The White House announced Thursday its plan to make the issue of antibiotic resistance a national priority. In addition to the release of the much-anticipated President’s Council of Advisors on Science and Technology (PCAST) report on antibiotic resistance requested by President Obama last year, there are three related developments. These include an Executive Order (EO) establishing an interagency task force for combating antibiotic-resistant bacteria, the release of the administration’s National Strategy on Combating Antibiotic-Resistant Bacteria, and a $20-million prize, co-sponsored by the National Institutes of Health and the Biomedical Advanced Research and Development Authority, for developing rapid, point-of-care diagnostic tests for identifying highly resistant bacterial infections. “Controlling the development and spread of antibiotic resistance is a top national security and public health priority for this administration,” said John Holdren, director of the White House Office of Science and Technology Policy and assistant to the president, during a call with reporters. According to the Centers for Disease Control and Prevention (CDC), antibiotic-resistant infections are associated with 23,000 deaths and 2 million illnesses in the United States each year. Estimates of annual impact of antibiotic-resistant infections on the U.S. economy vary but have ranged as high as $20 billion in excess direct health care costs and even higher if you count lost productivity from sick days and hospitalizations. The interagency task force will be co-chaired by the Secretaries of Defense, Agriculture, and Health and Human Services and must submit an action plan to the president by February 2015 that implements the national strategy and addresses PCAST’s recommendations. The PCAST report recommends steps to improve surveillance of antibiotic-resistant bacteria, increase the longevity of current and new antibiotics, and increase the developments of new antibiotics. When it comes to antibiotics use on farms, the report states that, “The benefits of antibiotic use in animal agriculture, however, must be weighed carefully against the serious potential risks to human health posed by antibiotic resistance.” Its recommendation for limiting the use of antibiotics in animal agriculture is to support FDA’s new Guidances 209 and 213:
- FDA should proceed vigorously with the implementation of these guidances, including completing its rulemaking to update the language of the Veterinary Feed Directive.
- USDA, through its Cooperative Extension Service, should establish and lead a national education and stewardship program to assist farmers, ranchers, and animal agriculture producers across the United States in complying with these FDA guidances.
- FDA should assess progress by monitoring changes in total sales of antibiotics in animal agriculture and, where possible, in usage of such antibiotics; and by developing and undertaking studies to assess whether decreases are observed in antibiotic resistance among farm animals.
“If the FDA guidances are not effective in mitigating the risk of antibiotic resistance associated with antibiotic use in animal agriculture, FDA should take additional measures to protect human health,” the report added. It also recommended that alternatives to antibiotics in agriculture be developed. “The national strategy correctly recommends improved tracking of antibiotic use and resistance in human medicine and agriculture,” said Allan Coukell, senior director of drugs and medical devices at The Pew Charitable Trusts. “The administration has already taken steps to phase out these drugs for growth promotion in livestock. It is essential now to ensure that antibiotic use in animals is really reduced and that these important drugs are administered only in medically appropriate ways under the supervision of a veterinarian.” Some consumer advocate groups such as Keep Antibiotics Working were frustrated that the report didn’t include “more effective” actions. “While the Council rightly acknowledges the seriousness of antibiotic resistance and its link to antibiotic overuse, their recommendations related to animal agriculture fall dangerously short,” read a statement from the coalition. “Instead of recommending that FDA move to address overuse of antibiotics for disease prevention and the farming practices that create the need for them, the report recommends a wait and see attitude on reducing antibiotic use in food animals.”