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US President Barack Obama ordered new steps on 18 September to combat the spread of antibiotic-resistant bacteria.

It is a deadly problem: according to the US Centers for Disease Control and Prevention (CDC), antibiotic-resistant infections kill at least 23,000 people and sicken 2 million each year.

A national strategy released by the White House lays out a series of steps to address the decreasing effectiveness of antibiotics; many are similar to those identified in April by the World Health Organization. They include establishing surveillance systems for tracking the spread of antibiotic-resistant infections in health-care and agricultural settings, providing financial and regulatory incentives for researchers and pharmaceutical companies to develop new antibiotics and devising methods to quickly diagnose antibiotic-resistant infections.

An executive order signed by Obama sets up a government task force to develop a plan, due next year, to implement the strategy.

The White House also announced a competition — sponsored by the US National Institutes of Health, the Biomedical Advanced Research and Development Authority and the Food and Drug Administration — that will award a US$20-million prize for the development of a rapid test to identify antibiotic resistant infections.

John Holdren, director of the White House office of science and technology policy, says that antibiotic resistance is not just a health concern but a national security issue. “What one sees in the possibility of having infections against which we have no remaining antibiotic is the potential for runaway spread of infection…that could undermine social stability,” he says. “We see the potential for an enormous increase in cost to the economy, which would reduce the capacity of the country to respond to other threats.”

The White House action comes at the same time as the release of a long-awaited report on antibiotic resistance from the President's Council of Advisors on Science and Technology (PCAST). The PCAST analysis suggests spending $900 million a year — twice as much as the current budget — for national pathogen surveillance systems and developing infrastructure to speed clinical trials of new antibiotics. The report also recommends funding more basic research into the spread of antibiotic resistance and alternatives for farmers who use antibiotics to promote growth in farm animals.

PCAST also suggests that the government require hospitals to enact antibiotic-stewardship programmes if they wish to continue receiving reimbursement from Medicare, a programme that provides health insurance for people aged 65 or older. According to the CDC, up to 50% of antibiotic use in hospitals is unnecessary.

But some experts say that the PCAST report does not pay enough attention to the use of antibiotics in agriculture, which contributes to the spread of resistant bacteria.

In December 2013, the US Food and Drug Administration (FDA) issued voluntary guidance asking companies to change the labels on their drugs so that they cannot be marketed to fatten up farm animals, and requiring the involvement of a veterinarian in prescribing these drugs. PCAST says that the guidelines have been adopted by all 26 major manufacturers of antibiotics for farm animals.

The PCAST report suggests that the FDA continue tracking how these measures affect use of antibiotics and the extent to which agricultural use contributes to resistance. But it has few details on how exactly this surveillance would work or what evidence would lead to stricter regulations, says Mae Wu, a health attorney at the Natural Resources Defense Council in Washington DC.

“It’s a little too passive,” she says. “How long do we have to wait for them to take more aggressive action to reduce the amount of antibiotic use on farms?” She says the report does too little to address the use of widespread use of antibiotics for disease prevention rather than for treating known diseases.