March 12, 2024
On March 5, 2024, the One Health Trust (OHT), the Infectious Diseases Society of America (IDSA), the AMR Action Fund, Sepsis Alliance, and the Cystic Fibrosis Foundation (CFF) held a briefing for U.S. Congressional staff on antimicrobial resistance (AMR) to recap the progress that has been made in addressing the global health crisis since 2015 and the threats that remain. The widely attended event featured an hour-long, moderated panel discussion with five speakers, including OHT founder and president, Dr. Ramanan Laxminarayan.
The briefing began with an introduction by the panel’s moderator, Mary Dwight, the senior vice president and chief policy and advocacy officer for CFF. She set the stage for the day’s discussion, emphasizing the need for congress to focus on investments in surveillance, antibiotic stewardship, and infection prevention, as well as economic incentives for new antibiotic development.
The first speaker on the panel was Jackie Duda, an AMR survivor and advocate. Duda shared her story of surviving often deadly septic shock, one of the most serious AMR infection complications. Duda’s infection, caused by antimicrobial-resistant Escherichia coli, needed to be treated with what her doctors called ‘hard hitters’ – antibiotics that should only be used in the direst circumstances. These powerful antibiotics thankfully worked on Duda’s infection, but many people have not been as lucky. Recent estimates show that approximately 7.7 million deaths per year are caused by bacterial infections around the world, 4.95 million of which are associated with AMR.
Following Duda’s story underscoring the gravity of AMR for people everywhere, Dr. Laxminarayan, who has been a member of the U.S. Presidential Advisory Council on Combating Antimicrobial Resistance since its inception in 2015, noted that this is an issue which has gone from no funding in 2015 to tremendous investment and progress today, all thanks to action taken by the U.S. government. Congress has made investments related to AMR since 2016 to implement the National Action Plan to Combat Antibiotic-Resistant Bacteria (CARB) with incredible success. For instance, in 2022, 97 percent of U.S. acute care hospitals reported having a stewardship program meeting all 7 of the U.S. Centers for Disease Control and Prevention (CDC) Core Elements of Antibiotic Stewardship. However, the COVID-19 pandemic did detract attention from AMR, resulting in more tenuous funding schemes that put the progress made so far in addressing AMR at serious risk. Congress must remain committed to adequately funding the CDC to keep Americans safe.
Dr. Paul Pottinger, the Director of the Antimicrobial Stewardship and Infectious Diseases Training Program at University of Washington Medical Center and a Fellow at IDSA, expressed that from his perspective treating patients every day, AMR is a top concern. He explained that stories like Duda’s are all too familiar to him on the front lines – and many patients do not survive. Dr. Pottinger explained that treating AMR often involves using ‘hard-hitter’ last-line antibiotics but that this practice comes at a cost. Every time one of these drugs is used, it creates the potential for more resistance. And the more we use these drugs, the quicker the bacteria will evolve to become resistant to them. AMR is inevitable based on the biology of bacteria, but proper stewardship in prescribing can delay resistance, buying us precious time to innovate and test new antibiotics and ultimately save more lives.
John Alter, the Head of External Affairs of AMR Action Fund, followed Dr. Pottinger and emphasized the need for antibiotic research and development. Drug discovery, he noted, is more difficult than people think. There are scientific challenges, such as the ability of the bacteria to evolve to defend themselves against new and older drugs. There are economic challenges, too – antibiotics can cost upwards of US$1 billion to innovate, get regulatory approval, and produce, and the profit they are expected to make pales in comparison. As a result, large pharmaceutical companies simply do not want to invest in new antibiotics, so much of the innovation in antibiotics is by very small biotech companies which do not have resources to make the drugs available to patients. Alter’s organization, the AMR Action Fund, is one of a few that provides temporary stop-gap funding to continue to promote antibiotic innovation. But these funds will not last forever, and government action is needed to create a sustainable market.
Alter emphasized that there are mechanisms to promote a sustainable market for antimicrobials. The bipartisan PASTEUR Act, which is currently a bill on the floor of Congress, would establish a mechanism to de-link the idea of profits and drug development. The ‘pull incentive’ present in the bill would essentially make sure that companies make a profit on their investments in these urgently needed drugs, so long as the drugs have shown clinical promise, in exchange for access rights to the drugs. Despite bipartisan support, progress on this bill has been slow. It is crucial that Congress not allow this bill to stall any longer, as we are losing precious time and lives.
The United States must create a meaningful incentive structure for innovating and providing access to new antibiotics. Continuing inaction is eroding leadership in this area, and it extends to pandemic preparedness and national security. Dr. Daniel Jernigan, the Director of the National Center for Emerging and Zoonotic Infectious Diseases at the CDC, revealed how this global issue threatens the safety of Americans, recounting how a number of infections in U.S. nursing homes and long-term care facilities resulted in multiple deaths, prompting CDC and FDA involvement. They found that the extensively-drug-resistant Pseudomonas aeruginosa outbreak originated in a specific brand of artificial tears that were contaminated during manufacturing in India.
Dr. Jernigan noted that the United Nations High-Level Meeting on AMR, which will take place this September in New York City, presents an opportunity for the United States to exercise leadership and drive progress around the globe through supporting global targets and governance.
The briefing was critical in uniting a variety of perspectives about the AMR crisis and informing the audience what Congress can do to continue to fight to keep Americans safe and ensure sustainable access to effective antibiotics for patients around the world.
