WASHINGTON—The rise of antibiotic-resistant bacteria that trek between farms and clinics and across international boarders is unquestionably one of the most serious public health threats of our time. They currently sicken around two million people in the US each year, killing at least 23,000. To tackle the issue, the Obama Administration last year released a National Action Plan and established a panel of diverse experts to research and guide the government’s efforts to squash those deadly superbugs.

That 15-person panel, called the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria or PACCARB, convened this week in Washington, DC to discuss and vote on its first progress report and key recommendations, which now head to the president’s desk. Thursday, the council unanimously voted for six recommendations, which spanned calls for funding and collaboration. But chief among them is the call for the president to establish a White House-level leader that could coordinate all of the government agencies’ efforts to fight drug resistance.

Such a leader would be critical, several panel members as well as panel chair Martin Blaser, told Ars. Currently, efforts to fight off drug resistant germs are scattered among several agencies, including the Centers for Disease Control and Prevention, the Food and Drug Administration, the Department of Agriculture, the Centers for Medicare and Medicaid Services, the Department of Defense, and several others—all of which have different priorities and budgets. The piece-meal approaches even made it difficult for the panel to assess what government agencies were up to and how they overlapped.

A Czar could make sure all of the agencies work together and don’t double-up on efforts, Blaser, a microbiologist at NYU School of Medicine, noted. And having a leader could really put teeth in what are still fledgling efforts.

“We had a unanimous vote—it’s a good omen for future work,” Blaser said. “And yet, we have a long way to go.” It’s hard to predict if the president will follow through on appointing a leader, or if the next administration will, he added. But, he hoped the recommendation “sets the stage.”

Getting through the bureaucratic tangle with clear leadership would also be critical for fulfilling one of the council’s other main recommendations: to embrace a “One Health” approach to the problem. This approach is one that considers the health of humans, animals (food animals, pets, and wildlife), and the environment as interconnected. That means that health experts will have to reach across the divide between human medicine and animal medicine and try to establish parallel programs to ensure that antibiotics are being used only when necessary. It also will require more environmental and ecological work to understand how superbugs make their rounds between people and animals.

On the human side, the panel reported encouraging progress. Government agencies are making headway at preventing infections with new hygiene strategies; studying new ways to convince doctors to prescribe fewer antibiotics; making enrollment in programs on responsible antibiotic use mandatory for certain hospitals and long-term care facilities; and bolstering surveillance and monitoring of drug-resistant germs and infections.

But, on the animal side, critics say the panel fell flat.

Farm Raised Superbugs

Currently, about 70 percent of antibiotics sold in the US go to food animals. All of those antibiotics are identical or very similar to drugs used in humans, which can lead to cross-overs in which drug resistant bacteria developing and living on farms then spread to people (and vice versa). Most notably is the recent case of bacteria becoming resistant to a last-resort antibiotic, called colistin. Resistant germs were first reported on Chinese pig farms that used colistin, but they were then found causing infections in humans in several countries.

Many experts feel the most obvious solution is to cut the amount of drugs used. However, while the President’s National Action Plan set clear targets for reducing antibiotic use in clinics, the PACCARB fell far short of trying to make a plan or a goal to cut drug use on farms—a failure critics say is troubling.

Instead, the panel noted that the FDA has made recent efforts to change the way antibiotics are used on farms, specifically with guidelines requesting veterinarian oversight (veterinary antibiotics were previously all over-the-counter) and an end to the use of low-level antibiotics to help fatten up livestock—an injudicious use of antibiotics that almost certainly promotes drug resistance in bacteria.

But, critics note that those FDA guidelines are not mandatory—they’re just on a voluntary basis. And since the agency introduced the guidelines in 2012, there's been little data to suggest that they're working. In fact, the meat industry has largely seemed to ignore them. Between 2009 and 2014, antibiotic use in agriculture increased by 22 percent.

“The president’s key advisors must take a step back and address the fundamental flaws in the current plan,” David Wallinga, senior health officer at the Natural Resources Defense Council said. “Chief among these is the lack of a specific target for reducing antibiotics sales for use in livestock. Without clear and ambitious goals, we are one step closer to a future where we can no longer count on our miracle drugs to work when we’re at death’s door.”

Steve Roach, of the Food Animal Concerns Trust (FACT), a nonprofit advocacy group, echoed the sentiment. “There is a serious disconnect between the size of the problem and effort put into addressing it,” he said.

Still, PACCARB members defended their efforts on the agriculture side of things. “It’s a really, really complicated issue,” Michael Apley, panel member and veterinarian medical expert at Kansas State University, told Ars.

A key roadblock is that there’s little data on how farmers currently use antibiotics—how much, of what, for which diseases. Advocates, such as the NRDC, have been clamoring for such data to be released for years. But the meat industry has pushed back, arguing that the data is proprietary and that it will be used to blame the industry for the public health issue of superbugs. “I don’t know how you tell them ‘you’ve just got to come up with this [data],” Apley said.

But, without that data, he added, it’s difficult to say how and what should be cut. It would be inhumane not to treat sick animals properly, so this needs to be done carefully, Apley emphasized.

He and other members of the panel told Ars that they expect to work collaboratively with the agriculture industry to collect that data and work towards responsible use of the drugs. “I’m very confident that we can move along the path with reporting [antibiotic use] with the industry involved,” he said.