From the U.S. Government Accountability Office, www.gao.gov Transcript for: Antibiotic Resistance Description: The rising rate of antibiotic-resistant bacterial infections poses a serious health threat to Americans. Tim Persons and Mary Denigan-Macauley join the Watchdog Report to talk about federal efforts to get a handle on 'superbugs.' Related GAO Work: GAO-20-341, Antibiotic Resistance: Additional Federal Actions Needed to Better Determine Magnitude and Reduce Impact Released: April 2020 [ Intro Music ] [Tim Persons:] We're fighting against a living, adapting, microscopic enemy. [Matt Oldham:] Welcome to GAO's Watchdog Report, your source for news and information from the US Government Accountability Office. I'm Matt Oldham. Some bacteria develop the ability to defeat the available medicines designed to kill them, making treatment difficult or even impossible. We're seeing rising rates of resistance for these bacteria. And with me to talk about a GAO report on these superbugs is Tim Persons, GAO's chief scientist and a science technology assessment and analytics managing director, and Mary Denigan-Macauley, a healthcare director. Thank you both for joining me. [Tim Persons:] Thanks, Matt. [Mary Denigan-Macauley:] Thank you. [Matt Oldham:] So how big of an issue is this? [Tim Persons:] Airborne resistance is one of the major public health threats of our time. I don't say that lightly given that we're in the middle of the COVID-19 pandemic. But this one's still been around a while and this is an important public health issue that also can't be ignored. What's happening is that millions of Americans are getting infections each year and tens of thousands of Americans are dying. So at the moment, again, while we're paying attention to COVID-19, unfortunately, antibiotics don't work on the viruses, and nonetheless they are critical for any bacterial infection or diseases. And bacteria can and do evolve ultimately to resist antibiotics. So some have over that time or as a result have become resistant to the antibiotics that are out there. And what, unfortunately, happens is that patients will die of infection at times if these antibiotics that we currently have aren't able to defeat the bacteria because they're resistant to them. [Mary Denigan-Macauley:] The World Health Organization and the CDC consider antibiotic resistance to be one of the greatest global health threats that we have today. So our continued focus on this issue is very important. [Matt Oldham:] So what's the federal government doing about it today? [Tim Persons:] Well, the first thing is the CDC's been working to collect more data on what resistant infections are occurring and where, and yet they're constrained. The coroners don't actually write on the death certificate and say that it was an antibiotic-resistant bacteria that was the cause of death. It might say pneumonia or something like that. We don't know the precise magnitude of the problem. [Mary Denigan-Macauley:] You know, the federal government is very concerned about this issue and they developed a National Action Plan back in 2015 that specifically called for federal agencies to strengthen surveillance, advance the development of diagnostic tests and new antibiotics and to slow the emergence of resistance of the bacteria, among other things. And as Tim mentioned, there are several challenges associated with this. [Matt Oldham:] So it sounds like the CDC is well aware of the problem. They've got a National Action Plan. They're collecting more data as these superbugs continue to spread in the United States. What else could they do to tackle this problem? [Mary Denigan-Macauley:] Well, experts have warned that the current pipeline of our antibiotics in development is not sufficient to meet the current resistance threat that we have out there. And they do have incentives that they've put in place, but the incentives are just not enough. So we're not talking about antibiotics that someone takes for an infection for an extended period of time. Antibiotics are very expensive to be able to do the research and development, to get on the market, and the return on the investment is not enough to keep them in business. And many have actually gone out of business. And so one of the things that GAO would like to see is HHS take a lead in understanding what more is needed to keep that pipeline going. We'd also like to make sure that there's judicious use of the antibiotics, and the federal government is taking several steps. They've done training. They've issued guidance. They tried to issue incentives to prescribers to make sure that the judicious use -- which means giving the right amount of antibiotic to the right person for the duration of time -- is sufficient. But there's only so many things that they can do. You can't make it mandatory and you can't make it be a requirement for everyone across the entire United States. So we're still struggling with that as well. [Matt Oldham:] So will the current COVID-19 pandemic have an effect on HHS or CDC's efforts, specifically with things like diagnostic testing? [Tim Persons:] Testing is going to be an issue. This is largely a capacity of the public health system. We're in the middle of the COVID-19 crisis. But that said, there's going to need -- just like we're seeing in the COVID-19 scenario, there needs to be testing that just develops overall for antibiotic resistance. It is key because it's helping our providers, you know, choose the appropriate treatment and to generate the data that we need for the surveillance you know, how much or how big of a problem is this and to what extent? There are studies done, for example, in European Center of Disease Control and Prevention -- sort of a sister agency to our US-CDC -- has done a study where the hospital-acquired infections and disease burden in a smaller European country, the costs outweighed Alzheimer's and cancer combined. So if that's true I mean, the US is not a small European country. But if that were to be true, then I think we're just seeing the tip of the iceberg. And testing and capabilities for testing are critical to develop through the life cycle, not just at the research stage, but through development, through the regulatory process. And to have the market incentives in place. [Mary Denigan-Macauley:] And I would add that the current COVID pandemic response is massive, as you can see. And first and foremost, it's a local response. And those labs that are doing the testing and the diagnostics are actually the same labs that can help us to do the surveillance. And if they're wrapped up and tied up in a COVID response -- which we have all hands on deck right now -- that is going to impact our ability to work on other issues. Fortunately, the government has put forward a supplemental package to help deal so that we're not taking money from other important areas that are doing research, for example, on antibiotic resistance. But there's also going to be other unintended consequences that's in the pipeline, as we had talked about, for drug manufacturing, whether it's here in the United States or overseas. The COVID has the ability to impact that and slow it down. [Matt Oldham:] So then last question. What's the bottom line of this report? [Tim Persons:] I think from the big picture, we're essentially we're fighting against a living, adapting, microscopic enemy. And of all the various aspects of antibiotic resistance that we discussed in this report, the surveillance of the disease, the testing, the treatments, the stewardship. One aspect on its own is not enough. In other words, you can do surveillance very well, but if you don't do testing or treatments or stewardship well, then it's not enough to cover this. You have to do them all well. And that requires a lot of coordination. It requires looking at this in a large-scale systems context. And a multifaceted approach is critical. [Mary Denigan-Macauley:] Yeah, and I agree with Tim wholeheartedly. Bacteria is smart, and they will continue to adapt. And we will never completely stop this problem. But a multi-pronged approach to curb the development of resistance is needed not only in a public health setting, but GAO has also reported on this effort that's needed in the animal health setting. Because many of the drugs that we use for animals and humans are the same. So it is definitely an all hands on deck for solving the problem. [Matt Oldham:] Tim Persons and Mary Denigan-Macauley were talking about a GAO report on the federal response to the growing problem of antibiotic resistant bacterial infections. Thank you both for your time. [Tim Persons:] Thanks, Matt. [Mary Denigan-Macauley:] Thank you. [Matt Oldham:] And thank you for listening to the Watchdog Report. To hear more podcasts, subscribe to us on Apple Podcasts. Make sure you leave a rating and review to let others know about the work we're doing. For more from the Congressional Watchdog, the US Government Accountability Office, visit us at GAO.GOV.