U.S. & Global Policies
U.S. Policies and Resources
Antibiotic resistance is a major public health threat that requires action from all stakeholders, including government. Below is a compilation of key government activities, guidelines and policies related to antibiotic use in humans and food animals in the U.S. with the goal of improving antibiotic stewardship and reducing antibiotic resistance. While there has been progress in creating policies and strategies to curb overuse and misuse of antibiotics in humans and animals, there is more work to do to truly combat the threat of antibiotic resistance.
The Antimicrobial Resistance Challenge
On September 25 2018, the U.S. Centers for Disease Control and Prevention (CDC) and U.S. Department of Health and Human Services (HHS) launched the Antimicrobial Resistance Challenge at the United Nations General Assembly meeting. The challenge calls on governments, private industry and civil society to commit to taking actionable steps that further progress in combating antibiotic resistance around the world.
Learn more about ARAC's commitment: http://battlesuperbugs.com/amrchallenge
Learn more about the challenge: https://www.cdc.gov/DrugResistance/intl-activities/amr-challenge.html
National Strategy for Combating Antibiotic-Resistant Bacteria
In 2014, the White House announced the National Strategy for Combating Antibiotic-Resistant Bacteria. The plan outlines five main goals for combating antibiotic resistance. Each goal has accompanying milestones to be achieved by 2020. The goals serve as a roadmap for the federal agencies working to preserve antibiotic efficacy. The following documents give detailed information on the strategy and goals:
National Action Plan for Combating Antibiotic-Resistant Bacteria (2020)
Fact Sheet: Obama Administration Releases National Action Plan to Combat Antibiotic-Resistant Bacteria (2014)
Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria
National Strategy for Combating Antibiotic-Resistant Bacteria (September 2014)
Executive Order 13676, Combating Antibiotic-Resistant Bacteria (September 18, 2014)
The Food & Drug Administration (FDA)
Supporting Antimicrobial Stewardship in Veterinary Setting Goals for Fiscal Years 2019 - 2023; FDA Center for Veterinary Medicine
FDA Report: Annual Summary Report on Antimicrobials Sold or Distributed in 2017 for Use in Food-Producing Animals (December 2018)
FDA Report: Annual Summary Report on Antimicrobials Sold or Distributed in 2016 for Use in Food-Producing Animals (December 2017)
Final Rule Related to the Reporting of Antimicrobial Sales and Distribution Information (May 2016)
Veterinary Feed Directive (Updated June 2015)
Guidance for Industry #213, “New Animal Drugs and New Animal Drug Combination Products Administered in or on Medicated Feed or Drinking Water of Food-Producing Animals: Recommendations for Drug Sponsors for Voluntarily Aligning Product Use Conditions With GFI 209” (December 2013)
Guidance for Industry #209, “The Judicious Use of Medically Important Antimicrobial Drugs in Food-Producing Animals” (April 2012)
Guidance for Industry #152, “Evaluating the Safety of Antimicrobial New Animal Drugs with Regard to Their Microbiological Effects on Bacteria of Human Health Concern” (October 2003)
Key U.S. Government Reports on Antibiotic Resistance
Antibiotic Resistance: More Information Needed to Oversee Use of Medically Important Drugs in Food Animals, U.S. Government Accountability Office (March 2017)
Antibiotic Resistance Threats in the United States, 2013, U.S. Centers for Disease Control and Prevention (2014)
Antibiotic Resistance: Agencies Have Made Limited Progress Addressing Antibiotic Use in Animals, U.S. Government Accountability Office (2011).
In 2015, California became the first state in the United States to pass legislation that goes far beyond federal rules. On January 1, 2018, California will enact Senate Bill 27, first-of-its-kind legislation, which will require a veterinarian's prescription for use of antimicrobial drugs and ban non-therapeutic antimicrobial uses for disease prevention and growth promotion in livestock. The bill also requires the California Department of Food and Agriculture to develop a program to gather information on antibiotic use in meat production. It also puts livestock antibiotic use under veterinary oversight and calls for the development of guidelines and best management practices for the use of antibiotics in livestock.
In May 2017, Maryland adopted a law (Keep Antibiotics Effective Act/ SB422/HB602) banning routine antibiotic use for livestock on farms within the state. Unfortunately, the new law does not require the state to collect data to determine if the new rule is helping to reduce unnecessary uses of antibiotics in food animal production. Organizations working on this issue, including ARAC, have promised to continue to pursue legislation mandating data collection in 2018. The law will take effect in October 2017 and farmers in Maryland will have until January 1, 2018 to comply with the law.
Global Policies and Resources
Antibiotic resistance is a global problem. Dangerous bacteria spread rapidly around our interconnected world. Antibiotic-resistant bacteria picked up in one country are just a plane ride away from finding their way to another. As a result, all countries must take aggressive action in order to protect antibiotics from overuse and slow the emergence of antibiotic resistant bacteria. Below are key resources that outline international efforts to protect life-saving antibiotics.
In September 2016, the United Nations (UN) convened the first ever, high-level meeting on antimicrobial resistance. The primary objective of the meeting was to gather national, regional and international political commitment to address the growing threat of antimicrobial resistance. Leading up to the meeting, public health advocates around the world urged the UN and all of its member countries to work together to ensure meaningful progress and guide the global change needed to address antimicrobial resistance. The meeting concluded with the first ever UN declaration on the importance of combating antibiotic resistance that was signed by 193 member states.
Frontiers 2017: Emerging Issues of Environmental Concern, UNEP (United Nations Environment Programme), December 2017
World Health Assembly Resolution WHA 68.7, “Political Declaration of the High-Level Meeting of the General Assembly on Antimicrobial Resistance” - Adopted September 21, 2016
The FAO action plan on antimicrobial resistance 2016-2020, Food and Agriculture Organization of the United Nations
World Health Organization
In May 2015, the World Health Assembly (WHO) endorsed a global action plan to tackle antimicrobial resistance, including antibiotic resistance. The global action plan sets out five strategic objectives: to improve awareness and understanding of antimicrobial resistance; to strengthen knowledge through surveillance and research; to reduce the incidence of infection; to optimize the use of antimicrobial agents; and develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions.
WHO guidelines on use of medically important antimicrobials in food-producing animals - November 7, 2017
WHO Global Action Plan on Antimicrobial Resistance - 2015
WHO List of Critically Important Antimicrobials (CIA), World Health Organization (5th Revision - 2017)
Worldwide country situation analysis: response to antimicrobial resistance, World Health Organization (2015)
Antibiotic resistance: Multi-country public awareness survey, World Health Organization (2015)
Antimicrobial resistance: global report on surveillance 2014, World Health Organization (2014)
For more from WHO on antimicrobial resistance, click here.
Additional Key Resources
EU Report: More Evidence on Link Between Antibiotic Use and Antibiotic Resistance, European Food Safety Authority (July 2017)
G20 Leaders Declaration: Shaping An Interconnected World (July 2017)
European Union Antimicrobial Resistance Action Plan 2017, European Commission (June 2017)
Tackling Drug-Resistant Infections Globally: Final Report and Recommendations, Review on Antimicrobial Resistance (May 2016); Commissioned by the UK Government and the Wellcome Trust http://europa.eu/rapid/press-release_IP-17-1762_en.htm
The OIE Strategy on Antimicrobial Resistance & the Prudent Use of Antimicrobials, World Organisation for Animal Health (2016)
State of the World’s Antibiotics 2015, Center for Disease Dynamics, Economics & Policy (2015)
EU Summary Report on antimicrobial resistance in zoonotic and indicator bacteria from humans, animals and food in 2013
For specific antimicrobial resistance strategies and action plans for European Union member states and Canada, visit the European Centre for Disease Prevention and Control.
Resistance Map, Center for Disease Dynamics, Economics & Policy
Antimicrobial resistance interactive database, European Union
Antimicrobial consumption interactive database, European Union
Model Data Collection & Reporting Systems
Denmark: DANMAP is the Danish Programme for surveillance of antimicrobial consumption and resistance in bacteria from animals, food and humans.
The Netherlands: Nethmap 2020: Consumption of antimicrobial agents and antimicrobial resistance among medically important bacteria in the Netherlands / Maran 2015: Monitoring of antimicrobial resistance and antibiotic usage in animals in the Netherlands in 2019