Tuesday Talks with Dr. Patterson
February 10, 2015
More on Antibiotic-Resistant Bacteria
In this week’s Tuesday Talk, I return to an issue first discussed on September 30, 2014, antibiotic-resistant bacteria. That article is reprinted in full below. As an update, President Obama announced on January 27 that he is recommending doubling funding to address the problem of antibiotic-resistant bacteria to $1.2 billion in his FY 2016 budget proposal. Under the proposal, the Department of Health and Human Services will see its funding for this problem doubled to about $1 billion; the U.S. Department of Agriculture will see its funding quadruped to $77 million; and the Departments of Veteran’s Affairs and Defense will see their funding increased to $85 million and $75 million, respectively. The agencies will be involved in research on the problem of antibiotic-resistance, which has been described as the most pressing public health problem facing the world today. (White House)
White House. Office of the Press Secretary. Fact Sheet: President’s 2016 Budget Proposes Historic Investment to Combat Antibiotic-Resistant Bacteria to Protect Public Health. January 27, 2014. (Accessed February 8, 2014): http://www.whitehouse.gov/the-press-office/2015/01/27/fact-sheet-president-s-2016-budget-proposes-historic-investment-combat-a
September 30, 2014
On September 18, 2014 President Obama signed an executive order creating a taskforce to develop a national strategy to combat antibiotic-resistant bacteria. The order called this problem a serious threat to public health and the economy. The taskforce will be co-chaired by the Secretaries of Defense, Agriculture, and Health and Human Services. The President’s executive order coincided with the release of a report by the President’s Council of Advisors on Science and Technology (PCAST) entitled “Report to the President on Combating Antibiotic Resistance.” The task force is to submit a five year plan to the President by February 15, 2015. The executive order also called on the Food and Drug Administration (FDA) to “continue taking steps to eliminate the use of medically important classes of antibiotics for growth promotion purposes in food-producing animals” (Obama).
To understand the importance of this issue, one need only recall the good old days before antibiotic use in medical treatments. As recent as the early 1900’s one out of nine people who developed a serious skin infection died; pneumonia killed 30 percent of those who contracted it; and, ear infections often caused deafness (PCAST). Many other examples of health maladies associated with bacterial or microbial infections that benefited from treatment by antibiotics could be cited. However, as antibiotics have been used to treat these and other diseases, the bacteria in which they are intended to destroy or weaken have evolved through natural selection to become resistant to antibiotics – superbugs. As early 1945, penicillin-resistant strains of staphylococcus aureus were reported (PCAST). During the past 10 years the rate of growth of antibiotic-resistant bacteria has reached an alarming level. The Center for Disease Control reports that in the United States there are two million illnesses and 23,000 deaths annually caused by antibiotic-resistant bacteria. The illnesses result in an estimated $20 to $35 billion in excess direct health care costs and as much as $35 billion per year in lost productivity (PCAST). Indiscriminate use of antibiotics in human health care is cited as one factor contributing to the problem. The CDC estimates that up to 50 percent of the antibiotics prescribed in the United States are not needed (PCAST).
Animal agriculture is also cited as a contributor to the growing problem of antibiotic-resistant bacteria. Antibiotics are of course used to treat sick animals. Antibiotics are also commonly used as a way of promoting growth in animals, notably those in contained animal feeing operations (CAFOs). This practice increases food production and increases producer profits. As antibiotics have been used in animal agriculture, growing antibiotic resistance has been observed. Furthermore, there is concern that these antibiotic resistant bacteria could affect human health. This is especially concerning if the antibiotic is medically important for human health. However, the linkage between bacteria affecting animal health and human health is not well understood, though some evidence points to cases where the bacteria move from animal hosts to humans. This is an area that needs further research, as is discussed in the PCAST report.
The charge to the FDA to continue steps to eliminate the use of medically important antibiotics for growth promotion purposes in animal agriculture refers to FDA Guidelines Number 209 and 213 issued in April 2012 and December 2013, respectively. Guideline 209 is a voluntary guideline that urges drug manufacturers and producers to (1) limit medically important antimicrobial drugs to uses in animals that are considered necessary for assuring animal health (therapeutic purpose); (2) it recommends that veterinary oversight or consultation be required in in their use. This would move the antibiotics used for animals, which are often incorporated in feed or water, from an over-the-counter type product, which is easily purchased at a feed store, to a prescription product. Guideline 213 is a voluntary guideline urging drug manufacturers to (1) phase out claims on animal growth promotion for medically important antibiotics and (2) limit use to therapeutic purposes. The PCAST report recommends that the FDA move these guidelines to rules by changing the language in its Veterinary Feed Directive. Critics argue this will result in little change, as veterinarians could make recommendations on therapeutic uses that are really for growth promoting purposes. Most veterinarians argue that such an action would be unethical and illegal under the recommended rules.
Antibiotic resistance is a complex scientific and policy problem calling for more research. The PCAST report recommends doubling funding to $900 million per year to monitor this problem, abate its growth, and research its causes. Indeed, this is part of the President’s 2015 budget recommendation. The report also recommends new funding for research on developing new antibiotics and incentives for firms to develop them. Animal agriculture groups and farm lobby groups have generally responded positively to these recommendations and the executive order, welcoming opportunities to work with government in better understanding the problem and developing solutions to control the evolution of these superbugs.
Obama, Barrack. “Executive Order – Combating Antibiotic-Resistant Bacteria.” September 18, 2014. Accessed (September 28, 2014): http://www.whitehouse.gov/the-press-office/2014/09/18/executive-order-combating-antibiotic-resistant-bacteria
President’s Council of Advisors on Science and Technology. “Report to the President on Combating Antibiotic Resistance.” Executive Office of the President of the United States, September 2014. Accessed (September 28, 2014): http://www.whitehouse.gov/sites/default/files/docs/carb_national_strategy.pdf
Dr. Paul Patterson is associate dean for instruction for the College of Agriculture and Professor of Agricultural Economics.