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June 2016
Antimicrobial Resistance: Persistence Pays Off With This Strategic Priority
The discovery last month of colistin-resistant bacteria infecting a woman in Pennsylvania was disheartening and brought us one step closer to an eventuality that members of our field have been concerned about for many years: the day we have nothing left in our arsenal to fight drug-resistant bacteria. 
For a long time now, IDSA has mobilized key leaders and resources around this cause. Through legislative, regulatory, advocacy, and public awareness efforts, we have brought together like-minded organizations and agencies to join in the fight against antimicrobial resistance. Here’s a brief look back (with an eye toward the future): 
2002: While antimicrobial resistance was an area of focus for the Society from its inception, it is officially identified as a strategic priority. 
2004: The Society issues its landmark report, “Bad Bugs, No Drugs,” calling attention to a frightening twist in the antibiotic resistance problem that—until that time—had not received adequate attention from federal policymakers: The pharmaceutical pipeline for new antibiotics was drying up.
2006: Thanks in part to IDSA’s efforts, the Biomedical Advanced Research and Development Authority (BARDA) is established and serves as the focal point within the Department of Health and Human Services to provide an integrated, systematic approach to the development of vaccines, drugs, therapies, and diagnostics for public health emergencies—including antimicrobial resistance.
2010: IDSA launches the 10 x ’20 Initiative, “Bad Bugs Need Drugs,” an advocacy campaign focused on one specific goal: to create an antibacterial research and development enterprise powerful enough to produce 10 new antibiotics by 2020. 
2011: The Society issues “Combating Antimicrobial Resistance: Policy Recommendations to Save Lives” to spur federal action on a range of issues, including antibiotic research and development, stewardship, surveillance, and data collection.
2012: The Generating Antibiotic Incentives Now (GAIN) Act is signed into law, providing incentives for drug development by extending the period of exclusivity for certain new antibiotics.
2014: IDSA convenes the Stakeholder Forum on Antimicrobial Resistance (S-FAR), a group of 85 like-minded organizations committed to advancing policies to address antimicrobial resistance. 
2015: President Obama issues the National Action Plan, which includes key IDSA priorities and benchmarks to assess progress, and establishes the Presidential Advisory Council, on which several IDSA leaders serve.
2016: IDSA’s Limited Population Antibacterial Drugs (LPAD) bill passes the full House of Representatives and the Senate Health Committee. The bill would allow antibiotics for the most deadly and highly resistant infections to be studied in smaller clinical trials and approved only for the limited populations of patients who most need them. 
2016: Our antibiotic and diagnostics tax credit bill (the Reinvigorating Antibiotic and Diagnostic Innovation [READI] Act) continues to gain bipartisan support. The bill would provide a much needed economic incentive for the most urgently needed new antibiotics and rapid diagnostic tests, which are crucial for guiding appropriate antibiotic use. 
2016: IDSA successfully leads advocacy for significant funding increases for antimicrobial resistance activities at the Centers for Disease Control and Prevention, the National Institute for Allergy and Infectious Diseases, BARDA and other agencies. 
As of today, six of our 10 x ’20 new drugs have been approved, S-FAR now boasts over 110 partner organizations, and IDSA continues to push forward on LPAD, tax credits and other efforts. 
But that’s not the whole story. As ID doctors, we know that developing new drugs is but one aspect of fighting resistance. Of equal importance is protecting the drugs that we do have in our arsenal, and the key to that is antimicrobial stewardship. 
The recent proposals by the Centers for Medicare and Medicaid Services to require antimicrobial stewardship programs (ASPs) as a Condition of Participation for acute care and critical access hospitals and long-term care facilities are major steps forward. IDSA has long been advocating that ASPs be required and has promoted that they be the standard of care for all health care facilities. We are at a critical juncture at which we as experts in infectious diseases, with our unique understanding of prescribing the right drug, at the right time for the appropriate duration, need to take a leadership role in stewardship. IDSA has a variety of resources online to prepare you for this role. 
These are all achievements to be celebrated, but, as the recent colistin-resistant case painfully illustrates, our work is not done and we must not slow down. The pipeline of new antibiotics is still fragile and woefully few pharmaceutical companies are engaged in research and development of these desperately needed new drugs. With the active engagement of our membership, we will continue to advocate for legislative solutions and for the critical role of the ID physician in stewardship. Now more than ever is the time to be a vocal advocate for the field of infectious diseases.

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