibiotic use and resistance, the administration’s plan aims to incentivize the development of new drugs and diagnostics and help prevent and control infections worldwide.
Pew supported such collaboration in comments to inform WHO’s Global Action Plan, recognizing that Americans use antibiotics more frequently than people in other industrialized nations—with rates over twice as high as those in Germany and the Netherlands. Food animals in the U.S. are administered more antibiotics than those in other countries as well, with U.S. livestock receiving about six times the amount of drugs given to animals in Norway and Denmark.