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To Fix Antibiotic Resistance: A Cabinet Post And More Money

Turkeys in a North Carolina intensive farm.
Turkeys in a North Carolina intensive farm.
Photograph by Mercy for Animals via Wikimedia Commons.

A White House panel of experts has made a striking recommendation: the United States needs a champion—perhaps even a new Cabinet member—backed with plenty of funding to fight antibiotic resistance.

This champion, who could also be an assistant secretary, would guarantee the issue does not slip away beneath short-term priorities and agency infighting. And most of all, as the group mentions numerous times, the effort needs money: “The (government) must commit sufficient resources to solving the problem with funding continued over a long period of time… Key elements necessary to achieve the goals of the national action plan are underfunded.”

Eighteen months ago, the Obama White House made a historic commitment—the first by any administration—to combating antibiotic resistance. The administration announced a national strategy against resistance, President Obama signed an executive order launching the effort, and the White House subsequently held a first of its kind Forum on Antibiotic Stewardship.

To figure out what the country should do, the White House named a Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria. Today that panel of experts launches a two-day meeting to start dealing with the practicalities, and has issued a 126-page report out of their first 180 days of research.

Other priorities (which will be familiar from other examinations of resistance such as the reports from the British Review on Antimicrobial Resistance): improve surveillance to detect resistance faster, stimulate the development of new drugs, foster innovation in rapid diagnostic devices to cut down on useless  prescribing, explore international agreements on conserving antibiotics,  try to educate the public on appropriate antibiotic use.

From the launch of the national strategy and the council’s being named, many advocates have criticized its makeup for being long on medical research but short on the kind of public health insight that could push back against the agricultural status quo. So it’s encouraging that the group put at the top of their list a commitment to a “One Health” approach, which is to say, considering human and animal issues to be connected, and not separate realms. Each of the major issues examined by the report contains a “One Health” addendum.

At the same time, the report (which will be voted on Thursday at the meeting’s conclusion) has relatively little to say about the specifics of reducing antibiotic use in agriculture, beyond support for the ongoing Food and Drug Administration policies that are forcing relinquishment of growth promoter antibiotics by next year. Dr. David Wallinga, a senior health officer at the Natural Resources Defense Council, expands on this in a Medium post, saying the US is going down a path that failed in Europe, which found that growth-promoter bans led to sneaky label changes.

“The Advisory Council should take a step back,” he writes. “Evaluate what’s not working for the U.S. to reach its ultimate goal of reducing widespread overuse of antibiotics. And issue a Plan B, one that recommends meaningful targets for reducing of antibiotic use in livestock, or alternatively recommends an end to the use of antibiotics in livestock for both growth promotion and disease prevention.”

The lack of specificity is frustrating, given that recent news has made the connection between agricultural use and human health threats even more clear than scientists have demonstrated previously. The extremely resistant superbug MCR-1, a gene that confers resistance to the last resort drug colistin, has now moved around the world. As I reported last fall, MCR arose because human medicine had dismissed colistin as not-useful,  agriculture took up the drug, and then medicine decided it was needed after all. Since then, MCR has been identified in more than 20 countries, in humans, farm animals, food or the environment. Recently, researchers in Tunisia found MCR in chickens on several large farms there, and traced the birds back to hatcheries in France.

As Laurent Poirel and Patrice Nordmann, two prominent European researchers into antibiotic resistance, wrote Tuesday in the Journal of Antimicrobial Chemotherapy: “MCR-1 is one of the few and clear examples of the animal origin of a resistance trait that may later hit the entire human health system.”

The expansion of that last-ditch resistance is unlikely to slow down without explicit international regulations and targets. As Bloomberg reported Tuesday night in a blockbuster set of stories reported in India, farms there are freely using colistin and other crucial antibiotics (Cipro, Levaquin, doxycycline) including ones banned in Western agriculture (Baytril, gentamicin) in multi-drug cocktails that are likely to encourage multi-resistant organisms.

As the think tank CDDEP has demonstrated, the demand for meat is rising in the developing world—and with it, antibiotic use to support meat production is rising too. The use of antibiotics in agriculture is a crucial part of the fight against resistance. It’s important that the White House effort examine that issue with the detail it gives to other parts of the puzzle.

6 thoughts on “To Fix Antibiotic Resistance: A Cabinet Post And More Money

  1. The present state of the war between humans and microorganisms is an indication of which organism is the more intelligent.

  2. My experience in pathology, microbiology and infection control suggests that, although ‘acquired’ antibiotic resistance’ is a real problem in hospitals and certain other facilities, it is a far lesser problem in wild-type bacterial pathogens. Another way of putting this is that the delivery of antibiotics to humans, pets and various farm animals, is not increasing wild-type bacterial resistance. Why? Partly because far more potential bacterial pathogens exist in ‘wild-type’ situations than in humans and animals treated with antibiotics. Just as important is that–in my opinion–bacteria with antibiotic resistances due to human therapeutic measures, are just a little bit ‘less fit’ than are the same bacteria WITHOUT acquired bacterial resistance ‘in the wild.’ Given the laws of natural selection, antibiotic resistance dies right along with the bacterium possessing it.

    Yes, a Staph bacterium that ‘accidentally’ acquires methicillin resistance in an environment–usually a hospital–in which said bacterium is exposed to methicillin, is selectively-advantaged in this unique situation. The methicillin resistant bacterium reproduces at the expense of dying methicillin-sensitive bacteria. This situation completely changes, however, should the patient leave the hospital and never again be exposed to methicillin. Wild type Staph will be advantaged and will soon replace methicillin-resistant Staph. Why? It probably takes a certain amount of metabolic energy for a bacterium to produce antibiotic resistance factors. We are NOT looking forward to a world in which most human-associated bacteria are antibiotic resistant.

    Personal experience: I work in a hospital where I am exposed to patients, the microbiology laboratory, autopsies, infected human specimens etc. While working at home, I experienced a sinus injury in which my maxillary sinus was destroyed. The damaged tissue became infected with Pseudomonas aeruginosa–pure culture. Now this was very bad news because hospital-acquired P. aeruginosa is almost invariably resistant to a panoply of antibiotics. My Pseudomonas, however, was sensitive to all but one or two of the antibiotics it was tested against. Evidently, I acquired my Pseudomonas outside of the hospital, in a world where multiple antibiotic resistances puts Pseudomonas at a physiologic disadvantage.

    MM: The argument you cite, that bacteria that become resistant in the hospital would not be fit enough to survive and maintain their resistance in the wider world, is the reason why a good portion of medicine in the US refused to believe in the existence of community MRSA when is was identified in 1996. The thought was that the investigators in Chicago who identified it had made a mistake; indeed, their paper reporting it was kicked back by a journal for just this reason. In fact of course it both did exist and also stood up a very substantial out-of-hospital epidemic.

    1. Except when you have superbugs teaming in raw meat it passes to human hosts. You claim to know about bacteria but you sure are ignorant.

  3. The MCR-1 gene is rapidly spreading world wide and it has been proven to originate from factory farm practices of antibiotic abuse as growth stimulant and passes on to human hosts by handling raw meat. The MCR-1 gene renders pathogens impervious to all antibiotics known to man.

  4. Adding antibiotics in factory farm animals’ food and water at a daily basis will create superbugs..and the meat is highly contagious just by handling it. First there was MRSA…but Vanco and Zyvox killed it. Now the MCR-1 gene has evolved and Vanco and Zyvox won’t touch these superbugs. MCR-1 has spread to 19 European countries and now is in South Africa…It may even be in America but I doubt the USDA checks for that due to the $900 billion a year meat industry of USA. It’s just a piece of evolution. Nothing more. America ALSO sprays bacteriophages on raw meat and research has proven this practice will spread superbugs as well because it spreads superbug genes to other bacteria–the bacteriophages are doing that. http://www.sciencedaily.com/releases/2015/05/150515134825.htm

  5. The idea of sustained attention and resources for efforts to limit antibiotic resistance reads well to this epidemiologist, and dare I say, would probably be the same for many public health professionals. My concern is with the approach being recommended. I am not in favor of establishing a high-ranking official for every serious issue that we have. We do that with flu; we have done it for drugs; we did it for Ebola; and it is being proposed for Zika virus. The “czar” for the disease of the day has not been working well, especially when the immediacy of the problem fades into the background. I would much rather see a comprehensive strengthening of our Public Health system, such that it is robust and recognized as an essential component of our nation’s well-being and security.

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