development and production that could be mobilized to respond quickly to future infectious disease emergencies. Securing this capability would require development of an integrated national process, as described above. The committee offers two options for implementation of this recommendation:
Develop an integrated management structure within the federal government and provide purchase guarantees, analogous to farm commodity loans, to vaccine manufacturers that are willing to develop the needed capacity.
Build government-supported research and development and production facilities, analogous to the National Cancer Institute's program for cancer therapeutics and the federal space, energy, and defense laboratories. The assigned mission of these new facilities would be vaccine development for future infectious disease contingencies.
The usefulness of antimicrobial drugs can be ensured only if they are used carefully and responsibly, and if new antimicrobials are continually being developed. The development of drug resistance by microorganisms, as well as the emergence of new organisms, will require replacement drugs to be in the "pipeline" even while existing drugs are still effective. The establishment of public/private sector alliances, along the lines of the National Cooperative Drug Development Groups at the NIH, may be desirable to ensure the continued development of effective antimicrobial drugs.
The committee recommends that clinicians, the research and development community, and the U.S. government (Centers for Disease Control, Food and Drug Administration, U.S. Department of Agriculture, and Department of Defense) introduce measures to ensure the availability and usefulness of antimicrobials and to prevent the emergence of resistance. These measures should include the education of health care personnel, veterinarians, and users in the agricultural sector regarding the importance of rational use of antimicrobials (to preclude their unwarranted use), a peer review process to monitor the use of antimicrobials, and surveillance of newly resistant organisms. Where required, there should be a commitment to publicly financed rapid development and expedited approval of new antimicrobials.
The United States and other developed countries have been able to free themselves to a remarkable degree from the burden of vector-borne diseases