To Fix Antibiotic Resistance: A Cabinet Post And More Money

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.