Time for the Biden administration to act on antibiotic resistance

While the COVID-19 pandemic rages on, another public health threat is worsening: antibiotic resistance. 

The Centers for Disease Control and Prevention (CDC) conservatively estimates that at least 2.8 million Americans acquire serious infections caused by antibiotic-resistant bacteria or superbugs each year, with 35,000 of people dying. That equates to a death every 15 minutes. Experts are concerned that widespread use of antibiotics during the pandemic is making things worse.

COVID-19 patients who have weakened immune systems and may be on ventilators, and are therefore at risk for secondary bacterial infections, need antibiotics. But these life-saving drugs are also critical for patients fighting cancer, receiving dialysis, undergoing surgery and requiring countless other medical treatments and procedures. Indeed, antibiotics underlie many of the medical procedures and treatments we take for granted today. The paradox is that all use of antibiotics contributes to the emergence of resistance, which means that science must search for new antibiotics at the same time that medical professionals work to more effectively steward existing antibiotics.

As the Biden administration continues to battle the COVID-19 pandemic, Pew urges prompt action to address related public health threats, including antibiotic-resistant bacteria. There are several immediate opportunities where our new president and his team can build on existing bipartisan support and advance a proactive agenda to combat superbugs.

Strengthen federal funding to combat antibiotic-resistant bacteria

President Biden’s first budget presents an opportunity to support federal programs that combat antibiotic-resistant bacteria. Key agencies such as CDC, the Food and Drug Administration (FDA), the National Institutes of Health (NIH), the Biomedical Advanced Research and Development Authority and the U.S.Department of Agriculture (DOA) require sustained and significant investment to perform essential functions such as collecting data to track resistant bacteria, improving antibiotic use and funding antibiotic research.

By allocating more resources to these programs, the administration can ensure that the fight against superbugs is a national priority and that scientists and policymakers have the information they need to respond effectively. 

Prioritize development of urgently needed new antibiotics

Since bacteria are constantly evolving to resist existing antibiotics, we must invest in the discovery of novel drugs. Unfortunately, scientific challenges and market dynamics have led to an exodus of major pharmaceutical companies from antibiotic research and development. Many small companies have even gone bankrupt. That leaves few companies with the resources needed to focus on antibiotic discovery and development.

We urge the administration to enlist Congress to put economic incentives in place to ensure aggressive research and development for new antibiotics. Congress can immediately consider the Pioneering Antimicrobial Subscriptions to End Up Surging Resistance Act, or PASTEUR Act, introduced last year with bipartisan support. The bill, together with reimbursement reform, would help companies pursue new treatments for increasingly resistant superbugs and ensure that critical antibiotics remain available to patients once they’ve been approved.

Preserve effectiveness of existing antibiotics by optimizing their use

Further, the administration must assess federal agencies’ progress in advancing the agenda outlined in a 2014 executive order to promote antibiotic stewardship programs nationwide. These programs confront the challenge that all use of antibiotics — in both humans and animals — contributes to the growth of resistance. To implement these stewardship programs effectively in human medicine, health care systems need new federal resources to reduce inappropriate antibiotic use, improve patient outcomes and lower costs. The administration must ensure that this stewardship is being extended to outpatient settings, such as physician’s offices, and it should consider evaluating stewardship in telehealth settings given the significant increase in telehealth during the pandemic.

The new administration should ensure that FDA accelerates implementation of its five-year animal antibiotic stewardship action plan, which was unveiled in September of 2018. In addition, the administration must also direct FDA and the DOA to expand on-farm data collection and use reporting nationwide, while increasing investment in agricultural research to improve our understanding of antibiotic use and resistance in animal settings.

Re-evaluate and strengthen the National Action Plan for Combating Antibiotic-Resistant Bacteria. 

Lastly, to build on existing work, the administration should re-evaluate the National Action Plan for Combating Antibiotic-Resistant Bacteria, first published in 2015 and updated in October 2020. The plan highlights the need to implement policies that stimulate development of urgently needed drugs, improve antibiotic use and strengthen the country’s capacity to track antibiotic resistance and use, but lacks critical details to achieve its stated goals.

To maximize the plan’s impact, the administration should go further and outline the economics of essential antibiotic development, as well as provide an actionable plan for implementing more meaningful incentives for research and development.

As the urgent fight against COVID-19 continues, we hope that the administration will focus on the fight against antibiotic-resistant bacteria. The safe practice of medicine, and people’s lives, depends on it. 

Kathy Talkington directs health programs at The Pew Charitable Trusts.