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Examining the Long-term Health and Economic Effects of Antimicrobial Resistance in the United States

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This committee will look at progress on the National Strategy for Combating Antibiotic-Resistant Bacteria. It will discuss ways to improve detection of resistant infections, and ways to estimate the risk to human health from environmental sources of resistance. The report will discuss the effect of agricultural practices on human and animal health and animal welfare and ways these practices could be improved and advise on key drugs and diseases for which animal-specific test breakpoints are needed. The role of economic incentives for the development of drugs and diagnostics for both human and veterinary use will be explored.

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Description

The National Academies will convene an expert committee to examine and quantify the long-term medical and economic impacts of increasing antimicrobial resistance in the United States. The study shall examine progress made on the U.S. National Strategy and Action Plan for Combating Antibiotic-Resistant Bacteria, including domestic and international strategies employed by NIH, CDC, FDA, ASPR, USDA, and USAID.

Opportunities to add to the current body of knowledge include:

• advising on an effective strategy to scale up global detection of resistant infections and infection prevention and control efforts – especially outside of the U.S. and Europe;

• helping to assess and quantify the risk to human health from environmental sources and reservoirs of antibiotic resistant pathogens and genes;

• assessing any methodologies for evaluating how interventions in agriculture impact public health and how to improve them;

• assessing any methodologies for evaluating the impacts of interventions in agricultural settings on animal health and welfare and how to improve them;

• assessing the impact of new incentives for antibiotic development (BARDA’s project Bioshield, 2019 CMS IPPS) on the health of the antibiotic pipeline;

• exploring methodological innovations to improve projections of the burden of AMR and its economic impacts, with an eye toward informing the development of incentives for antimicrobial products;

• exploring ways to develop, benchmark, and track rigorous quantitative measures of the impact of various strategies to mitigate AMR, with a focus on relevant, timely, and actionable measures;

• assessing the need for and advise on key diseases and antibiotics for which animal-specific antimicrobial susceptibility testing breakpoints are needed; and

• assessing the need for and explore how to incentivize and promote cooperative relationships between industry and professional societies to prioritize test development of new diagnostics for use in veterinary settings, especially animal-side diagnostics that allow precise selection of antibiotics.

Contributors

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Chair

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Gillian Buckley

Staff Officer

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Conflict of Interest Disclosure

The conflict of interest policy of the National Academies of Sciences, Engineering, and Medicine (http://www.nationalacademies.org/coi) prohibits the appointment of an individual to a committee authoring a Consensus Study Report if the individual has a conflict of interest that is relevant to the task to be performed. An exception to this prohibition is permitted if the National Academies determines that the conflict is unavoidable and the conflict is publicly disclosed. A determination of a conflict of interest for an individual is not an assessment of that individual’s actual behavior or character or ability to act objectively despite the conflicting interest.

Jennifer Dien Bard has a conflict of interest in relation to her service on the Committee on the Committee on Examining the Long-term Health and Economic Effects of Antimicrobial Resistance in the United States because of research support provided to Children’s Hospital Los Angeles (CHLA) by diagnostic companies: Luminex Corporation, BioFire Diagnostics, and Qiagen.

The National Academies has concluded that for this committee to accomplish the tasks for which it was established its membership must include at least one person who has current experience with microbiological surveillance for resistance, understanding the challenges of diagnosing resistance and managing surveillance in a hospital microbiology lab. As described in her biographical summary, Dr. Dien Bard has extensive experience as the director of clinical microbiology and virology at CHLA in rapid laboratory diagnostics and their relationship to antimicrobial stewardship and the development of rapid tests for detecting resistant microorganisms.

The National Academies has determined that the experience and expertise of Dr. Dien Bard is needed for the committee to accomplish the task for which it has been established. The National Academies could not find another available individual with the equivalent experience and expertise who does not have a conflict of interest. Therefore, the National Academies has concluded that the conflict is unavoidable.

The National Academies believes that Dr. Dien Bard can serve effectively as a member of the committee, and the committee can produce an objective report, taking into account the composition of the committee, the work to be performed, and the procedures to be followed in completing the study.

Sponsors

National Institute of Allergy and Infectious Diseases

Staff

Gillian Buckley

Lead

Aashaka Shinde

Kara N. Laney

Crysti Park

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