[Congressional Record Volume 155, Number 73 (Wednesday, May 13, 2009)]
[Extensions of Remarks]
[Pages E1142-E1143]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




   REGARDING INTRODUCTION OF THE STRATEGIES TO ADDRESS ANTIMICROBIAL 
                         RESISTANCE (STAAR) ACT

                                 ______
                                 

                           HON. JIM MATHESON

                                of utah

                    in the house of representatives

                        Wednesday, May 13, 2009

  Mr. MATHESON.  Madam Speaker, I rise to re-introduce the ``Strategies 
to Address Antimicrobial Resistance (STAAR) Act,'' which I believe has 
the potential to save many thousands of lives by strengthening the 
United States' response to infectious pathogens, including H1N1 
influenza, that are becoming increasingly resistant to existing 
antimicrobial drugs (antibacterials, antivirals, antifungals, etc.).
  I have been working on the issue of antimicrobial resistance for 
several years and it is alarming how often reports of resistant 
infections now appear. I do not believe the public health community 
simply is crying ``wolf.'' We no longer can be complacent.
  When I first introduced this bill two years ago, we were facing 
reports of extensively-drug resistant tuberculosis (XDR-TB) and fears 
of an Avian flu pandemic. Over the last few weeks, we all have followed 
the H1N1 influenza outbreak as we ramped up our awareness of influenza 
mitigation strategies and the impact of infectious pathogens. What 
received less attention is the fact that H1N1 is resistant to some of 
the drugs in our arsenal. The Centers for Disease Control and 
Prevention (CDC) will continue to watch the spread and evolution of 
this pathogen as flu season hits the southern hemisphere. Hopefully, we 
again will buy some time before we truly face a pandemic. But, now the 
possibility of a pandemic has become real to many of us. We have been 
forced to think about how quickly an infection can spread, especially 
in the age of international air travel, and the disastrous result if it 
were a strain of bacteria that failed to respond to our current 
antiviral drugs.
  Another resistant infection that caught our attention over the past 
year is community-acquired methicillin-resistant Staphylococcus aureus 
(CA-MRSA). Historically, this infection was acquired during a hospital 
stay, but now is impacting young, healthy people and spreading in our 
communities. We've heard stories of high school, college and 
professional athletes losing their lives or careers as a result of 
these infections. Many of our constituents are facing serious illness 
and death due to MRSA infections. Sadly, this infection has become far 
too common, difficult to treat and has few options to fight it. It can 
leave individuals disfigured, if they survive. In my own state of Utah, 
the number of children with MRSA infections at the Primary Children's 
Medical Center in Salt Lake City has increased by almost 20 fold over 
the past two decades.
  There are still more infections to worry about. We have numerous 
reports of our soldiers coming home from Iraq and Afghanistan with 
Acinetobactor--a resistant bacterial infection that is especially 
difficult to treat and the only option is a very toxic antibiotic.
  Other examples of concern include vancomycin-resistant Staphylococcus 
aureus (VRSA), an alarming development because vancomycin is the drug 
of last resort for treating several serious infections, and Escherichia 
coli (E.coli), which has caused outbreaks due to contamination of 
spinach, peanut butter, and other foods we regularly consume.
  Madam Speaker, I believe strongly that this year we must take this 
issue seriously and ensure we have the public health infrastructure in 
place to both monitor and respond to these emerging drug resistant 
infections. The STAAR Act is the most comprehensive legislation 
introduced to date to address this serious and life-threatening patient 
safety and public health problem. We must act now to begin to reverse 
the alarming trend, and infectious disease experts tell me that the 
multi-pronged approaches contained in the STAAR Act provides our best 
chance to address the multiple problems that face us.
  We have taken antimicrobial drug development for granted. Few of us 
remember medicine before the discovery of antibacterial and antiviral 
drugs. Antibacterial drugs in particular have allowed many medical 
advances, including routine invasive surgeries, organ transplants, and 
other procedures that otherwise would be impossible due to resulting 
infections. But we are falling behind in our ability to protect 
ourselves against infections, and we have a lot of catching up to do. 
Fifteen years ago, the Congressional Office of Technology Assessment 
(OTA) examined the problem of antimicrobial resistance and reported to 
Congress that ``The impacts of antibiotic-resistant

[[Page E1143]]

bacteria can be reduced by preserving the effectiveness of current 
antibiotics through infection control, vaccination and prudent use of 
antibiotics, and by developing new antibiotics specifically to treat 
infections caused by antibiotic-resistant bacteria.''
  In addition, there are problems of significant and inappropriate use 
of antimicrobials; a lack of adequate research to address the many 
facets of resistance, including basic, clinical, interventional, and 
epidemiologic research as well as research to support the development 
of new diagnostics, biologics, devices and, of course, drugs; a 
fractured and under-funded resistance surveillance system; and 
insufficient coordination of the federal response, which is critically 
needed as the solutions to addressing antimicrobial resistance involve 
multiple agencies and departments.
  To begin to respond to the drug resistance problem, eight years ago 
Congress passed legislation that became Section 319E, ``Combating 
Antimicrobial Resistance'' of the Public Health Service Act. This law 
directed the Secretary to establish an Antimicrobial Resistance Task 
Force to coordinate Federal programs relating to antimicrobial 
resistance; required research and development of new antimicrobial 
drugs and diagnostics; established educational programs for medical and 
health personnel in the use of these drugs; and established 
demonstration grants for programs promoting the judicious use of 
antimicrobial drugs and the detection and control of the spread of 
antimicrobial-resistant pathogens. Authorization for these programs 
expired September 30, 2006. The STAAR Act reauthorizes these programs 
and builds on the Federal efforts that have been highlighted in the 
Public Health Service Action Plan to Combat Antimicrobial Resistance, 
published in 2001 by the Task Force.

  The Action Plan identified thirteen key elements (out of 84 elements) 
as top priority action items that are critically necessary to address 
the growing resistance crisis. Regrettably, the Action Plan has never 
been funded.
  In spite of these past efforts to address the problem, antimicrobial 
resistance continues to grow. In 2004, the Infectious Diseases Society 
of America (IDSA) published, ``Bad Bugs, No Drugs: As Antibiotic 
Discovery Stagnates a Public Health Crisis Brews'' to highlight the 
lack of research and development for new antibiotics. Updates to this 
report continue to make the case that we need to do more. Antibacterial 
drugs are not profitable compared to those that treat chronic (long-
term) conditions and lifestyle issues. In addition, when a new 
antibiotic comes on the market, it is discouraged from use to avoid the 
development of resistance. Also, antibiotics are taken for short 
periods of time--unlike those for chronic disease which may be taken 
daily. As a result, big pharmaceutical companies have pretty much 
turned their back on antibiotic development. IDSA has published several 
other reports that support many of the provisions found in the STAAR 
Act.
  The ``Strategies to Address Antimicrobial Resistance (STAAR) Act'' is 
comprehensive legislation that advances the thirteen key elements 
identified in the federal Action Plan and authorizes adequate funding 
for these strategies.
  My bill strengthens existing efforts by establishing an Antimicrobial 
Resistance office (ARO) within the Office of the Secretary of Health 
and Human Services. The Director of the ARO would serve as the director 
of the existing interagency task force and work in conjunction with the 
many Federal agencies which share responsibility to address 
antimicrobial resistance to ensure accountability and progress on the 
Action Plan. Also, to encourage input from experts outside the federal 
government, and to ensure accountability, my bill would establish a 
Public Health Antimicrobial Advisory Board (PHAAB) to provide much 
needed advice about antimicrobial resistance and strategies to address 
it. The STAAR Act will strengthen existing surveillance, data 
collection, and research activities as a means to reduce the 
inappropriate use of antimicrobials, develop and test new interventions 
to limit the spread of resistant organisms, and foster the development 
of new tools to detect, prevent and treat these ``bad bugs.'' 
Infectious diseases experts have said they strongly support this multi-
faceted, strategic approach.
  The STAAR Act has been endorsed by a number of organizations, 
including: Infectious Diseases Society of America (IDSA), American 
Academy of Family Physicians (AAFP), Alliance for the Prudent Use of 
Antibiotics (APUA); American Association of Critical-Care Nurses 
(AACN); National Parent-Teacher Association (PTA); American Public 
Health Association (APHA); National Foundation for Infections Diseases 
(NFID); Council of State and Territorial Epidemiologists (CSTE); and 
Michigan Antibiotic Resistance Reduction Coalition (MARA); American 
Society of Health-System Pharmacists (ASHP); Association for 
Professionals in Infection Control and Epidemiology (APIC); 
International Society of Microbial Resistance (ISMR); Michigan 
Antibiotic Resistance Reduction Coalition (MARA); National Athletic 
Trainers Association (NATA); Society of Infectious Diseases Pharmacists 
(SIDP); and Trust for America's Health (TFAH).
  This legislation has been a long time coming. I urge my colleagues to 
join me in supporting this legislation and to work with me to give our 
federal agencies the tools they need to ensure that combating 
antimicrobial resistance becomes a priority.

                          ____________________