The White House

Office of the Press Secretary

Executive Order -- Combating Antibiotic-

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COMBATING ANTIBIOTIC-RESISTANT BACTERIA

By the authority vested in me as President by the Constitution and the laws of the United States of America, I
hereby order as follows:

Section 1. Policy. The discovery of antibiotics in the early 20th century fundamentally transformed human and
veterinary medicine. Antibiotics save millions of lives each year in the United States and around the world. The
rise of antibiotic-resistant bacteria, however, represents a serious threat to public health and the economy. The
Centers for Disease Control and Prevention (CDC) in the Department of Health and Human Services (HHS)
estimates that annually at least two million illnesses and 23,000 deaths are caused by antibiotic-resistant
bacteria in the United States alone.

Detecting, preventing, and controlling antibiotic resistance requires a strategic, coordinated, and sustained
effort. It also depends on the engagement of governments, academia, industry, healthcare providers, the
general public, and the agricultural community, as well as international partners. Success in this effort will
require significant efforts to: minimize the emergence of antibiotic-resistant bacteria; preserve the efficacy of
new and existing antibacterial drugs; advance research to develop improved methods for combating antibiotic
resistance and conducting antibiotic stewardship; strengthen surveillance efforts in public health and
agriculture; develop and promote the use of new, rapid diagnostic technologies; accelerate scientific research
and facilitate the development of new antibacterial drugs, vaccines, diagnostics, and other novel therapeutics;
maximize the dissemination of the most up-to-date information on the appropriate and proper use of antibiotics
to the general public and healthcare providers; work with the pharmaceutical industry to include information on
the proper use of over-the-counter and prescription antibiotic medications for humans and animals; and
improve international collaboration and capabilities for prevention, surveillance, stewardship, basic research,
and drug and diagnostics development.
The Federal Government will work domestically and internationally to detect, prevent, and control illness and
death related to antibiotic-resistant infections by implementing measures that reduce the emergence and
spread of antibiotic-resistant bacteria and help ensure the continued availability of effective therapeutics for the
treatment of bacterial infections.

Sec. 2. Oversight and Coordination. Combating antibiotic-resistant bacteria is a national security priority. The
National Security Council staff, in collaboration with the Office of Science and Technology Policy, the Domestic
Policy Council, and the Office of Management and Budget, shall coordinate the development and
implementation of Federal Government policies to combat antibiotic-resistant bacteria, including the activities,
reports, and recommendations of the Task Force for Combating Antibiotic-Resistant Bacteria established in
section 3 of this order.

Sec. 3. Task Force for Combating Antibiotic-Resistant Bacteria. There is hereby established the Task Force for
Combating Antibiotic-Resistant Bacteria (Task Force), to be co-chaired by the Secretaries of Defense,
Agriculture, and HHS.

(a) Membership. In addition to the Co-Chairs, the Task Force shall consist of representatives from:

(i) the Department of State;

(ii) the Department of Justice;

(iii) the Department of Veterans Affairs;

(iv) the Department of Homeland Security;

(v) the Environmental Protection Agency;

(vi) the United States Agency for International Development;

(vii) the Office of Management and Budget;

(viii) the Domestic Policy Council;

(ix) the National Security Council staff;

(x) the Office of Science and Technology Policy;

(xi) the National Science Foundation; and

(xii) such executive departments, agencies, or offices as the Co-Chairs may designate.

Each executive department, agency, or office represented on the Task Force (Task Force agency) shall
designate an employee of the Federal Government to perform the functions of the Task Force. In performing its
functions, the Task Force may make use of existing interagency task forces on antibiotic resistance.
(b) Mission. The Task Force shall identify actions that will provide for the facilitation and monitoring of
implementation of this order and the National Strategy for Combating Antibiotic-Resistant Bacteria (Strategy).

(c) Functions.

(i) By February 15, 2015, the Task Force shall submit a 5-year National Action Plan (Action Plan) to the
President that outlines specific actions to be taken to implement the Strategy. The Action Plan shall
include goals, milestones, and metrics for measuring progress, as well as associated timelines for
implementation. The Action Plan shall address recommendations made by the President's Council of
Advisors on Science and Technology regarding combating antibiotic resistance.

(ii) Within 180 days of the release of the Action Plan and each year thereafter, the Task Force shall
provide the President with an update on Federal Government actions to combat antibiotic resistance
consistent with this order, including progress made in implementing the Strategy and Action Plan, plans
for addressing any barriers preventing full implementation of the Strategy and Action Plan, and
recommendations for new or modified actions. Annual updates shall include specific goals, milestones,
and metrics for all proposed actions and recommendations. The Task Force shall take Federal
Government resources into consideration when developing these proposed actions and
recommendations.

(iii) In performing its functions, the Task Force shall review relevant statutes, regulations, policies, and
programs, and shall consult with relevant domestic and international organizations and experts, as
necessary.

(iv) The Task Force shall conduct an assessment of progress made towards achieving the milestones
and goals outlined in the Strategy in conjunction with the Advisory Council established pursuant to
section 4 of this order.

Sec. 4. Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria. (a) The Secretary of HHS
(Secretary), in consultation with the Secretaries of Defense and Agriculture, shall establish the Presidential
Advisory Council on Combating Antibiotic-Resistant Bacteria (Advisory Council). The Advisory Council shall be
composed of not more than 30 members to be appointed or designated by the Secretary.

(b) The Secretary shall designate a chairperson from among the members of the Advisory Council.

(c) The Advisory Council shall provide advice, information, and recommendations to the Secretary regarding
programs and policies intended to: preserve the effectiveness of antibiotics by optimizing their use; advance
research to develop improved methods for combating antibiotic resistance and conducting antibiotic
stewardship; strengthen surveillance of antibiotic-resistant bacterial infections; prevent the transmission of
antibiotic-resistant bacterial infections; advance the development of rapid point-of-care and agricultural
diagnostics; further research on new treatments for bacterial infections; develop alternatives to antibiotics for
agricultural purposes; maximize the dissemination of up-to-date information on the appropriate and proper use
of antibiotics to the general public and human and animal healthcare providers; and improve international
coordination of efforts to combat antibiotic resistance. The Secretary shall provide the President with all written
reports created by the Advisory Council.

(d) Task Force agencies shall, to the extent permitted by law, provide the Advisory Council with such
information as it may require for purposes of carrying out its functions.

(e) To the extent permitted by law, and subject to the availability of appropriations, HHS shall provide the
Advisory Council with such funds and support as may be necessary for the performance of its functions.

Sec. 5. Improved Antibiotic Stewardship. (a) By the end of calendar year 2016, HHS shall review existing
regulations and propose new regulations or other actions, as appropriate, that require hospitals and other
inpatient healthcare delivery facilities to implement robust antibiotic stewardship programs that adhere to best
practices, such as those identified by the CDC. HHS shall also take steps to encourage other healthcare
facilities, such as ambulatory surgery centers and dialysis facilities, to adopt antibiotic stewardship programs.

(b) Task Force agencies shall, as appropriate, define, promulgate, and implement stewardship programs in
other healthcare settings, including office-based practices, outpatient settings, emergency departments, and
institutional and long-term care facilities such as nursing homes, pharmacies, and correctional facilities.

(c) By the end of calendar year 2016, the Department of Defense (DoD) and the Department of Veterans Affairs
(VA) shall review their existing regulations and, as appropriate, propose new regulations and other actions that
require their hospitals and long-term care facilities to implement robust antibiotic stewardship programs that
adhere to best practices, such as those defined by the CDC. DoD and the VA shall also take steps to
encourage their other healthcare facilities, such as ambulatory surgery centers and outpatient clinics, to adopt
antibiotic stewardship programs.

(d) Task Force agencies shall, as appropriate, monitor improvements in antibiotic use through the National
Healthcare Safety Network and other systems.

(e) The Food and Drug Administration (FDA) in HHS, in coordination with the Department of Agriculture
(USDA), shall continue taking steps to eliminate the use of medically important classes of antibiotics for growth
promotion purposes in food-producing animals.

(f) USDA, the Environmental Protection Agency (EPA), and FDA shall strengthen coordination in common
program areas, such as surveillance of antibiotic use and resistance patterns in food-producing animals, inter-
species disease transmissibility, and research findings.

(g) DoD, HHS, and the VA shall review existing regulations and propose new regulations and other actions, as
appropriate, to standardize the collection and sharing of antibiotic resistance data across all their healthcare
settings.

Sec. 6. Strengthening National Surveillance Efforts for Resistant Bacteria. (a) The Task Force shall ensure that
the Action Plan includes procedures for creating and integrating surveillance systems and laboratory networks
to provide timely, high-quality data across healthcare and agricultural settings, including detailed genomic and
other information, adequate to track resistant bacteria across diverse settings. The network-integrated
surveillance systems and laboratory networks shall include common information requirements, repositories for
bacteria isolates and other samples, a curated genomic database, rules for access to samples and scientific
data, standards for electronic health record-based reporting, data transparency, budget coordination, and
international coordination.

(b) Task Force agencies shall, as appropriate, link data from Federal Government sample isolate repositories
for bacteria strains to an integrated surveillance system, and, where feasible, the repositories shall enhance
their sample collections and further interoperable data systems with national surveillance efforts.

(c) USDA, EPA, and FDA shall work together with stakeholders to monitor and report on changes in antibiotic
use in agriculture and their impact on the environment.

(d) Task Force agencies shall, as appropriate, monitor antibiotic resistance in healthcare settings through the
National Healthcare Safety Network and related systems.

Sec. 7. Preventing and Responding to Infections and Outbreaks with Antibiotic-Resistant Organisms. (a) Task
Force agencies shall, as appropriate, utilize the enhanced surveillance activities described in section 6 of this
order to prevent antibiotic-resistant infections by: actively identifying and responding to antibiotic-resistant
outbreaks; preventing outbreaks and transmission of antibiotic-resistant infections in healthcare, community,
and agricultural settings through early detection and tracking of resistant organisms; and identifying and
evaluating additional strategies in the healthcare and community settings for the effective prevention and
control of antibiotic-resistant infections.

(b) Task Force agencies shall take steps to implement the measures and achieve the milestones outlined in the
Strategy and Action Plan.

(c) DoD, HHS, and the VA shall review and, as appropriate, update their hospital and long-term care infectious
disease protocols for identifying, isolating, and treating antibiotic-resistant bacterial infection cases.

Sec. 8. Promoting New and Next Generation Antibiotics and Diagnostics. (a) As part of the Action Plan, the
Task Force shall describe steps that agencies can take to encourage the development of new and next-
generation antibacterial drugs, diagnostics, vaccines, and novel therapeutics for both the public and agricultural
sectors, including steps to develop infrastructure for clinical trials and options for attracting greater private
investment in the development of new antibiotics and rapid point-of-care diagnostics. Task Force agency efforts
shall focus on addressing areas of unmet medical need for individuals, including those antibiotic-resistant
bacteria CDC has identified as public and agricultural health threats.

(b) Together with the countermeasures it develops for biodefense threats, the Biomedical Advanced Research
Development
Authority in HHS shall develop new and next-generation countermeasures that target antibiotic-resistant
bacteria that present a serious or urgent threat to public health.

(c) The Public Health Emergency Medical Countermeasures Enterprise in HHS shall, as appropriate,
coordinate with Task Force agencies' efforts to promote new and next-generation countermeasures to target
antibiotic-resistant bacteria that present a serious or urgent threat to public health.

Sec. 9. International Cooperation. Within 30 days of the date of this order, the Secretaries of State, USDA, and
HHS shall designate representatives to engage in international action to combat antibiotic-resistant bacteria,
including the development of the World Health Organization (WHO) Global Action Plan for Antimicrobial
Resistance with the WHO, Member States, and other relevant organizations. The Secretaries of State, USDA,
and HHS shall conduct a review of international collaboration activities and partnerships, and identify and
pursue opportunities for enhanced prevention, surveillance, research and development, and policy
engagement. All Task Force agencies with research and development activities related to antibiotic resistance
shall, as appropriate, expand existing bilateral and multilateral scientific cooperation and research pursuant to
the Action Plan.

Sec. 10. General Provisions. (a) This order shall be implemented consistent with applicable law and subject to
the availability of appropriations.

(b) Nothing in this order shall be construed to impair or otherwise affect:

(i) the authority granted by law to an executive department or agency, or the head thereof; or

(ii) the functions of the Director of the Office of Management and Budget relating to budgetary,
administrative, or legislative proposals.

(c) This order is not intended to, and does not, create any right or benefit, substantive or procedural,
enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its
officers, employees, or agents, or any other person.

(d) Insofar as the Federal Advisory Committee Act, as amended (5 U.S.C. App.) (the "Act"), may apply to the
Advisory Council, any functions of the President under the Act, except for that of reporting to the Congress,
shall be performed by the Secretary in accordance with the guidelines issued by the Administrator of General
Services.

BARACK OBAMA

THE WHITE HOUSE,