Remarks at a UN High-Level Dialogue on Antimicrobial Resistance

Francis S. Collins, M.D., Ph.D.
U.S. National Institute of Health
Bethesda, MD
April 29, 2021


Thank you very much, and appreciate your skillful moderation of this session with all the challenges of videos and live appearances. I’m glad to be one of the live people. This is not a video this is really live me.

I am the Director of the National Institutes of Health, appointed by the President, this is my third tour because I was originally appointed by President Obama, and then carried over by President Trump, and now carried over again by President Biden. I want to extend my appreciation on behalf of the U.S. government to everyone joining us for this high-level dialogue. I want to thank His Excellency Volkan Bozkir, the President of the General Assembly, for his leadership on AMR, and also the Groups of Friends, led by the UK, for planning this session.

The progress of our modern medical approach to infections is being increasingly threatened by the escalation of antimicrobial resistance. In the United States, we have more than 2.8 million antibiotic resistant infections every year and tragically 35,000 people die, as a result, every 15 minutes, someone dies in the United States with an infection for which our antibiotics are no longer working.

So how does this happen? Well if we needed any kind of a course in how any microbial resistance can occur, look at COVID-19. When you apply a situation of selection, then variations occur, microbes evolve, and under pressure from treatments that are too widespread in too many circumstances. This sets the stage for mutations that will help those microbes survive but then to be resistant to future treatment. For AMR we’ve developed many effective containment strategies. We that global community must scale these up and develop new ones to prevent infections and save lives. That means more help in the One Health arena across settings with industries and countries against the threat of AMR. The United States welcomes the leadership of WHO, FAO, OIE, and UNEP and we recommit to working hand in hand with our partners to combat AMR, especially using this One Health approach.

The U.S. government has demonstrated its commitment in the past to tackling AMR, establishing a transatlantic taskforce on antimicrobial resistance, or TAPFAR, with the European Union, and with important leadership from Prime Minister Reinfeldt of Sweden. That was established in 2009. In the U.S., we established a National Action Plan on Combating Antibiotic Resistant Bacteria, which of course has an acronym CARB, was established in 2015. And that was developed and implemented in the U.S. by agencies including NIH, CDC, the Food and Drug Administration, the Department of Agriculture, the Environmental Protection Agency. This also reflects a One Health approach to slow the emergence and spread of resistant infections, and this has just been renewed for another five years from 2021 to 2025 so CARB is a major part of our effort.

Within CARB, NIH has taken a lead in the effort to develop research on drugs, vaccines, and other therapeutics. I think we all recognize that it is a challenge to provide sufficient private sector investment in the development of antimicrobials, the markets are expected to be quite small, new drugs will need to be saved for situations where they’re really needed. Otherwise, they too will fall into the category of being no longer useful. And so, it is particularly important to come up with other ways to de-risk projects for private sector investment. NIH been very engaged in that. And that has included working with BARDA, our partner in the U.S. government, to facilitate product development.

I can tell you, we have helped to advance more than 85 compounds in 11 different countries all aimed at trying to come up with better solutions for currently resistant organisms. We’ve also expanded our Antibacterial Resistance Leadership Group, which is a clinical trial network where new antibiotics can be tested in situations where they’re needed to see whether they’re safe and effective. And we’ve also established a national sequence database on antibacterial pathogens so that we have complete genome information on organisms that are emerging and seem not to respond to current antibiotics, so we can understand the mechanism of that resistance and try to utilize that to develop better therapeutics.

CARB is also examining the impact of COVID-19 on this problem of antimicrobial resistance and what lessons we might learn from the pandemic. And as we just heard from the former Minister of Health of Mexico. We have seen inappropriate use of antibiotics – something like 70% of the time – for a viral infection for which antibiotics are generally not the right choice. COVID, however, has also demonstrated how all aspects of our lives are interconnected across the world and that certainly means that as we try to tackle this problem with even more vigor, about antimicrobial resistance we can learn from those lessons as well. And, again, if I wanted to look a little bit on the bright side in what has been an incredibly painful and difficult year, and it’s not over yet.

With COVID-19, we have developed some technologies that may in fact provide new approaches, I have to mention one of those being that the messenger RNA vaccines, which have turned out to be highly safe and effective for COVID-19, and which provide a new strategy for vaccines for other infectious diseases. For instance, those who have been working for a long time on trying to develop a vaccine for tuberculosis are now energized by the possibility of using this messenger RNA platform as a new way to begin to tackle those issues. So, we must always try to learn from these experiences, even though they have been incredibly challenging.

So together, to conclude, we in the United States want to contribute everything we can to be part of the effort to be better stewards for global public health and the antimicrobials that we need to develop to protect future generations from serious, but avoidable, losses to our health and prosperity from AMR. So, we welcome the chance to have this kind of conversation – sponsored by the United Nations – and I will stop there and be glad to listen to other presentations.

Thank you very much.