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alex-gregory-your-infection-may-be-antibiotic-resistant-but-let-s-see-how-it-respond-new-yorker-cartoonIn my last post, I discussed seven things individual consumers can do to stop the spread of antibiotic resistant superbugs. I left out one important element: the need to lobby our government’s leaders to make this issue a priority. This summer, combating antibiotic resistance is making headlines on both the national and international level. On June 25-26, the Netherlands hosted an international conference on antibiotic resistance as a follow-up to a World Health Organization (WHO) report on antimicrobial resistance. On July 1, British Prime Minister David Cameron announced the creation of a new review panel to investigate antibiotic overuse and explore why new drugs are not being developed. And here in the states, the President’s Council of Advisors on Science and Technology (PCAST) will meet tomorrow to discuss its work on antibiotic resistance.
Momentum is building. Pressure from constituents will further influence government to give the threat of antibiotic resistance the attention it deserves. The following list provides six things constituents should nudge government officials at the local, national and international level to consider among their top priorities.

  1. President Barack Obama should join the British Prime Minister, David Cameron, in publicly addressing the immediacy of the threat of antibiotic resistance and join the world’s leadership in taking meaningful steps to address the problem.

Leading with the threat that the world could soon be “cast back into the dark ages of medicine” unless action is taken to tackle the growing problem of antibiotic resistance, Prime Minister David Cameron announced his commitment to explore why so few antimicrobial drugs have been introduced in recent years. Convening a multidisciplinary panel of experts from science, finance, industry, and global health, led by Goldman Sach’s economist Jim O’Neill, the group is charged with issuing a plan to create incentives to develop new antibiotics.
British efforts can only go so far if working alone. President Obama must reinforce Cameron’s leadership by making his own public commitment to address antimicrobial resistance. Elevating this issue to a White House priority is paramount to effectively spurring immediate attention to the issue. For more on government leadership, see here.

  1. Create an International Framework Convention to Thwart the Spread of Antibiotic Resistance like the World Health Organization’s Framework Convention on Tobacco Control.

Like almost all communicable public health threats, antibiotic resistance knows no boundaries. Designing a program to retard resistance on a local or regional level is a necessary start, but its ultimate impact will be severely limited if not coordinated across borders. Public Health advocates have been calling for an international framework to address this problem for years. Back in 2002, the World Health Organization (WHO) published a bulletin entitled Antimicrobial resistance: a global response, which considered the capacity of national and international institutions and mechanisms to generate a collective response to antimicrobial resistance. Yet, 12 years later, WHO released a global report finding that surveillance of antibiotic resistance is generally “neither coordinated nor harmonized, compromising the ability to assess and monitor the situation.” Now more than ever, public leadership on both the national and international level needs to unite to create a mechanism to responsibly, swiftly and effectively approach antimicrobial resistance.

  1. Antibiotic use in livestock should be limited by law to cases of illness and last resort antibiotics should be forbidden from animal use entirely.

European countries have already taken great measures to address these issues. Two years ago, the French government committed to the Ecoantibio 2017 plan, reducing the use of antibiotics in veterinary medicine over a five year period. This past June, Sweden, long known for low rates of antibiotic use in animals, issued a challenge to other European Union states to match its livestock welfare standards, including only medicating animals if they are ill. Addressing the WHO Conference on Antibiotic Resistance, Edith Schippers, the Dutch Minister of Health, Welfare and Sport, championed banning last-resort antibiotics from animal husbandry all together.
In the US, FDA issued guidance in December 2013 for the safe use of antibiotics in livestock, but the guidance only offers suggestions for voluntary participation on the part of producers. FDA should follow its European counterparts in taking stronger, more resolute efforts to swiftly limit the alarming rate of antibiotic use in animals.

  1. Cultivate a culture of responsibility among the medical profession.

Overprescribing and improper use of antibiotics are largely caused by the medical professionals responsible for their distribution. According to the Centers for Disease Control (CDC), as much as 50 percent of antibiotics prescribed annually are unnecessary and doctors are too often prescribing broad-spectrum antibiotics when a narrow-spectrum antibiotic would work.
The federal government should support efforts to promote proper antibiotic stewardship. Hand washing and proper hygiene offer the most important frontline defense in preventing the spread of superbugs. The CDC has an entire webpage devoted to hand hygiene, but making sure this information gets to every healthcare provider is paramount. More research money needs to be allocated to create better diagnostic tools for doctors to use in determining whether to prescribe antibiotics in the first place. Educational campaigns to help doctors understand safe antibiotic stewardship will certainly help to reduce resistance. For example, research shows that simply posting signs about antibiotics use reduced unnecessary prescriptions among study participants by 20 percent. Other programs, like a national prescription surveillance project, with peer review systems for medical professionals (also supported by Dutch Minister of Health, Edith Schippers) will help generate the necessary data to understand prescribing habits. Lastly, we need to consider the incentives we offer doctors and hospitals. Today, doctors and hospitals get paid when they treat an infection with antibiotics. Can the government offer incentives to doctors to limit antibiotic use?

  1. Create incentives for the private sector to design next generation antibiotics.

As emphasized by Prime Minister’s Cameron’s directive to explore new economic models to incentivize antibiotic discovery, the lack of financial reward for drug makers is as great a threat to the growing problem of antibiotic resistance as anything else. Since the market has failed to provide new antibiotics, the government must step in to offer ingenious new ways to incentivize development. For a good discussion of some of these options, see here.

  1. Support public and private educational campaigns to promote consumer level antibiotic safety practices.

Since 2006, the CDC has led the Get Smart: Know When Antibiotics Work program. This program uses various education tools to reach national and local governments, providers and consumers. The program includes an annual week-long educational program, Get Smart: About Antibiotics Week, which coincides with European Antibiotic Awareness DayAustralia’s Antibiotic Awareness Week and Canada’s Antibiotic Awareness Week. The American Academy of Pediatrics made judicious antibiotic use one of five targeted practices in its Choosing Wisely® Campaign. The Infectious Diseases Society of America spearheads the 10 x ‘20 Initiative, a global effort to foster development of 10 innovative antibiotics by 2020.
These programs are among many dynamic and highly necessary efforts by medical professionals, policy advocates, and government leaders to immediately and effectively address the growing problem of antibiotic resistance. However without more government support, legislative change, and federal dollars, the programs will be limited in scope and ultimate capacity.

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The views reflected in this expert column are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.

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