Fact Sheet: Over 150 Animal and Health Stakeholders Join White House Effort to Combat Antibiotic Resistance

As part of the continued effort to combat antibiotic resistance, today the Obama Administration is convening a "White House Forum on Antibiotic Stewardship" to bring together key human and animal health constituencies involved in antibiotic stewardship—the development, promotion, and implementation of activities to ensure the responsible use of antibiotics. As part of the event, more than 150 food companies, retailers, and human and animal health stakeholders will highlight commitments to implement changes over the next five years to slow the emergence of resistant bacteria and prevent the spread of resistant infections.

In addition, today the President will sign a memorandum directing Federal departments and agencies to create a preference for meat and poultry produced according to responsible antibiotic-use. The Presidential Food Service is also committing to serving meats and poultry that have not been treated with hormones or antibiotics. Separately, the Food and Drug Administration (FDA) will announce that it has finalized changes to the Veterinary Feed Directive (VFD) regulation, an important piece of FDA's overall strategy to promote the judicious use of medically important antibiotics in food-producing animals as it facilitates bringing the feed-use of such antibiotics under the oversight of licensed veterinarians.

Today's convening builds on a number of steps the Administration has taken to combat antibiotic resistance. In September 2014, President Obama signed Executive Order 13676 prioritizing Federal efforts to combat the rise in antibiotic-resistant bacteria. The Administration also issued the National Strategy on Combating Antibiotic-Resistant Bacteria, and the President's Council of Advisors on Science and Technology released a report with recommendations to address the crisis of the proliferation of antibiotic-resistant bacterial infections. In March 2015, the Administration released the National Action Plan for Combating Antibiotic-Resistant Bacteria, a comprehensive plan that identifies critical actions for key Federal departments and agencies to enhance diagnosis and treatment and limit the spread of antibiotic-resistant bacteria.

The Centers for Disease Control and Prevention (CDC) estimates that drug-resistant bacteria cause two million illnesses and about 23,000 deaths each year in the United States alone.

Creating a Preference for Meat and Poultry Produced According to Responsible Antibiotic-Use Policies Presidential Memorandum:

The Presidential Memorandum (PM) signed today by President Obama directs Federal departments and agencies to create a preference for meat and poultry produced according to responsible antibiotic-use in the meat supply chain by supporting the emerging market for meat produced according to responsible antibiotic-use policies. To achieve this goal, the PM directs a three-tiered, phased approach using Federal purchasing authorities to offer options for meats from animals raised according to responsible antibiotic-use policies within Federal agencies' facilities. Specifically, the three phases include:

1. Initiating a process within 120 days of issuance of the proposed memorandum to make available meats and poultry from animals raised according to responsible antibiotic-use policies in certain Federal cafeterias. The General Services Administration (GSA), which operates a significant number of Federal cafeterias, will lead this approach, although other departments and agencies may join;

2. Broadening the availability of meats and poultry produced according to responsible antibiotic-use policies for sale in all Federal cafeterias serving civilian Federal employees by 2018 for poultry and 2020 for other meats, not solely those operated by GSA; and

3. Developing an acquisition strategy for applying a preference by 2020 in Federal acquisitions for meats and poultry produced according to responsible antibiotic-use policies sold or served in all Federal facilities.

Private Sector Commitments:

Private sector participation is essential to our Nation's success in preventing, detecting, and responding to antibiotic-resistant bacterial infections and in preserving the efficacy of our existing antibiotics while enhancing the innovation and development of new antibiotics, therapeutics, diagnostics, and vaccines. Below are key highlights from over 150 formal commitments made by business leaders in an effort to improve antibiotic use, prescribing and slow the rise of antibiotic resistant infections that threaten modern medicine. These represent only a portion of the outpouring of private sector commitment and leadership to implement robust antibiotic stewardship practices and to enhance education efforts and programs across all sectors.

Hospitals, Health Systems, Long-term Care, and Pharmacies. Improving antibiotic prescribing practices in human medicine protects patients from unnecessary risk for preventable allergic reactions, antibiotic-resistant infections, and deadly diarrhea. A number of healthcare-related entities are making significant commitments to enhance stewardship practices. For example in addition to continuing current collaborations with CDC:

• Ascension Health will, establish facility-based antimicrobial stewardship programs in all Ascension hospitals and adopt the CDC's Core Elements of Hospital Antibiotic Stewardship Programs, submit antibiotic use and resistance data to CDC, plus regularly evaluate facility antibiograms (the result of a laboratory test for the sensitivity of an isolated bacterial strain to different antibiotics).

• Hospital Corporation of America will develop and implement new clinical decision support and real-time antibiogram tracking to rapidly respond to lab results, catch bug-drug mismatches, implement strategy to prevent health-care associated infections in adult intensive care unit patients, and strengthen national efforts to identify and report cases of antibiotic resistance.

• Intermountain Healthcare will reduce inappropriate outpatient antibiotic use for upper respiratory conditions by 50% by 2020, ensure all Intermountain Healthcare acute care hospitals have antimicrobial stewardship programs by the end of 2017, plus support telemedicine efforts to extend infectious disease expertise to rural healthcare settings.

• Kaiser Permanente will support antibiotic stewardship programs and guide prescribing practices for antimicrobials at every Kaiser Medical Center with electronic alerts, order sets, etc.

Pharmaceutical, Diagnostics, Vaccine, Data Companies. With better and faster tests, prescribers can get patients the right medicine at the right time when necessary. Information about the number of resistant pathogens at facility, state and national levels helps clinicians have a sense of what drugs are not working in their area. A number of pharmaceutical-related companies are committing to address this challenge, including:

• BD Diagnostics will develop rapid carbapenem-resistant Enterobacteriaceae diagnostic tests, new antibiotics to test antibiotic susceptibility testing platforms, and molecular multidrug resistant-tuberculosis diagnostic test to simultaneously test patients for bacteria and resistance, and pioneer new ways to examine and reduce C. difficile healthcare-associated infections.

• BioMerieux will produce a real-time antibiotic surveillance system; collaborate with the U.S. government to ensure next-generation sequence-based typing of pathogens to track patterns; create high-medical-value multiplex assays combining host resistance markers, pathogen detection and antimicrobial resistance markers to rapidly diagnose (within approximately 1 hour) the cause of an infection to more accurately tailor empiric and definitive therapy; and validate biomarkers that can differentiate bacterial from viral infections in large cohorts to determine best combination of markers in a single rapid diagnostic assay.

Clinical Societies, Non-profits, and Foundations. Human health and veterinary professionals look to clinical societies, non-profits, and foundations to identify best practices and practical guidance for antibiotic stewardship efforts in their field. Over 24 non-profit organizations, consumer and patient advocates, and foundations are committing to advocate and support innovative changes in practice related to antibiotic use and antibiotic resistance, including:

• ABIM Foundation Choosing Wisely Initiative with Consumer Reports will operate a grant program in which more than 20 participating health systems, hospitals, and medical groups will work toward a goal of reducing their utilization of antibiotics to treat viral infections in adults.

• Accreditation Council for Graduate Medical Education will identify and disseminate targeted antibiotic stewardship information to faculty, residents, and fellows, reaching over 122,000 residents and fellows in over 9,500 programs in pediatrics, internal medicine, family medicine, surgery and more.

• American Society of Consultant Pharmacists will educate clinical staff using the CDC's Core Elements of Antibiotic Stewardship for guidance, including tracking and reporting antibiotic prescribing patterns and committing to taking a leadership role in ensuring appropriate dissemination of information.

• Pediatric Infectious Disease Society will assure that adult-based hospitals that care for children have effective antimicrobial stewardship for their pediatric patients, plus support clinical studies to optimize antibiotic use in children.

• Society of Hospital Medicine will, in addition to continuing current collaborations with CDC on this issue, create a Society of Hospital Medicine Behavior Change (Awareness) Campaign to enhance hospitalists' awareness of key antibiotic use best practices and ask them to formally commit to at least two behavior changes to reduce inappropriate antimicrobial use and reduce antimicrobial resistance.

Livestock and Poultry Farmers, Food Producers, and Retailers. Major stakeholders have already taken action or are committing to voluntarily phase out the use of medically important antibiotics for growth promotion, only accepting product from suppliers that have stopped the use of medically important antibiotics for growth promotion, or funding research for alternatives and instituting a company-wide policy to eliminate all medically-important antibiotics by a target date. The organizations making some of the most significant commitments to address this challenge include:

• Foster Farms this year is beginning to emphasize preventative flock health programs, proper nutrition, and advanced husbandry practices to protect and preserve the effectiveness of antibiotics, while ensuring the welfare of their chicken flocks. Foster Farms will only treat chickens that have a documented microbial disease or for disease control as dictated by a veterinarian, and will never use antibiotics critically important for human medicine.

• McDonald's will establish principles and criteria for antimicrobial use; develop field projects to serve as Centers of Innovation (that is, demonstration farms) for each species in an effort to demonstrate the benefits of judicious antimicrobial use; and develop methods to verify judicious antimicrobial use and establish goals for measuring progress.

• Panera Bread has extended its "raised without antibiotics protein" offerings to include roasted turkey, smoked chicken, breakfast sausage, ham and bacon. Panera has committed to purchasing livestock and poultry that have been raised responsibly, which for Panera means having been fed vegetarian-based and customized diets without the use of antibiotics, and raised in reduced-stress environments. Today, all chicken, ham, roasted turkey, and breakfast sausage in salads and sandwiches meet their standard.

• Tyson Foods, Inc. will eliminate the use of human antibiotics from its U.S. broiler chicken flocks by September, 2017. Tyson Foods will also work with independent farmers and others who are a part of Tyson's beef, pork, and turkey supply chains on ways to reduce antibiotics on cattle, hog, and turkey farms.

• Smithfield has already acted and today prohibits the use of medically important antimicrobials for production purposes (growth promotion and feed efficiency) in their animals. Smithfield has committed to a partnership this year with the Virginia Tech College of Agriculture and Life Sciences and at the Virginia-Maryland College of Veterinary Medicine, in part, to investigate alternatives to antibiotics and other methods to enhance animal well-being and production efficiency in swine-rearing operations. Smithfield is providing meaningful, accurate measurement on antibiotic use information to the public on its website and has robust training programs for its employees on antibiotic use.

• Walmart is asking suppliers to adopt and implement the Judicious Use Principles of Antimicrobial Use from the American Veterinary Medical Association (AVMA) including accurate record-keeping, veterinary oversight, and limiting antimicrobial treatment to animals that are ill or at risk.

Animal Pharmaceutical Companies, Veterinary and Animal Agriculture Associations, and Industry Organizations. Today, 10 organizations will announce they have committed to work with veterinarians and feed mill operators to ensure swift and seamless adoption of the FDA's guidance to align their medically important antibiotic products with FDA's final rule on veterinary feed directive and data collection, including removing growth promotion uses and changing marketing status to require veterinary oversight of product use. They are investing in vaccines, best management practices, on-farm hygiene, and proper nutritional innovations that will benefit animal health while lessening the reliance on traditional antibiotics. The organizations making some of the most significant commitments to address this challenge include:

• Elanco Animal Health will dedicate two-thirds of their food animal research budget to attack disease challenges where shared class antibiotics are used routinely because few or no alternatives exist today. Elanco will quickly evaluate 25 new technology platforms to deliver 10 viable development candidates within the next year.

• Merck Animal Health developed a commercial surveillance program to monitor multi-drug resistant bacteria, across live animal, beef, and dairy production. The outcome of this investment is expected to be a program that can be implemented by veterinarians to understand the pathogens present, throughout the animal's lifecycle, and to make protocol recommendations that are based on actual pathogen populations, and their relative susceptibility. By implementing this potential surveillance program, veterinarians will be able to provide targeted, responsible treatments with antibiotics and other therapeutics when needed.

• Zoetis committed to place the administration of medically important antibiotics under the direct purview of a veterinarian for the purpose of fighting disease – thereby eliminating their use for growth promotion. Along with this commitment, Zoetis will work directly with veterinarians and livestock producers to implement these important changes to how our products are utilized in food producing animals.

Call to Action, Comprehensive Commitment.

There is more work to be done to strengthen nationwide antibiotic stewardship programs, tracking of antibiotic use, to get faster and better tests to better tailor disease treatment, and understand the drivers of antibiotic resistance. Combating antibiotic resistance and improving antibiotic use requires commitments across a vast variety of sectors and disciplines. Below is a comprehensive list of companies and organizations that have committed to help thwart the public health and national security threat posed by antibiotic resistant bacteria.

All Committed Organizations

AARP
Abbott/Ibis Biosciences
ABIM Foundation (Choosing Wisely)
Accelerate
Accreditation Council for Graduate Medical Education
Achaogen
Actavis
AdvaMedDX
Advancing Excellence in Long-Term Care Collaborative
Alere
ALK-Abello
Alliance for Aging Research
Alliance for the Prudent Use of Antibiotics
America's Essential Hospitals
American Academy of Emergency Medicine
American Academy of Family Physicians
American Academy of Pediatrics
American Academy of Physician Assistants
American Animal Hospital Association
American Association of Avian Pathologists
American Association of Bovine Practitioners
American Association of Nurse Practitioners
American Association of Swine Veterinarians
American College of Physicians
American College of Veterinary Preventive Medicine
American Dental Association
American Feed Industry Association
American Health Care Association and the National Center for Assisted Living
American Hospital Association
American Medical Association
American Medical Directors Association
American Osteopathic Association
American Public Health Association
American Society for Microbiology
American Society of Consultant Pharmacists
American Society of Health-System Pharmacists
American Veterinary Medical Association
Animal Health Institute
Anthem
Ascension Healthcare
Association for Professionals in Infection Control and Epidemiology, Inc.
Association of American Medical Colleges
Association of American Veterinary Medical Colleges
Association of Public and Land-grant Universities
Association of Public Health Laboratories
Association of State and Territorial Health Officials
AstraZeneca
Banfield Pet Hospital
BD Diagnostics
Bell & Evans
BioMerieux
Cargill
CareFusion
Carolinas Medical Center
Center for Disease Dynamics, Economics & Policy
Cepheid
Clinical and Laboratory Standards Institute
Clorox Company
Consumers Union/Consumer Reports
Costco
Council of State and Territorial Epidemiologists
CVS Health/Minute Clinic
Elanco Animal Health
Farm Foundation
Federation of Animal Science Societies
Foster Farms
Galderma Laboratories
Genesis Healthcare
GOJO
George Washington University Milken School of Public Health Antibiotic Resistance Action Center
Hospital Corporation of America
IMS Health©
Infectious Diseases Society of America
Intermountain Healthcare
JBS
Johns Hopkins Medicine
Johnson & Johnson
Kaiser Permanente
McDonald's
Medscape/WebMD
Melinta
Merck/Cubist
Merck Animal Health
NACDS Foundation
Nanosphere
National Association for the Advancement of Animal Science
National Association of Chain Drug Stores
National Association of County and City Health Officials
National Association of Directors of Nursing Administration in Long Term Care
National Association of State Departments of Agriculture
National Association of State Public Health Veterinarians
National Cattlemen's Beef Association
National Chicken Council
National Consumer Voice for Quality Long-Term Care
National Grain and Feed Association
National Milk Producers Federation
National Pork Board
National Pork Producers Council
National Quality Forum
National Turkey Federation
Nile's Project
North American Meat Institute
OpGen
Panera Bread
PDI Healthcare
Pediatric Infectious Disease Society
Peggy Lillis Foundation
Perdue
Premier Healthcare Alliance
Procter & Gamble
Reckitt-Benckiser
Safe Care Campaign
Sanofi Pasteur
School Food Focus
Shionogi
Smithfield
Society for Healthcare Epidemiology of America
Society of Hospital Medicine
Society of Infectious Diseases Pharmacists
The Evangelical Lutheran Good Samaritan Society
The Joint Commission
The Pew Charitable Trusts
Theravance BioPharma
TridentUSA
Trust for America's Health
Tyson
University of Pennsylvania Health System
VCA Pet Hospitals
Volunteer Hospital Association
Walgreens/Take Care Clinics
Walmart
What to Expect Foundation
Zoetis