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White House: ‘Critical’ to Handle Antibiotic-Resistant Bacteria

The rise of antibiotic-resistant bacteria is a looming public health crisis. Last week, the White House simultaneously released a national strategy, a report, and an executive order from the president that takes aim at this issue.

As Rewire reported last year, the CDC has called neisseria gonorrhoeae, the bacteria that causes gonorrhea, an “urgent threat.” Between 1940 and 2007, this bacteria became resistant to whole classes of drugs Gonorrhea (Neisseria gonorrhoeae) via Shutterstock

Antibiotic-resistant bacteria, White House officials charge, poses not just a health threat, but an economic and national security threat as well.

People for more than a century have relied on antibiotics to cure everything from earaches and strep throat to gonorrhea and syphilis. But bacteria are constantly evolving and existing medications—especially if they are overused—will not be effective indefinitely.

In fact, the Centers for Disease Control and Prevention (CDC) estimates that drug resistance already leads to more than two million illnesses and 23,000 deaths each year. Experts expect those numbers to go up unless action is taken to address the problem of drug resistance.

The White House last week simultaneously released the National Strategy for Combating Antibiotic Resistance, a detailed report on the topic by the President’s Council of Advisors on Science and Technology (PCAST), and an executive order requiring action by early 2015. At a news conference on September 18, Jim Holdren, director of the White House Office of Science and Technology Policy, said, “The rise in antibiotic-resistant bacteria represents a serious domestic and international challenge to human and animal health, national security and the economy.”

The PCAST report explains that “responsible stewardship of antibiotics requires identifying the microbe responsible for disease (ideally with rapid and inexpensive diagnostics); administering the most effective antibiotic at the appropriate dose, route, and time; and discontinuing antibiotic therapy when it is no longer needed.”

It goes on to say that scientists need increased and improved surveillance to help better understand how resistant infections emerge and are transmitted.

Even with these advances, PCAST warns, “it is critical to develop new antibiotics, diagnostics, vaccines, and other interventions at a rate that outpaces the emergence of resistant microbes. A robust antibiotic pipeline is essential for creating new antibiotics to replace those being steadily lost to antibiotic resistance.”

Antibiotics—which are typically taken for no more than two weeks—are less profitable than drugs designed to treat chronic conditions that are often taken for many years. Pharmaceutical companies do not have the financial incentive necessary to put their research and development dollars into this pipeline.

This is among the problems that the National Strategy and the PCAST report aim to solve. The strategy lays out five goals, including curbing the overuse of antibiotics, encouraging the development of new drugs, and boosting the advancement of diagnostics tests that can immediately determine whether bacteria are drug resistant.

Though the strategy does not mention funding, the accompanying report suggests that reaching these goals will require doubling the government’s investment in fighting drug resistance from $450 million to $900 million per year. The president’s executive order does not mention funding either, but it does create a task force to look into the problem and mandates that the task force develop a five-year action plan by February 2015.

As a first step, the White House announced the launch of a $20 million prize for the development of rapid, point-of-care, diagnostic test for health-care providers to use to identify highly resistant bacterial infections.

Advocates for sexual health are particular interested in these new announcements because of the fear that an outbreak of antibiotic resistant gonorrhea is imminent.

As Rewire reported last year, the CDC has called neisseria gonorrhoeae, the bacteria that causes gonorrhea, an “urgent threat.” Between 1940 and 2007, this bacteria became resistant to whole classes of drugs: sulfanilamides, penicillins, tetracyclines, and fluoroquinolones. Today, only cephalosporins remain effective to treat the estimated 800,000 cases of gonorrhea in this country each year.

The CDC now recommends ceftriaxone plus either azithromycin or doxycycline as first-line treatment for gonorrhea. In 2011, there were 3,280 cases of gonorrhea that had reduced susceptibility to ceftriaxone and 2,460 that had reduced susceptibility to azithromycin. Other countries are seeing cephalosporin-resistant cases.

Most recently, four cases of gonorrhea resistant to ceftriaxone were reported in Sweden.

Lynn Barclay, president of the American Sexual Health Association, told Rewire that her organization was excited about the attention being paid to this issue: “Resistance to antibiotics, which is fueled in part by over-use of these common medications, is an enormous challenge to public health that increases costs and worsens patient outcomes. We’re down to one antibiotic to treat gonorrhea, that’s not just unacceptable, it’s actually scary. This plan, which seeks to facilitate more appropriate use of antibiotics while encouraging expanded pipelines of new products, is some of the best news we’ve heard in years. For my money it can’t be implemented quickly enough.”

William Smith, executive director of the National Coalition of STD Directors, which has asked for increased government investment in fighting antibiotic-resistant gonorrhea, is also excited about this plan.

“We’re really supportive of what the president is trying to do,” he said in an interview with Rewire. “We think the goals are smart—particularly, the increased focus on creating diagnostic tests for resistance.”

Smith said that the problem is mammoth and more resources are needed.

“We need larger incentives for diagnostic companies to develop tests and larger investments in the development of new drugs,” he said. “But we also need a significant investment in the infrastructure of public health departments that have been subjected to repeated budget cuts. If we expect public health readiness when an antibiotic resistant outbreak hits, we need big dollar investment in those workers on the front lines.”