Marc Siler

Antibiotic Resistance:
The Microscopic Issue that is not so Microscopic

Unknown to most, the issue of antibiotic resistance is one that is very serious and very
dangerous. When antibiotics were first discovered, they were considered miracles and wonder
drugs that helped save thousands of lives and increased the human lifespan. However, as soon as
antibiotics were introduced, antibiotic resistance was already occurring and becoming an issue.
Several decades later, and antibitotic resistance has been labled a ticking time bomb and
deemed one of the three biggest dangers to human health. Each year, thousands of people die,
and millions more are affected due to infections from antibiotic resistance. There are people and
organizations that understand that it is crucial to fight antibiotic resistance and that it is not only
necessary but also vital to our society; not only health and medical organizations, but political
figures as well have looked to become involved. Within the past few years, senators and
representatives have lobbied congress to become more involved in the fight against antibiotic
resistance, and have even proposed bills to help provide solutions for the issue. Senator Sherrod
Brown proposed the Strategies to Address Antimicrobial Resistance Act on April 10, 2014. Also
known as the STAAR Act (S.2236), it proposes to increase the efforts to fight antibiotic
resistance through a variety of methods, which include an Antimicrobial Resistance Office, Task
Force, and Advisory Board in order increase surveillance on antibiotic resistance and use. The
STAAR Act is a policy that is suited to combat antibiotic resistance by focusing on certain
aspects that have lacked in the current fight. The act emphasizes surveillance and understanding
of the issue through an office and task force rather than solely research and development. This
policy can help provide a brighter future not only within the medical field, but society as a
whole.
Antibiotic resistance is a complex issue, which can be attributed to multiple causes,
mainly a lack of new antibiotics, misuse of drugs, and simply evolution. The years between 1950
and 1970 were labeled as a golden era of antibiotics, with multiple new drug classes and
antibiotics being discovered and produced. Yet since then, there has been a severe decrease in
the development of new antibiotics. This can be attributed to pharmaceutical companies severely
cutting back funding on their research and development programs or just stopping completely.
For these companies, the costs of looking for new antibiotics outweigh the benefits, and do not
provide a great return on their investment. Drug misuse only compounds that issue. Common
forms of drug misuse are using antibiotics for sicknesses they cannot treat, or not taking the
drugs as prescribed. If an antibiotic is used to treat a viral infection, there is no benefit and the
drugs lose effectiveness against bacteria. Likewise, if a person were to take antibiotics for a
shorter period than prescribed, all the bacteria may not be gone, and the surviving will develop
resistance and spread to infect others. Also, bacteria have existed since arguable the existence of
Earth, and antibiotics havent even been discovered for over a century. Bacteria have figured
ways to survive and thrive in various conditions, becoming resistant to antibiotics is part of that.
Antibiotic resistance is not something that can be completely stopped, but it can be slowed and
infections can be prevented.
The decline in developing new antibiotics due to the decrease in research and funding
from pharmaceutical companies is a factor that has been pointed out by many involved within
the issue of antibiotic resistance. So why not increase research and development programs from
pharmaceutical companies and hopefully produce new antibiotics? The Infectious Diseases
Society of America (IDSA) looks to accomplish just that, with their implement of the 10 x 20
(ten by twenty) Initiative. According to the IDSA, their goal is to have 10 new antibiotics
produced by the year 2020. However, this is easier said than done.
It would be difficult to persuade various companies to commit to re-funding their
research and development programs.
Addressing only one aspect of the issue is not the most effective approach, but rather a
policy that acknowledges all contributing factors of antibiotic resistance. As noted earlier, the
main causes of antibiotic resistance are: the lack of development of new antibiotics, over-
prescription of drugs, drug misuse, and limited understanding of the issue. We must understand
the complexity and the depth of the issue at hand. Without it, all efforts will be unsuccessful.
This is what the STAAR Act looks to accomplish. The goals of the STAAR Act are to promote
prevention, track resistant bacteria, improve the use of antibiotics, and enhance leadership and
coordination in addition to supporting research. The STAAR act looks to accomplish this by
increasing surveillance on the use of antibiotics and the infections caused by antibiotic
resistance, establishing and Antibiotic office, task force, and advisory board, and creating a more
strategic research plan.
The main purpose of this policy is the establishment of the Antimicrobial resistance
office, antimicrobial resistance task force, and the Public Health Antimicrobial Advisory Board.
The task force is to be composed of the Antimicrobial resistance office and representatives from
15 organizations and departments, including the Department of Defense, the Centers for Disease
Control and Preventions, and the Department of Homeland Security, amongst others.

Collectively, all three groups will have a variety of responsibilities:

1. Intensify and expand their efforts to collect antimicrobial resistance data and
assess the ongoing, observed patterns of emergence of antimicrobial
resistance
i. Monitor the changes in the patterns of antimicrobial resistant pathogens
ii. Recommend how best to strengthen antimicrobial resistance-related
surveillance and prevention
iii. Collect surveillance data regarding emerging antimicrobial resistance
from reliable sources including the CDC
2. Collect data on the amount of antimicrobial products used in humans from
reliable sources, including data from the CDC
i. Provide ways to encourage the availability of an adequate supply of
safe and effective antimicrobial products,
3. Facilitate research to better understand resistance mechanisms and how to
prevent, control, and treat resistant organism
4. Establish a list that prioritizes diseases based on the greatest need for the
development new drugs, especially those that are particularly serious and
life-threatening and have few treatment options
5. Provide reports of federally supported antimicrobial resistance research and
antimicrobial drug development for antimicrobial resistant infections
(S.2236)
Senator Brown understands the need to develop a fuller understanding of this issue, and
ensures that focus within the policy. This is because the Center for Disease Control and
Prevention released a report in 2013, and stated that there is a inadequate knowledge in the
understanding of antibiotic resistance because of the limited national, state, and federal capacity
to detecturgent and emerging antibiotic resistant threats, no systematic surveillance of
antibiotic resistance threats, and data on antibiotic use in human healthcareare not
systematically collected (CDC). That will hopefully change if the STAAR Act were to pass. In
fact, the terms surveillance and data are used approximately 50 times total. That just goes to
show how committed this policy is in looking to fight antibiotic resistance in ways other than
only research and development programs.
The STAAR Act proposes the use of an Antibiotic office, task force, and board that
would incorporate surveillance and collect data, but this does not come without costs. The
proposal asks for $100,000,000 annually for each of fiscal years 2015 through 2021 to carry
out this [policy] (S.2236). If implemented, the policy would cost approximately $600 million if
they stay within budget. At first glance, $600 million appears to be an extreme amount of money,
however, relative to the financial burden that antibiotic resistance is currently costing, it is less
than one-eighth of what it being spent to treat infections caused by antibiotic resistant bacteria.
People that are infected by a resistant pathogen require longer hospital stays and more expensive
drugs, leading to increased costs in health care. And with over 2 million people affected by
resistant bacteria, the costs definitely adds up. In fact, it adds up to over $5 billion, annually (Bad
Bugs, No Drugs). In order to perspective of how prevalent of an issue antibiotic resistance is, just
two decades ago, $1.3 billion was spent to treat those infected by resistant bacteria (Aminov).
That is a 284% increase, and it will continue to increase if nothing new is done to slow antibiotic
resistance. It was stated earlier that new research and development programs would cost
anywhere from $800 million to $1.7 billion (Bad Bugs, No Drugs). The STAAR Act is likely
cheaper and likely more effective.
While the financial costs of the policy are explicitly stated, the other costs are not. The
introduction of the new Antibiotic Task Force and Office is something new. It is unknown if they
will be successful or effective in helping to combat antibiotic resistance. If they are not, then the
policy would cost us five or six years of time. It is also unknown how much worse the issue of
antibiotic resistance can become. In five or six years, there will be more superbugs and more
deaths. If the policy fails, it could also discourage further federal involvement within this issue.
The social, medical, and political costs have the risk to be substantial. Yet what the STAAR Act
looks to accomplish has the potential to be enormous, finally gaining an understanding of
antibiotic resistance, hopefully decreasing the rate of infections, decreasing drug misuse, and
ultimately, saving lives. If the act is successful and effective, the potential benefits outweigh the
risks of the costs.
Although the STAAR Act looks to accomplish many things all at the same time and
appears to be a task that is a bit too ambitious, implementation of the policy is one that is
feasible. There are already numerous organizations working to combat antibiotic resistance, but
with the STAAR Act, many organizations can work together with leadership and develop a
direction to create a more organized and effective fight. Employing the policy will not go
without bumps in the road. A large part of the act relies on submission and collection of data, but
initially that could be an issue. This requires that hospitals and doctors comply in reporting their
data to the appointed task office. In an interview by Innovations Exchange Team of the Agency
for Healthcare Research and Quality (U.S Department of Health & Human Services), Dr.
Edward J. Septimus states that the main challenge is getting doctors to commit to spending the
time thats required. The IDSA confirms that statement because they recognize that reporting
datais an extra, onerous activity for hospitals, (IDSA) and that it may be necessary to
incorporate a plan that presents incentives ensuring participation and commitment from the
hospitals to make that time and effort in reporting antibiotic consumption and resistance data.
Yet this issue has not been overlook by Brown, and included in the policy that incentives (are)
necessary to establish uniform mechanisms and date sets forreporting of resistance (S.2236).
Incentives may be the only way to persuade these hospitals and doctors report data. In Atul
Gawandes Better, its told that a decade or so ago, that it was an issue with doctors taking the
time to wash their hands, which is a basic, yet crucial exercise. If doctors are unable to spend
time washing their hands, how can we rely on them to report data? Doctors should understand
that antibiotic-resistance infections have typically been hospital-acquired. Therefore, the issue in
implementing this policy will not be ignorance, but it will be compliance. In order for the policy
to be successful, it will require a collective group effort from everyone, not just the office or the
task force or the advisory board. If that can happen, the policy is definitely feasible and possible.
Its unknown how catastrophic the consequences of ineffective antibiotics can be, but we
are not far away from finding out. Our society is dangerously close to having to survive without
being able to rely on antibiotics. If no action is taken, it is likely that we enter a post-antibiotic
era. That means that some of the most common infections or smallest of cuts can kill. Thats a
scary thought. Imagine a child, being a son/daughter or little bother/sister, falling and scraping a
knee, becoming infected and there being no options for treatment. Its sad and unfortunate, but
its a scenario thats likely in the near future. Congress needs to understand the urgency of this
issue and the need to implement the STAAR act. Many people do not know what its like to live
with out antibiotics, and Im sure many do not want to know what that life is like. The need for
the STAAR Act is real. The time is now.

Reflection
What was most difficult about writing this draft?
Collecting all my thoughts into one paper. There was so much research conducted this
quarter that I was able to understand how I wanted to organize this paper and what I
wanted to include. Yet, it was being able to actually type everything that I wanted to
include and being able to construct a paper that still flowed and fulfilled the purpose.

What did you work hardest on?
I feel like I worked hardest on trying to establish the urgency of the issue. Antibiotic
resistance isnt a well-known issue or as commercialized as things like cancer and
diabetes, yet it poses a far greater risk. I wanted to establish that urgency without losing
focus on the prompt.

What do you think still needs the most work?
The alternative policy needs the most work. Its hard to discuss the strengths of a policy
when your focus of the paper is to advocate for a different policy. Im able to refute the
alternative without much trouble, but I need to focus on why that alternative policy is
somewhat plausible.

What would you like me to focus on when commenting?
Challenge my ideas. Act as a devils advocate in a sense, because I want people to be
able to understand how important of an issue this is and why my policy works. If certain
things do not make sense, or can be refuted, point it out so I can challenge it or find an
alternative way to present certain ideas.










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