White House Unveils Plan to Battle Antibiotic Resistance

September 18, 2014

Updated September 19, 2014 — The Obama administration today unveiled a complicated game plan to battle antibiotic resistance (AR), as well as a $20 million contest to develop a rapid point-of-care diagnostic test to identify superbugs that are killing at least 23,000 Americans per year.

Central to the new federal AR initiative is a national strategy that aims to slow the emergence and prevent the spread of resistant bacteria, to better track the bacteria, and to speed up the development of new antibiotics to treat them.

At a news conference today, Thomas Frieden, MD, MPH, the director of the Centers for Disease Control and Prevention, called AR "an urgent health threat, and a threat to our economic stability as well."

"The estimated annual impact of antibiotic-resistant infections is $20 billion in direct healthcare costs, and far more in lost productivity," said Dr. Frieden.

Bacteria for which there is no effective antibiotic pose a national security threat, added John Holdren, PhD, director of the White House Office of Science and Technology Policy.

"What we see...is the potential for [a] runaway spread of infection, which ultimately, as they go to very large scale, undermines social stability," Dr. Holdren said. "We see the potential for [an] enormous increase in costs, which can reduce the capacity of the country to respond to other threats."

"This May Sound Bureaucratic, but It's Anything But"

The national strategy wasn't the only AR news announced today. In an executive order, President Barack Obama established an interagency task force charged with developing a 5-year "national action plan" by February 15, 2015, to implement the national strategy. Cochaired by the heads of the departments of Health and Human Services, Defense, and Agriculture, the task force in particular must propose ways in which the government can make it easier for drug companies to develop new antibiotics.

The task force also must respond to, but not necessarily adopt, a menu of AR recommendations released today by the President's Council of Advisors on Science and Technology (PCAST). Among other things, PCAST suggested ways to promote the appropriate use of antibiotics by clinicians, and thus help increase their longevity. A recent Medscape Medical News survey found that roughly 1 in 5 antibiotic prescriptions are written when the prescriber is not sure it is needed. PCAST also suggested possible economic incentives, such as higher reimbursement, that might spur more pharmaceutical companies to bring new antibiotics to market.

The president's executive order sets in motion other governmental action designed to manage AR. It directs:

  • the US Food and Drug Administration to continue its efforts to eliminate the use of antibiotics in agriculture to promote growth in livestock,

  • the Department of Health and Human Services to create a Presidential Advisory Council on Combating Antibiotic Resistant Bacteria composed of nongovernmental experts, and

  • the Department of Health and Human Services and the State Department to designate representatives to work with the World Health Organization in crafting that group's AR battle plan.

At today's news briefing, government officials rebuffed the suggestion that today's announcements were largely bureaucratic in nature.

"This may sound bureaucratic, but it's anything but," said PCAST Cochair Eric Lander, PhD. "The president has laid out a series of boxes that have to be filled in...by February 15 of 2015, addressing a whole set of very specific things. This is a pretty tight timeline to come up with a national action plan."

The Stimulating Effect of Challenge Prizes

In putting its money where its mouth is, the White House announced it would award a $20 million prize to the individual or group that develops a rapid point-of-care diagnostic test to spot highly resistant bacterial infections. The official cosponsors of the prize are the National Institutes of Health and the Biomedical Advanced Research and Development Authority.

"What we have found with challenge prizes is that very often the prize stimulates investment far out of proportion to the magnitude of the prize itself, just for the honor and prestige of triumphing in the competition," said Dr. Holdren.

The $20 million prize resembles one to the tune of $17.1 million announced recently by the Nesta Foundation, the Technology Strategy Board of the United Kingdom, and the British Broadcasting Corporation for the sake of developing a rapid point-of-care test for antibiotic-resistant pathogens.

"I've Been Doing This For Years, and I'm Scared"

On another front in the war against AR, a House subcommittee on September 19 listened to physicians, pharmaceutical company executives, an official from US Food and Drug Administration, and other experts discuss how to put more antibiotics into the research and development pipeline. One of those speakers, Barbara Murray, MD, the president of the Infectious Diseases Society of America, described the grievous consequences of not having an effective antibiotic at hand to treat infected patients.

Dr. Barbara Murray. Source: Infectious Diseases Society of America

Dr. Murray recalled a young patient with lupus who developed a severe infection impervious to every antibiotic available, and even surgical intervention. "We sent her to hospice for comfort care while she waited for the infection to claim her life after a very long and expensive stay in the hospital," she told the health subcommittee of the House Energy and Commerce Committee.

Then there were 2 women that Dr. Murray had to hospitalize this summer to treat urinary tract infections, not because they were seriously ill but because they were resistant to oral antibiotics. "Having to be hospitalized for a common infection is inconvenient, decreases productivity, and increases healthcare costs," she told lawmakers.

Dr. Murray, director of the Infectious Diseases Division at the University of Texas Medical School at Houston, said in an interview with Medscape Medical News that she was experiencing the AR crisis as a potential patient.

"I've been [treating infectious diseases] for years, and I'm scared," she said. "I don't want to go to the hospital. This is the first time I've felt this way."

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