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Trump budget cuts threaten antimicrobial stewardship
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The significant budget cuts proposed by President Donald J. Trump’s administration threaten recent progress on combating antimicrobial resistance, according to a commentary published in Annals of Internal Medicine.
“By 2050, a total of 350 million cumulative deaths will likely be attributable to [antimicrobial resistance] if current trends continue,” Helen W. Boucher, MD, director of the infectious diseases fellowship program at Tufts Medical Center and associate professor of medicine at Tufts University School of Medicine, and colleagues wrote. “In the past 2 years, national and global leaders have united against this threat, making tangible progress. However, budget cuts of a historic magnitude proposed by the Trump administration now threaten to undo this progress, placing patients in grave danger.”
The 21st Century Cures Act, enacted in 2016, allows for patients with serious or life-threatening infections who are taking antibacterial and antifungal drugs to be studied in smaller, faster clinical trials. With $379 million in funding from Congress, health experts and leaders across the U.S. have worked to fight antimicrobial resistance over the past 2 years, according to Boucher and colleagues. This funding has been used to improve investment in rapid detection and response to outbreaks and emerging resistance, expand tuberculosis screenings, enhance prevention networks in health care settings and promote appropriate antibiotic stewardship, they wrote; however, because the Trump administration seeks significant cuts to funding for public health and research, these efforts are at risk of being undone.
In May 2017, the president released a budget request that proposes to cut the National Institute of Allergy and Infectious Disease’s funding by 23% and the CDC's antimicrobial resistance funding by 14%, positioning it within the Prevention and Public Health Fund, which the administration and Congress are seeking to repeal, Boucher and colleagues wrote. The budget would also cut the United States Agency for International Development's global health programs by 51% and its tuberculosis program by 26%. The proposed cuts would significantly lessen the ability to monitor antimicrobial resistance; prevent infection and promote stewardship; and support the development of new antimicrobial drugs, diagnostics and vaccines. The cuts would also hinder the global health security efforts of the CDC and United States Agency for International Development by substantially reducing support for global surveillance and increasing the chance that multidrug-resistant pathogens will spreading across borders undetected, according to Boucher and colleagues.
“Over the past 2 years, our nation’s health experts and leaders have worked diligently to enable the United States to tackle [antimicrobial resistance] head-on. If now enacted, these proposed budget cuts would reverse this course, which would go against the widespread agreement of experts and be to the detriment of our nation,” Boucher and colleagues wrote. “Given the severity of the threat posed by [antimicrobial resistance], and the United States' position as a world leader traditionally at the forefront of global progress, we believe that we must reaffirm our investment in research and public health efforts to combat this threat.” – by Savannah Demko
Disclosures: Boucher reports personal fees from Infectious Diseases Society of America and from NIH’s Antibacterial Resistance Leadership Group. Please see the full article for a complete list of all other authors’ relevant financial disclosures.
Perspective
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Barbara E. Murray, MD
Proposed cuts to antimicrobial resistance funding would devastate every aspect of our federal response to this crisis, including essential efforts to promote antibiotic stewardship. In recent years, increased investment to combat antimicrobial resistance has already yielded some progress. A new report from Blue Cross Blue Shield found that the fill rate of outpatient antibiotic prescriptions declined 9% among commercially insured Americans from 2010 to 2016. While this is encouraging, much work remains. According to CDC, 30% of outpatient antibiotic prescriptions are unnecessary. Total inappropriate outpatient antibiotic prescriptions, which includes inappropriate antibiotic selection, dosing and duration, approaches 50%. CDC provides guidance and support to implement stewardship, and tracks antibiotic use to allow us to evaluate the impact of stewardship interventions. Sustained federal funding is necessary to continue this important work and drive needed progress. Further, efforts to curb antibiotic use also underscore the tremendous challenges to antibiotic research and development. How can a company develop a new antibiotic knowing that the goal is to use it as infrequently as possible? Federal investment in novel incentives to support antibiotic innovation is also essential. We are grateful that many in Congress have expressed similar concerns and urge them to reject these short-sighted proposed cuts.
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