HHS' Azar Kicks Off Global Effort to Fight Antibiotic Resistance

Troy Brown, RN

September 26, 2018

The US Department of Health and Human Services (HHS) Secretary Alex Azar and the Centers for Disease Control and Prevention (CDC) announced the US government's global Antimicrobial Resistance (AMR) Challenge on September 25 at a high-level meeting during the 73rd session of the United Nations General Assembly.

The yearlong effort — called "the most ambitious global initiative to date to combat the growing threat of antibiotic resistance" in a CDC news release — will intensify efforts to fight AMR worldwide by enabling governments, private industries, and nongovernmental organizations worldwide to formally commit to furthering the gains already made against AMR.

"We are seeing resistance to life-saving antibiotics, and scientists worldwide are uncovering new types of resistance. Our shared commitment to confront this threat is critical to all American communities and companies, protecting our progress in healthcare outcomes, food production and even life expectancy, CDC Director Robert Redfield, MD, said in the CDC release.

The Bill & Melinda Gates Foundation, the Pew Charitable Trusts, the United Nations Foundation, the Wellcome Trust, and the CDC Foundation cohosted the event, at which Azar unveiled the first commitments from more than 100 organizations intent on continuing progress against one of the most urgent global public health threats.

Attendees at the meeting along with Azar included Tedros Adhanom Ghebreyesus, director-general, World Health Organization (WHO), Balram Bhargava, MD, DM, director-general, Indian Council of Medical Research, New Delhi, and secretary, Department of Health Research, and Anand Anandkumar, chief executive officer and managing director of Bugworks Research Inc.

"Untreatable infections are the reality for too many families around the world — and in the U.S." Azar said in the CDC news release. "We've had some success fighting antibiotic resistance but, if we don't all act fast together, we will see global progress quickly unravel. Antibiotic resistance isn't slowing down. Every country and industry has to step up," he added.

Antibiotic resistance is a global concern. At least 2 million people develop resistant infections each year in the United States alone, 23,000 of which are fatal, Azar said in prepared remarks presented to the assembly Tuesday night.

Collaborative Global Approach Needed

"Modern travel of people, animals, and goods means antibiotic resistance can easily spread across borders and continents. Antibiotic resistance in one country means antibiotic resistance in every country," Azar explained in the CDC release. "Fighting this threat requires a collaborative global approach across sectors to detect, prevent, and respond to these threats when they occur. Every country, regardless of resources, can take steps to slow antibiotic resistance."

"We cannot achieve better health and wellbeing without developing new and effective medicines," the WHO's Tedros said at the meeting. With respect to research and development for new antimicrobials, "the cupboard is disturbingly bare," he added.

Tedros noted that, although research and development are sorely needed, they alone are not the answer. We also need to "address the root cause of the problem. For example, we can prevent infections in the first place with improved sanitation and hygiene," he explained.

Tedros ended by outlining three priorities for the prevention of AMR: using antibiotics responsibly and only when necessary; meeting the challenge of research and development of new medications; and using a One Health approach, which acknowledges the connections between the health of people, animals, and the environment.

The AMR Challenge urges pharmaceutical companies, health insurance companies, food animal producers and purchasers, medical professionals, government health officials, and other leaders worldwide to work together to find solutions to antibiotic resistance.

Steps these and other groups can take to head off AMR include decreasing antibiotics and resistance in the environment — for example, in water and soil; improving antimicrobial use, including making sure antimicrobial agents are available to people who need them; inventing new vaccines, medications, and diagnostic tests; enhancing infection prevention and control; and improving the collection and sharing of data.

Continuing Momentum

A similar national initiative begun in 2015, the National Action Plan for Combating Antibiotic-Resistant Bacteria, has been successful, and the AMR Challenge plans to build on that success.

In September 2018, the CDC published The Core Elements of Human Antibiotic Stewardship Programs in Resource-Limited Settings: National and Hospital Levels to assist healthcare settings around the world in improving antibiotic use. Information about other steps the US government is taking to combat AMR is available at the CDC's website.

Initial AMR Challenge Commitments

Participating organizations can make commitments starting September 25, 2018, and ending in September 2019.

"The AMR Alliance, which represents more than 100 pharmaceutical companies, agreed earlier in 2018 on a framework that promotes responsible antibiotic manufacturing. Last week, these companies took a further step by publishing the first list of targets to guide environmental risk assessments regarding the discharge of antibiotics and their residue," Azar explained in his prepared remarks to the assembly.

Walmart US said it is working with its animal protein suppliers to promote responsible antibiotic use in farm animals, which will affect more than 5000 stores and clubs in the United States.

NovaDigm Therapeutics is working to develop a vaccine for Candida auris, an emerging resistant fungus that has seriously sickened and killed persons around the world.

Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator (CARB-X) has committed to investing $80 million globally by the end of December 2019 to help more than 40 product developers pursue new medication classes for the treatment of gram-negative bacteria, new diagnostics to speed identification of new resistance and infections, and new treatment alternatives and vaccines. "Each award agreement will include commitments to access and stewardship to ensure proper use of these life-saving innovations," Azar said in his prepared address before the assembly.

Aetna has agreed to partner with state health departments to give feedback to healthcare providers regarding their antibiotic prescribing performance and advocate for vaccinations.

Petco agrees to prohibit prophylactic antibiotic use in its supply chain and support veterinary oversight for antibiotic access in its 1500 US locations and online channels.

"We have also seen commitments from healthcare providers. Systems that provide care at more than 20,000 healthcare facilities in the U.S. and abroad have committed to improving antibiotic stewardship, and hundreds have also committed to reducing infections," Azar explained.

Professional clinical societies, representing more than 283,000 US healthcare providers, have committed to improving their members' use of antibiotics in patients.

Organizations that represent patients affected by antibiotic resistance and sepsis continue to educate and promote awareness to patients and caregivers about the threat of AMR.

The Association of Public Health Laboratories, the Association of State and Territorial Health Officials, and the Council of State and Territorial Epidemiologists are collaborating with state and local health departments to develop more than 50 commitments tailored to each state's antibiotic resistance threats and goals.

"Next year at the General Assembly, I look forward to marking the end of this 12-month challenge and celebrating the progress we have made. The threat of AMR is real and looming. Indeed, part of the promise of modern medicine itself is at stake. But together, with every country and sector doing its part, we can keep future generations safe," Azar concluded.

Information about all the commitments to the AMR Challenge made to date by various companies and organizations can be found at the CDC's website.

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