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National Action Plan for Combating Antibiotic-Resistant Bacteria Progress Report: Fiscal Year 2021

Publication Date
Task Force for Combating Antibiotic-Resistant Bacteria

Pathogens that have evolved to be resistant to the drugs currently used to treat infections are an ongoing threat to public health, animal health, food production, and national security. Globally, a recent analysis estimated that 1.2 million deaths were caused by antibiotic-resistant (AR) bacteria in 2019, making this threat a leading cause of death for people of all ages worldwide. Domestically, the CDC estimates that more than 2.8 million Americans suffer from AR infections each year and that more than 35,000 die. While significant progress to address AR has been made in recent years, CDC found surges in antibiotic use and AR infections in U.S. hospitals during the first year of the COVID-19 pandemic, including an alarming 15 percent increase in both resistant hospital-onset infections and deaths.

To coordinate and enhance the public health response to the AR threat, the U.S. Government developed the National Action Plan for Combating Antibiotic-Resistant Bacteria, 2020-2025, which takes a global One Health approach recognizing that AR arising in humans, animals, or the environment may spread from one to the other, and from one country to another. The 2020 Plan provides a roadmap to guide the Nation in reducing the prevalence of AR bacteria through infection prevention and control, surveillance, diagnostic testing, therapeutic and other product innovation, and global coordination.

The FY21 Report summarizes progress toward the 2020 Plan and includes highlights related to pandemic preparedness, equity, and other challenges, new and updated targets for the 2020 Plan, common challenges and barriers, and progress toward targets in FY21. Select achievements include:

  • The critical role of CDC’s significant foundational investments to build capacity to prevent, detect, and respond to AR across the United States in supporting the response to COVID-19 early in the pandemic, particularly in state and local health departments;
  • CMS’s steps to measure the impact of its policies on health equity; develop sustainable solutions that close gaps in health and health care access, quality, and outcomes; and invest in solutions that address health disparities, including those driven by infections with AR organisms;
  • FDA’s multiple advances to foster stewardship of medically important antibiotics in animals, including a proposal for revising the process and criteria for ranking antibiotic drugs for animals based on their importance in human medicine;
  • ASPR/BARDA’s continued role as a major driver of antibacterial development with 14 new projects awarded across the CARB-X and Advanced Research and Development portfolios, and procurement of the antibiotic NUZYRA (omadacycline) from Paratek Pharmaceuticals as a potential medical countermeasure to treat infections caused by Bacillus anthracis;
  • NIH support of CARB-X and launching of innovative new programs to increase understanding of mechanisms of resistance and stimulate development of preventive approaches and novel treatments, including antibiotics and nontraditional therapeutics;
  • DoD’s Global Emerging Infections Surveillance Branch support for a globally positioned network of DoD laboratories that was uniquely poised to rapidly respond to new and emerging threats during the COVID-19 pandemic; and
  • USDA’s Food Safety and Inspection Service (FSIS) expansion of microbiological sampling of National Antimicrobial Resistance Monitoring System (NARMS) samples.

The primary challenge to implementing the 2020 Plan has been the COVID-19 pandemic, which led to increased numbers of hospitalized patients, increased lengths of stay and severity of illness for many patients, staffing shortages, changes in antibiotic use, and departures from standard infection prevention and control practices. The CARB Task Force continues to monitor, evaluate, and adapt to the impact of the COVID-19 pandemic on AR and ongoing efforts to address its threat.

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