On April 28, 2023, the United States House of Representatives Oversight and Investigations Subcommittee held a hearing on “Antimicrobial Resistance: Examining an Emerging Public Health Threat.” Antimicrobial resistance (AMR) happens when microorganisms (i.e., bacteria, viruses, fungi, and parasites) develop the ability to survive against drugs designed to kill them. The World Health Organization (WHO) calls AMR “one of the biggest threats to global health, food security and development today” as a growing number of infections – including pneumonia, tuberculosis, and salmonellosis – are becoming harder to treat as the antibiotics historically used to treat the conditions are becoming less effective. Additionally, as more pathogens become resistant to drugs, more people are susceptible to severe complications, such as sepsis.
Background on AMR
While antibiotics are a critical component of health care, the overuse of antibiotics is considered a contributing factor to the rise of AMR. Centers for Disease Control and Prevention (CDC) data show that roughly 30% of antibiotics prescribed in medical settings are unnecessary and prescribed for infections that do not require such treatment. For example, during the COVID-19 pandemic, antibiotics were frequently prescribed for patients despite being ineffective against viral infections. Such overuse (and misuse) of antibiotics can lead to the spread of AMR pathogens in and between health care facilities, causing infections in patients, and potentially spreading to the community at large.
AMR resulted in an estimated 1.27 million global deaths in 2019. In the United States alone, more than 2.8 million antibiotic-resistant infections occur each year, resulting in more than 35,000 deaths. A CDC study found that treating multi-drug resistant pathogens costs the United States health care system $4.6 billion annually.
Subcommittee Hearing
Witnesses present at the hearing included Amanda Jezek, Senior Vice President, Public Policy and Government Relations, Infectious Diseases Society of America; Kevin Outterson, Professor of Law and Executive Director of CARB-X, Boston University; Mary Denigan-Macauley, Director, Health Care, United States Government Accountability Office; and Amy J. Mathers, Associate Professor of Medicine, Infectious Diseases and International Health, University of Virginia School of Medicine.
The hearing focused on several topics, including why AMR is considered a public health threat and what some potential consequences of inaction may be. The hearing also discussed the impact that the COVID-19 pandemic had on AMR and what may be done in the future to inform future efforts to address AMR, as well as what solutions are currently available to combat AMR and how effective they are.
Testimony and Statements
During her opening statement, House Energy & Commerce Committee Chairwoman Cathy McMorris Rodgers referred to a recent recall of eye drops due to “contamination by an extensively drug-resistant strain of bacteria that has led to multiple deaths and loss of vision among patients in 16 states” as well as an anecdote about a hospital in downtown Seattle that announced an outbreak of AMR bacteria infected 31 people (resulting in 4 deaths).
Morgan Griffith, the Subcommittee on Oversight and Investigations Chairman, noted that “over time, pathogens become resistant to the commandeered classes of antibiotics” in his opening statement, saying that “if a new way to kill the pathogen is not found, the patient is defenseless to the disease caused by the pathogen.” Griffith also pointed to data that said since 1990, 78% of major drug companies have cut or scaled back antibiotic research due to development challenges.
In her statement, Amanda Jezek noted that antimicrobials are “unlike any other therapeutic” and they “enable and sustain modern medicine because so many of our modern medical advances carry a risk of infection and rely upon antimicrobials.” She went on to say that because of increased resistance, many physicians are being forced to turn to older – and more toxic – antibiotics that can have a severe negative impact on a patient, but ultimately save their life in the moment. She gave the example of a patient have to decide between colistin, a drug that causes serious kidney damage and potentially needing dialysis for the rest of a patient’s life, and dying from their infection.
Kevin Outterson spoke about how when antibiotics receive FDA approval, they tend to be held in reserve and as such, billions of on-patent revenues have been lost. This led larger companies to largely abandon their own R&D programs and leave innovation to very small companies. Unfortunately, he notes that all “small companies with an approved antibiotic in the past decade have suffered economically, despite the success of FDA approval.” He went on to say that push incentives, such as CARB-X, have helped “advance new products but pull incentives like subscriptions are now needed” and that the combination of both may “sustainably restore antibacterial innovation at an affordable price.”
Mary Denigan-Macauley focused on federal efforts (and challenges) related to the surveillance of AMR, the development and use of diagnostic testing to identify AMR, the development of treatments for resistant infections, and appropriate antibiotic use. One such challenge was faced by the CDC when it came to obtaining data on infections and testing to track AMR across health care settings, as well as difficulty in obtaining complete and timely information on the magnitude of, and trends in, AMR.
Amy J. Mathers discussed the importance of improved AMR surveillance in the United States (and globally), noting that resources needed to be “devoted to understanding the contributors and locations of antimicrobial resistance” to “target interventions and slow or even reverse the emergence of antimicrobial resistance bacteria and fungi.” Dr. Mathers was able to draw from her personal experience as an infectious disease physician who is “motivated by the negative impact that antimicrobial resistance has had on many patients I have cared for,” including within the last week when one of the transplant patients she was working with “succumbed to an untreatable infection.” She focused on basic and translational research and development as well as the important role diagnostics play and the need for antimicrobial stewardship.