I

107TH CONGRESS

1ST SESSION H. R. 1771

To provide for funding for the top priority action items in the interagency

public health action plan that has been developed in response to the

problem of antimicrobial resistance, to the extent that the activities

involved are within the jurisdiction of the Department of Health and

Human Services.

IN THE HOUSE OF REPRESENTATIVES

MAY 9, 2001

Mr. BROWN of Ohio (for himself, Mr. BILIRAKIS, Mr. DINGELL, Mr. WAXMAN, Mr. GANSKE, Mr. TOWNS, Ms. SLAUGHTER, Mr. PALLONE, Ms.

DEGETTE, Mr. GREEN of Texas, Mr. SAWYER, Mr. FILNER, Ms. LEE,

Mrs. JONES of Ohio, Mr. KILDEE, Mr. HINCHEY, Mr. CAPUANO, Mr.

KUCINICH, Mr. TIERNEY, and Mr. DEFAZIO) introduced the following

bill; which was referred to the Committee on Energy and Commerce

A BILL

To provide for funding for the top priority action items

in the interagency public health action plan that has

been developed in response to the problem of antimicrobial resistance, to the extent that the activities involved are within the jurisdiction of the Department of

Health and Human Services.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
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1 SECTION 1. SHORT TITLE.

2 This Act may be cited as the ‘‘Antibiotic Resistance

3 Prevention Act of 2001’’.

4 SEC. 2. FINDINGS.

5 The Congress finds as follows:

6 (1) The discovery in the 1940s of antimicrobial

7 drugs, such as penicillin and streptomycin, led to

8 ground breaking treatment of day-to-day illnesses

9 and fatal diseases.

10 (2) Drug-resistant pathogens have developed

11 because many physicians and other health profes12 sionals have historically overprescribed antimicrobial

13 drugs.

14 (3) Antimicrobial resistance can be spurred by

15 patients seeking antibiotics for viruses rather than

16 bacterial infections. Antibiotics are effective only for

17 bacterial infections, not viral infections.

18 (4) Patients who fail to finish their prescribed

19 doses of antibiotics leave themselves vulnerable to

20 certain bacteria, strengthening antibiotic resistance.

21 (5) Microbes that have increasingly built up re22 sistance to antibiotics include the microbes involved

23 in pneumonia; ear infections and meningitis; skin,

24 bone, lung, and bloodstream infections; urinary tract

25 infections; food borne infections; and infections

26 transmitted in health care settings.
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1 (6) Many other pathogens are also becoming re2 sistant to conventional treatments, including the

3 bacteria that cause tuberculosis and gonorrhea; the

4 fungi that cause yeast infections; and the parasites

5 that cause malaria.

6 (7) A substantial but as yet undetermined per7 centage of all antibiotics produced in the United

8 States are used in animals, with estimates ranging

9 from 40 to 80 percent. A substantial percentage of

10 these antibiotics are used nontherapeutically in feed

11 or in the water of farm animals to make them grow

12 faster, while only about 20 percent of antibiotic feed

13 additives are used to treat established infections.

14 (8) This usage of antibiotics in farm animals,

15 at levels too low to cure bacterial diseases but high

16 enough to control them, is creating selective pressure

17 on bacteria, causing them to develop resistance to

18 the antibiotics.

19 (9) Antibiotic resistant bacteria selected in ani20 mals can reach humans and pass their resistance to

21 bacteria pathogenic to humans or, if pathogenic

22 themselves, can cause disease that is not easily

23 treatable, prolonging recovery.
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1 (10) Statistics have shown that antibiotic resist2 ance can cause the total costs of inpatient care to

3 be more than double the direct costs of such care.

4 (11) Expenses incurred by hospitals around the

5 Nation have risen to nearly $1.3 billion per year as

6 a result of six ordinary types of resistant bacteria.

7 (12) The Institute of Medicine, the American

8 Society for Microbiology, the World Health Organi9 zation, the Congressional Office of Technology As10 sessment, and the General Accounting Office each

11 have found that the Nation should improve surveil12 lance for mounting antimicrobial resistance prob13 lems; prolong the useful life of antimicrobial drugs;

14 develop new drugs; and utilize other measures, such

15 as improved vaccines, diagnostics, and infection con16 trol measures, to prevent and control antimicrobial

17 resistance.

18 SEC. 3. DEPARTMENT OF HEALTH AND HUMAN SERVICES;

19 FUNDING FOR TOP PRIORITY ACTION ITEMS

20 UNDER PUBLIC HEALTH ACTION PLAN TO

21 COMBAT ANTIMICROBIAL RESISTANCE.

22 (a) IN GENERAL.—For the purpose of carrying out

23 the top priority action items designated in the Anti24 microbial Resistance Action Plan, but only to the extent

25 that the activities involved are within the jurisdiction of
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1 the Department of Health and Human Services (as deter2 mined under Federal laws other than this Act), there are

3 authorized to be appropriated such sums as may be nec4 essary for each of the fiscal years 2002 through 2006.

5 Such authorization is in addition to other authorizations

6 of appropriations that are available for such purpose.

7 (b) TOP PRIORITY ACTION ITEMS.—For purposes of

8 this Act, the term ‘‘top priority action items’’ are action

9 items designated by number in the Antimicrobial Resist10 ance Action Plan and included (by reference to such num11 bers and to the categories used in such Plan) in the fol12 lowing list:

13 (1) In the category ‘‘Surveillance’’, the fol14 lowing action items:

15 (A) Action Item #2, described in the Plan

16 as follows: ‘‘With partners, design and imple17 ment a national AR surveillance plan that de18 fines national, regional, state, and local surveil19 lance activities and the roles of clinical, ref20 erence, public health, and veterinary labora21 tories. The plan should be consistent with local

22 and national surveillance methodology and in23 frastructure that currently exist or are being

24 developed.’’.
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1 (B) Action Item #5, described in the Plan

2 as follows: ‘‘Develop and implement procedures

3 for monitoring patterns of antimicrobial drug

4 use in human medicine, agriculture, veterinary

5 medicine, and consumer products.’’.

6 (2) In the category ‘‘Prevention and Control’’,

7 the following action items:

8 (A) Action Item #25, described in the

9 Plan as follows: ‘‘Conduct a public health edu10 cation campaign to promote appropriate anti11 microbial use as a national health priority.’’.

12 (B) Action Item #26, described in the

13 Plan as follows: ‘‘In collaboration with many

14 partners, develop and facilitate the implementa15 tion of educational and behavioral interventions

16 that will assist clinicians in appropriate anti17 microbial prescribing.’’.

18 (C) Action Item #39, described in the

19 Plan as follows: ‘‘Evaluate the effectiveness (in20 cluding cost-effectiveness) of current and novel

21 infection-control practices for health care and

22 extended care settings and in the community.

23 Promote adherence to practices proven to be ef24 fective.’’.
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1 (D) Action Item #58, described in the

2 Plan as follows: ‘‘In consultation with stake3 holders, refine and implement the proposed

4 FDA framework for approving new anti5 microbial drugs for use in food-animal produc6 tion and, when appropriate, for re-evaluating

7 currently approved veterinary antimicrobial

8 drugs.’’.

9 (E) Action Item #63, described in the

10 Plan as follows: ‘‘Support demonstration

11 projects to evaluate comprehensive strategies

12 that use multiple interventions to promote ap13 propriate drug use and reduce infection rates,

14 in order to assess how interventions found ef15 fective in research studies can be applied rou16 tinely and most cost-effectively on a large

17 scale.’’.

18 (3) In the category ‘‘Research’’, the following

19 action items:

20 (A) Action Item #70, described in the

21 Plan as follows: ‘‘Provide the research commu22 nity genomics and other powerful technologies

23 to identify targets in critical areas for the devel24 opment of new rapid diagnostics methodologies,

25 novel therapeutics, and interventions to prevent
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1 the emergence and spread of resistant patho2 gens.’’.

3 (B) Action Item #75, described in the

4 Plan as follows: ‘‘In consultation with academia

5 and the private sector, identify and conduct

6 human clinical studies addressing AR issues of

7 public health significance that are unlikely to be

8 studied in the private sector (e.g., novel thera9 pies, new treatment regimens, and other prod10 ucts and practices).’’.

11 (C) Action Item #76, described in the

12 Plan as follows: ‘‘Identify, develop, test, and

13 evaluate new rapid diagnostic methods for

14 human and veterinary uses with partners, in15 cluding academia and the private sector. Such

16 methods should be accurate, affordable, and

17 easily implemented in routine clinical settings

18 (e.g., tests for resistance genes, point-of-care

19 diagnostics for patients with respiratory infec20 tions and syndromes, and diagnostics for drug

21 resistance in microbial pathogens, including in

22 nonculture specimens).’’.

23 (D) Action Item #77, described in the

24 Plan as follows: ‘‘Encourage basic and clinical

25 research in support of the development and ap-
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1 propriate use of vaccines in human and veteri2 nary medicine in partnership with academia

3 and the private sector.’’.

4 (4) In the category ‘‘Product Development’’,

5 the following action items:

6 (A) Action Item #79, described in the

7 Plan as follows: ‘‘Create an Interagency AR

8 Product Development Working Group to iden9 tify and publicize priority public health needs in

10 human and animal medicine for new AR prod11 ucts (e.g., innovative drugs, targeted spectrum

12 antibiotics, point-of-care diagnostics, vaccines

13 and other biologics, anti-infective medical de14 vices, and disinfectants).’’.

15 (B) Action Item #80, described in the

16 Plan as follows: ‘‘Identify ways (e.g. financial

17 and/or other incentives or investments) to pro18 mote the development and/or appropriate use of

19 priority AR products, such as novel compounds

20 and approaches, for human and veterinary med21 icine for which market incentives are inad22 equate.’’.

23 The 13 action items specified in this subsection all have

24 top priority under the Plan, regardless of their order on

25 the list.
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1 (c) ANTIMICROBIAL RESISTANCE ACTION PLAN.—

2 For purposes of this Act, the term ‘‘Antimicrobial Resist3 ance Action Plan’’ means the plan that—

4 (1) is entitled ‘‘A Public Health Action Plan to

5 Combat Antimicrobial Resistance’’; and

6 (2) was developed by an interagency Task

7 Force on Antimicrobial Resistance, created in 1999,

8 that—

9 (A) is cochaired by the Centers for Disease

10 Control and Prevention, the Food and Drug

11 Administration, and the National Institutes of

12 Health; and

13 (B) in addition includes—

14 (i) the Agency for Healthcare Re15 search and Quality and the Health Re16 sources and Services Administration;

17 (ii) the Health Care Financing Ad18 ministration;

19 (iii) the Environmental Protection

20 Agency; and

21 (iv) the Department of Agriculture,

22 the Department of Defense, and the De23 partment of Veterans Affairs.
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1 (d) AR.—For purposes of this Act, the term ‘‘AR’’

2 means antimicrobial resistance.

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