Panel takes One Health approach to combating antimicrobial resistance

A presidential advisory council has recommended accounting for the threat of antimicrobial resistance (AMR) in the nation's pandemic preparedness policies given the possibility that a resistant bacterium could cause the next outbreak.

Jomana F. Musmar, PhD, executive director and designated federal officer of the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria (PACCARB), briefed the AVMA House of Delegates (HOD) on the council and its most recent report during the HOD's regular annual session on July 13 in Denver.

Jomana F. Musmar, PhD
Jomana F. Musmar, PhD, Executive Director of the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria (PACCARB), speaks to AVMA delegates about the council's report on antimicrobial resistance and pandemic preparedness.

"We emphasize a One Health approach, and that just shows you the interconnectedness of all of us," Musmar said. "A big part of what we do is elucidate the fact that what you do in human health, agricultural health, or environmental health has a butterfly effect—that what you do in one area impacts and affects the rest."

The PACCARB has issued 11 reports since 2015, which are considered by the Secretary of the U.S. Department of Health and Human Services to inform policy related to combating AMR. The council also consults with the U.S. departments of agriculture and defense.

The latest PACCARB report, "Preparing for the next pandemic in the era of antimicrobial resistance," (PDF) highlights the need for additional national policies to comprehensively address the threat posed by all infectious, including resistant pathogens.

"Particularly striking is the limited attention given to antimicrobial resistance," the report states. "While current national and global attention is focused on continuing to address COVID-19 and preparing for the possibility of another viral pandemic, the next large-scale outbreak or pandemic could be caused by a resistant bacterial pathogen."

Bacteria, the report continues, have been responsible for some of the deadliest pandemics in history. Cholera, caused by the bacterium Vibrio cholerae, is responsible for seven global pandemics and several major outbreaks since 1817.

Even if the next pandemic is viral, resistant secondary bacteria or fungal infections may be significant causes of illness or death.

During the COVID-19 pandemic, AMR infections caused substantial morbidity and mortality in hospitalized patients. For example, U.S. hospitals saw a 15% increase in resistant hospital-onset (nosocomial) infections and death, according to the report.

The report recommended, among other actions, bolstering the workforce by expanding recruitment and support of public health professionals, infection preventionists, and infectious disease specialists as well as engaging a broader set of providers in human and animal healthcare.

Pathways should be developed that would allow for qualified practitioners in other One Health domains to provide support to human health care during a public health emergency. Capacity should be built for both human and animal diagnostic laboratory networks to meet emergency surge testing demands.

The report also recommends expanding and diversifying sectors participating in domestic AMR surveillance efforts to include outpatient clinical settings, independent and clinical laboratories, wildlife, companion animals, wastewater, and others.

Another proposal is modernizing existing surveillance databases for One Health interoperability to accommodate data input from different human, animal, and environmental health sources, as well as variables that capture social determinants of health.