Dean to U.S. Senators: Action Needed on Antimicrobial Resistance

Tufts University School of Medicine Dean and Chief Academic Officer of Tufts Medicine Helen Boucher testified in front of a United States Senate committee on July 11 to emphasize the importance of congressional action to confront the worsening problem of antimicrobial resistance, or AMR—when antimicrobial drugs become ineffective to treat infections.

While resistance develops in nature, overuse of antimicrobial drugs pushes pathogens, such as fungi or bacteria, to develop resistance to those drugs faster, creating a race between microbial evolution and drug development. In the U.S., more than 2.8 million antimicrobial-resistant infections occur each year, causing about 35,000 deaths, according to the U.S. Centers for Disease Control and Prevention.

Senators Ed Markey and Roger Marshall of the U.S. Senate Committee on Health, Education, Labor & Pensions led the hearing. “If we do not address antimicrobial resistance, we will face a growing health care threat to our country,” said Markey.

Boucher, introduced by Markey, spoke to the committee about her experience as an infectious disease physician dealing with the real-life impacts of antimicrobial resistance. Boucher, Immediate Past Treasurer of the Infectious Diseases Society of America and inaugural member of the Presidential Advisory Council on Combatting Antibiotic-Resistant Bacteria, is not only a practicing infectious disease (ID) physician but also a founding member of the Stuart B. Levy Center for Integrated Management of Antimicrobial Resistance, a Tufts research center dedicated to finding solutions to antimicrobial resistance.

“As an ID physician, I see firsthand how AMR and the dearth of new antimicrobials is harming patients. AMR is everyone’s crisis and everyone’s responsibility,” Boucher told the committee.

Boucher went on to illustrate the growing threat, noting that antimicrobial resistance costs the U.S. healthcare system more than $4.6 billion annually and kills millions of people around the world each year. “I have had the sad duty of caring for a person with an infection caused by resistant bacteria for which we had no effective antibiotic,” she said. “He was unable to proceed with the transplant he needed and had to go home on hospice, ultimately leaving his two young sons fatherless.”

Both the opioid epidemic and climate change exacerbate the threat of antimicrobial resistance, said Boucher. Injecting opioids “interrupts the protective layer that skin gives our body,” she said, noting that the worsening opioid crisis in Massachusetts is helping to propagate antimicrobial-resistant disease. Climate change increases the risk of infection by opening up new pathways for pathogens to travel, as well. For example, said Boucher, waterborne pathogens travel better in warmer climates, and animals forced to move due to climate-related habitat loss carry pathogens to new places. While antimicrobial resistance is a multi-tentacled problem, “there’s lots of room to act,” said Boucher.

The primary action Congress can take, she said, would be to advance the PASTEUR Act, a bill reintroduced this year that would provide more support for hospitals to use newly developed antimicrobial drugs and would create incentives for pharmaceutical companies to develop such drugs. The bill would require the government to enter into contracts with antimicrobial drug developers based on the value of the new drugs rather than the volume sold.

Importantly, said Boucher, the bill would provide links to antimicrobial stewardship to ensure that these precious drugs are used in the most optimal way, preserving their usefulness for the maximum number of patients. “This is a much-needed first step to getting us back to a healthy economic framework for antibiotics,” she said.

In addition to advancing the PASTEUR Act, Boucher expressed that Congress needs to support better training and incentives to add more infectious disease specialists to the medical system. “Patients with serious infections do better when they are treated by an ID physician,” she said. “Congress must help ensure the availability of the ID workforce.”

In the U.S., nearly 80% of counties lack an infectious disease physician. Incentives to become an infectious disease physician are low, as they’re among the lowest paid specialists. To encourage more students to choose the profession, Boucher said Congress should work to address the student debt crisis and provide resources for training for early-career infectious disease physicians. Additionally, Boucher suggested that the federal government could appoint a national spokesperson to spread awareness about the problem of antimicrobial resistance.

“This is a wicked problem,” said Boucher. “And it requires a multi-pronged approach.”