As of 2017, the emergence and spread of antimicrobial resistance continues unabated around the world, leaving devastating health and economic outcomes in its wake. Those consequences will multiply if collaborative global action is not taken to address the spread of resistance. An influential report released in 2016 estimated that each year at least 700,000 people across the world die from infections that are resistant to current antibiotics, and by 2050, drug-resistant infections will take an estimated 10 million lives per year (Review on Antimicrobial Resistance, 2016). The same report further predicts that the economic cost of lost global production caused by antimicrobial resistance will amount to approximately $100 trillion between now and 2050 if antimicrobial resistance is not tackled. Despite this crisis, there are very few prospects for new antibiotics in the development pipeline that are likely to receive regulatory approval; new drugs will be critical as existing antibiotics lose their effectiveness against infections at an escalating rate. Additionally, improved antimicrobial stewardship practices that promote appropriate use of antimicrobials may be needed to be adopted widely in reducing drug resistance and achieving better patient outcomes. As the burden of resistance to antibiotics grows, even routine medical conditions and procedures will become life threatening because of the risk of untreatable infection. International multilateral organizations have recognized the threat of antimicrobial resistance and have developed plans for action, but there is an urgent need for the immediate implementation of collective actions. “Imagine the emergence of a rapidly spreading bacteria resistant to all known antibiotics. . . . We need to act
now or run the risk of entering a postantibiotic era,” warned Victor Dzau, president of the National Academy of Medicine.
Major drivers of antimicrobial resistance in humans have been accelerated by inappropriate antimicrobial prescribing in health care practices; the inappropriate use of antimicrobials in livestock; and the promulgation of antibiotic resistance genes in the environment. The National Academies of Sciences, Engineering, and Medicine have been engaged with the issue of antimicrobial resistance for nearly two decades (IOM, 1998, 2010, 2011). To build on this work, to explore developments since the last workshop was convened, and to help parlay knowledge into immediate action, an ad hoc planning committee,1 under the auspices of the Forum of Microbial Threats at the National Academies, planned the 2-day public workshop Combating Antimicrobial Resistance: A One Health Approach to a Global Threat.
The workshop explored issues of antimicrobial resistance through the lens of One Health, which is a collaborative approach of multiple disciplines—working locally, nationally, and globally—for strengthening systems to counter infectious diseases and related issues that threaten human, animal, and environmental health, with an end point of improving global health and achieving gains in development. The approach can be used to examine how factors across those three domains of human, animal, and environmental health converge and contribute to the emergence and spread of antimicrobial resistance. A concerted effort across these three domains can help strengthen the fight against the threat of antimicrobial resistance. Furthermore, the workshop was convened to explore immediate and short-term actions and research needs that will have the greatest effect on reducing antimicrobial resistance, while taking into account the complexities of bridging different sectors and disciplines to address this global threat. Topics explored during the workshop include the following2:
- The implications and effects on human health of the movement of resistance genes across different ecosystems;
1 The planning committee’s role was limited to planning the workshop, and this Proceedings of a Workshop was prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.
- The expected effect of new regulatory policies and waste management techniques in the United States regarding the use of antimicrobials in animal agriculture;
- The role and effectiveness of antibiotic stewardship programs in reducing and preventing antimicrobial resistance;
- The importance of data availability and data sharing to monitor and evaluate strategies’ implementation and progress;
- Strategies for maintaining the effectiveness of existing drugs, for developing new drugs and diagnostics, and for implementing disease prevention strategies, including vaccine use and the alternatives to antibiotics; and
- The need for national and international collaboration and coordination mechanisms across the One Health domains for prevention, control, and research and development.
The 2-day workshop was held on June 20 and 21, 2017, in Washington, DC, and was chaired by Lonnie King, professor and dean emeritus of The Ohio State University College of Veterinary Medicine. Workshop speakers and discussants contributed perspectives from government, academia, private, and nonprofit sectors. The workshop comprised 2 keynote addresses and 25 speaker presentations over 4 sessions. During the final session, speakers and discussants broke out into four groups to identify impactful short-term actions that are feasible and cost-effective against antimicrobial resistance.
In accordance with the policies of the National Academies, the workshop did not attempt to establish any conclusions or recommendations about needs and future directions, focusing instead on information presented, questions raised, and improvements recommended by individual workshop participants. Chapter 2 includes highlights from the keynote addresses that discuss harnessing the global momentum to prioritize a strategy for immediate action to combat antimicrobial resistance. Chapter 3 focuses on microbial and genetic movements across the One Health domains. It discusses approaches to strengthening the knowledge and evidence base for surveillance of antimicrobial resistance and for the effect of antimicrobials in the environment. Chapter 4 features strategies for applying social and behavioral sciences to help improve responsible use of antimicrobials. It delves into achieving desired behavioral changes toward antimicrobial use through stewardship programs, incentives, and policies, as well as education and prevention measures. Chapter 5 covers research and development actions aimed at reducing antimicrobial use, specifically
examining strategies to accelerate and prioritize basic and applied research and development for vaccines and diagnostics, and funding mechanisms to promote such investments. Chapter 6 lays out the importance of partnerships and collaboration in combating antimicrobial resistance. Chapter 7 provides an overview of the actions suggested during the four breakout groups’ discussions that took place as the final session of the workshop, as well as the subsequent discussion and general synthesis.