White House releases plan to curb antibiotic resistance

In its latest salvo in the battle against antibiotic resistance over the past year, the Obama administration today unveiled a detailed plan for addressing the threat in the next 5 years.

Infectious disease groups lauded the White House's plan, but some said the measures fall short, because they don't do enough to tackle the issue of antibiotics used in raising food animals.

The plan released today is part of multipronged effort to address antibiotic resistance. In September President Barack Obama outlined a national strategy and issued an executive order that set up an interagency task force on combating antibiotic-resistant bacteria and a Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria.

He asked the task force to come up with a 5-year plan based on recommendations made in September by the President's Council of Advisors on Science and Technology.

Today's plan revolves around the strategy's five goals: (1) slow the emergence and prevent the spread of resistant bacteria; (2) strengthen national "one-health" surveillance efforts; (3) advance the development and use of innovative diagnostic tests; (4) accelerate basic and applied research and progress on new antibiotics, other therapeutics, and vaccines; and (5) improve international collaboration.

Multi-pronged plan

Though the plan primarily targets US government activities, it is also designed to guide actions by public health, healthcare, and veterinary partners, according to the 62-page document.

It includes multiple steps under each of the five goals. For example, under slowing the emergence of resistant bacteria and preventing their spread, the plan calls for public health programs and reporting policies that support antibiotic stewardship. It also pushes for the elimination of medically important antibiotics for growth promotion in food-producing animals and brings other agricultural uses of antibiotics under veterinary oversight.

Under the goal of strengthening "one-health" surveillance to help curb resistance, the plan creates a regional public health lab network to boost the nation's capacity to identify resistant bacterial strains and a specimen repository to help with the development and testing of diagnostic tests and treatments. It also offers incentives for healthcare facilities to report antibiotic use and antibiotic resistance in a timely manner and boosts federal and state capacity to test for antibiotic resistance and zoonotic pathogens.

The plan would also arm clinicians with new diagnostic tools to help distinguish viral and bacterial pathogens and gauge antibiotic resistance, as well as providing better tests for diagnosing and treating resistant infections.

It also includes several measures to boost research on new therapies, diagnostics, and vaccines. And it details steps to support international surveillance, research, and communication.

To help monitor implementation, the plan sets out 1-, 3-, and 5-year milestones for each step, with progress to be monitored by the task force that developed the plan.

Groups welcome new steps

Several infectious disease and infection control groups welcomed the announcement today and urged Congress to fund the initiatives spelled out in the plan.

The Infectious Diseases Society of America (ISDA) said in a statement that the action plan marks a new phase of well-coordinated federal activity to combat the threat. But it added that, for the plan to deliver its results, Congress must approve additional funding in Obama's proposed budget that targets the problem.

The administration has proposed to boost spending on antimicrobial resistance programs by $550 million over the 2015 level, which would fully fund the National Strategy on Combating Antibiotic Resistant Bacteria.

The IDSA urged the government to establish antibiotic stewardship programs in all health facilities and enact new incentives to foster the development of new antibiotics, vaccines, and diagnostic tests.

The Association for Professionals in Infection Control and Epidemiology (APIC) said today that the interagency action plan correctly focuses on the demand and supply side of the antibiotic resistance problem and addresses overuse in both human and agricultural settings.

However, APIC warned that many health facilities don't have enough infection prevention and control staff, and it called on Congress to fund the programs that will give the new action plan a chance to succeed.

Meanwhile, the Society for Healthcare Epidemiology of America (SHEA) said the stewardship milestones detailed during the first year are the building blocks for reducing antimicrobial resistance and helping the plan meet its other goals. SHEA said the plan includes several major points that the group outlined in a 2012 joint policy statement.

SHEA added that it is especially pleased to see that in 3 years the Centers for Medicare & Medical Services will issue new Conditions of Participation (COP) or revise current COP guidelines to encourage compliance with Centers for Disease Control and Prevention (CDC) hospital antibiotic stewardship recommendations. "This is essential to ensuring broad based support for stewardship programs," SHEA said.

Critics see gaps in curbing ag antibiotic use

Rep Louise Slaughter, D-N.Y., a microbiologist, said in a statement today that the Obama administration has fallen short on meaningful actions to curb the overuse of antibiotics in healthy food animals.

She said 80% of antibiotics produced in the United States are used in agriculture, mostly for prevention. "Any meaningful solution to the looming antibiotic resistance crisis must begin with limits on the farm—and trusting a voluntary policy that lets industry police itself will not bring about real change," Slaughter added, warning that the United States is a decade behind European nations on battling the threat and that inadequately addressing the problem could become a major trade issue.

Slaughter recently introduced legislation that would bar eight antibiotic classes from routine use in healthy farm animals.

David Plunkett, JD, senior food safety attorney for the Center for Science in the Public Interest (CSPI), a consumer safety watchdog based in Washington, DC, said in a statement that the action plan misses a critical chance to shrink the use of antibiotics in animal agriculture.

He applauded the Obama Administration for involving the CDC and the US Department of Agriculture in improving surveillance for antibiotic-resistant Salmonella and Campylobacter. However, Plunkett said the plan doesn't ban non-treatment uses for antibiotics, including deadlines for measuring effectiveness, and lacks steps to be taken if voluntary programs don't reduce on-farm antibiotic use.

See also:

Mar 27 White House statement

Mar 27 National Action Plan for Combating Antibiotic-Resistant Bacteria

Mar 27 IDSA statement

Mar 27 APIC statement

Mar 27 Slaughter statement

Mar 27 CSPI statement

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