Editing Antimicrobial resistance (section)

==Society and culture==

=== Innovation policy ===
Since the mid-1980s pharmaceutical companies have invested in medications for cancer or chronic disease that have greater potential to make money and have "de-emphasized or dropped development of antibiotics".<ref name="NYT_jan_21_2016" /> On 20 January 2016 at the [[World Economic Forum]] in [[Davos]], [[Switzerland]], more than "80 pharmaceutical and diagnostic companies" from around the world called for "transformational commercial models" at a global level to spur research and development on antibiotics and on the "enhanced use of diagnostic tests that can rapidly identify the infecting organism".<ref name="NYT_jan_21_2016">{{cite news | url=https://www.nytimes.com/2016/01/21/business/to-fight-superbugs-drug-makers-call-for-incentives-to-develop-antibiotics.html | title=To Fight 'Superbugs,' Drug Makers Call for Incentives to Develop Antibiotics | newspaper=New York Times |date=20 January 2016 | access-date=24 January 2016 | vauthors = Pollack A | series=Davos 2016 Special Report | location=Davos, Switzerland | archive-url=https://web.archive.org/web/20180424142407/https://www.nytimes.com/2016/01/21/business/to-fight-superbugs-drug-makers-call-for-incentives-to-develop-antibiotics.html?smid=tw-share | archive-date=24 April 2018 | url-status=live }}</ref> A number of countries are considering or implementing delinked payment models for new antimicrobials whereby payment is based on value rather than volume of drug sales. This offers the opportunity to pay for valuable new drugs even if they are reserved for use in relatively rare drug resistant infections.<ref>{{cite journal | vauthors = Leonard C, Crabb N, Glover D, Cooper S, Bouvy J, Wobbe M, Perkins M | title = Can the UK 'Netflix' Payment Model Boost the Antibacterial Pipeline? | journal = Applied Health Economics and Health Policy | volume = 21 | issue = 3 | pages = 365–372 | date = May 2023 | pmid = 36646872 | pmc = 9842493 | doi = 10.1007/s40258-022-00786-1 }}</ref>

===Legal frameworks===
Some global health scholars have argued that a global, legal framework is needed to prevent and control antimicrobial resistance.<ref name="A. Behdinan, S.J. Hoffman 2015">{{cite journal | vauthors = Behdinan A, Hoffman SJ, Pearcey M | title = Some Global Policies for Antibiotic Resistance Depend on Legally Binding and Enforceable Commitments | journal = The Journal of Law, Medicine & Ethics | volume = 43 | issue = 2 Suppl 3 | pages = 68–73 | year = 2015 | pmid = 26243246 | doi = 10.1111/jlme.12277 | s2cid = 7415203 }}</ref><ref>{{cite journal | vauthors = Hoffman SJ, Outterson K | title = What Will It Take to Address the Global Threat of Antibiotic Resistance? | journal = The Journal of Law, Medicine & Ethics | volume = 43 | issue = 2 | pages = 363–8 | year = 2015 | pmid = 26242959 | doi = 10.1111/jlme.12253 | s2cid = 41987305 | url = https://scholarship.law.bu.edu/cgi/viewcontent.cgi?article=1007&context=faculty_scholarship | access-date = 11 November 2019 | archive-date = 12 October 2022 | archive-url = https://web.archive.org/web/20221012000131/https://scholarship.law.bu.edu/cgi/viewcontent.cgi?article=1007&context=faculty_scholarship | url-status = live }}</ref><ref name="Hoffman">{{cite journal | vauthors = Hoffman SJ, Outterson K, Røttingen JA, Cars O, Clift C, Rizvi Z, Rotberg F, Tomson G, Zorzet A | title = An international legal framework to address antimicrobial resistance | journal = Bulletin of the World Health Organization | volume = 93 | issue = 2 | pages = 66 | date = February 2015 | pmid = 25883395 | pmc = 4339972 | doi = 10.2471/BLT.15.152710 }}</ref><ref>{{cite journal | vauthors = Rizvi Z, Hoffman SJ | title = Effective Global Action on Antibiotic Resistance Requires Careful Consideration of Convening Forums | journal = The Journal of Law, Medicine & Ethics | volume = 43 | issue = 2 Suppl 3 | pages = 74–8 | year = 2015 | pmid = 26243247 | doi = 10.1111/jlme.12278 | s2cid = 24223063 }}</ref> For instance, binding global policies could be used to create antimicrobial use standards, regulate antibiotic marketing, and strengthen global surveillance systems.<ref name="Hoffman" /><ref name="A. Behdinan, S.J. Hoffman 2015" /> Ensuring compliance of involved parties is a challenge.<ref name="Hoffman" /> Global antimicrobial resistance policies could take lessons from the environmental sector by adopting strategies that have made international environmental agreements successful in the past such as: sanctions for non-compliance, assistance for implementation, majority vote decision-making rules, an independent scientific panel, and specific commitments.<ref>{{cite journal | vauthors=Andresen S, Hoffman SJ | year=2015 | title=Much Can Be Learned about Addressing Antibiotic Resistance from Multilateral Environmental Agreements | journal=Journal of Law, Medicine & Ethics | volume=43 | issue=2| pages=46–52 }}</ref>

==== United States ====
{{update section|date=October 2023}}
For the [[2016 United States federal budget|United States 2016 budget]], [[President of the United States|U.S. president]] [[Barack Obama]] proposed to nearly double the amount of federal funding to "combat and prevent" antibiotic resistance to more than $1.2&nbsp;billion.<ref>[https://obamawhitehouse.archives.gov/the-press-office/2015/01/27/fact-sheet-president-s-2016-budget-proposes-historic-investment-combat-a President's 2016 Budget Proposes Historic Investment to Combat Antibiotic-Resistant Bacteria to Protect Public Health] {{Webarchive|url=https://web.archive.org/web/20170122010901/https://obamawhitehouse.archives.gov/the-press-office/2015/01/27/fact-sheet-president-s-2016-budget-proposes-historic-investment-combat-a |date=22 January 2017 }} The White House, Office of the Press Secretary, 27 January 2015</ref> Many international funding agencies like USAID, DFID, [[Swedish International Development Cooperation Agency|SIDA]] and [[Gates Foundation]] have pledged money for developing strategies to counter antimicrobial resistance.{{citation needed|date=April 2023}}

On 27 March 2015, the [[White House]] released a comprehensive plan to address the increasing need for agencies to combat the rise of antibiotic-resistant bacteria. The Task Force for Combating Antibiotic-Resistant Bacteria developed ''The National Action Plan for Combating Antibiotic-Resistant Bacteria'' with the intent of providing a roadmap to guide the US in the antibiotic resistance challenge and with hopes of saving many lives. This plan outlines steps taken by the Federal government over the next five years needed in order to prevent and contain outbreaks of antibiotic-resistant infections; maintain the efficacy of antibiotics already on the market; and to help to develop future diagnostics, antibiotics, and vaccines.<ref name="whitehouse.gov">{{cite web|url=https://obamawhitehouse.archives.gov/the-press-office/2015/03/27/fact-sheet-obama-administration-releases-national-action-plan-combat-ant|title=FACT SHEET: Obama Administration Releases National Action Plan to Combat Antibiotic-Resistant Bacteria|access-date=30 October 2015|archive-url=https://web.archive.org/web/20170121155651/https://obamawhitehouse.archives.gov/the-press-office/2015/03/27/fact-sheet-obama-administration-releases-national-action-plan-combat-ant|archive-date=21 January 2017|url-status=live|via=[[NARA|National Archives]]|work=[[whitehouse.gov]]|date=27 March 2015}}</ref>

The Action Plan was developed around five goals with focuses on strengthening health care, public health veterinary medicine, agriculture, food safety and research, and manufacturing. These goals, as listed by the White House, are as follows:
* Slow the Emergence of Resistant Bacteria and Prevent the Spread of Resistant Infections
* Strengthen National One-Health Surveillance Efforts to Combat Resistance
* Advance Development and use of Rapid and Innovative Diagnostic Tests for Identification and Characterization of Resistant Bacteria
* Accelerate Basic and Applied Research and Development for New Antibiotics, Other Therapeutics, and Vaccines
* Improve International Collaboration and Capacities for Antibiotic Resistance Prevention, Surveillance, Control and Antibiotic Research and Development
The following are goals set to meet by 2020:<ref name="whitehouse.gov"/>
* Establishment of antimicrobial programs within acute care hospital settings
* Reduction of inappropriate antibiotic prescription and use by at least 50% in outpatient settings and 20% inpatient settings
* Establishment of State Antibiotic Resistance (AR) Prevention Programs in all 50 states
* Elimination of the use of medically important antibiotics for growth promotion in food-producing animals.

Current Status of AMR in the U.S.

As of 2023, antimicrobial resistance (AMR) remains a significant public health threat in the United States. According to the Centers for Disease Control and Prevention's 2023 Report on Antibiotic Resistance Threats, over 2.8 million antibiotic-resistant infections occur in the U.S. each year, leading to at least 35,000 deaths annually.<ref name="CDC2023">{{cite web | title=Antibiotic Resistance Threats in the United States, 2023 | publisher=Centers for Disease Control and Prevention | url=https://www.cdc.gov/antimicrobial-resistance/data-research/threats/update-2022.html | access-date=October 20, 2023}}</ref> Among the most concerning resistant pathogens are Carbapenem-resistant Enterobacteriaceae (CRE), Methicillin-resistant Staphylococcus aureus (MRSA), and Clostridioides difficile (C. diff), all of which continue to be responsible for severe healthcare-associated infections (HAIs).

The COVID-19 pandemic led to a significant disruption in healthcare, with an increase in the use of antibiotics during the treatment of viral infections. This rise in antibiotic prescribing, coupled with overwhelmed healthcare systems, contributed to a resurgence in AMR during the pandemic years. A 2021 CDC report identified a sharp increase in HAIs caused by resistant pathogens in COVID-19 patients, a trend that has persisted into 2023.<ref name="COVID2021">{{cite journal | title=The Impact of the COVID-19 Pandemic on Antimicrobial Resistance and Management of Bloodstream Infections | journal= Pathogens| year=2023 | volume=21 | issue=6 | pages= e22–e25 | doi= 10.3390/pathogens12060780| doi-access= free| pmid= 37375470| pmc= 10302285| vauthors = Petrakis V, Panopoulou M, Rafailidis P, Lemonakis N, Lazaridis G, Terzi I, Papazoglou D, Panagopoulos P}}</ref> Recent data suggest that although antibiotic use has decreased since the pandemic, some resistant pathogens remain prevalent in healthcare settings.<ref name="CDC2023" />

The CDC has also expanded its Get Ahead of Sepsis campaign in 2023, focusing on raising awareness of AMR's role in sepsis and promoting the judicious use of antibiotics in both healthcare and community settings.<ref name="Sepsis2023">{{cite web | title=Get Ahead of Sepsis | publisher=Centers for Disease Control and Prevention | url=https://www.cdc.gov/sepsis/get-ahead-of-sepsis/index.html | access-date=October 20, 2023}}</ref> This initiative has reached millions through social media, healthcare facilities, and public health outreach, aiming to educate the public on the importance of preventing infections and reducing antibiotic misuse.

=== Policies ===
According to [[World Health Organization]], policymakers can help tackle resistance by strengthening resistance-tracking and laboratory capacity and by regulating and promoting the appropriate use of medicines.<ref name="who.int" /> Policymakers and industry can help tackle resistance by: fostering innovation and research and development of new tools; and promoting cooperation and information sharing among all stakeholders.<ref name="who.int" />

The U.S. government continues to prioritize AMR mitigation through policy and legislation. In 2023, the National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB) 2023-2028 was released, outlining strategic objectives for reducing antibiotic-resistant infections, advancing infection prevention, and accelerating research on new antibiotics.<ref name="CARB2023">{{cite web | title=National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB) 2023-2028 | publisher=The White House | url=https://www.hhs.gov/sites/default/files/carb-national-action-plan-2020-2025.pdf/ | access-date=October 20, 2023}}</ref> The plan also emphasizes the importance of improving antibiotic stewardship across healthcare, agriculture, and veterinary settings.
Furthermore, the PASTEUR Act (Pioneering Antimicrobial Subscriptions to End Upsurging Resistance) has gained momentum in Congress. If passed, the bill would create a subscription-based payment model to incentivize the development of new antimicrobial drugs, while supporting antimicrobial stewardship programs to reduce the misuse of existing antibiotics.<ref name="PASTEUR">{{cite web | title=PASTEUR Act of 2023 | date=28 October 2021 | publisher=United States Congress | url=https://www.congress.gov/bill/117th-congress/house-bill/965/ | access-date=October 20, 2023}}</ref> This legislation is considered a critical step toward addressing the economic barriers to developing new antimicrobials.

=== Policy evaluation ===
Measuring the costs and benefits of strategies to combat AMR is difficult and policies may only have effects in the distant future. In other infectious diseases this problem has been addressed by using mathematical models. More research is needed to understand how AMR develops and spreads so that mathematical modelling can be used to anticipate the likely effects of different policies.<ref>{{cite journal | vauthors = Knight GM, Davies NG, Colijn C, Coll F, Donker T, Gifford DR, Glover RE, Jit M, Klemm E, Lehtinen S, Lindsay JA, Lipsitch M, Llewelyn MJ, Mateus AL, Robotham JV, Sharland M, Stekel D, Yakob L, Atkins KE | title = Mathematical modelling for antibiotic resistance control policy: do we know enough? | journal = BMC Infectious Diseases | volume = 19 | issue = 1 | pages = 1011 | date = November 2019 | pmid = 31783803 | pmc = 6884858 | doi = 10.1186/s12879-019-4630-y | doi-access = free }}</ref>