Feds release new national antibiotic resistance plan

Stack of pill packets
Stack of pill packets

Global Panorama / Flickr cc

In the midst of a global pandemic, the federal government late last week released a new action plan to help prevent a future pandemic of antibiotic-resistant bacteria.

The updated "National Action Plan for Combating Antibiotic-Resistant Bacteria, 2020-2025" is a roadmap to guide the nation's response to the rise and spread of drug-resistant bacteria, which, according to the most recent data from the Centers for Disease Control and Prevention (CDC) are responsible for more than 2.8 million infections and 35,000 deaths a year in the United States. It's the second action plan released by the government.

Same goals, updated objectives

The five goals of the plan remain the same as those in the first plan, which came out in March 2015. They include slowing the emergence of resistant bacteria and preventing the spread of resistant infections; strengthening "One Health" surveillance efforts; advancing the development and use of rapid diagnostics; accelerating the development of new antibiotics, vaccines, and alternative therapies; and improving international collaboration on antibiotic-resistant prevention and control.

But the objectives for meeting those goals have been updated. Among the new objectives are a 20% reduction in the number of healthcare-associated antibiotic-resistant infections and 10% reduction in community-acquired antibiotic-resistant infections by 2025, support for 10 new resistance-related diagnostics projects by 2021, and support for the clinical development of 10 novel therapeutics for bacterial infections by 2022.

Other objectives include increasing the amount of laboratory testing for antibiotic resistance; expanding the number of hospitals that provide antibiotic resistance surveillance data; lowering the annual rate of inappropriate outpatient antibiotic prescribing; collecting and analyzing more data on resistant pathogens in food, animals, and the environment; and selecting a "champion" to advocate for US policy positions on antibiotic resistance in international meetings and negotiations.

The plan was developed by the Federal Task Force for Combating Antibiotic-Resistant Bacteria, a collection of federal departments that include the Department of Health and Human Services (HHS), the US Department of Agriculture (USDA), and the Department of Defense, and the agencies within those departments, such as the CDC and the Food and Drug Administration (FDA). Each department and agency will provide annual reports on their progress in helping meet the objectives.

The Task Force says the document provides "a set of coordinated, strategic actions aimed at changing the trajectory of antibiotic resistance and improving the health and wellbeing of all Americans, as well as the health of animals, plants, and the environment."

Among the tasks of the CDC in helping achieve the objects of the plan will be supporting infection prevention and control efforts in hospitals to reduce resistant infections, collecting antibiotic use data from hospitals to help optimize antibiotic use, and increasing investments in state and local health departments to improve their capacity to detect resistant pathogens.

The FDA will play a role in supporting research into new antibiotics and other therapeutics, developing evidence-based guidelines for the use of diagnostics, and producing more published reports and dashboards on antibiotic use in animals.

Other agencies involved in meeting the goals of the plan, and tracking progress, include the Biomedical Advanced Research and Development Authority within HHS, the Animal and Plant Health Inspection Service within the USDA, and the Environmental Protection Agency.

"Tracking progress toward the targets listed here should inform the Task Force's understanding of relevant changes over time, allowing agencies to change course when necessary to more effectively achieve the objectives and make progress toward the goals," the document says.

Building on accomplishments

As the Task Force notes, the first national action plan had a significant impact, leading to the creation of the CDC's Antibiotic Resistance Laboratory Network, the launch of the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator (CARB-X), the development of new programs to improve antibiotic use across healthcare settings, and new initiatives to support antibiotic stewardship in veterinary settings—a key element of the One Health strategy.

Infectious disease and antibiotic resistance experts say the new plan will be important for building on these accomplishments and advancing the national effort to combat antibiotic resistance.

"I think it's great that the plan has so many elements, because there are so many areas of attack and things that we have to fix," said Martin Blaser, MD, chair of the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria (PACCARB), which has been advising the federal government on antibiotic resistance policies since 2016, and director of the Center for Advanced Biotechnology and Medicine at Rutgers University.

Blaser said he's particularly encouraged with the focus on infection prevention and stewardship activities, because even if several new antibiotics are developed in the coming years, resistance is inevitable and over time will "swallow them up."

"We think that stewardship is extremely important, because unless we collectively change our practices and steward the antibiotics better, in the hospital, in outpatients, and on the farm…the progress in this area is going to be very slow," Blaser said. "That's something that we at PACCARB have been pushing, and will continue to work on."

"Having a National Action Plan for Combating Antibiotic-Resistant Bacteria is important both symbolically and functionally," said David Hyun, MD, senior officer with the Pew Charitable Trusts' antibiotic resistance project. "When the first plan came out in 2015, it sent an important signal that the US recognizes and is working to combat the growing threat of antibiotic resistance, and by issuing an updated plan, the US is sending a clear message that the fight against superbugs remains a national priority."

Experts point to flaws in the plan

But Hyun said the thinks the plan falls short in some areas, and is lacking in targets and specifics. Most notably, he said, it does not specifically address the need for incentives to fix the financial model for antibiotics, which is widely seen as a roadblock to bringing innovative new antibiotics to market.

"Many of the actions listed do not go far enough to ensure sustained success in achieving the objectives, such as the economic incentives needed to stabilize and revitalize the broken antibiotic market—an area where there is broad consensus among stakeholders," he said.

The Infectious Diseases Society of America (IDSA) also highlighted this issue in a statement on the updated action plan.

"A new financing mechanism that provides a meaningful, predictable return on investment for the most critically needed antibiotics and that is delinked from the sales and use of those antibiotics is essential," the IDSA said.

In addition, Hyun pointed out that the plan doesn't incorporate goals from the FDA's 5-year plan to improve antibiotic stewardship in animals, and doesn't provide incentive strategies for requiring hospitals to report antibiotic use to the CDC's National Healthcare Safety Network to achieve the goal of 100% reporting of acute care hospitals by 2025. These are among the priorities that Pew said in March should be included in the updated action plan.

Hyun called it a "missed opportunity."

The plan lacks some of the specific targets for antibiotic use set out in other national antibiotic resistance plans. The 5-year plan released by the UK government in 2019, for example, called for a 15% decrease in human antibiotic use by 2024 and 25% decrease in the use of antibiotics in food-producing animals by 2020.

Blaser said the question of specific targets, and how important they are, is a philosophical issue on which stakeholders have different opinions.

"Many people say targets are extremely important," he said. "I'm more of a conceptual guy. I think we need to spell out the concepts, and we have to do it more and more and more."

The Task Force notes that among the challenges in implementing the plan will be the ongoing COVID-19 pandemic, which has drawn away many of the public health and infectious disease resources previously focused on antibiotic resistance. Blaser said COVID-19 highlights why it's important for the United States and other countries to collaborate on efforts to combat antibiotic resistance.

"Microbes don't respect borders. They don't respect political boundaries. They don't respect political ideology," he said. "So whatever our borders and national ideologies are, we need to work together; otherwise, it's going to take a terrible toll."

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