The White House Forum on Antibiotic Stewardship

The White House Forum on Antibiotic Stewardship


Amy Pope: My
name is Amy Pope. I am the Deputy Homeland
Security Advisor here at the National Security Council at
the White House and we have a wonderful event planned
for you at this very early hour and I hope you can take
the opportunity to further all of the really, really
great work that you and your companies are
accomplishing in the name of antibiotic stewardship. I want to thank you for
coming to today’s forum. I want to thank you for the
very important commitments that you all have made here
today and I would like to welcome Dr. John Holdren
who is the Assistant to the President for Science and
Technology Policy and the director of our office of
Science and Technology Policy to the podium to
being today’s forum. John Holdren: Well
thank you, Amy. And good morning everybody. I’m grateful to all of you
for getting up early enough to attend this remarkable
forum beginning as Amy has noted at this early hour. I want to welcome you to the
White House not just on my own behalf but on
President Obama’s behalf. He puts a high priority on
this issue and we’re all just delighted with the turn
out and with the commitment. I want to acknowledge and
thank Secretary Burwell. Secretary Vilsack who will
be appearing momentarily, CDC Director Tom Frieden and
all of our distinguished panel members and guests
for being here today. Your presence here and the
commitment you have made are I think compelling testimony
to the importance of combatting antibiotic
resistant bacteria and addressing one of the more
complex challenges we face in the public health space
here in the United States and around the world. I say it’s complex because
there are many drivers of the emergence and spread of
antibiotic resistance and a number of those drivers
remain poorly understood. What we do know is that we
cannot let this grave public health threat go unaddressed
killing tens of thousands of Americans each year, many
more around the world and affecting millions. In addition to classical
infection control strategies — from hand hygiene to
operating room practices — the single most important
action to slow the development and spread
of antibiotic resistant infections is to change the
way antibiotics are used. Antibiotic stewardship, the
development, promotion, and implementation of activities
to promote optimal use of antibiotics nationwide is
the theme that has brought us all together
this morning. The White House is hosting
this forum in recognition of the importance and the
complexity of the antibiotic resistance issue the
management of which requires multi-faceted strategies
that involve multiple sectors of society. Today, we are uniting
leadership from the human and animal healthcare
system, the pharmaceutical diagnostic and vaccine
industries, scientific and professional societies. The livestock industry, food
processors and retailers and government. Cooperation among all of
these sectors is essential to confront the threat posed
by antibiotic resistant infections. This room is filled with
people who have been leading the push for the judicious
use of antibiotics for years and in some cases
even decades. I thank you for your
continuing engagement as we seek to expand the programs
that implement antibiotic stewardship practices
in humans and animals. The commitments that you’re
announcing today prove that our broad community is
determined to address the antibiotic
resistance crisis. Today’s commitments also
demonstrate the power of voluntary action to effect
sweeping change just as did the pharmaceutical industry
when it stepped up and voluntarily removed animal
growth promotion from anti-biotic labels following
the FDA issuing guidance on that topic in 2013. As I’ve already said,
the President has made combatting antibiotic
resistant bacteria a priority and has set forth
this strategy and action plan by which the federal
government will do it’s part to preserve the efficacy of
our existing antibiotics while promoting the
development of new diagnostics, new generations
of therapies and expanding the use of vaccines to
prevent diseases in humans and in animals. Today the President will
issue a memorandum declaring that it’s a policy of the
federal government to encourage responsible uses
of medically important antibiotics in the meat
and poultry supply chain. By supporting the emerging
market for meat and poultry that have been produced
according to responsible antibiotic use policies. This policy builds on
the important work. The food and drug
administration, antibiotic manufacturers,
veterinarians, food suppliers and retailers and
farmers who are already taking substantial steps
to phase out the use of medically important
antibiotics for growth promotion in live stock. Within 120 days the General
Services Administration will initiate a process to make6
meat and poultry produced according to responsible
antibiotic use policies and that would be true. federal cafeterias
managed by the GSA. In the coming years, as meat
produced under responsible use practices becomes
more readily available. Each agency will develop and
implement a strategy that creates a preference for
awarding contracts to vendors that offer as an
option, meat and poultry produced according to
responsible antibiotic use policies and that will be
true in domestic federal cafeterias for civilian
federal employees and visitors to the extent that
such an option is available and cost effective. Finally, but 2020,
appropriate rule making will be used to implement a
preference in federal acquisitions for meat and
poultry produced according to responsible antibiotic
use policies served or sold in all federal facilities
allowing for exceptions to ensure that acquisition of
such products can be made at fair and reasonable prices
and within an reasonable time frame. We’re already putting this
into practice here at home. Beginning last week the
Presidential food service at the White House has
committed to serving only meats and poultry that
have been produced with no hormones or antibiotics. Again, let me thank you for
being here today, for your efforts, for your
commitments. I hope you find the
discussions ahead to be productive and effective in
moving us toward our shared antibiotic stewardship goal. Let me now invite to the
podium Secretary of Health and Human Services Sylvia
Burwell for her remarks. Sylvia? (applause) Sylvia Burwell:
Thank you, John. And good morning to
everybody and thank you all so much for joining us today
for what is an important and hopefully historic step to
protect the health of our nation as well as
our global community. Among my friends and
colleagues I am known for being analytical. I’m a numbers person and
after a long day I actually like to curl up with a few
budget briefings and a cup of tea to relax. Since I’ve worked on
the issue of antibiotic resistance for awhile both
at the Gates Foundation at OMB, at Wal-Mart, now at HHS
— I’ve often seen it in terms of the statistics
and by that measure, this challenge is most upsetting
and every year at least two million people become
infected with bacteria that are resistant to antibiotics
and 23,000 people die a year. But the issue is much more
than numbers and for me I saw this come to fruition in
terms of human cost in April when my uncle was diagnosed
with MRSA and it led to an exacerbated complication
that eventually led to his passing. And as we marvel and so we
know that this is not just about numbers but it is
about people too and I think that’s part of what’s
helping us gain traction on this effort. As we marvel at the
advancements of medicine it’s sometimes hard to
believe that just 75 years ago something a simple as a
cut in the hand could lead to your own death and the
discovery of penicillin and antibiotics put a stop to
that stark reality but it also did much, much more. It opened the door to the
world of modern medicine. With the ability to fight
common infections we didn’t just make surgery safer,
we made organ and bone transplants possible. Chemotherapy or treatments
for rheumatoid arthritis — anything that heals us while
weakening our immune system is only possible because we
have the tools to fight the accompanying infections. So antibiotics have been
called miracle drugs and it’s not really hard to see
why but like other miracles they sometimes don’t last
forever and unlike most medications, antibiotics
lose their efficacy as the infections they attack
evolve and learn. Dr. Brad Spellberg author of
“Rising Plague” put it this way, “Antibiotics are the
only class of drugs where the more we use the
more rapidly we lose. For every prescription that
isn’t completed or wrongly prescribed we risk enabling
the adaptation that will render us defenseless.” Overuse and misuse are
rampant complicated by the fact that many antibiotics
are used for both humans and food producing animals. As all of you know, and as
we’ve all been warned, it’s already happening. We’re not entering he
post-antibiotic world, we’re actually in it and some of
you have heard the story of Addie Rerecich, the healthy,
active 11 year old from Tucson, Arizona who landed
in the hospital with a bacterial infection. After months of battling
drug resistant bacteria her doctors were forced to
do a lung transplant. It’s a terrifying thought
for a mother and worse still to know that many won’t
be as lucky as Addie. In the hospitals across our
country and in cities across the world this threat grows. Still, our greatest threat
isn’t adaptation, it’s actually our own inaction
and that’s why all of us are here today. The challenge is great but
so is our will to meet it. Last September we issued the
national action plan for Combating Antibiotic
Resistant Bacteria, our CARB plan and I’d like to thank
everyone here today from the task force who worked so
hard to those who helped us think about that
plan and draft it. It’s a research driven plan
to identify, prioritize, and coordinate investments that
prevent, detect, and control outbreaks to
resistant pathogens. It will ensure the continued
availability of effective therapies, detect and
control new resistant bacteria, and accelerate
our national response. And perhaps most importantly
this plan recognizes that one department, even one
government, or one company will not solve
this problem alone. We must work in
collaboration and we will. HHS is home to many of our
efforts to combat this problem. At CMS — the Center for
Medicare Services — in collaboration with CDC —
Center for Disease Control — I have a department of
lots of acronyms and other professional organizations
we’re working to create regulations for antibiotic
stewardship programs for acute care and critical
access hospitals as well as long-term facilities. When in place, what these
regulations will do is reduce harm that might arise
with overtreatment with antibiotics while enabling
patients to received effective antibiotics for
illnesses for bacteria when they’re actually needed. CDC is also working to
expand antibiotic use reporting under the national
health care safety network. The system allows hospitals
to track their antibiotic use and in time will help
the nation benchmark progress on antibiotic ship. In April, the VA system
began reporting antibiotic use data to CDC and several
large health systems represented here today have
already begun or will start reporting antibiotic
data use this year. To support stewardship of
these drugs in livestock, the FDA has proposed to
regulation to enhance reporting requirements for
sponsors of the antibiotics approved for use in
food producing animals. FDA is collaborating with
the CDC and USDA to collect more information on use and
resistance at the farm level as well. More data is critical for us
to measure and promote the judicious use of medically
important antibiotics. Today, the FDA is announcing
changes to the veterinary feed directive regulation. Which outlines requirements
for veterinary oversight of the use of drugs in animal. Putting animal antibiotic
use under the oversight of veterinarians is an
important step in combatting overuse. We are also sponsoring a
competition with a $20 million prize for the
development of a successful, rapid point of care
diagnostic test. For providers to combat
the spread of antibiotic resistant bacteria. We’re excited about this
challenge and we think it could lead to a
real breakthrough. These efforts will support
others happening across the government from the
department of agriculture to the department of defense. We are also working with
non-profits and those in the private sector and
seeing good progress. Ascension Health is
collaborating with CDC to establish facility based
antibiotic stewardship programs in all of
their hospitals. And Tyson’s Foods has
recently announced it will eliminate the use of human
antibiotics from its U.S. chicken flocks by 2017. Many of you have made
similar and very important commitments to
support this effort. From hospitals and health
systems to food producers and retailers — we are
partnering with key leaders like you in human
and animal health. This challenge requires big
solutions and I want to thank you for stepping up. Your support is
critical to success. I was recently in Geneva for
the World Health Assembly and I can report back that
it is not just a priority here in the U.S. but it is a priority that
has caught the attention of the entire world. The WHO’s global action plan
on antimicrobial resistance — which just passed this
session — requires that each country create an
antibiotic resistance national action plan
as we have done. We have many international
partners in this effort including countries. And multi-lateral
organizations and we are building the momentum we
need to fight this fight. And I know you all in this
room understand the need for action very well. The threat is real. The time to act is not are
on the line but we can meet this challenge and we
will find a solution. Together we will win this
fight and our road to victory starts here today. Hope you all enjoy the
session and thank you for being here. (applause) And now, I’d like to
introduce my colleague, CDC Director Tom Frieden. Thank you, Tom. (applause) Tom Frieden: Good morning
everyone and thank you so much for being here. Thank you for responding
to this call to action. Drug resistant bacteria
is a serious problem. It’s a problem that could
result in the medicine chest being empty when
we need it more. And it’s a
widespread problem. It affects every community
and potentially every patient. It’s not too late
to turn it around. We don’t want the miracle to
be over, the miracle event. And unless we take action
now that is a significant risk. As you’ve heard, 2 million
Americans get sick from drug resistant bacteria each
year and 23,000 die. There are an increasing
number of deaths from an organism called C-R-E. Or carbapenem-resistant
enterobacteriaceae. This is a true
nightmare bacteria. It spreads from patient to
patient, from organism to organism and it kills up
to half of the people with bloodstream
infections with it. C. difficile, which is caused
almost always by use or misuse of antibiotics, kills
another 15,000 Americans each year and these
infections can be horrendous for patients and
for families. Today we have with
us three families. The families of Peggy
Lillis, Nau Moss, and Josh Nam. They’re here with us today
and I want to salute them for brining their stories
into the public to help remind us and motivate us of
the importance of he work that we’re doing here
today to protect others. Thank you for what you do. (applause) Christian Lillis lost his
mother Peggy after she received antibiotics for a
routine outpatient dental procedure and
contracted the deadly C. difficile infection. She was previously healthy
and she was sick for only six days. Carol Moss’s son, Nau,
didn’t receive antibiotics in a timely manner and lost
his life to MRSA, MRSA pneumonia. He was only 15 years old. Victoria Nam’s son Josh was
hospitalized after a sky diving injury. He was on his way to
recovery but ultimately died of a gram negative infection
for which we have few or no antibiotics available. These three stories
represent some of the challenges we face
in antibiotic use. Some patients receive
antibiotics unnecessarily while others may not receive
them promptly enough and there are now infections out
there for which we have few or no antibiotics. It used to be that there was
thought to be a friction between what’s best for me
and my patient and what’s best for the
community at large. But it’s not clear that the
interests are truly aligned. What’s best for my patient
is the same as what’s best for the community, not the
most antibiotics, not the most wide spectrum
antibiotics but the right rugs at the right time for
the right patients so that we’ll have them
when we need them. If we don’t take better care
of the antibiotics that we have today, if we aren’t
better stewards of them, we could lose these antibiotics
and the next ones that come along. If we lose antibiotics we
undermine our ability to safely care for the 600,000
Americans who get cancer, chemotherapy each year,
patients who need organ transplantation or many
other things that are routine in modern medicine. We truly risk undermining
much of our ability to care and cure. We risk turning back the
clock when simple infections could kill. The administration has
proposed critically needed investments to better track
and prevent antibiotic resistant infections,
accelerate outbreak response, support
stewardship programs so that the right choice is
the default choice. That’s what works
best in public health. And to develop new
drugs and diagnostics. These will be
critical investments. It’s a big step in the
right direction and the commitments being made or
announced today are really important. They accelerate our
progress, and these, together with support from
Congress for the request of the President too, support
programs throughout the U.S. we think we really
can turn the tide. We think that within five
years we can prevent more than a half a million drug
resistant infections, save thousands of tens of
thousands of lives and save literally billions of
dollars in healthcare. This is not just an
issue of the human health consequence. Human health and animal
health are intertwined and it’s my honor to turn
it over to agriculture secretary Vilsack. (applause) Tom Vilsack: Good
morning to everyone. I’ve had this job for a
little over six years and what I have learned about
agriculture is that it is important, it is
complicated, and it is not fully understood or
appreciated by a lot of folks and I think the same
could be said for what brings us here today. Antibiotic resistance
is important. It is extraordinarily
complicated. It’s not fully understood
and perhaps not fully appreciate it by the general
public and that’s why I’m proud to be part of an
administration that is focused on this issue and
understands the connection between human health
and animal health. We at USDA take this
issue very seriously. We have committed a
substantial amount of research dollars
focused on this issue. We have suggested pursuant
to his budget that we quadruple the amount of
investment and we are doing this in the context of the
national action plane. It has five basic components
and USDA is engaged in all five. First of all, we obviously
need to know more about this whole process. How does it actually work? What is the process in terms
of animal health and how does it transfer and
impact human health? So that’s why it is
important for us to continue focusing on research. And making sure that we
inform producers in this country of the best-managed
practices that will allow us to reduce the potential
for this resistance. We obviously have to
strengthen our one health surveillance efforts. To do that it requires us to
focus our time and attention on a central repository of
veterinarian information so that we accumulate data. Us that effectively
understand better animal health and IT systems that
will allow us to link labs so that we can better
communicate again between animal health experts and
human health experts a use of standard protocols for
assessing the testing that we’re being — that’s
being conducted. We’re also looking at
advanced development and use of rapid and innovative
diagnostic tools, a better understanding of animal
healthy, a better understanding of how we
might be able to determine more quickly, accelerate the
basic and applied research in this area which really
involved big data, genomic mapping, better
understanding of how bacteria basically travels
in the animal health system. And finally, better
collaboration between agriculture and human health
physicians, doctors, and alike. Better collaboration amongst
and between animal groups and farm groups. I want to acknowledge that
today there is in the audience a wide variety of
areas of our society that are impacted and affected
by this and there are folks show are stepping up in a
very serious way in the agriculture business and in
the food business to take steps in this
collaborated effort. Tyson’s, Costco, McDonald’s,
Cargill, Chik-fil-a, Elonco — a wide variety of
interests who are making commitments and focusing
their attention on trying to help be part of the solution
but this is a complicated problem and it’s one that we
have spent the last 20 years working on at USDA and the
reality is we obviously have a significant amount
of more work to do. Last year we spent over
$19 million in research. This year the President’s
budget has asked for $56 million and we are hopeful
that Congress understands and begins to appreciate the
seriousness of this issue. I know that there are
several members of Congress who absolutely do who have a
passion for this and I hope that that passion translates
into a general understanding of the importance of this
issue and the resources are provided because nothing
can be more important. I know that producers are
quite anxious to work with their veterinarians to make
sure the use of antibiotics for animal health is
used judiciously and appropriately. Moving away from an
over-utilization, which it may have been a part of our
efforts in the past to a much more judicious and
reasonable use and I think that producers understand
the significance of this and the importance of it. They care about their
animals and they obviously care about their families
and their friends and community. So I’m here today just
simply to reiterate that agriculture’s going to
be part of the solution. That we are committed to
this at USDA and certainly we’ll continue to work
with all of you and the administration to make
sure that as the doctor suggested, that within five
years we’re in a better place than we are today. I think the fact that we
recognized the importance of this, that we recognize it’s
complicate and complex and requires additional
attention, and that we’re raised the visibility and
awareness of this I think is reflective of the importance
we place on it and I’m, again, proud to be part of
an administration where the President of the United
States is personally engaged and involved in this and is
directing this effort and is directing all of his cabinet
to be engaged and involved. So, thank you very much. (applause) Tom Frieden: So, we’re very
fortunate to have so many companies here that reflect
the full spectrum that’s important to address
antibiotic resistance. We have now guests at the
table who reflect the importance of these issues
and the wide breadth of commitment and concern I’d
like to introduce them one by one. Dr. Jonathan Perlin is
President of Clinical Services and Chief Medical
Officer of the Hospital Corporation of America. HCA will develop and
implement new systems to rapidly respond to lab
results, identify drug organism or drug bug
mismatches, and strengthen national efforts to identify
and report cases of antibiotic resistant
infections. Dr. John Loome is Senior
Vice President for Medical Affairs for the Southern
Area of Genesis Healthcare Corporation which will
disseminate best practices related to reducing urinary
tract infections and unnecessary antibiotic
use in the very important nursing home setting. Frank Yiannas is Vice
President of Food Safety at Wal-Mart, which will commit
to human treatment of and responsible antibiotic
use in farm animals. Jeff Simmons is President
of Elanco Animal Health and Senior Vice President and
Executive Officer of Eli Lily. Elanco will reinvest nearly
a quarter of profits in R&D to include more alternatives
to antibiotics such as enzymes and vaccines and
Donnie Smith is President and CEO of Tyson Foods which
recently announced its intent to eliminate use of
human antibiotics from it’s U.S. broiler chicken flocks
by September 2017. Thank you all so much for
your commitments and we look forward to hearing from you. Let’s start with the
greatest challenge that you face to advancing antibiotic
stewardship programs in your industry. Can we start with
you, Jonathan? And we’ll just go
right down the line. Jonathan Perlin: Well,
first, thank you. I’m John Perlin and as
Dr. Frieden said I’m President of Clinical
Services and Chief Medical Officer at Hospital
Corporation of America and also have the privilege
of chairing the American Hospital Association, the
association of virtually all of American’s hospitals and
many health professionals. In my spare time I also
serve as the advisor to the Secretary of Veterans
Affairs as the Chair of the Special Medical
Advisory Crew. In those roles we have
really the responsibility to serve a clinical,
ethical and social need. Clinically to assure the
best possible outcomes and avoidance of harm, ethically
to really make sure — as Dr. Frieden indicated —
that we have antibiotics to treat patients, and a social
responsibility to assure that we don’t continue into
a post antibiotic age. I think that there are many
opportunities to do things correctly and so, Dr.
Frieden, if I might — let me just reinforce the
commitment of those three organizations through the
prudent stewardship of antimicrobial resources. As was heard, their excess
— any avoidable harm is by definition excess — but
excess harm in the form of 10 million avoidable
infections, 23,000 avoidable deaths per year. And the context that
probably 30 percent according to CDC information
of instances of use of antimicrobials are
frankly inappropriate. So the commitments, which
are directed really at addressing the challenges,
are three-fold. One, HCA joins with VA in
commitment to reporting antimicrobial
use to the CDC. So we believe this is
critically important to understand not only the
nature of the use of antimicrobials but
simultaneously the nature of the infections that
we’re seeking to treat. VA has already made that
commitment electronically and HCA as really a
derivative or meaningful use, we’re using our
information systems to make that possible as well. Secondarily, we are
committing to a national antimicrobial stewardship
program to directly address the challenges
that are faced. So the principles that we
use in AHA — in HCA — are similar to the principles
that are espoused by the American Hospital
Association in their appropriate use materials
which is available at the AHA website under the
keyword antimicrobial use. Let me address some of the
barriers as you asked. Let me just start that the
first and most important consideration is really
good infection prevention. Dr. Frieden, I believe that
is you or I could choose to do one thing in the rest of
our career it’d probably be effective hand hygiene. We don’t need to be
vectors of transmission of infections inadvertently
certainly as health professionals and it’s
unacceptable that health professionals may not
be as good as some — as passengers on a cruise ship
in terms of the consistent use of good hand hygiene. So any good program starts
with good prevention and good prevention starts
with hand hygiene. I say that because
that is a barrier. We are not as good as we
need to be in terms of the hand hygiene and the
effective prevention. There are challenges in
three categories that I’ll speak about in this. General definitions and
measurement, provider related challenges
and implementation. We appreciate the work of
CDC in helping us toward agreed definitions
of appropriate use. We need to be able to
benchmark the use to really be sure that we’re not
fighting on definitions but fighting an epidemic of
overuse — of avoidable use of antibiotics — or
avoidable use of excess broad spectrum antibiotics. We need better data on
optimal dosing to duration. In fact, in our
organization, we think of the five D’s as
the cornerstone. The right diagnosis, the
right drug matched to that diagnosis sometimes called
bug drug, the right dose of that drug the third
day, the right duration. Not too long, not to short. Either one can result in
inadvertent harm to the patient or by breeding
antimicrobial resistance to others. And finally, appropriate
de-escalation. Once you have the data to
make sure that you can narrow to the most specific
therapy that kills the infection of interest
but doesn’t create an environment that allows
the harm full multi-drug bacteria or other
organisms to grow. We need derivative of that
standardized risk adjusted measures and benchmarks
and again the CDC and your national health safety
network would be terrific for that and when I think of
measures I really think of them as measures of
consumption — the use of antimicrobials. Measures of process —
how well we adhere to guidelines, and
measures about outcome. How well we do in terms of
the desired effects which are good clinical outcomes
for patients and avoidable, harmful effects either
adverse events for the patients themselves or
if the adverse event of breeding antimicrobial
resistance effecting all patients and all
communities, that friction which you so eloquently
spoke about. Provider related challenges
frankly, we — I am a physician — I am an
internal medicine physician. We need to be
more accountable. We need to be held
more accountable. Physician and health
work knowledge is not as contemporary as
it needs to be. Again, the CDC, HHS, AHA —
medical specialist societies and all the societies of
infections diseases really are sources education that
needs to be accountability for receiving them. That education needs to
be measured in terms of a practice of that. There are times where there
are incentives that work across purposes. And let me give
you an example. Patients increasingly and
unfortunately have adopted a belief that the need
antibiotics at times when they’re really
not necessary. We need to do a better job
with education because the incentive that physicians
and hospitals work under is one of patient
satisfaction as well. We want to satisfy
the patient. I like to personally explain
that the most satisfying course is the best
possible outcome. It takes time but we need to
recalibrate this potential mismatch of incentives where
there’s an expectation for antibiotics or other
antimicrobials when in fact they’re not necessary and
that leads to a challenge. Patient education. And finally, in terms of
implementation we may have great knowledge but we need
equal knowledge in the field of formally studying how we
change clinical behavior, how organizations such as
my own, such as the member organizations of the
American Hospital Association, how VA change
patient behaviors, change provider behaviors, and
change institutional behaviors and the agency
for healthcare research and quality along with CDC and
other elements of HHS, professional societies and
others have an interest in that. Through that they can really
support education programs and best practices, coherent
antimicrobial management programs that span settings
— outpatient, in patient, nursing home, home, and
community — expand the transitions of care between
those different parts of healthcare and home that
span not only the provider domain but work with pairs
who are represented here later today. And that support really
adherence to the most appropriate indications. So those are the challenges
and I look forward later to talking about how we’re
tackling those challenges through our commitments
at the American Hospital Association and my
home organization — HCA — through a
commitment to reporting, a commitment to antimicrobial
stewardships and prevention programs, and a commitment
to working with you in research and in the VA
through a commitment to prudent prescribing
practices and reporting and really also serving
as a laboratory. So thank you. Tom Frieden: Thank
you so much, John. And this really emphasizes
the importance of a whole of society not just whole of
government but whole of society approach we
have patients, doctors, institutions, payers, all of
them important to generate data, have the stewardship,
have a partnership to reduce antibiotic use. And of course it’s not just
human health but animal health as well. Jeff, in the animal health
world what are we looking at? Jeff Simmons: Yeah, I think
we’re pleased to be here and I know on behalf of really
the animal health industry in a broad sense it’s to
bring both industries together — the human health
leaders and animal health — I think there’s an
opportunity today really to create a platform
on this key issue. The concern over the reduced
effectiveness of antibiotics is real, needs
to be addressed. I think we’re really looking
to shape the future focusing on how we can continue to
really bring the importance of the health of the
animal into the one health discussion and how it links
to human health, our food chain health, and the
environmental health. I think that’s important. So this is really about, I
think, putting one health to work today. Let me back up though and
just say I think the FDA has made great progress. Today’s announcement on the
VFD is an example of that. It’s important I think
though to understand a little bit of animal health. We look at antibiotics
really in a shared class and animal only class. Shared class being those
that are used in both humans and animals. Then animal only that are
only used in animals and I think it’s important to have
a little bit of a dialog today on that. The FDA has made strong
progress with guidance 209 and 213 where really
limiting the use of shared class antibiotics, moving it
only to therapeutic class, phasing out growth
promotion, and increasing that oversight. That actually was instituted
today even more so with this VFD. I would say that all 26
animal health companies have voluntarily confirmed our
commitment to comply with these measures and
there’s good progress. I think animal only
antibiotics do create a positive solution where the
treatment and the wellbeing of animals can be done with
animal only antibiotics and this also can then continue
the longevity on the human side. So I think that’s important. You know I will, I’ll just
highlight I think what probably is the biggest
barriers we’re talking about as Secretary Vilsack said,
science and disease and I think we need to
be very careful. So I think the biggest
challenge is we must not enact regulations or
policies, you know, that would move faster
than the science. We can’t get ahead of I
think the science and the solutions and jeopardize
animal health, jeopardize food safety, jeopardize
food security. I think this is important. Setting times lines with out
solutions and I command that the company’s here and
others who were mention today on not doing this but
setting the right timelines without solutions
could be dangerous. Compromising animal welfare. For example, policies that
require complete elimination of all antibiotics in animal
production, you know, aren’t right for the animal are not
right for the consumer as well. So, this is a challenging
endeavor, not without risk, but I think with intentional
focus, with some dedicated investment, with the
collaboration from today’s discussions I think
we can make progress. We believe that there is a
positive future both for he health of humans and the
animals and I can share later our commitments
that we’ve made today and announced today relative
to this later on. Tom Frieden:
Thank you so much. Real progress here, real
change and it affects all of us as we consume food and as
we participate in medical care. We’ve got Wal-Mart here. Such an important retailer
or whole sale that the enormous impact that you
have on our entire food supply I think often not
only is it a significant proportion of the food
supply, but it drives the market. So thank you for your
commitment, Frank. Frank Yiannas: Well, thank
you Dr. Frieden and we’d like to thank the White
House and the administration for being part
of this session. You know first of all at
Wal-Mart we are absolutely committed to providing safe,
affordable, and sustainable food so people
can live better. And so, our position on
antibiotic stewardship is consistent with our
commitment to continuous improvement and
sustainability and of sustainable food system. You know, when our customers
stop in our stores they expect great prices
and great products. But our customers have told
us that then expect us to source products and food in
particular in a way that’s sustainable for the
planet and for people. And so that’s why about
a week ago we had an announcement regarding our
antibiotic position and it was based on three
basic pillars. Number one, we are asking
all of our suppliers whether they provide us with foods
that are meat or poultry products, see food, dairy,
eggs, to use antibiotics very judiciously
and responsibly. That means that they should
use them only to treat or prevent disease in Animals. That they should use them
with Veterinary oversight, that they should keep good
records and that they should document outcomes and so
that’s very consistent with the principle of the
American Veterinary medical association. Number two we’re asking
my suppliers to not use antibiotics for growth
promotion and as you know that’s very consistent
with FDA guidelines. But number three we’re
asking our suppliers to work with us to promote
transparency and how antibiotics are being
used in the food system. And so we’ve asked our
suppliers to report to us on an annual basis how they’re
using antibiotics, how much antibiotics they’re using
and for what purposes. We’re not only asking them
to report it to us, but we’re asking them to make
that report available to the general public. We think that’s important
because we now that transparency leads
to accountability. We also know that
transparently leads beyond to accountability
to responsibility. It tends to regular
self-governing or self-regulating behaviors
and so that’s why we’re strong proponents
of transparency. In terms of the question you
asked, Dr. Frieden, in terms of challenge — you know,
the one challenge that I can think of is just the
challenge of changing. Change in general can be
difficult and so if you think about a food system
and food producers that have been doing things one
particular way for many years knowing what type of
yields it provides, the efficiencies. If you ask them to change
there are questions. It could naturally questions
about what type of yield might I achieve? Am I going to see the
same efficiencies? Will I see more
sick animals. And so just like there are
barriers to progress, there are enables so I’d rather
focus on the enablers of progress and there’s
two key ones that I see. One is mentioned here
today, information sharing. You know, there are others
that are a little bit further along on this
antibiotic stewardship journey. And so if they can share the
lessons learned, some of the pitfalls, what’s working
and what’s not working, the innovations that they’ve
used to prevent disease in the first place that lessen
he need to antibiotics, that benefits everyone. And the second one as I
mentioned, I think a real enabler will be this
principle of transparency. Tom Frieden: I think this
is music to our ears in the human epidemiology field
because we do think that sunlight is a great
disinfectant and transparency is really
important when we have — whether it’s infection rates
in hospitals or anti-biotic use for different purposes,
it drives progress in a way that keeps everyone in the
game and we are really honored to have Tyson here. Donnie, I know that you are
not a Johnny Come lately to this area. It’s been a focus for you
for some time and we thank you for your new commitment. Donnie Smith: Thanks, so. Thank you so much Dr.
Frieden and we have made a lot of progress over the
last few years reducing human use antibiotics in
our poultry value chain by 80-something percent over
the last four years or so. So addressing the challenge
issue, really what we need are more alternatives,
you know? Whether it’s — and we
depend on companies like Elanco and the animal
pharmaceutical industry and great research and
veterinarians and the academic community and
others to help us, whether it’s in, you know, and
enzyme or botanical probiotic or that type. Or, it’s as Jeff mentioned,
these animal-used only antibiotics we think are
very important to making sure we keep that balance
between this global health concern and our commitment
to animal welfare and to something Frank said,
and keeping that product affordable, right? That’s a very delicate
balance and so being able to — being able to straddle
that fence so to speak by finding more alternatives
— I loved hearing what the Secretary of Agriculture
said about increasing the research budget. We need more research on
what these alternatives might be and we’ve got great
partners all through the, you know, animal and
livestock industry that are — that are — eager to make
progress on these issues and as we find more alternatives
and we can put them into use we’ll make a lot of
progress on this issue. Tom Frieden: Thank you,
and as you mentioned, the proposal for the FY16 budget
has a significant increase in funds for research in
this area, in the animal health, and also for funds
that we would provide to every state in the country
to have prevention programs out there to detect, also to
learn more about the human health aspect and
what can be done. Because some of the
challenges that we have we know how to address and
it’s just a question of implementing. Others are more difficult
and that takes us to John to look at the long term care
in nursing home sector which is one of the areas where
we know that there are many infections and many of them
we know how to prevent but some of them are tougher. So share your
perspective please. John Loome: Yes. Thank you, Dr. Frieden, I
want to thank you as well as the CDC for reaching out to
us, Dr. Stone, bringing us all together. We are Genesis Healthcare. We’re the largest provider
of SNF and long-term care in the country and now have a
national footprint of over 500 centers. This is music to our ears
Dr. Freiden because we have been committed to really
what this is about is responsible and
sensible prescribing. We have resources within our
company already where we’ve been working on this with
— we have expertly trained nurses in our centers who
have infection control background, training,
certification. We work closely with
our, with our — we hire pharmacists and have
pharmacy partners as well as, you know, our pharmacy
provider to help us with sensible and responsible
prescribing. So, what we’re looking I
guess for the CDC for is to work on logistics, breaking
down barriers and further guidance in that area. I am also an internist and
one of the things we teach our providers is in
accordance with the ABIM foundation is the choosing
wisely campaign which very much espouses a lot of these
principles about sensible prescribing. And our partner organization
— American Healthcare Association — the American
Healthcare Association and AMDA — American Medical
Directors Association — are committed to this as well
and American Medical Directors Association has
as part of their advanced curriculum training many
things related to antibiotic prescribing and
antibiotic stewardship. So this is something very
much that we are committed to and as far as the
barriers go, I think things like this help break
down the barriers. It’s really the things
about collaboration and communication that bring us
together and to talk about these things in this kind of
a forum and continuing to work towards the common goal
are things that I see as being common barriers. Thank you. Tom Frieden: Thank you so
much and it makes such an important point that the
best treatment isn’t the most treatment. It’s the most
appropriate treatment. And yet that sometimes is a
real discussion that we have to have with our patients. Let me ask each of you, do
you think there’s a business case for antibiotic
stewardship and antibiotic stewardship programs? John? Jonathan Perlin: Well,
thanks Dr. Frieden, and you know, this is one of the
great, unappreciated ironies. It’s something that’s been
driven home to me in VA, something that’s driven home
to me in my day job at HCA, Hospital Corporation of
America and something we know across American
Hospital Association. Good quality is
good business. Let me put it like this. If we were making cars and
we had a complication, an error, and you had to
rework it, that would be an unnecessary expense. This is what happens with poor choices of antimicrobials. An avoidable infection
is not only costly and potentially the ultimate
price for patients, expensive for communities. But it’s in practical day in
and day out terms and excess expense. And our home organization —
as we track those five days — the choice of making
sure that we have the right diagnosis, choosing the
right drug, appropriate dosing, duration, and
de-escalation — those sorts of activities correlate
with cost per patient day. So it’s really clear that
there is an immediate business case for
quality in this regard. The American Hospital
Association has an extraordinary example. With the support of HHS,
the American Hospital Association set forth with
the largest collaborative hospital engagement network
and in the hospital engagement network, working
on healthcare associated infections and microbial
stewardship another hospital acquired a healthcare
associated complications. AHA’s work across many
states not only avoided an excess of 90,00 adverse
events but saved a better part of a billion dollars. In fact, the conservative
calculation was that the savings were $988 million
over the period of operation of those hospital
engagement networks. That’s real money. But as it mentioned, the
really cost is patience. Let me just direct you to
the specific website for the AHA resources. www.AHA.org/appropriateuse
and that will take you to that resource. Really, to get to that
business case though requires putting into
process a set of interventions for
appropriate antimicrobial stewardship that are
centered around not only the education but
the measurement. And with that measurement of
the use — or consumption of antimicrobials — the
process measures, adherence to guidelines, and that
sort of thing, the outcome measures, the effective
cures of patients. Measurement hopefully of
decreasing adverse events — there are also
financial measures. And here’s the really
remarkable thing. Because these broad-spectrum
antibiotics that tend to be overused were used too
long are more expensive. The proxy measure for your
entire program is actually a decrease in cost of
antimicrobials — good quality, good safety, good
stewardship — is great business. Tom Frieden:
Thank you so much. Doing well by doing it
sounds like and it clearly intersects with the
direction that Health and Human Services under
Secretary Burwell’s leadership is going in
increasing the proportion of our care that’s based on
value based purchasing rather than volume
based purchasing. So there’s an intersection
here of what we’re doing to try to make sure that what
pays is also what helps people stay healthy
and become healthy. Jeff? Jeff Simmons: Yeah, I think
it’s a great question and actually, you know, we’re
part of Eli Lily, a pharmaceutical company
that’s been in business for over 140 years and our
mission is to make lives — higher quality, longer
lives is the mission of our company — and right along
with diabetes and cancer and Alzheimer’s is
animal health. So I say actually animal
health to us is we are in the people business. We provide suppliers like
Tyson with products to make animals healthy, which
create safe, abundant, affordable food. That’s ultimately
what we’re about. So, you know, today we’ve
announced things that were already in place and some
additional extra intentions and I think this is really
our business case today in terms of what we’re doing. We’ve got an eight point
— and I think this word stewardship is very ideal
because it’s all about stewardship — and how
we steward the health of animals into this equation
is going to be absolutely critical. So, here’s what we’re really
committing to is one, is I think further execution of
Guidance 209 and 213 by non just looking at
this in the U.S. I think we’ve got to
broaden the context in our discussions today to talk
about this global issue and take it globally. And I think putting together
training, which is already occurring and
antibiotic use policies. That, to me, is absolutely,
you know, critical across the food chain, and two good
examples sitting here today. Number two, Elanco has
ceased all promotion of — growth promotion for any
shared-class antibiotics and will have that in the
regulation and labels by the end of 2016. Third is eliminating
continuous use of shared-class antibiotics. We know that’s a concern,
and working with suppliers on alternatives. Not easy, but that’s
our goal, is to remove continuous use of
shared-class antibiotics. The next one is eliminating
over-the-counter, OTC shared-class antibiotics. This is something that’s —
be — above the guidance globally, including even
injectable products that are shared-class where
veterinary oversight exists. I think the other one is
eliminating — there are places where concurrent use
of shared-class antibiotic is used to treat the same
disease and we’re working to eliminate that. Supporting that oversight, I
think today’s announcement with the FDA and the CVM is
very critical, is, “How do we put the right
infrastructure together?” The VFD, the Veterinary Feed
Directive is an example of that. The next are really
around just innovation. And the two areas of
innovation is developing new animal-only antibiotics
I think is a way that no animals should ever be
treated with a shared-class antibiotic when an
animal-only option exists. And then lastly is, today
we’re being very intentional by saying, “We’re going
to create antibiotic alternatives,” and I
know other animal health companies are
doing very similar. But Elanco commits to invest
two thirds of our food animal budget that would
match numbers that were shared today. To quickly evaluate, today
we have 25 candidates in our pipeline that are
non-antibiotics and our goal is to deliver 10 viable
non-antibiotic development projects that
address diseases. And these would come from
platforms like vaccines, immune modulation enzymes,
and novel therapies across chickens, pigs, and cattle,
and enteric and respiratory disease, and also
mastitis in cattle. And in one year, we’ll host
and share a forum with the right parties, an animal
health accountability summit, to share progress. So I believe that —
Dr. Frieden, we believe strongly that there
are solutions. There are pipelines. There are options, not just
in Elanco, but I know in the animal health industry, and working together is critical. I think predictability,
having things like ADUFA, the Animal Drug User Fee
Act, is absolutely critical if we have predictability
and we have prioritization put on products that are
non-antibiotic solutions. And the innovation is going
to be absolutely critical going forward to make
this business case real. Tom Frieden: Thanks, Jeff. And the importance of
innovation and the breadth of your commitments
is impressive. In the human health field,
we look at vaccines as an example. Vaccines save three dollars
in healthcare costs for every dollar that they cost
and $10 in societal costs. Vaccines are one of the
greatest accomplishments of the last 100 years, and
they prevent infections. No infection, no
antibiotic-resistant infection. So expanding vaccines and
other non-antibiotic uses is certainly a very important
area to go forward on. Frank, from your
perspective? Frank Yiannas: Very good. It’s a great question. Is there a business case
for antibiotic stewardship? You know, at Wal-Mart, I can
tell you that our commitment to antibiotic stewardship is
first and foremost based on the principle that it’s
simply the right thing to do. You heard earlier today
about the real human face to this issue. And so it’s an important
issue of our day. It’s an important medical
challenge and we’re a responsible retailer and
we want to do our part. So first and foremost, it’s
simply the right thing to do. Secondly, it is good for
business and our customers. We listen to our customers
continually and our customers have told us
they want us to source and provide foods in a way
that’s sustainable to people on the planet. So listening to your customer is always good business. But lastly, if you think
about the challenge that we’re talking about this
morning, complications and human treatment because
of antibiotic resistance, whether it’s a person that’s
sick and they’re a customer, whether it’s an employee,
whether it’s someone in the food system, whether it’s
just a person at large in society, you know, these
illnesses have consequences and clearly direct and
indirect implications for business and commerce. And so we do believe that
antibiotic stewardship is good business and that
it’s good for business. Donnie Smith: So it’s
been interesting. As we’ve walked down this
path and been very, very intentional over the last
four years to reduce human used to antibiotics, we’ve
actually found a cost benefit by the mechanisms
that we’ve put in place to reduce the use. So often drugs that are not
broad spectrum, that are suited for a particular
disease at a particular time for a short period of time,
it’s cheaper to use and all these — all these
substances that we use are expensive. And so when we can find
ways, whether it’s through animal husbandry — the
technology of the housing that modern animals are
produced in today is phenomenal. And that environmental
impact has a huge impact on their health and in
keeping the cost low. So yes, there’s absolutely
a business case for that. And maybe to the point that
Frank just mentioned — and I’ll just add one point to
that — anything we can do to reduce concern on the
consumers’ behalf of the food they choose —
because think about it. You know, we’re what, two
maybe even three generations off the farm today. And as the secretary started
today, you know, what we do’s pretty complicated
and it’s not widely known. And so consumers today
aren’t as informed, maybe, as they would have been
three or four generations ago about how their food
gets to the grocery store. So the things that we can do
to reduce that concern are good for all of
our businesses. Tom Frieden: Jon? John Loome: Yes,
Dr. Frieden. There is absolutely a
business case for this on our side as well. There’s a tremendous primary
monetary savings in, you know, making sure that we’re
doing the right thing. And it’s great when doing
the right thing at the same time — you know, and being
responsible, that good things follow on the
business side as well. So that — that does not
happen very often, but when it does, it’s great, and
it’s great for us, too. There’s a secondary case,
also, that has been alluded to as well, especially in
the human arena with the — all the adverse events. Especially, you know, in the
sniff (spelled phonetically) and long-term care industry,
we see primarily urinary tracts being over — urinary
tract infections being over diagnosed tremendously,
trying to teach our providers and nurses to
stick to dose duration and diagnosis and figuring out,
“Are we treating an actual urinary tract infection? Are using the correct dose
and are we treating for the correct duration?” is very important. And when we do that,
obviously all the positive secondary things
will follow. But when we don’t do that,
we don’t follow that path, we get into trouble with
a lot of adverse events, especially in our industry. So if urinary tract
infections are very common, the common thing we see
with overprescribing and irresponsible prescribing
is clostridium difficile infection and what that’s
done over the last 10 years especially. So, you know, again a great
primary case monetarily and even probably better case
secondarily with the — from the clinical aspect. Tom Frieden: Thank you. One of the things that’s so
striking to us when we look at the problem of antibiotic
resistance is that in the human health arena at least,
no one institution can go it alone. If you’re the best hospital
system in the world but you’re working across the
street from another hospital or a nursing home or a
private clinician who’s not using antibiotics
responsibility, you may have to bear the brunt of that
problem, and that means that there is an interest in
all of us working together across communities,
throughout the country in animal and human health. And that brings up the role
of government and we’re from the federal government
and we’re here to help. So how can we help
most effectively? What can the federal
government do to advance this as effectively and
rapidly as possible? John? Jonathan Perlin: Well,
Dr. Frieden, I can’t think of a better way to highlight
this, not only issue, but, honestly, opportunity —
opportunity to recalibrate our practice, the
opportunity not only to avoid harm but the flip side
of that, which is really to improve health
and healthcare. So this White House
forum is an extraordinary opportunity. As you mentioned,
it spans sectors. It spans the different
elements of the human health environment. It spans the
pharmaceutical industry. It spans the animal health
and agricultural industries. So I think there is an
important convening role that’s so well served today. But let me offer some
specific suggestions about what I believe that
different elements of the federal government, and
frankly the state and local health officials in
conjunction not only with their community partners
at hospitals, but major infectious disease
organizations can do. Patient community education. I mentioned the challenge of
the relationship where we have a society now that
believes a medication is always necessary. Sometimes the best
medication is no medication. Sometimes the best
approach is really prudent stewardship, and that’s
something that we need to work with, I believe
starting at the highest levels of the government as
this forum offers down to state and local
health departments. There’s an opportunity. There’s an opportunity with
great industry partners to help educate and inform
because they want their products to be as effective
as possible, as they will be when they’re used as
appropriately as possible. We believe that your role at
CDC in terms of providing effective surveillance and
response as incredibly necessary. And I know we sometimes like
to think of CDC as belonging to us, but honestly, CDC is
a resource for the world. And this is not just
a health threat in a community, in a state, in
a region, in a country. It’s a worldwide issue. And so the work that
you provide in terms of convening and coordinating
response and surveillance internationally is
critically important. There are some that suggest
we need to be stricter. Secretary Burwell was here
and colleagues from the Center of Medicare and
Medicaid Services are here as well, and they’ll
have to consider whether (unintelligible) stewardship
programs are — need to be a part of — condition of
participation, certainly the accreditation bodies like
the joint commission and others can help work to
assure accountability. I think the terrific
advance that’s been made in electronic health
information with Meaningful Use and HITECH provides
an opportunity to really deliver what I like to
call the data dividend. Guess what? We’ve bought the plane. We got to fly it. That plane is a cargo of
health information that includes information about
all the infections we treat and all the
medications we use. And as VA is doing, as HCA,
Hospital Corporation of America commits to doing, as
chair of American Hospital Association, as I hope to
use my pulpit to encourage my colleagues to do, just
to use that electronic information to share with
CDC and HHL so that we don’t have to have a lot of manual
surveillance system, but in as close to real time as
possible, we have the opportunity to examine
antimicrobial use and make it better. And so there is a real
opportunity from HITECH and Meaningful Use and the
Office of National Coordinator would own
that responsibility. Tom Frieden: Thank you. I want to — Male Speaker: Thank you. Tom Frieden: — be sure
to get to everyone. So Jack? Jeff Simons: Yeah. Just a quick
couple comments. First of all, I think
today’s a great example. I think the Animal Health
Industry welcomes and we hope we — we’re a little
disappointed we might have to separate in different
rooms because we’d like to collaborate more together. I think this opportunity and
hopefully this forum leads to more. I think as I’ve already said
I think accelerating at the appropriate way, regulatory
approvals, and animal new drug application is complex
if not more than humans as we look at food safety,
animal, environmental beyond the efficacy of the product. I think the ADUFA that
Dr. Dunham and others have done has been very effective
in doing that, keeping standards high but
creating predictability. My challenge would be very
similar in the areas of human pharmaceutical
priority review relative to any antibiotic replacement
ought to be considered. That’s something I think the government ought to consider. I think their modernizing
data collection. Today we’re collecting
volume and sale’s data and one challenge is we’ve
got emerging diseases in different species and
different, you know, environmental conditions. And the one challenge
is I think we need more meaningful data around the
demonstration of responsible use. And our other policies in
place are either being adhered to — the impact on
resistance development and even just the effect of
animal health outcomes. So I think our measures need
to shift a little bit and need to be focused on
things that are the leading indicators to the challenge. I think the other one
is just as I said. Let’s not get ahead of
ourselves with policies before the science. And then I think, you know,
let’s standardize this at a national level. It concerns me and worries
me when we have different municipalities at the
state or city level. This needs to be national
and global, I think, as we attack this problem. And it can really, you know,
break and fraction our efforts if we’re looking
at this at a state level. So — and I think continued
— the last thing is just intellectual property
protection, just like in human pharmaceuticals,
is critical. It’s part of the business
in terms of, if you want increased investment and
a flow of innovation, intellectual property
protection needs to be I think adhered to and
continued to be important. Those are things I think the
government would help us with. Tom Frieden: Thank you. Frank? Frank Yiannas: Great. In terms of what the federal
government might do better or differently, first and
foremost, let me stress that antibiotic stewardship is
a shared responsibility. Let me repeat that. Antibiotic stewardship is
a shared responsibility. As you mentioned, Dr.
Frieden, there’s no federal agency that can
do this alone, there’s no company that can do
this alone, no medical institution, no
academic institution. And so we need all hands on
deck pulling in the same direction. One of the things Dr.
Frieden and his agency would like to state, there
are some battles in public health that are
winnable battles. And all though this will be
a long and difficult battle, we do believe that the
battle against antibiotic resistance is a winnable
battle, but it’s going to take a lot of people pulling
in the right direction. And the federal government
has done their part. This is a perfect example We commend the White House
in the administration for today’s summit. The White House is a
great convener, bringing stakeholders to the table. And so what you’re seeing
today is a louder or bigger conversation on
antibiotic stewardship. Brilliant. We thank the FDA for what
they’ve done with the guidelines that
they’ve published. And, in fact, it’s informed
and shaped our thinking and what we’re doing about it. We thank the Centers for
Disease Control with all of the work they do in terms
of tracking organisms and certainly the Get Smart
Program and the USDA with the work they’re doing. If there was one thing I
might suggest that might be useful, as you’ve heard
today, we’re putting a lot of emphasis on this
issue of transparency. And so any guidance or
direction on how companies could voluntarily report
usage and standardized formats and standardized
rights or metrics so that we can compare how one company
is doing compared to another. We think that would
be beneficial. Tom Frieden: Great. Thank you very much. Donnie? Donnie Smith: So quickly the
only build — I just want to come back to research. You know, as — you know,
what — I think the government could be very,
very helpful if they would, you know, sponsor and
support research that would help us find these
alternatives we need to eliminate human-used
antibiotics from the supply chain. The data collection comments
that have already been made, can’t add anything to that. But the more we know
about, you know, how these antibiotics, particular
shared-used or human-used antibiotics, are used
today and help the public understand that many of the
antibiotics used today are not used in human medicine,
I think that gives them a lot of comfort that a lot
of progress is being made. So the more we can do to do
those type of things, to help the public understand
through transparency what’s really going on out there
will, be very, very helpful as we continue
down this path. Tom Frieden: Great. Thank you. John? John Loome: Yeah, I think
as far as the government is concerned, there are
really three things. One is, again, to solidify
the research and what the correct answers are. I think, you know, the other
thing is that we would like, especially in my industry,
to be — continue to be brought to the table
for collaboration, communication, and to be
part of the solution before it comes down in
policy and regulation. And I think my industry
partners would agree with that as well as our
partner organization. So, you know, we look
forward to that also. Tom Frieden: Thank you. I want to thank everyone on
the panel and everyone in the room who’s worked so
hard to get us to this point. You’re hearing a lot of
the essential elements of successful programs,
political commitment, collaboration, open data,
continuous innovation. All of these are essential
to progress and all of these are critically
important to address the antibiotic-resistant
problem. So I would now like to
invite to the stage Lisa Monaco who is assistant to
the President for Homeland Security and
Counterterrorism and Deputy National Security Advisor. Lisa. (applause) Lisa Monaco: Well,
thanks very much, Tom. And thank you all very
much for being here. I think it’s terrific to see
this forum in place and to see these seats filled with
all of you and not with White House staffers at yet
another employee all hands meeting. This is, I think, a much
better — better use for this room. I also want to recognize my
colleagues for having been here this morning. Secretary Burwell, Secretary
Vilsack, and of course Director Frieden
from the CDC. And I really am heartened
and proud that we have so many leaders from such a
broad cross section of American industry here. It’s a real testament to
your work on this issue, to have you here this morning. Now, some of you may
wonder, “Why is it that the President’s Homeland
Security and Counterterrorism Advisor
is here speaking about antibiotics?” My father who wanted a
doctor for a daughter may also be wondering that. Typically people associate
my job with terrorism, cybersecurity, or special
operations rates of our military members oversees,
and they’d all be correct. But make no mistake. I am here today on another
matter that is vital to our security, our public health
security here in the United States and of course
around the world. And that threat that we’re
here to talk about is the threat — the growing threat
from antibiotic-resistant bacteria. There was a time, as you all
know, when a simple cut or a small break in your
skin could mean death. The treatment for infections
and blood poisoning was often just to wait
and, frankly, to hope. But with the discovery
of penicillin and the widespread production
and use of antibiotics, countless lives
have been saved. It was a watershed moment
in human history when those life-saving developments
were made, a triumph of science and medicine that,
frankly, changed the world. But, in that victory, we
also have created a new challenge for ourselves. Over the past several
decades, the use of antibiotics has grown and,
in many cases, becoming overused or misused, as I
know has been the topic of some discussion today. Bacteria have evolved,
developing resistance, and blunting the effectiveness
of what at one time was a miracle cure. Doctors have had to increase
dosages and find new and more potent drugs
to treat diseases. And unless we can slow or
stop the cycle of growing antibiotic resistance,
we may once again find ourselves in the case
where common illnesses and everyday infections
can be fatal. Now, this is not a problem
that any of us can afford to kick down the road. That’s why President Obama
said recently, and I quote, “This is a challenge was
have to take seriously and invest in now.” In the U.S. alone, about two million
illnesses are caused by drug-resistant bacteria each
year and, tragically, some 23,000 deaths occur. This challenge of
course is quite real. Fortunately, there are some
fairly simple steps we can take today to
counter the threat. The single most important
thing we can do to combat antibiotic-resistant
bacteria is to reduce the frequent with which
we use antibiotics. Now, as mentioned, I’m the
daughter of a doctor and I remember when I was young my
father explaining to me that not only would antibiotics
not work for everything, the common cold just to name
one, but it might actually be dangerous to take
antibiotics in the wrong circumstances. Simply by ensuring
antibiotics are only used when they’re needed, we can
improve patient outcomes and reduce the potential for
bacterial resistance. But we need to make some
changes beyond the doctor’s offices. We also have to ensure
that antibiotics that are medically important for
humans are used responsibly in animals. And I know that’s a topic of
commitments and discussion made here today. That’s why yesterday
President Obama signed a new memorandum to encourage
reducing antibiotics in the meat industry. Over the next few years, the
federal government will do its part and the meat and
poultry purchased for use in federal government
cafeterias will include that from farmers who follow
responsible use guidelines for antibiotics. This mission will take us
all working together, and we are taking steps that
hopefully this forum and others like it can build on
over the coming weeks and months. So what are we doing? First, we’re giving people
the tools and information they need to adopt
better practices. Earlier this year, President
Obama released a national action plan for combatting
antibiotic-resistant bacteria, and it outlines
the steps the federal government will take
to limit the spread of resistant bacteria. The CDC has also developed
important guidelines for hospitals to improve their
stewardship of antibiotics and this summer they’ll also
issue similar guidance for long-term care facilities. We’re also trying in the
federal government to lead by example, working to
make sure our healthcare facilities are in line with
standards set by the CDC including through Medicare,
Medicaid, and Department of Defense and veterans
affairs facilities. To support this work,
President Obama has requested $1.2 billion
in his budget for 2016. That’s nearly double the
amount of federal support for programs to combat
antibiotic-resistant bacteria. Second, we’re raising
awareness and educating the public about the risk of antibiotic-resistant bacteria. We need to help people
understand that antibiotics are not in fact a cure-all. Third, we’re improving how
we collect and share data about the problem. And finally, as this forum
exhibits, we’re doing more to partner with all of you. Today, I am pleased to
announce that more than 150 private sector partners and
business leaders are making commitments to do their
part to curb the spread of antibiotic-resistant
bacteria. That includes healthcare
providers pledging to improve prescription
practices, pharmaceutical companies developing better
tests and new treatments, clinical groups cultivating
best practices, and farmers phasing out the use of
antibiotics to promote livestock growth. These steps are a great
start and today I’m hoping the sessions that you’ll
have can be used to determine what more we can
do and should be doing together. With all the challenges
we’re facing around the world from terrorism to
cyber threats to natural disasters, slow burning
crises like the rise of antibiotic-resistant
bacteria don’t always get the front-page attention
that they deserve. But this is a serious risk
to the future health and security of people
everywhere and we all have to take steps to improve the
way we’re using antibiotics today so they will in fact
be effective when we truly need them in the future. You’re presence here today
and your careful and thoughtful and diligent work
on this issue is clear — makes clear that you
recognize the risk we face. And I want to thank you on
behalf of President Obama for being here today, for
putting your shoulders to the wheels on this issue,
for working together in partnership on this critical
issue and I want to thank you for the work that you’ll
do today and in the days and months to come. So thank you very much. (applause)

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