How Preventing Antibiotic Overuse Is Helping Fight Superbugs
Antibiotics have revolutionized modern medicine by making it possible to prevent and treat previously life-threatening infections, but their overuse and misuse can cause bacteria to mutate and develop resistance to the drugs intended to treat them—which erodes the efficacy of our existing drug supply and threatens public health. Such drug-resistant infections are more difficult to cure and can lead to longer hospital stays, costlier treatments, and even death. The Centers for Disease Control and Prevention estimates that each year 2.8 million Americans fall sick with antibiotic-resistant infections, and 35,000 die as a result.
To address this problem, in 2014, Pew launched the antibiotic resistance project, a multifaceted campaign that aimed to improve the stewardship of antibiotics and limit their inappropriate use within animal agriculture and human health care settings. It also hoped to revitalize the development of antibiotics to ensure a steady stream of new drugs. Recently, Pew’s evaluation and learning unit—which helps the organization learn from its work, improve program effectiveness, and inform future decision-making—commissioned a team of independent experts to review the antibiotic resistance project’s work over nearly 10 years in the field to evaluate its achievements and offer lessons that might inform future initiatives.
This independent evaluation found that progress was made in many areas of the project’s work, including significant contributions to stronger policies at the Food and Drug Administration and U.S. Department of Agriculture. Pew’s work also propelled voluntary antibiotic stewardship standards, which were agreed to and are now used by major food producers in the U.S., as well as the requirement that U.S. hospitals must have stewardship programs in order to be accredited. Pew also spearheaded the creation of new tools to advance drug discovery, including a data-sharing platform to aid scientists working on developing new antibiotics and a roadmap of strategies to address barriers to discovery and strengthen collaborations between scientists.
While Pew was an essential driver of these achievements, any work in a field as complex as antibiotic resistance requires the cooperation and dedication of many actors. The evaluation noted that the project’s collaborative engagement with a range of stakeholders—government agencies, nonprofit partners, consumers and advocates, trade associations, and industries ranging from food producers to hospitals and more—was critical to its success.
Forging new collaborations
Inclusion, or a belief that diverse voices generate better ideas, is one of Pew’s organizational values, and the evaluators found that Pew sought to build a wide range of partnerships and collaborations to advance stewardship in human health care. Together with the CDC, Pew held several convenings of health care stakeholders—including infectious disease experts, pharmacists, government officials, hospital executives, and insurance industry representatives—to determine goals for reducing antibiotic use in hospitals and outpatient settings and discussing and developing appropriate implementation strategies. Of these convenings, which in some cases combined stakeholders who had never worked together before, one government official said the “blend of the scientific community, prescribers, insurers, government agencies, and associations allowed for broadened perspective of the issue and [the] identification of realistic solutions.” The process built trust among participants and catalyzed support across the groups. The evaluators found the meetings ultimately informed CDC guidelines on the core elements of hospital stewardship programs, which would become the basis for all future regulations for stewardship in hospitals. Pew also organized and supported diverse coalitions that could convey the personal cost of antibiotic resistance. For example, it formed Stand Up to Superbugs—a group of health care professionals, public health officials, scientists, farmers, veterinarians, and survivors of drug-resistant infections and individuals who lost loved ones to these infections. Pew coordinated annual Capitol Hill visits where group members could share their personal experiences with policymakers and encourage Congress to commit more resources to the problem of antibiotic resistance. These ambassadors “added a voice and real-world story to the science and evidence for antibiotic use reform,” said evaluator Sarah Moreland-Russell, an associate professor at Washington University in St. Louis.
Building trust
It took some time for Pew to find its footing in addressing antibiotic misuse in animal agriculture. Despite significant early policy successes with the USDA and FDA, a changing political landscape made it difficult to sustain momentum. Recognizing the need for private sector partnership, Pew sought to work with farmers and other key players within the food supply chain; however, initially Pew lacked the trusting relationships needed with these stakeholders to make progress. To bridge this gap and build trust among industry insiders, Pew hired a veterinarian who was an expert in animal agriculture issues and understood the complex challenges farmers face. The antibiotic resistance project also partnered with the Farm Foundation, a nonprofit that works to address concerns facing the agriculture industry and which is highly trusted among farmers. Together, Pew and the Farm Foundation were able to gather representatives from major food companies, the pharmaceutical industry, and trade associations to develop and adopt a voluntary framework for antibiotic stewardship best practices in food animal production. In their report, the evaluators noted that “this group would not have come together if it were not for Pew’s efforts and influence.” Stakeholders appreciated Pew’s efforts to facilitate dialogue and find common ground, which ensured that all interested parties had a seat and a voice while helping to repair previously strained relationships and build trust.
Promoting scientific collaboration
As drug-resistant strains of bacteria erode the effectiveness of current antibiotics, it becomes even more important to have a robust pipeline of new drugs coming to market. However, the research and development of new antibiotics is a long and expensive process, and few efforts ultimately succeed. This makes major pharmaceutical companies hesitant to invest while smaller companies doing this work have frequently gone bankrupt, leading to the loss of valuable research data. To help overcome these research challenges, the evaluators found that Pew spearheaded collaborative efforts to break down these and other barriers to the development of new drugs.
In 2016, Pew published “A Scientific Roadmap for Antibiotic Discovery” to outline promising strategies for accelerating the discovery of new antibiotics. The roadmap resulted from two years of consultations with dozens of industry and academic experts as well as public and private sector representatives, and also served as a springboard for new partnerships. These relationships among stakeholders continued after the roadmap was complete, further advancing scientific collaboration.
One priority area identified in the roadmap was the need for better data, materials, and knowledge-sharing across disciplines. To address this, Pew developed the Shared Platform for Antibiotic Research and Knowledge, or SPARK, an open-access web portal aimed at preventing data loss and promoting collaborative innovation. Within six months of its launch, SPARK had more than 500 registered users as well as data-sharing agreements with two major pharmaceutical companies, successfully safeguarding scientific data that would have been lost after several small pharmaceutical companies eventually went bankrupt.
Ultimately, the evaluators found that from its inception, Pew’s antibiotic resistance project adopted a collaborative and inclusive approach of working with a diverse array of stakeholders—from scientific researchers to grassroots advocates and industry representatives to government agencies. Along the way it forged new partnerships and strengthened and repaired old relationships, and created a space where divergent voices could be heard, find common ground, and generate practical solutions. Despite political challenges and at times divided interests, these group efforts successfully generated collective buy-in from those directly impacted by the issue, connected experts with policymakers to elevate antibiotic resistance on the policy agenda, and advanced tangible improvements to antibiotic stewardship and development.
Richard Silver is an officer and Michele Lempa is director for The Pew Charitable Trusts’ evaluation and learning unit.
