Transcripts For CSPAN Hearing 20240706

Recognized as one of the best internet providers and we are just Getting Started building 100,000 miles of new infrastructure to reach those who need it most. Charter communications supports cspan as a Public Service along withhese other Television Providers givingou a frontrow seat to democracy. Next a hearing on a report about Antimicrobial Resistance. And how federal agencies are addressing the problem. Witnesses testified on Public Health concerns at the house energy and commerce subcommittee investigates the threat posed to the u. S. Health care system. This is two hours. I ask all guests to take their seats. Welcome to what i hope would be a welcome to the hearing on Antimicrobial Resistance. We heard that the risk of a pathogen escaping from a lab and causing a pandemic is real. Just as real as the threat posed by antimicrobial resistant pathogens. Significant research was being done on bacteria phage therapy. Its where we search for a virus to provide attack harmful bacteria. Ever since penicillin, antibiotics have been developed to treat previously untreatable infections and they truly are lifesavers. Unfortunately face therapy phage therapy fell to the wayside. The problem is over time pathogens become resistant to the commonly used classes of antibiotics. If a new way to kill a pathogen is not found, the patient is defenseless to the disease caused by the pathogens. Now, antibiotic resistance infections can be difficult to treat. Amr is referred to as the silent pandemic and has become one of the biggest medical concerns today. The pipelines for amr drugs have been drying up due to various regions, that deserve our attention. We hope to highlight that today. Despite the increased demand there has been an reduction in investment and development of new antimicrobials. According to the data, 70 of Major Drug Companies have cut or scaled back antibiotic research due to develop metal challenges. According to the centers for Disease Control and prevention, at least two point 8 Million People 2. 8 Million People are infected with antibiotic resistant bacteria in the u. S. Each year. More than 35,000 people will die as a result of such infection. The rise of drugresistant infections places a heavy burden on our Nations Health care system. The cdc suggests 30 of all antibiotics prescribed in the u. S. Are for infections that do not require antibiotics, which amassed to 47 million antibiotic courses prescribed. That said, often what happens, individual doctors face perplexing symptoms, while trying to save their patients, they will turn to antibiotics. Amr is not just an issue that arises in the hospital or health care setting. Humans and animals have the possibility of developing antimicrobials with expanding resistance. Its a problem that sometimes we dont understand. Its everything nature is doing. I met with a veterinarian which is in my district about her work in southern africa. While there, she came across abandoned mongoose who had an antimicrobial resistant, to antibiotics, that she had never seen before. This shows that the Antimicrobial Resistance can appear anywhere and everywhere. I look forward to hearing from our witnesses about potential, Innovative Solutions like phase therapy. Well hear from the gao about deficiencies at the department of health and Human Services, the agency with the most responsibility for tackling the amr problem. One issue i hope we can bring more oversight into is the number of federal programs and initiatives the government currently has to address Antimicrobial Resistance. Im pleased to see we are addressing this style of pandemic, it is congresss duty to provide oversight for how dollars are being spent. Have the programs found any success . Which of these programs are duplicate of . As we consider solutions to confront the antimicrobials, wwe must consider the work being done in the dollars being spent to combat the crisis, and look for ways that we yield more successful while there is no easy solution to the problems of amr, we are committed to exploring potential solutions to address this doublet health crisis. I want to emphasize and be clear that this hearing is not about taking a position on any legislation introduced, but rather, as the committee usually does, it is to gather information, and to find out the facts. I want to examine the amr problem, and examine the role of federal government, and find potential solutions. I look forward to hearing from our Witnesses Today. I yield back and now recognize the ranking matter member of the subcommittee. Good morning, and thank you mr. Chairman for holding this important meeting on the issue of Antimicrobial Resistance. If we have learned anything from covid19, it is that we must dedicate sufficient resources to prepare for the Public Health threats that we know of, while also working to prepare for the new and emerging threat. The cdcs 2019 threat assessment report, identified 18 bacteria and fungi that are showing resistance to available treatments. That trend is expected to rise. The u. S. Government has been aware of the threat for some time and has taken steps to address it. In 2015, president obama, the federal government, in accordance with an executive order issued by obama, the federal government released an action plan for combating antibiotic resistant bacteria that outline the framework for the federal response to this growing health threat. While we have made strides in preventing and treating antibiotic resistance, there is ground to regain as we emerge from three years of a pandemic that put unprecedented strains on the entire health care system, and rolled back some of the progress. The effort to combat antibiotic resistance requires a strong, coordinated response involving both private and Public Sector stakeholders to advance new technologies, effectively collect data on incidents of antibiotic resistant infections, make Resources Available for hospitals and providers to practice sound antibiotic stewardship. We have to foster Scientific Research and implement prevention measures. At yesterdays hearing, some republicans on the subcommittee expressed skepticism about the value of pandemic research. Today we are hearing about the importance of addressing Antimicrobial Resistance, which will require a strong supportive medical and scientific workforce. The tones of these back hearings are intentional, i hope we can come out of them with a better appreciation for the work of our scientific community. Let me make a point, while there are many fronts on which to have on which we have to fight the serious threats, we make no progress without consistent investment in Scientific Research. If the republicans proceed with appropriation in accordance with the default on america act that they passed this week, Scientific Research will suffer greatly. We need scientists to study these threats, to help us prepare against them. They should be able to do so, free of political interference, or banning Public Health research. Our important oversight responsibility include pressing for improvement across the scientific and research enterprise. In doing so, to build trust and confidence in the agencies at the forefront of a national response, like the cdc and nih. Im pleased that the gao is testifying on its third report that was completed right at the start of the covid19 pandemic. Its an excellent resource to build from, as we enter pandemic recovery, and turn our attention to the array of Public Health threats. Hopefully, with a new appreciation for the importance of preparedness. Id like to think our other witnesses for being here to share your expertise on these different angles of this complex issue. Antimicrobial resistance is a problem for patients, Health Care Professionals and researchers across the health care system. It is important to emphasize that there are environmental and agricultural aspects contribute into the rise in resistance that we have to address as well. A multipronged issue requires a multipronged solution. I look forward to the discussion today, coming out of this hearing with a deeper understanding of the nature and scope of the threat of Antimicrobial Resistance, so we can make more informed policy decisions to help combat it. Thank you again mr. Chairman, for holding this important hearing. I yield back. Thank you gentlelady for yielding back. I recognizing the chair of the committee for her five minute opening statement. Thank you, for convening this hearing about this growing threat of Antimicrobial Resistance or amr. Facing our nation and indeed the world. Thank you to our panel of Witnesses Today. More than 2. 8 million antibiotic resistant infections occur in the u. S. Each year, resulting in more than 35,000 deaths. In 2019, an estimated 1. 3 Million Deaths globally were a direct result of drug resistance. Amr is a real threat. Weve had eyedrop recalls due to contamination by an extensively drug resistant of bacteria, that has led to multiple deaths, loss of vision among patients in 16 this outbreak strain has never been ordered in the united eats prior to the outbreak. Just this week a hospital in downtown seattle announced an outbreak often found in Health Care Settings which infected 31 people for whom have died. This morning we seek to gain a better understanding of am i anr examining this ongoing Public Health threat and explore innovative path forward. Antibiotics are powerful lifesaving drug drugs. This discovery revolutionized modern medicine in addition to their use to protect human lives they are used to that care to treat the animals and keep our food supply safe from harmful passages. Globally and in the u. S. Antifungals are relatively inexpensive way to control plant diseases and protect agricultural crops. Over time, however, through an natural adaption and use, microbes can develop into superbugs, making drugs ineffective against them. Amr is a complex web that could develop and spread through a variety of settings, including Health Care Facilities, food production, the community and the environment. Theres a need to learn more about amr amr, its underlying causes to address this threat. We also must examine and understand the already existing efforts and initiatives underway and assessed how these programs are operating, including any successes and shortcomings. In 2016, theres an unprecedented hundred 16 million new investments for cdc this i amr. By fiscal year 2022, this appropriation had increased to more than 180 2 million. We are working understand how this funding has been used, what initiative cdc is undertaking, and how effective they have been. In addition to cdc funding, there are countless numbers of hhs interagency efforts focused on amr, including the creation of numerous federal task force and committees, such as the president ial Advisory Council on combating antibiotic bacterial in the combating any biotic task force, as well as an array of National Plans, strategies, databases and monitoring systems, guided documents, toolkits and guides. These efforts are not restricted to hhs. According to the Congressional Research service, the dod, state department, epa, usaid, and interior, each have their own individual existing initiatives and programs. Several sub agencies within these agencies also have separate programs. Hhs has at least eight sub agencies with individual initiatives. The fact that amr continues to be a growing threat and a Health Burden despite this heavy investment of resources is alarming and im hopeful our witnesses here today will be able to provide greater insight into why this is a case in how we can improve our ongoing efforts to address the problem. I thank you to the Ranking Member, my colleagues across the aisle, thank you to the chairman in the Ranking Member who are working together on this, i look forward to todays hearing as we explore the increasing burden and threat of amr facing our nation and world. Thank you, i yelled back. The chair recognizes the Ranking Member for his fiveminute opening statement. Thank you mr. German faq to our witnesses to help us better understand the serious threat that Antimicrobial Resistance causes to Public Health. It is not a new phenomena, it has been vexing scientists in congress for years, however, it has been increasing across the board and imposes health risks to the public. According to the center for Disease Control and prevention, more than two point eight americans have an infection in 2019 and one and 35,000 americans died from the infection in these numbers are expected to grow as more and more dangerous organisms develop resistance to the treatments available today. And that is deeply concerning tower Public Health. There is not seem to be one obvious solution to the issue and it cuts across the board to how we identify resistant threats to how we administer available drugs while also fostering the developments of new treatments. The challenging balance between withholding certain antibiotics for patients in order to avoid unintentionally promoting more resistant strains of bacteria and providing the patients the best treatment available. In terms of developing new treatments, the normal market is not always encourage the development of new drugs in this space. We want antibiotics to be developed at a more that are more powerful for those who needed and as little as possible. This is the challenge repeatedly addressed in our witness testimony and i look forward to all of your perspectives and how we might navigate this dilemma. The National Institutes of health will need to continue to support Good Research into the risk poses and how we combat those risks. We need to ensure that our health and Research Work force is Strong Enough to address these challenges from physicians and nurses, the whole spectrum of the Health Workforce has a role to play and we need to make sure our Health Centers and Research Labs are equipped. While the threat is increasing on the radar for the general public, it presents a constant threat for some individuals with Certain Health conditions, such as Cystic Fibrosis. They rely on antibiotics to treat ongoing risks of infections. Patients know the serious threats that antibiotic dash cam posed to your health if you have Cystic Fibrosis. The Public Health challenges are serious and are growing, i think that chairman for holding this hearing and look forward to the discussion with our witnesses. I yelled back. That conclude i yield back. That concludes Opening Statements. Members Opening Statements will be made a part of the record. I want to thank our witnesses for being here today and take the time to testify before our subcommittee. Each witness has an opportunity to give an opening statement. Our Witnesses Today are mary, director of health care u. S. Health care accountability office. Professor of law and executive of karp x at boston university. Amanda, Senior Vice President of Infectious Disease society of america. Amy, associate professor of medicine and pathology at university of Virginia School of medicine. We appreciate you all being here today and i look forward to supporting you on the issue. You are where the committee is holding this oversight hearing and when we hold oversight hearings we have the practice of taking testimony under oath. Do any of you have an objection to testifying under oath . Seeing no objections will proceed. You are also advised that you have the right to have counsel present should you use wish to do so pursuant to house rules. Do any of you wish to be advised by counsel during your testimony today . Seeing that none require, would you please rise in rage see her right hand. Do you promise to tell the truth, the whole truth and nothing but the truth so help you god . Seeing all witness answer in the affirmative, you are now sworn in and under oath. Title 18, section 1001 of the United States code, you may be seated. We will now recognize mary for her five minute opening statement. Thank you very much. Ranking members and members of the subcommittee, thank you for the opportunity to discuss the work on antibiotic resistance. As we address the covid19 pandemic, another pandemic has been quietly brewing. Not one from a single disease, but rather one of resistance. Since the discovery of penicillin less than 100 years ago, many lifesaving antibiotics have become essential to the practice of modern medicine. However, the rising prevalence of antibiotic resistance threatens these gains. Many infections today become more difficult, if not, impossible to treat because of an increasing number of microbes that have developed resistance to most or all currently available antibiotics. According to the who, if nothing changes by 2050, 10 Million People are expected to die from drug resistant diseases infections every year. Resistance can also complicate the response the republic oath emergency, with secondary exceptions exasperating a crisis. The cdc nw ho consider antibiotic resistance to be one of the greatest Public Health threats of all times. This solution to resistance is not simple. Its a complex issue involving the movement of not only bacteria but fungi, viruses and other microswitch we humans, animals and our environment. Today i will focus my statement on the most recent work related to federal efforts, human health and antibiotics. While many federal efforts are underway, id like to focus on four key areas where we believe more can be done. First, the precise magnitude of this problem is not known. While we have estimates that Antimicrobial Resistance has killed more than one Million People worldwide and infected many more, the true extent of the problem is not known because the data here in the u. S. , and overseas, is not complete or timely. Second, there are limitations with test for diagnosing antibiotic resistant infections. Rapid and accurate diagnostic tests help doctors identify cases of resistant infections and help them to know which antibiotic to prescribe. However, more studies are needed to develop tests and encourage their use. Further, because bacteria are always changing, their resistance to antibiotics also changes. Therefore, it is important to monitor test, update them to ensure they can accurately detect resistant infections. According to experts, the pipeline of antibiotics is insufficient to tackle this growing threat, notably because of the inadequate return on investment for drug companies. This is concerning because we reported in 2020 that no new classes of antibiotics approved for human use had been approved since the mid19 80s by government incentives. Experts believe there may be potential for other incentives, particularly those that would help newly developed drugs remain on the market to reduce costs and potentially save lives. Some experts believe nontraditional therapies are promising. Finally, more is needed to promote the appropriate use of antibiotics. The who has warned that the world urgently needs to change the way antibiotics are prescribed and how they are used in order to preserve their effectiveness and help slow their development of resistance. However, federal efforts to promote appropriate use are limited. For example, reporting on antibiotic use has, today, only been required for v. A. And dod Health Care Facilities. Greater reporting and monitoring are critical because behavior can be challenging to change. For example, a doctor may feel pressured to prescribe antibiotics to satisfy patients demands even when its not warranted, such as for a viral respiratory infection, which we know the antibiotic will not work. , as we emerge from covid19, while it is fresh on our minds before a new crisis emerges, i want to share some parallels with Antimicrobial Resistance which may help us understand the importance of preparedness for a Public Health threat. For example, both are complex global issues exasperated by supply disruption, poor hygiene and a lack of critical countermeasures. Enter data and diagnostic tools are needed to understand the magnitude and monitor progress. Public private partnerships, investments in innovations drive solutions. Clear communication and education are key, and finally, action saves lives now and for our future generation. Chairman 10 Ranking Members, this concludes my prepared statement, i look forward to our discussion on this important mission. Thank you so much. You are now recognize for your five minutes. To the chairs and to the Ranking Members and the other members of this committee, subcommittee, good morning, im professor of law at boston university, im the executive director of the global nonprofit accelerator for antibacterial innovation created under the u. S. Plan. I spent most of my academic career on the topics we are discussing today on thank you for the opportunity to speak with you. Americans rely on effective antibiotics and antifungals. Every hospital in your district, every cancer patient, every new mom that gets a csection, and even people my age thinking about hip or knee replacement, all of us depend on antibacterials and antifungals to enable modern medicine. The resistance is eating away at the miracle despite rest eating away at a bridge. In this market is really broken. Fda approval should be a celebration, but for new antibiotics, the payday in celebration never comes because the resistance. Doctors are doing the right thing by being careful with the newest antibiotics. They put them on the shelf hind glass like a fire extinguisher, the Fire Extinguisher Company gets paid the moment that fire extinguisher hangs on the wall, you get paid at the moment the preparedness starts, not when the fire starts, but for antibiotics we pay for them only after the fire starts. A new drug that is it used much in the early years cannot make money. In the last decade, seven antibiotics have come to the market sponsored by Small Companies. All of those companies, 100 of them have gone bankrupt or the economic equivalent of their r d investors losing their shares. Even after approval from the fda. No wonder that every expert report agrees that the pipeline of antibiotics is in terrible shape. Theres a couple dozen antibiotics in the pipeline being tested by humans. More than a thousand for cancer. Cancer does make money. Future cheers are always moving towards the patient. They lose money with the predictable results in innovation. Now is a great time to respond to this National Security crisis. We must change the way we pay for antibiotics. After more than a decade of this problem, the wealthy governments of the world are creating antibiotic to reward innovation while allowing the antibodies to be used carefully. If congress creates a Subscription Program and americans will get the new antibiotics we need, they will be sitting on the shelf ready to go, like that fire extinguisher and the companies will also get what they need, which is not bankruptcy. Antibiotic subscription should be crafted to ensure that taxpayers get a good deal. They must focus only on the most promising new drugs that required size of these antibiotic subscriptions as well understood, as well as the fair share that other wealthy countries should pay. Prescription payments can start at an appropriate point and increase over time if stronger evidence is presented on the importance of the new drug. Subscriptions will be remarkably good value for the u. S. Taxpayer. Global development, forecast financial return on investment for americans of six to one over a decade. From recent data that i published in a nature journal, we know that a u. S. Subscription was cost last than what we spent on antibiotics just a few years ago. This is affordable to do what we need to do because we did it ourselves five to 10 years ago. Its time to invest in the future of antibiotics again. By restoring common sense of the market of antibiotics, prescriptions will bend the curb towards innovation, globally the Health Impact of the Prescription Program is remarkable. 9. 9 million lives will be saved over the next three decades and an amazing legacy. I know all of this not just because of my academic work, i know it because in a sense ive seen the future. We see the most promising antibiotic candidates 10 to 15 years before fda approval. That future is bright so long as you continue to support incentives and complement them with a new poll incentive like the antibiotic subscription. I know is not legislative hearing but the example would be this acts. We mainly work with very small start up companies with highly Innovative Products, including three phases, many diagnostics, many first in class products. A dozen of these companies have initiated human testing, which is really the measure of our success. The incentives are working but the Companies Need a future other than bankruptcy and a Subscription Program will finish the job. It is bad today and will be worse tomorrow if you want a steady stream of innovation, lets do something about it, i think the path is clear. Thank you for your time, i look forward to your questions. Now recognizing here five minute opening statement. Your five minute opening statement. For inviting me to testify. We represent over 12,000 in positions and other Health Professional specializing. Our members are seeing more patients resistant. s ear mike functioning . Is the light on . Its on. Can you get a little closer to it. Click sorry. Thats all right. And the gets working, hang on. That worked. I think its good you start again so that we get all recorded so wouldnt they replay it, people can hear it at home. Lets see if we could switch microphones for you. Our highly skilled Technical Team down there. Go ahead. Take three. Ranking members, hello and distinguished subcommittee members, thank you for holding this hearing and for inviting me to testify on behalf of the Infectious Diseases society of america. We represent over 12,000 Infectious Disease positions physicians and other Health Professionals. Our members see more and more patients with resistance, sometimes impossible to treat infections such as the report earlier of an ongoing outbreak of bacteria at a Washington State hospital that impacted dozens that resulted in four deaths. I will describe challenges in one Health Policy opportunity to ensure we have the tools to combat. Including novel and i bike rovio, Stewardship Program and an expert workforce. In a microbial resistance, the ability to resist to evolve to its resist antimicrobial drugs. While resistance occurs in nature, antimicrobial misuse needs up resistance and they are unlike any other therapeutic in that used in one individual can impact efficacy and the rest of the population. In 2019 an estimated 1. 2 7 Million Deaths worldwide were directly caused by amr and amr played a part in nearly 5 Million Deaths. Antimicrobials enable modern medicine because so many of our medical advances, cancer chemotherapy, organ transplant, csection, wound and burn treatments all carry a risk of infection. The Opioid Epidemic is fueling the spread of resistant infections. Cdc estimates that individuals who inject inject drugs are 16 times more likely to develop a marseille infection. It is impacting healthy individuals in the community. An ongoing outbreak of eye infections due to contaminated eyedrops cause blindness and death in several patients. Amr disproportionately impacts historically marginalized populations. National Health Care Costs are in the biggest amr threats are estimated to be more than 4. 6 billion annually with 1. 9 billion of those cost estimated to be borne by medicare. Amr was further exacerbated by covid19 in 2020 u. S. Hospitals experience a 15 increase in amr infections and deaths. Emergencies like outbreak, pandemics and hurricanes and bioterror attacks all create ripe opportunities for the spread of secondary drug resistant infections. The current antimicrobial pipeline is insufficient. Antimicrobials must be used just asleep to limit the ability of resistance which limits the return on investment. This broken market has resulted in Large Companies leaving the market for Small Companies who have developed new antimicrobial bankruptcy and prevented prominent trucks from getting the patients. We must ensure the optimal use of antimicrobial period in 2020 about 80 of patients hospitalized with covid received antibiotics despite covid being caused by virus. Even before the pandemic half of hospitalized patients were prescribed antibiotics the 50 of those prescriptions being estimated as inappropriate or unnecessary. Antimicrobial Stewardship Programs aimed to ensure that patients receive the right drug for the right bug. They improve patient out on lower Health Care Costs. All many hospitals can meet the stewardship requirements on paper, they often lack the resources to extend the benefits of stewardships to all patients. The Infectious Disease work first that is needed to care for patients with resistant infections is in crisis. Nearly 80 of counties lack position. 56 of Training Program still filled in 2023. The barrier posed challenges tidy recruitment. They are among the lowest paid medical professions and high levels of medical student debt leave them going to hire specialties. Congress must take steps to ensure the availability of an expert workforce by addressing medical student debt, improving reimbursement and providing sufficient resources for training. Congress can also revitalize antimicrobial innovation by praying for the value of antimicrobial drugs instead of volume under a subscription model approach like the bipartisan act, which would support antimicrobial Stewardship Program. Nontraditional therapies may also have a very useful role in treat resistant infections in Additional Research should be pursued to inform clinical use of therapy. They are deeply grateful for the leadership on amr and we look forward to working with you to address the needs. Thank you. Thank you very much, we will take a brief timeout to change microphones for you. Maybe yours will work next time. Apparently we have an infected cable. We are used to dealing with the unexpected. [laughter] stanback, make sure that dr. Mathers microphone works. Sounds good. Lets go ahead and finish our Opening Statements. If you need more time to work on that that we could do that after. Thank you. Dr. Mathers, you are now recognized for your five minute opening statement. Distinguish members of the subcommittee, thank you for holding a hearing on amr and inviting me to testify. Im the director of antimicrobial stewardship in the microbiology at the university of virginia. I am here today recommending microbiology asm with 30,000 members it is one of the largest life science societies. Clinical practice, Global Health programs and policy is a top priority for asm. As an Infectious Disease physician who sees patients with serious infections, i motivated by the harm amr has had on many other patients i care for. This hearing is very timely as i see first several types of amr bacterias and fungi that are emerging and reemerging in the wake of the Public Health emergency. In my clinical practice story i work with other physicians, pharmacists and hospitals minimizing the selection pressure from antimicrobial overuse. I am a scientist. My expertise is detecting and tracking amr in my Research Works to understand where amr pathogens originate and how they spread in the most zero places like hospitals. My colleagues and i do this by collaborating developing novel interventions to prevent transmission, developing genomic technologies to better detect and understand amr emergence. Utilizing diagnostic tools to treat infections and curtail overuse. Given amr is one of the most daunting Public Health challenges facing the u. S. In the world, i believe there are four elements crucial to addressing amr. First, investments in basic transfers to addressing amr as there are Large Knowledge gaps in the emergence and transmissions. Variants emerge from a single species. Genes can now between bacteria is in species strains that adds a great deal of complexity. They develop a variety of pathogens and resistance may be exchanged between pathogenic and nonpathogenic bacteria. Infections have emerged more recently and posed a serious threat. Perhaps the most example is the rapid spread and Health Care Facilities which is considered an urgent threat. Second, antimicrobial monitoring and recording with the focus on pathogens, both in the u. S. And globally, will be critical in addressing gaps. The Public Health Academic Partnership to adopt technologies and improve data use through the network will be huge fully helpful. As an academic partner in the network for virginia, many of our projects focus on cutting edge tools from emerging amr pathogens, as well as exploring wastewater potential as a surveillance 248 tool for amr. Improved diagnostics is critical in preventing the continued use of antimicrobials as well as maximizing the treatment of patients with amr infections. For example, i recently had two unique patients come, both with severe bacterial infections requiring icu care. Both were prescribed powerful antimicrobial while we had to guess the type and reinfection that each one had while waiting for test results. One patient was exposed to antibiotics for three days before testing showed a more targeted antibiotic would work. The other patient had a bacteria that was highly resistant and did not get effective antimicrobials for almost two days. We need investment in research and Rapid Diagnostics to increase overuse and target pathogens when needed to treat infection. Another ongoing issue with diagnostics his personal shortage in the laboratories. We need to recognize and incentivize people to pursue it as a career, adequate personnel were allowed for the increase adoption of current improved laboratory process, including the breakpoints to optimize prescribing and detect amr. Testing antimicrobials at adoption of newer technologies that can streamline prescribing. We need more people postpandemic. In closing, asm, asm and i want to thank you for testifying at this important hearing that affects all of us. We look forward to working with you and your colleagues to advance policies that will enable us to address the challenge of amr head on for the benefit of all humankind. They queue very much. Thank. Let me apologize on that that half of the committee. The team is working in front of you and at one point they popped up in front of you. The fact that you kept your composure is remarkable. So we appreciate your patience. That being said, i appreciate all of your testimony and thank you for being here and it will move to the question and answer section of our hearing and i will recognize myself for five minutes. You all are the experts. Probably wondering why we finally paid attention to this and its not just me, but others were interested. I got hooked a few years ago. For those at home that may not understand this, this is a great romance story with a medical mystery wrapped all around it. Its good stuff. For those who dont have time to read the book or figure it out on their own, could you please share with the committee and with those at home what it is and there has to be an effective tool to combat amr or be an alternative to where those cases are needed . We think it has a great deal of progress promise, but theres not enough known about it. Most of the information comes from reports selecting it through compassionate use cases. In most of those cases it is used in addition to and in concert to antibiotics for infections that were not responding to antibiotics on its own. It has sort of an additive effect. But what clinicians really want are more robust studies to help them understand all the different kinds of indications where we can help us better understand how it can develop. That happens is well and help us understand the optimal dosing and duration so that we can really make sure patients get the great incentive. Its an area where more research can fill tremendous benefits. In the book that i just referenced, thomas pattersons wife was of rolla just to had all kinds of medical folks and they did use a cocktail of antibiotics. In the end they found a virus that attacked the shell of the bacteria that was causing all of these health problems. They found the bacteria that cracked the show but they still need the anabiotics to kill the bacteria off. That being said, let me ask you this, because this is one of the problems that we have, and im glad the fda granted them compassionate use in that case. We are so used to having Clinical Trials that so many of these amrs are one offs or very rare. Clinical trials are going to work for a lot of these fixes. We can get more creative with our approaches to Clinical Trials. In addition to Clinical Trials, simply having one central database where anyone who is using it in a compassionate use setting can report that data, and making sure we are reporting not only the cases where works, but also the cases where it didnt work. Sometimes we learn as much from our failures as we do from our successes. I believe there is a Clinical Trial for the therapy that is starting to get up and running. We are hopeful that we will have more information soon. On the anabiotic site, yes, Clinical Trials are difficult, there are enrollment challenges, but they are possible. The legislation included provisions to streamline and improve Clinical Trials. Its really the economic challenges that are the biggest barrier right now. This committee is always proud. Professor, youve been wanting to jump in, jump on in. We support threephase companies. Its the most concentrated support anywhere in the world. High wind and say that they are moving into Clinical Trials, and it would be interesting for the agencies to make sure they are well supported in that endeavor. I noticed the comments and funnel the author well. I would encourage you to have a hearing because the stories that they tell and people like them are remarkable. We are working to have that happen but this is step one and obviously theres more than just that. In the book theres a lot of things that each of you have touched on. Did you want to jump in on this . I apologize if i dont have time to get to you. Very quickly, the question about Clinical Trial is really important, but i think the day of penicillin, finding another penicillin or a magic bullet, if you will, antibiotics coming through from the 50s into the night into the 1980s and coming to markets, those days may not exist. They may not come together in a different way than the historic Clinical Trial to treat resistance and to actually get drugs to market. It is important before i yelled back, it is important we get these things to market particularly when we dont have anything else that might work. I note that they died of tuberculosis six to eight months before antibiotics were available. I yield back and now recognize her for her five minutes. Thank you, mr. Chairman. And things to our witness. I want to focus on two important factors identified by the experts here today and seeing a central parts of the approach to the amr diagnostics and surveillance of arming doctors with better diagnostic tools that can allow them to remove more targeted care to the patients. In your testimony you say this, diagnostics have a central role in preventing, detecting and combating amr and practicing antimicrobial stewardship. Went improvements in diagnostic tests[ are needed and how they help doctors provide better care . [simba] [standby] the Collateral Damage of resistance selection is occurring. If we can move the clock back and have more rapid diagnostic, that would be helpful. I think theres a couple of Different Things. They look at diagnostics, but investing in diagnostic technologies in research and development in moving the clock backward. Some of it may take a vantage advantage. One of the important things was data gathering and surveillance gathering to respond to a Public Health threat. They found in the 2020 report that cdc faces challenges for antibiotic resistance and he made recommendations to improve Public Health data. You notice that the cdc has made some progress, but they remain open. How can improving the quality of reporting critical information to the cdc improve the u. S. Response to amr . We recorded that the data is neither comprehensive nor complete. This is the case if you have data that voluntary. A lot of the data coming in is required only for certain organizations, for example, the v. A. Or dod because of the type to the federal government. If you have something optional or you have hospitals that are already taxed and short on resources, being able to get that data, even if they could do it through the federal government is very challenging. And there is some promise out there, its an understanding that legislation will come into effect in 2024 with hospitals to improve their Data Collection, which will definitely help. I understand across the data reporting enterprise for local Community State hospitals, its just so outdated in the congress provided significant funds by not having to do it by fax machines, so what is your recommendation for us to continue focusing on this and providing Public Health interests, the ability to report in the modern and efficient fashion . As i mentioned, there are a lot of parallels with what we see with antibiotic resistance, with what we sow with covid. So not losing the gains we had, we already lost some of the developments we had with Antimicrobial Resistance with the pandemic, the number of resistant infections going up. When you have more people in the hospital, they have an opportunity to spread and infections rise, making sure we dont lose the gains that we already have, many of our recommendations went to hhs. They have to get a better understanding on how much information is enough to know what the magnitude of the problem is to track the progress. For example, if covid were to come back, it would be disheartening if we werent able to know when are we done, when are we out of this problem. So we have a recommendation hhs and we urge congress to not lose the gains. Gentlelady yields back and recognizes the committee. According to the Congressional Research service, there are over 10 committees and programs from the u. S. Government, including five separate interprograms that are specific to our include Antimicrobial Resistance. Thats that. Eight different offices and agencies within health and Human Services cdc, fda, nih and the office of global affairs. Each one of these has individual ongoing work on amr, and this is in addition to the multilateral efforts that the u. S. As a part of an international. So i wanted to start, head ga gao examined the coordination and collaboration among all these efforts for at least the sharing of Lessons Learned. . We have. We are happy to report that because there is a president ial task force and there is the task force among the federal government and within hhs they are currently seeing that with a rotational leadership capacity between usda, dod and hhs. Hhs is the lead within that they have the coordination. From the standpoint, we also look at leadership. So we have looked at that, we did make a recommendation about how to better coordinate. In one particular aspect we talked about diagnostic tools and resistant infections and making sure theres not a lot of fingerpointing and who would take a leap to ensure we have the studies needed to show that using diagnostic tests have had positive outcomes. You references because i was focusing on health and Human Services and the programs there, and there were seven different usda offices, amr programs in other departments such as dod, state department, usaid, v. A. And the department of interior. Would you speak to how well the federal government is doing with a problem like this when the science is so many departments and agencies responsible for the strategy that i think you were talking to a little bit, who can be held accountable and how can any progress, Lessons Learned versus assesses be sure to probe learned or successes be shared appropriately . We do have leadership, which is extremely important. This is a complex issue and we are pleased to see that we are taking a one health approach. This is a problem of agriculture. We give jerks our animals in a preventative measure. We give drugs our pets, it happens in the environment and resistance occurs naturally. That coordination is key, and the fact that we have task force that are able to do that coordination across the government is very good. You had mentioned lesson learned. One of the recommendations we did make issue not only need to report on the progress, they do report yearly on the progress to the president , and that they are making, but you need to as the doctor said, you need to also talk about your failures. What cant you do . Thats why we dont make the progress that we need. We need to own up to that and say, heres what we need, and we do see in the budget this year, at least mentioned, some need for direction. Is a followup to that, in your testimony you discuss how you havent taken significant steps to address uncertainties around estimates of resistant infections and creating timely comprehensive reports on antibiotic resistance. Would you tell us do you want to elaborate more on the efforts to achieve that and the consequences of not achieving them . The agencies disagree with the recommendations, they are working on them and understand the importance of it. It is a complex issue, not only one that impacts United States, but we are global. Covid19 pandemic showed us that. More is needed. The rule is promising having hospitals require reporting is quite important, but we also dont have an understanding of whats happening in our community, and we have mentioned the fact that we have covid complicated the number of recent infections, but a lot of people werent even going to the doctor. I appreciate that, i just want to highlight that theres always fiscal concerns and programs always request more funding, the 2020 report outline certain funding provided has awarded 959 million in grants, agreements contracts for developers for drugs in 2010. They funded 47 programs crossing up to 143 million. I recently signed a letter regarding the one billion dollar Public Relations and communication. One billion dollars, perhaps nih could do a better job allotting funding that already should be put towards fighting this ami problem. I yield back. Thank, now i recognize the Ranking Member of the committee. Democrats in this committee have long prioritized a holistic approach to response and over the past two years in particular we have taken steps to foster a resilient Public Health workforce to protect disproportionately impacting communities and empower researchers to understand how Infectious Diseases spread. Public Health Preparedness requires the congress and the American People encourage rather than stifle beneficial research and build trust in our Public Health institutions rather than tearing them down. Let me start with dr. Mathers as we emerge from the covid19 Public Health emergency, what are some of the lessons we could take away from the pandemic to better tackle challenges like Antimicrobial Resistance . Thank you so much for the question. I think theres a couple of things that i take away from it. First off, we are seeing emerging antibiotic resistance postpandemic. The cdc has inconsistent data, but from the data we do have, there is emerging resistance and some of the most resistant pathogens, especially those for hospitalized patients, which says, what we were doing and how we were able to dedicate the same Resource Resources that had to be managed manage the Public Health emergency in the hospital and Infectious Diseases were at large, it was working to prevent the emergence of antibiotic resistance. There were several areas we were making progress, and now that we took the eye off the ball, we are seeing in our hospitals, like in my hospitals i see antibiotic resistance that i havent seen in years and in a way that its affecting patients post Public Health emergency. What we were doing was probably working. I think that yeah. I think that the other things that we need is we need to he has kinda come across year, we need to preserve the antibiotics we have with stewardship and diagnostics, but also to come up with new antibiotics. I have agents to get patients. Within the last month ive had a patient that expired from an untreatable antibiotic infection and this is happening in hospitals right now and i need new antibiotics, and maybe what im alluding to, it may not need that we have another super antibiotic or magic lit, because the bacteria has developed armor for the antibiotics we have that we need multipronged approaches between all the different technologies to treat antibiotic resistance. Lastly i will say surveillance would be hugely helpful, patients transferred from other hospitals, i dont know what their position looks like up the hospital because we dont have a central repository to really commute get about antibiotic resistance emergence, even at a state level let alone a federal government level. Theres huge gaps and where are the problems and theres a researcher trying to understand where should we put our effort, i dont really know or have resolution on what the biggest issues are. Let me ask you one more question because we are almost out of time. One of my concerns coming out of the pandemic is that the public has lost trust in some of our Public Health institutions and doctors generally. Can you talk about the importance of patients trust in their doctors and medical institutions when dealing with these issues . Quick some not an expert in this, but i could tell you personally i feel it, i feel mistrust from patients and it feels like somebody elses at the bedside. Theres just a lot of misinformation thats been out there that has impacted trust thats making it harder to take good care of patients, and rightfully so. We had a novel virus and a lot of people didnt know what to do with it, including myself, so we had to change course many times and that caused mistrust because we over promised under delivered in so many areas as a medical community. I think its a big issue, and i think Antimicrobial Resistance is such a complicated issue, it doesnt fit the soundbite, so its going to be really hard to communicate for how this is so important and how its affecting the individual. Maybe its almost too late. May be i worry because as i said earlier, we have these challenges that are basically telling people when they should take take things, when they should not, and if they dont trust the doctors are the health institutes, they wont listen. Thank you so much. Thank you. Now i recognize representative got three for five minutes of questioning. I appreciate the recognition. Tuna half years into the National Plan combating bacteria. Could you give us an update on the plan and focus on the first National Plan released in 2015 indicated there were six milestones achieved. And would you address where we are in the plan and how we will ensure we effectively address the milestones we want to achieve . The new plan came out after we last reported so we have not done a deep analysis on that plan. Its our understanding that they are behind in doing the progress report, so we will be reviewing those as part of our recommendation follow up they do come out. We want to make sure we meet the new milestones, would you commit to working with us in the committee to ensure that we get to this point. How does decide which products to invest in and why . Since 2016, how many products that have been funded have reached the market and what are the specific products on the market . Thank you for the question. They make the decision based on a review committee. We always pick based on what we seek is the best signs. We evaluate across the portfolio using a Portfolio Risk and value tool because we want to take many shots and quite early we do translational work and its out of the university into a small start up company. Our deliverable is to result in products that are completing their first Clinical Trials. At that point, the followups or groups by 70 action fund and other investors. Today we had 12 therapeutic products that have gone into human Clinical Trials. Of those, none of the therapeutics are anywhere near the approval, thats probably another five to eight years away. But two of our diagnostic products that we supported are actually on the market in europe were not yet approved here in the United States. So you have been supported by nih, Infectious Diseases at nih. Kinnear outlined specifically how this money had been used and what successes there are to show for it . In areas of anything. You always look at needs for improvement, rooms for improvement and what are your plans for improvement. One of the things we receive right now is 40 million u. S. Dollars per year. We have other charitable foundations that support the company. Barda is less than half. The nih provides free Clinical Services to companies and it does not fund us directly but they collaborate with us. The program the goal is to radically enhance the quality of the pipeline. As we heard from many witnesses, the clinical pipeline today of things weve seen with recently are not new classes as the witnesses have said. In the therapeutics, almost everything that we supported is an entirely novel class. It would be the first of my lifetime to make it, or a new method system of action, or something that sonu theres not even an established fda path. Many of the products that we support our two out of the three in more than a dozen are three out of those three. So we are taking highrisk, high reward and our goal is to deliver, through first in human thank, getting back to barda, there was not hundred 50 million provided. How does carbx benefit from the by a reserve fund . I dont think that carbx receives money from the bio shield fund. All of the other money goes to programs at barda including their phase two and phase 3 programs. The i o shield program has funded to Antibiotics Companies with that program. That has been publicized, that is separate from carbx. These are companies that are on or almost on the market. My time is expired, i guild back. I recognize the gentleman from new york. Thank you for bringing attention to an important topic. This was a topic close to the heart of the late congresswoman, the only microbiologist in congress, she raised the alarm on antibiotic resistance. I hope we can continue to work on this issue that was built on her legacy. Each of you here today has talked about how this situation is getting more dire, that his why federally funded research is so important. I heard from a family in my district who knows how urgent the situation is. Have a sixyearold who is diagnosed with Cystic Fibrosis when he was a newborn. He is a funny, athletic and intelligent kindergartner. He is the heart of their family. The family feels fortunate for the breakthroughs, but he has had two bouts with respiratory and lung infections that required antibiotics to fight off the infections. Antimicrobial insistence Antimicrobial Resistance is a fear for their family because it is a likely issue they may face if he becomes resistant to the antibiotics that fight these infections. Recognizing the magnitude of the threat, president bidens budget for fiscal year 24 includes increased funding for Antimicrobial Resistance and modernization efforts, to increase funding for bio shield. What do we need to do to more efficiently translate this research into treatments for those who need it most like my constituent . Thank you for the question, thank you for remembering the congresswoman. The community is remarkable, i have spent time talking to these individuals. It is shocking that the new drugs they are not dying from Cystic Fibrosis anymore, they are dying from resistant infections. This is a tragedy, i have met and talked with many of these people. Why have to have entirely new classes and approaches to restock the pipeline. We had a wonderful drug, we would love to have a drug that good again. Its hard to do it without taking radically difficult scientific approaches. The companies, given how little money is to be made, they typically stay within known classes and focus on things that are small improvements. Carbx, we take the 40 million a year and match it with other governments, and we invest in things that are radically novel so that 510 years from now, we will have options for patients like this young man. What benefits have federal investments and partnerships between the federal government and academic institutions brought about in addressing Antimicrobial Resistance . In my own experience, cdc has funded us to understand transmission of highly resistant bacteria within the hospital environment. If funded research and successfully developed interventions to prevent the spread of microbial resistant organisms from the hospital government to patients. That has been one successful funding effort. There has been important developments in the wake bill lee do susceptibility testing. And partnership between the way that we test bacteria, that was helpful in making sure we were updating and adopting breakpoints available on new science so they can be used readily in labs across the country. That has been important and funding. Most recently, with the the complexity around antibiotic resistance tracking in genomics and the way the bacteria exchanges resistance genes is complicated. That effort is getting going, the partnership will bear fruit. I hope there is hope on the horizon in terms of battling Antimicrobial Resistance. Thank you for your exchange here , its important to get updated. I yield back. Recognizing the gentle from florida for her five minutes of questioning. Thank you to our witnesses. I hope i pronounce this right. A good win on friday. My home state of florida, hurricane readiness and response are significant issues. Youve noted how it resistant infections can impact our Response Time to National Disasters like hurricanes. Can you tell us about the connection between Antimicrobial Resistance and Natural Disasters and how we can be better prepared . With hurricanes, there are Different Things that can happen that can trigger an increase in infection. When we see loss of activity, we see increased food spoilage and infections. When we see decreases in access to safe water and flood water, we see more infections from waterborne pathogens. When people need to leave their homes and go to emergency shelters, they can be crowded, thats an easy area for infection to spread. Many infections can be resistant. Even when they arent, individuals are given antibiotics, which fuels future resistance. Wildfires, serious burns can easily become infected. As we think about preparedness for Natural Disasters, we need tools to deal with infections, we need novel antimicrobial therapies and experts who know how to use them, who can figure out quickly, hours matter in Infectious Disease. You can figure out quickly what they have and the most effective treatment. Taking it from a Natural Disaster to a National Security threat, or global incident. He talked about the ways in which Antimicrobial Resistance could lead to a National Security crisis. We were alarmed with some of the things we are hearing today. When you think of it on a massive scale and how it could lead to the proliferation of an Antimicrobial Resistance, can you share how it is a threat to National Security . And what we need to do to be better prepared on a national and global scale. Terrifying as it is, pathogens can easily be weaponized. The pathogen can be engineered to become a more resistant and weaponized. If a bad actor work to weaponize and Antimicrobial Resistance pathogen and spread it, we are not prepared, we dont have the therapeutics we need, the diagnostics we need, as many Infectious Diseases experts. Even getting away from bioterror, and eat mass casualty event, a lot of people in a hospital, that can be any kind of terrorist attack, another pandemic. If hospitals get overwhelmed, we see infections flourish. We need more tools. It is getting scarier as we go through this. [laughter] it is important, im going to shift to you. Your report discusses areas for addressing this issue, amr. Surveillance, testing, treatment and stewardship. Which is the most important and what should we be prioritizing . I cant tell you which is the most important, they all go handinhand. This is a one health approach, it is complex. If you create a new antibiotic, and you dont have judicious use, you are just going to end up with resistance again. You have to understand the magnitude, be able to track the spread. The gao, what has the government done to combat amr and how successful has that been . I want to give credit, there has been a lot of work. There have been taskforces, it is critical, it is something the gao feels strongly in, and continuing this attention. The report came out in 2020. Being able to bring this to light, this is a pandemic, it is a Public Health threat. They have many efforts underway. There are more things that need to be done. Need that her diagnostic tools, we need them to be able we need doctors to use those tools. When someone walks in with a screaming baby, and they say they have an ear infection, and the doctor only has a few minutes, are they going to take the time to decide whether or not they are giving the right antibiotic. Its complicated and there is a lot of things, more is needed and we continue to track this. My time has expired, i yield back. I want to thank our witnesses, this is very important. This has been a difficult morning with votes, im happy event you are here with your expert testimony. I have throughout my life focused on older americans. It was no surprise to me when the cdc pointed out that medicare patients were most likely to die from drug resistant infections in american hospitals then any other group. Wanted to ask dr. Matthews, or any of you, are there any precautions, protocols, that should be in place in hospitals right now that would be more protective of older patients . Thank you for the question. The Geriatric Population is of interest to me, they are vulnerable to Antimicrobial Resistance. It is important in antimicrobial stewardship, one of the groups i worry about the most in the hospital. Especially because of a certain infection, it is related to antimicrobial overuse. Unnecessary antibiotic exposure can disrupt the gut flora and allow them to become vulnerable to this infection that can cause death. Elderly patients are moral more vulnerable to it. My day to day work is trying to make sure we are not overusing antibiotics in the Geriatric Population. Back to the importance of diagnostics, it is really a urinary tract infection or some other infection that may be mimicking symptoms. More research has been coming out. It goes back to we need experts to diagnose, work with the new diagnostics to make sure we are diagnosing and using antibiotics properly so we dont overuse them and put them select for resistance. I appreciate the question. Did someone else want to answer . I would expand, the protocols that are needed, antimicrobial Stewardship Programs, they are typically required but are not used appropriately. We saw studies showing gaps between Staffing Levels and the Staffing Levels that we had. Thats a major academic medical center, its worse when you get into rural hospitals. They cant hire people. We hear open positions for months for Infection Prevention nests, clinical lab personnel, we need to incentivize people to go into these careers. There was a milestone yesterday, the first micro biome therapy for recurrent was approved by the fda. It got lost in the news. It is a remarkable first in class approach. That company has been working on that for more than a decade. Carbx supports a more advanced version of their product. It takes time to get these things done. Many many people who die of a resistant infection, the death certificate does not say amr. Until we collect the data to know how many people are dying, we wont respond appropriately. I want to say that overall, arent we using too many antibiotics, especially for seniors, is this a yes . Unfortunately yes. Yes. We need better data on use. I yield back. I recognize the gentleman from texas. Following up on that last question, is anyone on the panel and md . When you are treating a patient, you are treating that patient, not a population. The expectation of that patient and their family is you are going to get them better, you are going to use every tool at your so if ash disposal. The argument that we are holding this back, so it might benefit someone else later on, doesnt fly in clinics. I appreciate the question and i agree. My job, talking to physicians about these things and patients about difficult discussions. You have to be a good doctor to know when you can hold back antibiotics, diagnostics would help, if we could tilt viral from bacterial infections sooner. As well as working with patients to talk through and educating doctors. Maybe we dont need, even if it looks like an inflection it doesnt require antibiotics. Working with my doctors, i go on rounds, trying to help and educate other doctors. Theres not enough people trained like me. Its a good point. I always want doctors to treat the patient in front of them. I support back. I need to support them. We have had hearings on this subject multiple times over the years. I always learn a lot. I have to remember the father of our country died from what began as a pharyngitis and turned into a abscess. Antibiotics would have been lifesaving. There is nothing more exciting then when you save someones life with antibiotics. I want to preserve those so that the next generation of physicians and patients can benefit from them. I think each of you for being here and your testimony, if i could ask you, i represent a part of texas that is outside the area where you think of San Joaquin Valley fever. Are the things that are going on now in your world that are working on Fungal Infections broadly . I grew up in texas, i spent 18 years there, i have never heard of valley fever in that time in texas. Valley fever and other Fungal Infections are rising in focus. People understand now. A Fungal Infection are on the cdc threat less. People are taking it seriously. For carbx specifically, our authorities from barda limits us to bacteria at the moment. Are there Lessons Learned from other countries that could help us in these decisions . The key lesson is if you want a new drug to treat an infection today, you need to have started it 10 years ago. We need Serious Research efforts today. I was talking to a patient advocate on valley fever, he suffered from it personally. Its a much more serious condition than the average people in the public understand. We need to respond to it with the same level of seriousness. We werent we were talking about this 10 years ago. We have not done the follow on that is necessary. Maybe this year will be different. You mentioned diagnostic tests. Everyone is now more familiar with diagnosis diagnostic tests. How can we encourage the usage before prescribing an antibiotic . Good diagnostic tests need to be available and making sure we have the workforce to run good tests. We have a shortage, we have had openings in our micro lab for since 2020. We need people going into a career in medical microbiology so we can give the result, and give timely results. Research and development and diagnostic testing is also needed. I will yield back. One of the concerns about having this hearing was a folks were afraid everybody would want to blame the doctors and the doctors are trying to cure the patients problems. Thank you for that statement. Antimicrobial resistance is a problem here at home and around the world. Resistant pathogens do not care about geographical borders. You must make sure we address this issue, not just in the u. S. But locally. The World Health Organization reported in 2014 that a post antibiotic era, and which, in infection and minor injuries can kill is a very real possibility for the 21st century. It declared Antimicrobial Resistance one of the top 10 mobile Public Health threats. How does global collaboration improve our ability to tackle this problem . More than half of the funding from carbx comes from outside the u. S. Government. It is the u. S. Government, the united kingdom, and germany. This is a global problem, we make our decisions at carbx, looking everywhere. The best way to know what might threaten a u. S. Hospital today is to visit a hospital in india or pakistan or some other place. You will see the things that we will be seeing in a short. Of time. Or we could see today from someone coming home on an airplane. What Tom Patterson almost died from, he contracted it in egypt. It has to be a global response, you have to work together. Have they identified areas where the u. S. Government could better engage with International Partners to address the increased spread of amr . We have, we do believe in part of our methodology to go over and speak, we met with the who and members in the united kingdom. We believe that Global Engagement is very important, we continue to track them. They turned to us as leaders. If the u. S. Doesnt take action, the other countries get worried. I know we have Infectious Disease doctors on the panel, one of my medical School Professors was dr. Paul farmer. Very few people have access to the most basics basic antibiotics period. At the same time we are trying to limit its use, its improper use, in these areas which pose a big challenge, especially in the most underserved settings. As in many other areas, there are workforce challenges it in place. There is a shortage of Infectious Disease physicians, are there special regions that are most in need of doctors . We know that nearly 80 of counties in the u. S. Do not have a single Infectious Disease physician, the shortages are worse in rural areas. Looking at the future, we are not training enough. The most recent match, only 56 of Training Programs filled their positions. That is not true across other medical specialties. Most specialties are filling all or nearly all of their programs. This has to do with financial challenges. Infectious diseases doctors earn less money than general internal medicine physicians, despite getting training. How do investments contribute to better prevention for amr . The question is timely, we need Infection Prevention personnel, epidemiologists and clinical microbiologists. We have two problems with the physician shortage crisis. I live in communities where i did research, we had a fulltime equivalent physician, one for over 9000 residents. We also had a crisis of distribution of physicians. We dont have a Strategic Plan or idea to help create the incentive for where we need the doctors and where they are needed the most to be able to increase access for the American People who need it the most. Its something i would like to work with the committee on establishing so we can take a birdseye Strategic Plan to help address critical areas in the provider workforce that would make a big difference. Thank you, i yield back. I recognize the gentleman from alabama. What can we do to improve communication between Health Care Facilities and to prevent the overuse or over prescription or misuse of antibiotics . The federal government has taken a variety of steps to try stewardship, the usage of antibiotics. There are barriers, the data is not sufficient, we have to be able to understand the question earlier about the use, how much is being used, where the infections are incurring occurring so we can tailor communication to those areas. Agriculture doesnt want the finger pointed at them, Getting Better data will help us to say with certainty where do justice judicious use is needed. The reporting, whether it is a rural hospital or a Major Hospital . When they discovered the antibiotics are not working as they should, do we have a rigorous reporting requirement that would allow you to accumulate data . We do not. The reporting requirement are for the v. A. And dod hospitals. There is new legislation that hopefully will get under reporting from the hospitals. We dont have rigorous reporting from the general community. There can be silent infections and we dont have that reporting at the doctor level. There is much work to be done. That is where we need to engage more vigorously on our side to get to a point where we are getting this data. You mentioned the fact these Drug Development companies are not able to cover their investment. What suggestions do you have for that . I think we both did. I can start. We pay for antibiotics based on the volume that is used. We want to try to keep that volume as limited as possible, especially for the new antibiotics for multidrug resistant infections, that reserve their effectiveness. We need a way that will allow us to pay for the value they provide to society, rather than paying for hughes. Its not a legislative hearing, but it would set up a prescription a model which would allow the federal government to enter into contracts to pay for the value that these antimicrobial drugs provide. I agree, other g7 governments are taking the same approach. U. K. Has had their prescription model in place for a few years. Japan announced they are intending to do one. Europe this week made their proposal public. Everyone is hoping think u. S. Will also lead on this issue. One of my concerns is the exposure this creates for our armed services. This is a huge health care issue, but it is also potentially a National Security issue, that we could be exposing our troops to things we dont have the antibacterials to treat. I can see it with a number of immigrants that are coming into our country as well. We could have a Major Health Care crisis, we could also have a serious crisis dealing with our military. Combat wounds and burns are two of the easiest things that become infected. There was a study looking at infections in the current conflict in ukraine, some of the infections were resistant to new antibiotics. Once we see these in a small population, they can spread quickly. We have made progress in treating our wounded on the battlefield, its shocking to think we could have someone survive a field wound and die from an infection. Thank you for holding this hearing, its important. I yield back. My understanding is penicillin was considered a state secret when it first came out because of the advantages on the battlefield. I now recognize the gentle lady from arizona, the vice chair of this subcommittee. How long do the university of virginia medical students study Antimicrobial Resistance and how to combat it . Thats a great question. We need improved education in antimicrobial effectiveness and management. We have started at uva giving stewardship lectures, we give a joint lecture, once they learn the basics of antibiotics, then we come back and talk through how to not overuse them, how to make sure you understand your role as the keeper of this precious resource. So about an hour . Yes. Can you go into more detail about the efforts that your society is making to increase awareness of amr and educate physicians . We have developed different curricula at different levels, getting with medical students and on to physicians that are advanced, to learn about appropriate antibiotic use. For Infectious Disease physicians, we teach them how to run a program. Which is focused on making sure patients get the optimal treatment. I dont want to deny drugs to people who need them, but we want to make sure they get the right drug. Our members do communications through media briefings, social media, both through the society and on their own, to educate the public and community about amr. We have found that those individual physicians are the most effective messengers because there has been an erosion of trust in government associated messengers. Having those id physicians is so important. I want to give you the opportunity to highlight the major accomplishments that carbx has done. The key way to measure success is whether highly Innovative Products make it into human clinical testing. Our annual report came out yesterday, we showed exactly that sort of progress. More than a dozen in the human clinical testing, and a couple are now on the market. That is my last question, i yield back. I recognize the gentleman from north dakota. According to the american veterinary nickel association, of the 118,000 veterinarians and the United States, only about five prints 5. 3 are in the food to animal space. There are a shortage of large animal veterinarians in rural areas. I understand that Antimicrobial Resistance is a Global Health and Development Threat that requires an approach to make sure we promote appropriate use. While the responsible use of antibiotics is crucial, i am concerned of the recently issued fda rule on ranchers and farmers who do not over medicate their animals. Ranchers are under extreme pressure and we have to balance the effective antimicrobial i have a hard time saying that world that word. Medication of livestock by producers is expensive and takes up time. Groups on both sides of this issue recognizes that over medication is something that can and should be prevented. How do we ensure the fdas action balances concerns with Antimicrobial Resistance with potentially unintended consequences on the food supply . The Animal Health space is not my area of expertise. As we have seen in human health, having good Data Collection to understand where and how antimicrobials are being used and how resistance patterns are tracking is critical to inform those efforts. Making sure we have complementary Data Collection and surveillance is critical. Working with veterinarians there, the ability to diagnose and understand what animals have resistant organisms i susceptibility testing is an important area to focus on. Having more veterinarians in the space. They are trying to come up with standards, cows metabolize penicillin different than humans, and that is different than chickens. When we are giving an antibiotic to an animal, it is one that is going to work. You cant tell a rancher or farmer know and not give them a good option, that will bankrupt them. We need to be researching vaccines and other ways that animals dont get sick. In norways, they farmed salmon, required one pound of antibiotic for every pound of salmon produce. They came up with vaccine. I would support giving farmers tools so they dont have this choice. Is interesting to bring norway and, my father in law was a microbiologist in norway. I know there is opportunities for educational campaigns, i appreciate the research, and we do need more large animal vet. We recognize we need all of those things. But far too often in this space, will we pass a regulation and try to figure it out later . The lack of availability of real Veterinary Services in all of these places, i appreciate the answers, we have to do them both at once, we cant pass a regulation and then come back to this later. The rancher in Western North dakota is going to have to follow the regulation regardless if the resources exist. The gao has a body of work looking at the venerating veterinarian workforce, there is a crisis there. We found that you are pulling veterinarians from limited tools to lucrative jobs in the private sector, they dont want to work in the food animal sector. We also look at the animal side, surveillance is needed on the farms. I know to large animal veterinarians that retired a decade ago, they are busier now than when they retired. May be these folks can work with veterinarians in my district, i have the only district with two schools of veterinary medicine. I now recognize mr. Carter of georgia. Thank you all for being here, this is important. I am a pharmacist, i have witnessed the excessive use of antibiotics that has led to a lot of this, it has given been a concern. I am in all of the advancements weve made in research and development. I started practicing in 1980 when i was 10 years old. I have seen nothing short of miracles, as a result of research and element. Im a big fan from that aspect. Im concerned about the Antimicrobial Resistance and the overuse of antibiotics. I know the pressure that physicians are under, you have a mother, she has been struggling with a childs your infection, and is demanding, no one was as demanding as my wife. I get it and understand that. Im glad that this subcommittee is looking at that, it needs to be addressed. We had an example six months ago, we had contaminated eyedrops that were causing a highly resistant i infection. This was a never before seen strain of bacteria that left patients blind. That is the kind of think that we need to avoid in this country. The time is now to invest in the pipeline. We live in a capitalist society, pharmaceutical manufacturers are going to invest in drugs that will give them the biggest returns. I have a healthy respect for that. That is where we in Congress Need to be assisting and making sure that we have a pipeline of these antibiotics, because they are not as profitable. Thats why i was a cosponsor of the bipartisan pasture act. In your testimony, you said that subscriptions are now needed. Can you tell me what pool incentives and subscriptions are . Thank you for making the effort. The language is to professoriate. For antibiotics we dont want the drug that sells to a million or 10 Million People, that would represent a Public Health disaster. The best case is Infection Control does a great job and Everything Else works purposely perfectly. In some areas, they would charge 1 million for that drug for a small number of patients. With antibiotics, we dont want the 1 million drug, we try to pay for the value to society for the drug, even if the volume is quite low. We dont have any incentive to overuse it, but it is there when we needed for the patients who need it. For carbx, the companies that are doing the innovations, the average size is 20 fulltime employees. Big pharma has left, it is smart tiny start companies. Its important for people to understand. Thank you for that explanation. You described the overuse of antibiotics, have you uncovered any reason for the overuse, besides what i mentioned . There are a lot of reasons, when a patient presents very ill, you dont know what is infecting them. Because ours can matter, you need to treat them right away while you wait for test results to come back. We also dont have enough experts who understand the best ways to use antibiotics. Giving someone the wrong antibiotic, putting it on putting them on it for the wrong duration. I was that mom too, i get that. This is extremely important, i want to compliment you for what you are doing. I know this firsthand, i want to thank you mr. Chairman, for this hearing, it is important. I keeled back. I yield back. We appreciate you being here, everybody has been engaged and passionate. It says a lot when you have members coming back and the vote has been over for 45 minutes or more on friday, that tells you folks are interesting in this issue. We greatly appreciate it. I would think our witnesses again for being here. I asked the witnesses that they submit answers 10 days following the receipt of the questions from the members who may have additional questions. Thank you all for gang here. Meeting adjourned. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] you think this is just a Community Center . It is way more than that. Comcast is partnering with Community Centers so students from low income families can get the tools they need to be ready for anything. Comcast support cspan as a Public Service, along with these other Television Providers, giving you a front row seat to democracy. Today, the chair of the Federal Reserve will give an update on Interest Rates and other Monetary Policy actions, live at 2 30 p. M. Eastern on cspan. Cspan now, the free mobile video app and online at cspan. Org. Welcome back. I enjoyed by Thomas Jipping senior legal fellow at the heritage foundation. Welcome to the program. Guest thank you for having me. Host will take your calls in a little bit based on party affiliation