The White House released a five-year, $1.2 billion plan on Friday to fight drug-resistant “superbugs” that includes better tracking of infections, faster tests and new drugs.
Hospitals will be pushed to do a better job of controlling infections such as carbapenem-resistant Enterobacteriaceae (CRE), methicillin-resistant Staphylococcus aureus (MRSA), and Clostridium difficile (C. diff), which kill 23,000 Americans every year and cost the economy billions of dollars.
“The loss of antibiotics that kill or inhibit the growth of bacteria means that we can no longer take for granted quick and reliable treatment of rare or common bacterial infections, including bacterial pneumonias, foodborne illnesses, and healthcare-associated infections,” the White House says in its report.
The Centers for Disease Control and Prevention and World Health Organization have been warning that the world could be about to enter a “post-antibiotic era” when fewer and fewer drugs will work to kill common infections.
“We're setting national goals for improving antibiotic use."
The problem’s caused by the overuse and misuse of antibiotics, a lack of tracking and screening to stop the superbugs from spreading, and the increasing use of antibiotics in farm animals. The more germs are exposed the antibiotics, the more likely they’ll evolve ways to resist their effects.
“We're going to provide real-time data about antibiotic resistance to doctors and hospitals nationwide, so they can monitor the rates of drug resistance in their area,” President Barack Obama said in an interview with Medscape.
“We're setting national goals for improving antibiotic use, and we're asking doctors and hospitals to help us meet them. And we're going to help health departments across the country achieve these goals.”
And very few truly new antibiotics are in the works. Most “new” drugs are tweaks to existing pharmaceuticals.
“Pharmaceutical companies want to know that if they spend the time and money to develop new drugs, those drugs will sell,” Obama said.
“This National Action Plan is a huge market signal. The federal government is making a long-term commitment to fighting drug resistance. That doesn't just mean producing one batch of new antibiotics — it means creating a stronger drug pipeline, so American drug companies will keep producing new antibiotics well into the future.”
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The White House plan lays out a five-point approach:
- Slow the emergence of resistant bacteria and prevent the spread of resistant infections.
- Strengthen national One-Health surveillance efforts to combat resistance.
- Advance development and use of rapid and innovative diagnostic tests for identification and characterization of resistant bacteria.
- Accelerate basic and applied research and development for new antibiotics, other therapeutics, and vaccines.
- Improve international collaboration and capacities for antibiotic-resistance prevention, surveillance, control, and antibiotic research and development.
It doesn’t give a great deal of detail on how to achieve those goals, and it will be up to Congress to approve the funding, which Obama has in his latest budget request.
But that doesn’t worry infection control experts, who welcome the report.
“There are some specifics in there that I am very happy with,” says Dr. Trevor Van Schooneveld of Nebraska Medical Center, who is a member of the Infectious Diseases Society of America and Society for Healthcare Epidemiology of America.
He’s especially happy about the plan to prod hospitals into keeping better track of antibiotics used and of how, when and where antibiotic-resistant infections occur.
“If nothing else, that is a big step forward,” Van Schooneveld told NBC News.
The federal government has a big stick to use to enforce this — Medicare, the federal health insurance plan for people over 65. “If you are going to get Medicare dollars and take care of patients using Medicare funding, you are going to need an antimicrobial stewardship program,” he said.
California already has a program, Van Schooneveld noted. States can wield some power using their contributions to Medicaid, the joint state-federal health insurance plan for people with lower incomes.
“This is really a far-reaching,” Van Schooneveld added. “If even 50 percent of this comes to fruition, I think it will be a huge boon.”
Doctors will also be encouraged to stand up far more to patients who demand antibiotics for inappropriate infections, such as viruses.
“Overprescribing is a serious problem,” Obama told Medscape.
“Using antibiotics when they aren't needed is one of the main causes of antibiotic resistance. So we need to give doctors the information and guidance they need to make the right call in hard situations.”
“If even 50 percent of this comes to fruition, I think it will be a huge boon.”
Not everyone praised the plan.
"Once again, the administration has fallen woefully short of taking meaningful action to curb the overuse of antibiotics in healthy food animals," said New York Rep. Louise Slaughter, a Democrat.
"With 80 percent of the antibiotics produced in the United States being used in agriculture mostly for prevention, any meaningful solution to the looming antibiotic resistance crisis must begin with limits on the farm - and trusting a voluntary policy that lets industry police itself will not bring about real change," Slaughter added.
The Natural Resources Defense Council says it doesn’t do enough to stop farmers from using antibiotics in healthy animals to make them grow bigger and faster. “The plan continues to allow the routine feeding of antibiotics to animals that live in the crowded conditions endemic to industrial farms,” the group says.
Studies show this use of antibiotics helps bacteria that resist their effects thrive and spread to people.
“Our government should be taking steps to reduce antibiotics to protect our health, rather than protecting poor industry practices,” the NRDC’s Mae Wu said in a statement.