Next week, President Barack Obama will unveil his full budget request for the coming fiscal year. When he does, he’ll also reveal details of how his administration plans to fund the national strategy for combating antibiotic resistance that the White House released last autumn.
Here’s what we know so far, based on a fact sheet that the White House released earlier this week:
The total request is $1.2 billion, “nearly doubling” current funding, and intended for multiple agencies within the Department of Health and Human Services. Here’s how that breaks down:
- $650 million shared by the National Institutes of Health and the Biomedical Advanced Research and Development Authority;
- $280 million for the Centers for Disease Control and Prevention;
- $85 million at the Department of Veterans Affairs;
- $77 million for the US Department of Agriculture;
- $75 million for the Department of Defense;
- $47 million for the Food and Drug Administration.
Much of the coverage of the White House release so far seems to have focused on research into new drugs, probably because the fact sheet mentions the very high profile announcement of the new antibiotic compound teixobactin (and the novel development technique that led to its discovery). But the White House plan goes beyond drug development — which is wise because, let’s face it, evolution pretty much always wins. Any new compound or drug family may extend the leaps in the game of leapfrog between drugs and bugs, but it is unlikely to end the game permanently.
The other things the White House will request break down into these categories: stewardship, or preserving existing drugs; surveillance and reporting, tracking drug use and the emergence of resistance; and funding innovation, including new drugs and clinical-trial designs.
A few of the details:
- Building regional collaborations that will help hospitals, and nursing homes and long-term care institutions, recognize when they are passing patients carrying resistant bacteria back and forth among them.
- Creating point-of-care or rapid diagnostics to reduce empiric prescribing — that is, prescriptions that doctors write in advance of receiving test results, because those take a few days, but which may increase resistance if they chose wrong.
- Researching how to create stewardship programs that work, reducing antibiotic use in an institution, without causing the staff to feel infantilized or coerced.
- Expanding resistance-prevention research at the VA, which already possesses possibly the best such program in the country.
- Funding research into new vaccines and non-antibiotic treatments.
There are some things in the budget request that specifically enhance programs already operating at the CDC, which has been the point of the spear for the fight against resistance (and released a major “threat report” in 2013 that may have jump-started the White House’s interest): chiefly, double the sites in the Emerging Infections Program, which analyzes state health department data to tease out foodborne illness, flu and healthcare-infection trends. The money would also build up the CDC-FDA-USDA network that detects resistant bacteria related to agriculture, in humans, meat animals and retail meat, knows as NARMS; and the National Healthcare Safety Network, which tracks hospital infections.
It’s good to see the White House fact sheet emphasize that some of the requested money will specifically target antibiotic use in agriculture; when the strategy was released, I criticized the effort for not addressing that enough. Among the efforts that would be funded, according to the White House, are building a surveillance program for resistant infections arising from animals; researching stewardship programs, that is, education that could help agriculture understand how to use fewer antibiotics; and looking for antibiotic alternatives, treatments that would not provoke the development of resistance. That last, at the USDA, has a dollar figure assigned: $77 million, which the White House says is a quadrupling of current funding.
The White House predicts that, if this money comes through, the funds could help cut resistant infection in significant, measurable ways. They predict reductions of:
- 60 percent in very highly resistant carbapenem-resistant Enterobacteriaceae (CRE)
- 50 percent in drug-resistant staph (MRSA) and Clostridium difficile (“C. diff”)
- 35 percent in multi-drug resistant hospital infections
- 25 percent in resistant Salmonella and invasive pneumococcal disease.
Those are bold goals, and it will be interesting to see whether the White House gets the full amounts it needs to embark on them. Budget requests seldom sail through unchallenged, but sources tell me that antibiotic resistance may be the one issue both parties are willing to collaborate on.