Lucky 13: Infection control on funding list

Antibiotic action plan draws bipartisan support

Infection control and surveillance are among the top priorities cited in recently proposed federal legislation to fund an ambitious national plan to combat antibiotic resistance.

Proposed May 9, the Antibiotic Resistance Prevention Act of 2001 (HR 1771) calls for federal funding to "evaluate the effectiveness [including cost-effectiveness] of current and novel infection control practices." Moreover, in what may provide a boost for infection control programs, the bill calls for federal funding to "promote adherence to [infection control] practices proven to be effective."

If approved, the legislation also would provide funding to the department of Health and Human Services (HHS) to launch a massive public education campaign about antibiotic use and misuse, possibly tempering some of the demand from patients for needless drug therapy.

Enjoying bipartisan support from the onset, the plan would fund 13 priorities for action identified in the recently completed federal task force plan. (See Hospital Infection Control March 2001, under archives at www.HIConline.com.)

Spearheaded by the Centers for Disease Control and Prevention and the Food and Drug Admini-stration (FDA), the plan to stave off rising antibiotic resistance includes a host of other federal agencies from such areas as agriculture and national defense.

The proposed bill essentially sets the wheels in motion to provide the initial funding to the HHS, which must now budget the priority items and report its needs back to Congress. Though specific levels have not been determined, millions perhaps billions of dollars could be allocated if the plan unfolds as proposed in the bill. If approved, the legislation would empower Congress to fund the antibiotic-resistant plan priorities for fiscal years 2002 through 2006. Rep. Sherrod Brown (D-Ohio) is the lead sponsor of the bill.

"This is to finalize and authorize funding," says Ted Miller, Brown’s spokesman. "It is a strong endorsement, but of course just a first step. This prioritizes the top tier of steps we need to take to move forward on this issue. Support for the bill is growing. There will be an education process here on the hill, but we have a good coalition of folks who are willing to help us."

The HHS will submit budget figures needed to accomplish each priority, and then the law will move forward for broader consideration, Miller says. As proposed, the bill would provide funding to HHS to begin implementing the following priority items. The 13 action items specified in all have top priority under the plan, regardless of their order on the list, the bill states.

1. With partners, design and implement a national antibiotic-resistance surveillance plan that defines national, regional, state, and local surveillance activities and the roles of clinical, reference, public health, and veterinary laboratories. The plan should be consistent with local and national surveillance methodology and infrastructure that currently exist or are being developed.

2. Develop and implement procedures for monitoring patterns of antimicrobial drug use in human medicine, agriculture, veterinary medicine, and consumer products.

3. Conduct a public health education campaign to promote appropriate antimicrobial use as a national health priority.

4. In collaboration with many partners, develop and facilitate educational and behavioral interventions that will assist clinicians in appropriate antimicrobial prescribing.

5. Evaluate the effectiveness (including cost-effectiveness) of current and novel infection- control practices for health care and extended care settings and in the community. Promote adherence to practices proven to be effective.

6. In consultation with stakeholders, refine and implement the proposed FDA framework for approving new antimicrobial drugs for use in food-animal production and, when appropriate, for reevaluating currently approved veterinary antimicrobial drugs.

7. Support demonstration projects to evaluate comprehensive strategies that use multiple interventions to promote appropriate drug use and reduce infection rates, in order to assess how interventions found effective in research studies can be applied routinely and most cost-effectively on a large scale.

8. Provide the research community genomics and other powerful technologies to identify targets in critical areas for the development of new rapid diagnostics methodologies, novel therapeutics, and interventions to prevent the spread of resistant pathogens.

9. In consultation with academia and the private sector, identify and conduct human clinical studies addressing antibiotic-resistance issues of public health significance that are unlikely to be studied in the private sector (e.g., novel therapies, new treatment regimens, and other products and practices).

10. Identify, develop, test, and evaluate new rapid-diagnostic methods for human and veterinary uses with partners, including academia and the private sector.

Such methods should be accurate, affordable, and easily implemented in routine clinical settings (e.g., tests for resistance genes, point-of-care diagnostics for patients with respiratory infections and syndromes, and diagnostics for drug resistance in microbial pathogens, including in nonculture specimens).

11. Encourage basic and clinical research in support of the development and appropriate use of vaccines in human and veterinary medicine in partnership with academia and the private sector.

12. Create an interagency product development working group to identify and publicize priority public health needs in human and animal medicine for new products (e.g., innovative drugs, targeted spectrum antibiotics, point-of-care diagnostics, vaccines and other biologics, anti-infective medical devices, and disinfectants).

13. Identify ways (e.g. financial and/or other incentives or investments) to promote the development and/or appropriate use of priority antibiotic products, such as novel compounds and approaches, for human and veterinary medicine for which market incentives are inadequate.

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