The 2001 Federal Interagency Action Plan to Combat Antimicrobial Resistance
In 1999 an interagency federal task force was created to develop a national plan to combat antimicrobial resistance. The task force, led by the Centers for Disease Control and Prevention, the Food and Drug Administration, the National Institutes of Health, and the Department of Health and Human Services, sought to create a plan to address antimicrobial resistance that reflected the broad-based consensus of stakeholders.
The task force released "A Public Health Action Plan to Combat Antimicrobial Resistance" in January 2001. The action plan is seen as a blueprint for a coordinated effort by federal agencies to address the emerging public health threat of antimicrobial resistance. The newly released report is the first section of a two-part project and focuses on domestic issues. The second section, which will be developed later, will focus on antimicrobial resistance at the international level.
The action plan addresses problems of antimicrobial resistance in both human (medical) and nonhuman (agricultural) settings and divides attempts to combat antimicrobial resistance into four major areas: surveillance, prevention and control, research, and product development. In total, 84 action items are identified within this report, including 13 actions that are considered top priority.
The action plan is an impressive and comprehensive effort to address the problem of antimicrobial resistance at the national level. Unfortunately it fails to even mention the obvious—and in our view essential—approach of canceling existing approvals of animal antibiotics. Instead, it largely endorses the cumbersome approach developed by the Food and Drug Administration's draft framework document on the approval of new animal drugs for use in food animals. The implementation of the action plan will take place incrementally over the next five years, contingent upon the availability of resources or new appropriations. A number of the actions may require either new statutory authority or changes in regulatory requirements.
Below are brief descriptions of the four major areas addressed by the action plan, including outlines of the key agriculturally related actions for each area.
Surveillance
The task force acknowledged that the United States lacks a coordinated national plan for antimicrobial surveillance and monitoring. The surveillance of antimicrobial resistance on the farm and in people is seen as necessary for providing an early warning of emerging drug-resistance problems, for monitoring changes in the patterns of resistance, and in targeting and evaluating prevention and control measures. Along with surveillance, the monitoring of antimicrobial drug use was identified as important for interpreting trends and variations in the rates of resistance, for improving the understanding of the relationship between drug use and resistance, and in helping identify preventative actions.Prevention and Control
The largest section of the action plan deals with the prevention and control of antimicrobial resistance in medical and agricultural settings. The task force approach aimed at agricultural settings will require a coordinated effort that extends from the farm to the federal government. Both a better understanding of the risks and benefits of antimicrobial use and techniques for preventing the emergence and spread of drug resistance were identified as necessary for limiting antimicrobial resistance transmission through the food chain. Aside from taking steps to understand the mechanisms of resistance development, the task force saw more appropriate drug use by practitioners as important. Finally, efforts to prevent and control the spread of drug resistance in agricultural settings will require a comprehensive and multifaceted approach that includes public-private partnerships.Research
A research infrastructure is needed to conduct, support, and promote basic and clinical research into antimicrobial resistance. The task force urged a better basic understanding of the process of resistance development in pathogens. This information is essential for developing appropriate responses when resistance emerges and for curtailing its spread. Such a knowledge base includes a better understanding of the biology, ecology, and mechanisms of resistance development. Additionally, the task force identified the need for a system to translate research findings into clinically useful products to detect, prevent, and treat antimicrobial resistant infections.Product Development
Few novel antimicrobial drugs have reached the market over the last decade. The task force found that new antimicrobial products are not being developed rapidly enough to address increasing microbial resistance. In the agricultural and veterinary sector, there is a need to promote the creation and use of new and existing products that reduce the risk of the development and transfer of antimicrobial resistance to human pathogens.
Surveillance: Key Action Items
- Design and implement a national antimicrobial surveillance plan (2)*
- Construct list of organisms and susceptibilities to specific drugs (1)
- Develop standards and methodologies for data collection, testing, and reporting (3)
- Develop and implement a national antimicrobial monitoring plan (5)
- Incorporate appropriate confidentiality protections
- Identify and evaluate data collection and dissemination methodologies (6)
- Ensure adequate state and local laboratory infrastructure and testing (8-14)
- Provide accessible centralized source for, and access to, surveillance data (15-16)
- Monitor antimicrobial resistant bacteria in humans and on farm (17)
- Evaluate the value of sentinel human monitoring (18)
- Conduct pilot studies of impacts from drug residues and antimicrobial resistant organisms in the soil and water (19)
- Gather data on resistance from antimicrobial pesticide and herbicide use (20)
*Number in parentheses corresponds to action item in the action plan. Italicized text identifies this as a top priority action item by the task force.
Prevention and Control: Key Action Items
- Understand the risks and benefits of antibiotics as growth promoters
- Evaluate the impact of antimicrobials as growth promoters (49)*
- Conduct more research to define the effects of drugs on the emergence of antimicrobial resistance in food animals (50)
- Conduct studies to assess the risk of the development and transfer of antimicrobial resistance in plants (51)
- Develop rapid tests for the detection of resistant bacteria on fresh products (52)
- Evaluate the effects of food processing and distribution systems on the emergence and spread antimicrobial resistant bacteria (53)
- Identify and evaluate food pasteurization strategies (54)
- Assess the risk of antimicrobial resistance due to environmental contamination by drugs or resistant bacteria in animal or human waste (55)
- Educate veterinary and agricultural drug users about resistance and promote appropriate use and evaluation guidelines (57)
- Refine and implement the FDA's so-called framework document (58)**
- Promote appropriate veterinary drug use
- Encourage veterinarian oversight of systemic antibiotic use (59)
- Evaluate the impact of making systemic antibiotics prescription only (60)
- Consider incorporating resistance issues into the regulation of antimicrobial and antibiotic pesticide use (61)
- Support demonstration projects to evaluate strategies that use multiple-intervention approaches to limit the development of antimicrobial resistance (63)
- *Number in parentheses corresponds to action item in the action plan.
**Italicized text identifies this as a top priority action item by the task force.
Research: Key Action Items
- Expand basic research programs to fill scientific gaps in understanding (67)*
- Mechanisms of changes in antimicrobial resistance
- Emergence and transfer of resistance genes
- Effects of drug use on microbiota of animals and plants and in soil and aquatic environments
- Microbial ecology as a repository of resistance and use of bacteria populations in control of antimicrobial resistance
- Effects of drug use patterns on the emergence and spread of antimicrobial resistance
- Develop rapid and inexpensive diagnostic methods to aid appropriate antimicrobial use (76)**
- Support the research, development, and appropriate use of vaccines (77)
- Encourage research on novel approaches to prevent and treat resistant infections (78)
*Number in parentheses corresponds to action item in the action plan.
**Italicized text identifies this as a top priority action item by the task force.
Product Development: Key Action Items
- Create a Product Development Working Group to identify present and future new antimicrobial product needs (79)*
- Identify ways to promote development and appropriate use of new products where market incentives are inadequate (80)
- Promote the development of new and alternative veterinary treatments unlikely to stimulate resistance to human-use drugs (83)
- Streamline the regulatory and approval process of veterinary and agricultural drugs that are unlikely to result in the transfer of antimicrobial resistance to humans (84)
*Number in parentheses corresponds to action item in the action plan. Italicized text identifies this as a top priority action item by the task force.
