Michael Craig speaking at World Antimicrobial Resistance Congress

Michael Craig, Director, Antibiotic Resistance Coordination and Strategy Unit, U.S. Centers for Disease Control and Prevention

 

What do you see as the biggest challenges facing the AMR space into 2022?

Probably no surprise, but the COVID-19 pandemic has significantly slowed national and global progress on antimicrobial resistance. Pre-pandemic, we were already losing too many lives to AR infections or Clostridioides difficile infections (often associated with taking antimicrobials). Nearly 50,000 people die from these threats in the U.S. every year, and a recently released report in The Lancet shows antimicrobial resistance is a leading cause of death globally. We can’t afford to give up any more ground. Many of the challenges we faced during the COVID-19 pandemic are the same ones that the AR experts have been highlighting for years. But now, in a post-pandemic world, people suddenly hear us when we say: we need stronger preparedness. Period. We need resilient, resourced systems like hospitals, water systems, public health laboratories that not only protect us day to day but also easily pivot to address the next crisis. We have gotten into a cycle of crisis to complacency for too long, and we cannot continue to only be reactive to public health threats. We don’t wait until our kitchen is on fire to make a fire safety plan. No, we have smoke detectors to give us early warnings there is a problem; we have a fire extinguisher at the ready to contain its spread; we call responders who are experts in these emergencies and can connect to ready water systems; and, if all that fails, we have an escape plan to keep our people, who are at the core of everything CDC does, safe. We must do more to support prevention, or we will get burned. Prevention is the most basic thing we can do to ensure we are prepared. The past two years have stretched healthcare facilities, personnel, and communities to their breaking points, and we are already seeing the ripple effects. In hospitals, AR infections are on the rise again, after several years of falling rates before the pandemic. Sicker patients, longer length of stays, closed community clinics – all of these had significant impacts on resistant infections across health care and the community. Now is the time to refocus our attention on preparedness. We need to learn our lesson. We need to prioritize investments in prevention so that we can be better prepared to face what’s next. That’s our biggest challenge, and our biggest opportunity, as we move out of this pandemic and back to a sense of normalcy.

 

If you could wave a magic wand, what would you like to see occur in the coming year to further combat AMR?   

Investment after investment in prevention. I’ll say it again, prevention is the best preparedness we have. As we’ve seen with AR, investing in core prevention activities – surveillance and detection, properly resourced laboratories for testing, research and innovation to address known gaps and needs – these investments are going to get and keep us ahead of whatever the next threat is. What I hope we do not see, is inaction. The consequences of us not learning our lesson from the past two years of this pandemic are dire, considering how many parts of every day life antimicrobial resistance impacts. Without more of an investment and coordinated buy-in to address AR, infections and complications from those infections will continue to grow – in health care, the community, the food supply, and the environment. The question we have to ask ourselves is how much are we willing to do to ensure this doesn’t happen, or are we willing to see our system and AR progress crumble again tomorrow, next year, and with the next major crisis.

 

What would you like to highlight about your work/your organization for this coming year?

In case you haven’t gotten the sense yet, we are the prevention people. CDC leads the public health response to AR for the U.S. Government, and with that we keep a focus on prevention front and center in all that we do. As we have in years before, we will continue to build off of our investments to stop the spread of AR globally and to address key gaps identified in CDC’s 2019 AR Threats Report. We also just launched our first network to address AR across One Health globally, the Global Antimicrobial Resistance Laboratory and Response Network, which will improve the detection of new and existing AR threats, identify risk factors that drive the emergence and spread of AR across One Health, and respond on-the-ground to these threats. CDC is also working on a new publication detailing how the pandemic has impacted the 18 pathogens highlighted in CDC’s 2019 AR Threats Report. While not an updated Threats Report, this publication is an effort to make current, albeit limited, data publicly available as data systems and public health catch up from the pandemic’s impact.

 

Do you have any predictions for the AMR space in 2022 and beyond? Any calls-to-action you’d like to highlight?

While the pandemic has shown us a lot of areas in which we can improve, I am also excited and energized about areas of opportunity for public health and AR in particular. These pathogens are innovating against our best tools every day, we need to continue to invest to keep in step. I see a lot of promise in continuing to invest in three prevention areas that would strengthen our ability to combat multiple types of AR pathogens. The three areas are AR vaccines, AR decolonizing therapies, and AR surveillance through wastewater. AR Vaccines: The pandemic has underscored once again the critical role that vaccines can play in preventing infections, hospitalizations, and deaths. AR vaccines hold tremendous promise because they can prevent all of those outcomes PLUS they can reduce antibiotic prescribing. We have great experience with the pneumococcal vaccine in preventing infections – including resistant infections – and lowering antibiotic prescribing. We need to do all that we can to support any vaccine that can either prevent AR infections or can reduce the need for antibiotics - and if it does both, even better. AR Decolonizing Therapies: Another critical area that CDC believes holds tremendous promise for the prevention of AR pathogens is decolonizing therapies. Increasingly, we see the transmission of AR pathogens in hospitals and communities as major drivers for the spread of pathogens and resistance. Decolonization therapies could potentially give us a powerful tool to address this and stop colonized carriers of AR pathogens before they’re able to spread the germs that cause sometimes deadly resistant infections and drive up the threat of resistance. AR Surveillance in Wastewater: CDC’s AR funding piloted efforts to look for pathogens in wastewater. These methods were then dramatically scaled up and implemented for COVID wastewater surveillance. With this powerful surveillance platform in place now, it will be important to see how it can be applied to AR threats for early identification, containment and prevention needs. Globally, it may hold even more potential as a source of data in areas where surveillance has been limited to date. There is much to do on these fronts, and more, but we must continue to move the field forward, especially as we learn and improve from the COVID-19 pandemic.

 


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