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President Barack Obama issued an executive order Thursday telling his administration to hurry up and do something about drug-resistant bacteria, which pose a “serious threat to public health and the economy.”
Infections caused by antibiotic resistant bacteria kill 23,000 people every year, make 2 million more sick and cost $35 billion in productivity lost to sick days, the Centers for Disease Control and Prevention says. “These are conservative estimates,” CDC Director Dr. Tom Frieden told reporters. “The true number is actually much higher.”
Experts have been screaming about it for years -– more and more infections resist most, if not all, antibiotics used against them and there are not any new drugs in the pipeline.
Dr. John Holdren, Obama’s chief science adviser, sees “the potential for the runaway spread of infection” that can “undermine social stability.”
“This is an urgent health threat and a threat to our economic stability as well."
Yet doctors continue to prescribe antibiotics for infections they will not help -– viruses for instance -- patients continue to take antibiotics improperly and farmers continues to dose animals with antibiotics to make them grow bigger. All of these inappropriate uses help bacteria mutate into drug-defying forms.
“This is an urgent health threat and a threat to our economic stability as well,” Frieden said.
The executive order sets up a task force headed by the secretaries of Health and Human Services, Defense and Agriculture to come up with a report and a five-year action plan by next February. One of their tasks is to look at a report from the President’s Council of Advisors on Science and Technology, also issued Thursday, and decide which recommendations to act on.
The broad framework is clear -– doctors need instant tests for infections, both so they can immediately tell if a patient should even get an antibiotic and to tell if someone has a drug-resistant infection. Doctors must use antibiotics more wisely, and agriculture also needs to use them when needed, not just as general growth promoters. And new antibiotics that work using new pathways are badly needed.
So the order also directs agencies to set up a $20 million prize for someone who can invent a new, fast test. Presidential advisers recommend using cash and other incentives to encourage drug companies to invest in new antibiotics, while spending more in government labs to invent them. And the advisers also recommend using government funds as a stick to make doctors use antibiotics more carefully.
Bacteria start to evolve resistance to antibiotics almost immediately. Some already have genes that help them either pump antibiotics out, or thrive despite their effects. They can swap these genes with one another, and the more often bacteria encounter an antibiotic, the more likely a few of them will survive and multiply.
Even before penicillin was introduced in 1943, Staphylococcus germs were identified that were resistant to its effects. Just nine years after tetracycline was introduced in 1950, a resistant strain of Shigella evolved. Methicillin-resistant Staphylococcus aureas (MRSA) evolved just two years after methicillin hit the market in 1960.
“Antibiotics are precious medicines that have saved millions of lives by treating infections caused by bacteria. But their misuse, and overuse, has serious health consequences and has contributed to antibiotic resistance in which these drugs become less effective, or ineffective, against harmful bacteria,” Food and Drug Administration Commissioner Dr. Margaret Hamburg said in a blog post.
The executive order also directs the HHS’s Biomedical Advanced Research Development Authority (BARDA) to develop new drugs and vaccines against superbugs.
One controversial area is the widespread use of antibiotics in farm animals. “Medically important antibiotics are also extensively used in animal agriculture not only to treat sick animals, but also to promote animal growth and to prevent infections,” the PCAST report reads.
“All of these uses promote the development of antibiotic resistance among bacteria in animals, and these resistant strains do, at least in some cases, spread to humans.”
FDA is working on this but the order stresses the need to continue. Hamburg says her agency is making progress. “We have now secured the commitment of all 26 affected animal health companies, and 31 products have been withdrawn from the market,” she says.
“Such aggressive action and investments in the antibiotic crisis are justified to contain the public health and economic impacts."
None of this will come cheap, PCAST says. “Federal spending for the antibiotic crisis has been limited –- approximately $450 million in direct funding in fiscal year 2014, corresponding to just over $1.40 per American,” it says. And this cash is spread across HHA, the VA, the Defense Department and USDA.
It recommends spending another $450 million a year, bringing spending to $900 million. And it will cost $800 million a year just to encourage drug companies to develop one new antibiotic a year. “Such aggressive action and investments in the antibiotic crisis are justified to contain the public health and economic impacts, which are likely to increase even more rapidly in the future if not checked,” the PCAST report reads.
The report also recommends using Medicare funds as a stick. Hospitals and clinics that don’t come up with good plans for better use of antibiotics should be threatened with having their funding taken away, the report recommends.