What do you see as the biggest challenges facing the AMR space into 2022?
Much of the workforce that is central to combating AMR—infectious diseases (ID) physicians, ID pharmacists, clinical microbiologists and others—are also on the front lines of the COVID-19 response and facing serious burnout and staffing shortages. Even before the pandemic, we did not have enough of these experts on the ground in health care facilities to guide optimal antimicrobial use, lead and enroll patients in clinical trials for novel antimicrobial and diagnostic research and development, and care for patients with serious multidrug resistant infections. For example, nearly 80 percent of counties in the U.S. do not have a single ID physician. REF The pandemic has exacerbated workforce shortages and diverted significant time from AMR activities to instead manage the COVID-19 response. As the work of stewardship teams was redirected to lead the complex administration of COVID-19 therapeutics, we experienced some increases in antibiotic use and in multidrug resistant infections in hospitals. These scenarios may have fueled the development of new resistance threats for which we are not prepared.
If you could wave a magic wand, what would you like to see occur in the coming year to further combat AMR?
I would like to finally see the federal government make the comprehensive investments necessary to secure a sustainable, multidisciplinary workforce to combat AMR. That means tackling student debt burden and compensation disparities to ensure that careers in infectious diseases are financially feasible. We have seen some encouraging signs—including large investments in the public health workforce in the American Rescue Plan. While the public health workforce is critical, it is equally important that we have a robust clinical workforce in health care facilities to combat AMR in health care settings, lead optimal prescribing and ensure the best possible patient outcomes. In addition, while we’ve greatly appreciated the many incremental efforts to support the antibiotic pipeline, this year I would like to see the federal government finally take the bold action necessary to truly revitalize the pipeline to meet current and future AMR threats. This will mean fundamentally changing the way the federal government pays for the most urgently needed novel antibiotics.
What would you highlight about your work/your organization for this coming year?
IDSA is championing two bipartisan pieces of legislation that would address multiple key AMR challenges. First, the Bolstering Infectious Outbreaks (BIO) Preparedness Workforce Act, by Sens. Baldwin (D-WI) and Collins (R-ME) and Reps. Trahan (D-MA) and McKinley (R-WV) would help support, grow and diversify the AMR workforce by providing loan repayment for health care professionals (including physicians, pharmacists, clinical laboratory personnel, infection preventionists, physician assistants and advanced practice nurses) who spend the majority of their time working in bio-preparedness (including antimicrobial stewardship and infection prevention and control) or who spend the majority of their time providing ID care in an underserved area. This will help expand the AMR workforce and ensure experts are more equitably distributed across the country.
Second, the Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (PASTEUR) Act would allow the federal government to pay for novel antibiotics based upon the value they provide to society, rather than based on the volume used. Under PASTEUR, the federal government would enter into contracts with developers of truly novel antibiotics that address critical needs. This approach provides the predictable return on investment necessary to fuel a robust and renewable antibiotic pipeline. Importantly, the bill also provides new resources to support hospital antibiotic stewardship programs, which do not have the staff and support needed to comprehensively implement the necessary interventions to optimize antibiotic use.
Do you have any predictions for the AMR space in 2022 and beyond? Any calls-to-action you’d like to highlight?
National attention is focused on infectious diseases in a way we have never experienced before. We need to seize that opportunity to enact the lasting, meaningful changes necessary to safeguard patients and modern medicine from the enormous threat of AMR. I call on all stakeholders who care about AMR to urge their Senators and Representatives to cosponsor the BIO Preparedness Workforce Act and the PASTEUR Act.