National action plan for combating antibiotic-resistant bacteria updated for 2020 through 2025

Oct. 13, 2020

The National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB), 2020-2025, has been updated and presents coordinated, strategic actions that the United States Government will take in the next five years to improve the health and wellbeing of all Americans by changing the course of antibiotic resistance, reported the US Department of Health and Human Services (HHS). 

This Plan is based on the U.S. Government’s 2014 National Strategy for CARB, and builds on the first National Action Plan released in 2015 by expanding evidence-based activities that have already been shown to reduce antibiotic resistance, such as optimizing the use of antibiotics in human and animal health settings. 

This Plan continues to prioritize infection prevention and control to slow the spread of resistant infections and reduce the need for antibiotic use. To ensure that patients receive the right antibiotic care, the Plan supports innovative approaches to developing and deploying diagnostic tests and treatment strategies. 

A One Health approach, which recognizes the relationships between the health of humans, animals, plants, and the environment, is integrated throughout the Plan, with an expanded effort to understand antibiotic resistance in the environment. The Plan also focuses on collecting and using data to better understand where resistance is occurring, support the development of new diagnostics and treatment options, and advance international coordination. 

To address the growing threat of antibiotic resistance, the U.S. Government released the National Strategy for CARB in September 2014, which outlined five inter-related goals to guide Federal action. At the same time, Executive Order 13676 established the Federal Task Force for CARB to identify actions to implement the National Strategy. In March 2015, the Task Force released the first National Action Plan for CARB, aimed at moving the nation toward the goals of the National Strategy through specific objectives, strategies, and milestones to be achieved within one, three, and five years. 

The Task Force has issued reports on progress toward these milestones for years one and two, year three, and year four of the original plan. A forthcoming final report will cover year five and an overall assessment of progress. The new National Action Plan for 2020-2025, presented here, maintains the original five goals of the National Strategy and includes new objectives and targets aimed at achieving those goals. 

Efforts to reduce the effects of antibiotic resistance are working: from 2012 to 2017, the overall number of U.S. deaths from antibiotic-resistant infections fell by 18 percent, and the number of U.S. deaths from resistant infections in hospitals fell by nearly 30 percent as a result of efforts to prevent infections and control their spread. However, antibiotic resistance continues to harm too many Americans, and worrisome trends are emerging, including the discovery of new resistant pathogens, such as Candida auris, and an increase in resistant Neisseria gonorrhoeae infections. 

Other drug-resistant, community-acquired bacterial infections from group A Streptococcus and ESBL-producing Enterobacteriaceae, for example, are also increasing. The U.S. Government is therefore committed to sustained and enhanced work to combat antibiotic resistance. In September 2018, the CARB Task Force began developing an updated National Action Plan for CARB, which would cover activities in the years 2020 through 2025. The Task Force reviewed prior efforts and anticipated future challenges and opportunities. The PACCARB solicited and reported on public input, which the Task Force considered alongside perspectives from Federal experts. The result is a set of coordinated, strategic actions aimed at changing the trajectory of antibiotic resistance and improving the health and wellbeing of all Americans, as well as the health of animals, plants, and the environment. 

Many of the actions build on and expand evidence-based activities initiated under the 2015-2020 National Action Plan for CARB that have already shown impact, such as the appropriate use of antibiotics in human health, animal health, and in the environment. The Task Force continues to consider infection prevention and control, especially within healthcare facilities, to be high priorities, to both slow the spread of antibiotic-resistant infections and to reduce the need for antibiotic use. Many actions focus on collecting data and turning it into information that can be used to better understand where resistance is occurring, to support the development of new diagnostics and treatment options, and to advance international coordination. 

Implementing the activities outlined in this plan will depend on the availability of resources and capacity. The new National Action Plan for CARB, 2020-2025, does not exhaustively list all Federal activities that address antibiotic resistance. Rather, it includes the continuing and new actions that are considered the highest priority for reducing antibiotic resistance in the next five years. Measuring and Reporting Progress The 2020 Plan maintains the original five goals of the 2014 National Strategy but establishes a new set of objectives to move the country toward those goals. 

Whereas the 2015 plan included one-, three-, and five-year milestones meant to capture the activities of specific Federal Departments and Agencies, the 2020 plan includes targets, many of which are composites of multiple activities pursued by multiple agencies. Each listed Department and Agency will report on progress toward these targets within the relevant timeframe. 

Where possible, the 2020 Plan has established targets to be achieved by 2021, with some targets set for longer timeframes. Each annual report on this Plan will provide updated or added targets as relevant along with rationale for these changes. For example, the first annual report might note that a 2021 target has been achieved and establish a new 2022 target for that objective. 

Task Force members reviewed the barriers faced in the past five years while implementing the 2015 Plan and anticipated challenges over the next five years. Certain challenges apply to all five goals, including the allocation of limited resources, obstacles to data gathering and sharing, and uncertainty about the participation of research and industry partners. Implementing the activities outlined in this plan will depend on the availability of resources and capacity. The COVID-19 pandemic has necessitated redirection of public health, infection control, and antibiotic stewardship resources and will continue to affect implementation of the activities described here. 

In future annual progress reports, the CARB Task Force will discuss challenges encountered during the preceding year, how it addressed these challenges, and any new challenges identified. Specific challenges are also noted for each Goal below. Appendix B lists all the Challenges. 

In most cases, the CARB Task Force will not have direct evidence that the activities listed in this plan cause changes in relevant outcomes. This is because important human, animal, plant, and environmental health metrics are influenced by a variety of interdependent factors, making it difficult to establish single cause and-effect relationships between specific activities and specific outcomes. 

However, tracking progress toward the targets listed here should inform the Task Force’s understanding of relevant changes over time, allowing agencies to change course when necessary to more effectively achieve the objectives and make progress toward the goals. 

Work under the 2015 Plan has clarified the Task Force’s understanding of the challenges inherent in collecting and analyzing the data needed to combat antibiotic resistance. The 2020 Plan therefore designates several “Data Development” objectives that aim to develop new or improved data infrastructure, collection, or analysis options. 

The Task Force will continue to report annually on progress, including challenges identified and actions taken to address those challenges. The Task Force may make changes to objectives or targets to accommodate potential new data sources or other unforeseen but informative changes to this work. These changes and their rationale will be included in annual reports. 

HHS has the report