White House escalates fight against antibiotic resistance

President Barack Obama ordered federal agencies to launch a concerted effort to combat the growing "urgent health threat" from bacteria that is resistant to antibiotic treatment, a problem that kills 23,000 people each year.

An executive order signed by Obama calls for a five-year plan to implement a newly announced national strategy for tackling the problem to be submitted to him by mid-February. It also posts a $20 million prize for the development of a rapid test that can be used to identify and track the spread of highly resistant bacterial infections.

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Thursday's order establishes a task force to be co-chaired by the secretaries of Defense, Agriculture and Health and Human Services, as well as a presidential advisory council made up of top nongovernmental experts.

At the same time Thursday, Obama's Council of Advisors on Science and Technology called for doubling the current investment in antibiotic surveillance, stewardship and research and development to $900 million annually, and spurring commercial development of new antibiotics with another $800 million in federal spending each year.

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"This represents a major elevation of the issue," said John Holdren, Obama's assistant for science and technology. "A major upgrading of the administrative efforts to help address it."

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The move came as officials noted that antibiotic-resistant infections lead not only to at least 23,000 deaths, but also to an estimated 2 million illnesses and $20 billion in excess direct health costs each year in the U.S. In addition, $35 billion is lost annually in productivity from hospitalizations and sick days, the Obama administration said.

"And the problem is worsening," said a fact sheet distributed by the White House. Officials added it is a worldwide problem that doesn't respect borders.

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"What one sees is the possibility of having infections against which we have no remaining antibiotics. ... There is the potential for runaway spread of infection, which ultimately as they go to a very large scale could undermine social stability," Holdren said.

"This is an urgent health threat, and a threat to our economic stability as well," said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention.

That problem stems from bacteria adapting to antibiotics, which are used widely throughout the world. While antibiotics have been credited with saving millions of lives and keeping millions more healthy, their overprescription has been blamed for an increase in resistant bacteria.

"Antibiotics are among the most commonly prescribed drugs in medicine," Frieden said. "But either half are not needed or are not optimally prescribed."

"We can help doctors use antibiotics more wisely and can be certain whether our efforts to reduce antibiotic resistance are working," Frieden said.

During a press call to announce the moves, a reporter said that it all sounded like a "very bureaucratic set" of steps, and questioned what the effect on people would be.

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"This may sound rather bureaucratic, but it's anything but," said Eric Lander, co-chairman of the President's Council of Advisors on Science and Technology, whose report to Obama called for added spending to address the problem.

"This has been a problem that's been brewing for decades. This is now an [issue] that I think we're all aware requires very serious, coordinated action," Lander said. "What's new here is a real federal focus on this."

Other highlights of Obama's executive order include:

• Directives to improve the current use of antibiotics to stem the spread of resistance bacteria;
• Increase national surveillance efforts on the spread of such bacteria;
• The promotion of new kinds of antibiotics;
• Strengthening international cooperation.

HHS, according to the administration, will soon hold a public meeting to focus the $20 million competition on the types of diagnostic tests most needed for recognizing and treating antibiotic-resistant bacterial infections.

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The prize will be co-sponsored by the National Institutes of Health and the Biomedical Advanced Research and Development Authority.

The administration's announcement came in advance of Friday's scheduled hearing on the issue by the health subcommittee of the House Energy & Commerce Committee.

A scheduled witness is Dr. Barbara Murray, president of the Infectious Diseases Society of America, which called Thursday's announcement "a step in the right direction."

In prepared testimony, Murray said: "We are on the very real, very frightening precipice of a post-antibiotic era with mortality rates for infections increasing."

"My colleagues and I are seeing more and more patients of all ages with serious or life-threatening infections that are resistant to all or nearly all available antibiotics."

The Natural Resource Defense Council said that while the report issued Thursday by Obama's council of science and technology advisors "underscores the crisis we're facing," it lacks "needed reforms for curbing" the use of antibiotics in livestock.

"Unfortunately, much more follow through is needed from the administration," said Mae Wu, health attorney for the NRDC. "Just as the administration is taking steps to deal with abuse of antibiotics in humans, it must take steps to curb the overuse of antibiotics in animals, which consume about 80 percent of the antibiotics sold in the United States. Shying away from taking these needed steps will not yield the 'substantial changes' that [the presidential advisory council] says are necessary."

That presidential advisory group, in its report, had noted, "it is clear that at least some drug-resistant pathogens have evolved under selective pressure from antibiotic use in agriculture and may have contributed significantly to resistance in clinical settings."