AMR Action: Letter to sign, letter to write, Bill Gates in NYT on fire extinguishers!

Dear All,

Following hard on the heels of the very successful call for signatories of a letter in support of PASTEUR (2 Mar 2023 newsletter; copy of final signed letter with > 230 signatories!), we now have two more calls for letters supporting key AMR funding initiatives. And importantly, you do not have to be US citizen or a US-based company to sign or submit comments … the US government appreciates the global nature of this problem and highlighting global interconnections would be valuable!

First (and easy to do), IDSA (Infectious Diseases Society of America), AdvaMedDx, American Society for Microbiology (ASM), BIO, Food Animals Concerns Trust (FACT), and the Society for Healthcare Epidemiology of America (SHEA) invite you to sign this letter (.docx, .pdf) to congressional appropriations leaders urging robust funding for federal AMR programs at CDC, ASPR/BARDA, NIAID, FDA, USDA, USAID, and the State Department. Sign by using this form! The official deadline is end of the day on Thu 25 Mar, but I’m told that your signature will be recorded if you sign by noon ET on Friday, March 24.

—
Second (and a bit more work, but worthwhile!!), a process to again re-authorize PAHPA (the Pandemic and All-Hazards Preparedness Reauthorization Act) and there is an RFI underway for topics to include. The AMR community believe that inclusion of PASTEUR in PAHPA is great opportunity to bring PASTEUR into being … and this is the point of the letter discussed in the first paragraph of newsletter. As you may recall, that letter began with “On behalf of the undersigned organizations representing health care providers, public health professionals, scientists, patients, and the pharmaceutical and diagnostics industries, we urge you to include the PASTEUR Act in any moving legislative vehicle this year, including the reauthorization of the Pandemic and All Hazards Preparedness Act (PAHPA).“

During the BEAM-AMR Conference last week in Basel, Sen. Todd Young gave comments by Zoom and noted that The Senate Health, Education, Labor, and Pensions (HELP) Committee now seeks your input on policies that the Committee should consider during the reauthorization process The full list of topics Committee outlined topics/questions that stakeholders could respond to is found below my signature. This is only a suggestion, and a letter on PASTEUR only will also be recorded.

Comments are to be sent to the Committee by email at PAHPA2023Comments@help.senate.gov no later than close of business on Wednesday, March 29, 2023.  Your comments should be in the form of letter urging the inclusion of the PASTEUR Act in the PAHPA reauthorization. Given the nature/focus of the legislative vehicle, you should explain how AMR impacts preparedness for outbreaks and pandemics, natural disasters like hurricanes, and bioterror events.

— 
And as inspiration for the importance of writing that letter to the Senate and for having the right antimicrobial fire extinguisher to hand, I close with a link to a 19 Mar 2023 Op-Ed by Bill Gates entitled “I Worry We’re Making the Same Mistakes Again”. As he says, “‌We need to prepare to fight disease outbreaks just as we prepare to fight fires. If a fire is left to burn out of control, it poses a threat not only to one home but to an entire community. The same is true for infectious diseases, except on a much bigger scale.” Love it! 

Antibiotics are the #FireExtinguishersOfMedicine!

All best wishes, –jr

John H. Rex, MD | Chief Medical Officer, F2G Ltd. | Operating Partner, Advent Life Sciences. Follow me on Twitter: @JohnRex_NewAbx. See past newsletters and subscribe for the future: https://amr.solutions/blog/. All opinions are my own.

PAHPA Request for Information
Send comments to at PAHPA2023Comments@help.senate.gov no later than close of business on Wednesday, March 29, 2023. 

Program Effectiveness 
What specific changes could Congress make to improve the efficiency and effectiveness of current HHS programs and activities? Specifically:

Public Health Emergency Coordination and Policy

1. The responsibilities and authorities of the Secretary of Health and Human Services (HHS) prior to or during a public health emergency (PHE)
2. The authorities, duties, and functions of the Assistant Secretary for Preparedness and Response (ASPR)
3. The National Health Security Strategy (NHSS)
4. The National Advisory Committees on Children and Disasters, Seniors and Disasters and Individuals with Disabilities and Disasters 

Medical Countermeasures Development and Deployment

1. The Strategic National Stockpile (SNS)
2. The Biomedical Advanced Research and Development Authority (BARDA)
3. Project BioShield
4. The Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) and related strategy, implementation plan, and budget plan
5. Emergency Use Authorizations and related authorities
6. The Public Readiness and Emergency Preparedness (PREP) Act
7. The Material Threat Medical Countermeasures Priority Review Voucher Program

Support for Jurisdictional Preparedness and Response Capacity

1. The Public Health Emergency Preparedness (PHEP) Cooperative Agreements
2. The Hospital Preparedness Program (HPP) Cooperative Agreements 
3. Other ASPR activities financed through the general HPP budget, such as the Regional Disaster Health Response System (RDHRS) demonstration projects
4. The National Disaster Medical System (NDMS)
5. The Medical Reserve Corps (MRC)
6. The Emergency System for Advanced Registration of Volunteer Health Professionals (ESAR-VHP) 
7. Epidemic Intelligence Service (EIS) Loan Repayment Program
8. The Epidemiology and Laboratory Capacity Cooperative Agreement Program and related activities, including mosquito abatement
9. Biosurveillance and Public Health Situational Awareness
10. Vaccine tracking and distribution
11. Policies for the inclusion of at-risk individuals in public health emergency preparedness and response activities

Gaps in Current Activities & Capabilities

1. What gaps do you see in the PAHPA framework, or how it has been implemented to date? (These gaps could be related to any of the programs noted above, or other aspects of the public health and medical preparedness and response ecosystem that are otherwise currently unaddressed.)
2. Additionally, aside from currently authorized programs and activities, what gaps exist in HHS’ capabilities, and what types of activities or authorities are necessary for HHS to fulfill the intent of PAHPA and related laws? 

Partnerships 
What specific steps could Congress take to improve partnerships with states and localities, community-based organizations, and private sector and non-government stakeholders, such as hospitals and health care providers, on preparedness and response activities? For example:

1. How can these entities be better supported in appropriately engaging with the federal government to understand available resources, capabilities, and expectations prior to, during, and following a public health emergency?
2. How can foundational programs, such as the public health emergency preparedness cooperative agreements and the hospital preparedness program, be improved to ensure state, local, and health system readiness to mount effective responses?