Sending Office: Honorable Louise McIntosh Slaughter
Sent By:
Clayton.Cox@mail.house.gov

Support Antibiotic Stewardship, Surveillance, and Research

*This includes programmatic and language requests*

Deadline: Tuesday, March 13, 2018

 

Current co-signers Ag: Slaughter, Payne, Grijalva, Lynch, DeSaulnier, Rush, Fitzpatrick, Yarmuth, Hastings, Garamendi, Norton, Moore, Speier, Ruppersberger, Schakowsky, Levin, Soto, Shea-Porter

Current co-signers LHHS: Slaughter, Pingree, Payne, Grijalva, Lynch, Rush, Fitzpatrick, Hastings, Garamendi, Norton, Moore, Speier, Ruppersberger, Schakowsky, Soto, Shea-Porter

 

Dear Colleagues,

Antibiotic resistance is the greatest public health threat of our time. Currently resistant bacteria infect over
2 million and kill at least 23,000 Americans every year, accounting for direct health-care costs of $20-35 billion. Globally, 700,000 die and the cost could be as high as
$1.2 trillion. If we do not act now, by 2050 antibiotic resistant infections will be the leading cause of death – surpassing cancer – and could

cost the world $100 trillion
. Although antibiotics literally transformed the practice of modern medicine, we have been poor stewards of their effectiveness and we
risk losing the greatest medical advance of the 20th century.

Funding to combat antibiotic resistance is desperately needed. All uses of antibiotics contribute to resistance and we must remember that it is the failure to use current drugs judiciously that has created rampant resistance and led to the current crisis.
Preserving the effectiveness of antibiotics, by ending overuse and misuse, must be part of any solution or we will continue to fritter away the few we still have.

Please join me in asking for funding to enhance antibiotic stewardship and surveillance programs by signing on to letters to the appropriate Appropriations Subcommittees supporting funding to implement the surveillance and stewardship programs called for
in the National Strategy for Combating Antibiotic-Resistant Bacteria. We must act now and we must act together to preserve the effectiveness of the antibiotics and prevent a nightmarish post-antibiotic future. 

Please contact Clayton Cox in my office at
clayton.cox@mail.house.gov
or at (202) 225-3615 to sign either letter.

Sincerely,

Louise M. Slaughter
Member of Congress

 

March 16, 2018

Dear Chairman Aderholt and Ranking Member Bishop,

Antibiotic resistance is the greatest public health threat of our time. Currently, resistant bacteria infect over 2 million, and kill at least 23,000, Americans every year, accounting for direct health-care costs of $20-35 billion. Globally, over 700,000 die
each year accounting for a cost as high as $1.2 trillion. If we do not act now, by 2050 antibiotic resistant infections will be the leading cause of death – surpassing cancer – and could cost the world $100 trillion. Although antibiotics literally transformed
the practice of modern medicine, we have been poor stewards of their effectiveness and we risk losing the greatest medical advance of the 20th century.

The antibiotic resistance crisis has been noted with increasing alarm by the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), and the President’s Council of Advisors on Science and Technology (PCAST), among others. Funding
to combat antibiotic resistance is desperately needed. While discovery of new antibiotics is needed to address the rising tide of resistance, we must remember that it is the failure to use current drugs judiciously that has created rampant resistance and led
to the current crisis.

All uses of antibiotics contribute to resistance. Animal agriculture is by far the largest consumer – 70 percent of all medically important antibiotics sold in the U.S are used in commercial livestock and poultry production. Although “growth promotion” has
been withdrawn as an indicated use, overall antibiotic use remains higher than when data reporting began. Current policy still allows antibiotics to be routinely given to healthy animals through drugs which allow long or unlimited duration of use and through
so-called “disease prevention”. These loopholes can be exploited to continue the unnecessary overuse and misuse of antibiotics which leads to resistance.

Efforts to combat the crisis of resistance must include antibiotic use in agriculture. In November 2017, the World Health Organization (WHO) recommended that farmers and the food industry stop using antibiotics routinely to prevent disease in healthy animals.
These widespread, and unnecessary, uses of antibiotics in food animals have been successfully phased out in other countries without impacting livestock production. Along with reduced antibiotics consumption, levels of resistant organisms in food and agricultural
settings also decreased. The U.S. can follow these examples.

In addition to a reduction in overall consumption, improvements in the monitoring and surveillance of antibiotic use are desperately needed. Calls for better information, including on-farm data collection, have been made by the U.S. Department of Agriculture
(USDA), Food and Drug Administration (FDA), and the U.S. Government Accountability Office (GAO). Better publically available data would improve understanding of the drivers of antibiotic use, helping researchers to develop alternative livestock management
practices and disease interventions that benefit both farmers and public health.

As you consider Fiscal Year (FY) 2019 appropriations, we respectfully request that reducing the use of antibiotics in agriculture and improving data collection be given increased consideration, including the following specific requests:

  • At least $65.5 million in funding for the USDA for antibiotics research and surveillance efforts within the Agricultural Research Service, Animal and Plant Health Inspection Service (APHIS), National Institute of Food and Agriculture, and National Agricultural
    Statistics Service to gain better understanding of pathogen resistance, minimize the development of antimicrobial resistance in pathogens of humans and livestock, seek answers to key questions about the relationships among microbes and livestock, the environment,
    and human health, share information about new antibiotic alternatives and share improved animal management and husbandry practices through the Cooperative Extension Service to limit the transmission of resistant bacteria through the food chain and support
    the government wide effort to combat antibiotic resistance.

    • $10 million funding increase to APHIS to enhance the understanding of on-farm levels of antibiotic usage by increasing data collection, developing monitoring programs, and leveraging other data sources from existing surveillance systems to inform policy
      related to appropriate antibiotic use in all settings across agriculture and clinical medicine.
    • Sufficient funds for the National Animal Health Monitoring System to ensure timely completion and public reporting of the 2017 studies of Antimicrobial Use on U.S. Feedlots and U.S. Swine Operations, as well as, the Veterinary Services Antibiotic Use Questionnaires
      for Cattle on Feed and Weaned Market Pigs.
  • At least $54 million in funding for FDA for initiatives directed toward Combating Antibiotic Resistant Bacteria to support efforts to address public health safety concerns associated with antimicrobial drug use in animals, and better protect antibiotic
    effectiveness for both human and animal populations.
  • At least $15 million for the National Antimicrobial Resistance Monitoring System collaboration between FDA, USDA, CDC, and state and local public health departments to track changes in antimicrobial susceptibility of enteric bacteria, better support unmet
    capacity needs in state and local public health labs, and enhance the ability to quickly conduct epidemiological investigations when needed.
  • Language that directs the Secretaries Health and Human Services and Agriculture to continue to coordinate efforts to improve efforts to collect data on antibiotic use, including directing FDA to sample feed distribution records. We request the following
    language:

“The Committee continues to support funding to combat the threat of antibiotic resistant bacteria. The Committee provides funds for FDA to continue its efforts to collect data on how and why antibiotics are used on farm and to
improve its coordination with the United States Department of Agriculture on antibiotic use data collection. We support the cooperative agreements FDA has funded to collect antibiotic use data on farm in cooperation with the poultry, cattle, and swine industries.
Further, the committee directs FDA to begin sampling feed distribution records maintained by feed companies under the regulations for veterinary feed directives as an additional source of information on how and why antibiotics are used on farm.”

  • Language that directs the Secretary of Health and Human Services to remove the remaining antimicrobial animal drugs that allow for long or unlimited durations of use. We request the following language:

“The Committee continues to support funding to combat the threat of antibiotic resistant bacteria. The Committee provides funds for additional steps to mitigate antibiotic resistance by addressing those medically important antibiotics
for use in food producing animals that either do not have a defined duration of use or have durations in excess of 21 days. The Committee expects the agency to require sufficiently short durations of use that are consistent with existing regulations and guidance
in order to protect public health.”

We greatly appreciate your leadership and consideration of these requests.

Sincerely,

XXXXXXXXXX
 

March 19, 2018

Dear Chairman Cole and Ranking Member DeLauro,

Antibiotic resistance is the greatest public health threat of our time. Currently, resistant bacteria infect over 2 million, and kill at least 23,000, Americans every year, accounting for direct health-care costs of $20-35 billion. Globally, over 700,000 die
each year accounting for a cost as high as $1.2 trillion. If we do not act now, by 2050 antibiotic resistant infections will be the leading cause of death – surpassing cancer – and could cost the world $100 trillion. Although antibiotics literally transformed
the practice of modern medicine, we have been poor stewards of their effectiveness and we risk losing the greatest medical advance of the 20th century.

The antibiotic resistance crisis has been noted with increasing alarm by the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), and the President’s Council of Advisors on Science and Technology (PCAST), among others. Funding
to combat antibiotic resistance is desperately needed. While discovery of new antibiotics is needed to address the rising tide of resistance, we must remember that it is the failure to use current drugs judiciously that has created rampant resistance and led
to the current crisis.

For instance, it is estimated that 30-50 percent of human patients who are prescribed antibiotics do not need them. Further, 70 percent of all medically important antibiotics sold in the U.S. are used in food animals, where many are routinely given to healthy
animals. Preserving the effectiveness of antibiotics, by ending overuse and misuse, must be part of any solution to the antibiotic resistance crisis or we will continue to fritter away the few we still have. It is clear that implementation of good stewardship
practices, robust monitoring and surveillance, and investment in discovery of new antibiotics are all needed to stem the rise of resistance.

As you consider the Fiscal Year (FY) 2019 appropriations we respectfully request the following:

  • $200 million for the CDC’s Antibiotic Resistance Solutions Initiative to fully implement the National Action Plan for Combating Antibiotic-Resistant Bacteria including establishing prevention programs in all 50 states, six large cities, and Puerto Rico,
    utilizing evidence-based approaches to stop the spread of drug-resistant bacteria and preserve the effectiveness of existing antibiotics.
  • $30 million to continue the Advanced Molecular Detection Initiative which allows CDC to more rapidly determine where emerging diseases come from, whether microbes are resistant to antibiotics, and how microbes are moving through a population by employing
    advanced molecular sequencing tools along with cutting-edge information technologies and bioinformatics experts.
  • $12 million for the Agency for Healthcare Research and Quality to implement the National Action Plan for Combating Antibiotic-Resistant Bacteria by supporting research to develop improved methods and approaches for combating antibiotic resistance and conducting
    antibiotic stewardship activities in multiple healthcare settings, with a focus on long-term and ambulatory care settings.
  • $21 million for the National Healthcare Safety Network to enable CDC to continue to provide data to inform national healthcare-associated infection elimination efforts and to enhance reporting to more than 20,000 healthcare facilities across the continuum
    of care, including acute-care hospitals, dialysis facilities, nursing homes and ambulatory surgical centers.
  • Continued support for the Biomedical Advanced Research and Development Authority to continue to leverage public and private partnerships to develop new broad-spectrum antibiotics, and other products, that directly support the government-wide National Action
    Plan for Combating Antibiotic-Resistant Bacteria.

We greatly appreciate your leadership and consideration of these requests.

Sincerely,

Related Legislative Issues

Selected legislative information: Agriculture, Appropriations, Environment

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