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EO 13676Executive OrderObama · D Quiet signal

Executive Order 13676

Combating Antibiotic-Resistant Bacteria

This executive order establishes a government-wide framework to combat antibiotic-resistant bacteria by creating an interagency task force, a presidential advisory council, and mandating specific actions including antibiotic stewardship programs in healthcare facilities, strengthened surveillance systems, promotion of new drug development, and international cooperation. It sets concrete deadlines for a national action plan and regulatory reviews to address what the CDC identified as at least 23,000 annual U.S. deaths from resistant infections.

Federal Register Open PDF 79 FR 56931

Impact dates

  1. HHS reviews existing regulations and proposes new regulations for hospital antibiotic stewardship programs

  2. DoD and VA review existing regulations and propose new regulations for their facilities' antibiotic stewardship programs

  3. First annual update to President on federal actions (within 180 days of Action Plan release)

  4. Task Force submits 5-year National Action Plan to President

  5. Secretaries of State, USDA, and HHS designate international representatives

Key directives

  • Establish Task Force co-chaired by Secretaries of Defense, Agriculture, and HHS
  • Establish Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria (max 30 members)
  • Task Force to submit 5-year National Action Plan by February 15, 2015 with goals, milestones, metrics, and timelines
  • HHS to review regulations and propose actions requiring hospital antibiotic stewardship programs by end of 2016
  • DoD and VA to review regulations and propose actions requiring their facilities' antibiotic stewardship programs by end of 2016
  • FDA to continue eliminating use of medically important antibiotics for growth promotion in food-producing animals
  • DoD, HHS, and VA to standardize collection and sharing of antibiotic resistance data
  • Secretaries of State, USDA, and HHS to designate international representatives within 30 days
  • Biomedical Advanced Research Development Authority to develop countermeasures for antibiotic-resistant bacteria
  • Annual updates to President on progress within 180 days of Action Plan release and yearly thereafter

Who is ordered

Timeline

Immediate

  • Establishment of Task Force and Advisory Council
  • Designation of international representatives within 30 days

Near term (90d)

  • Task Force submission of 5-year National Action Plan by February 15, 2015
  • Initial international engagement with WHO

Long term

  • Implementation of antibiotic stewardship programs by end of 2016
  • Annual progress reports ongoing after Action Plan release
  • Development of new antibiotics and diagnostics
  • Integration of surveillance systems

Risks & tensions

  • Implementation explicitly subject to availability of appropriations, creating funding uncertainty
  • Advisory Council effectiveness depends on HHS Secretary's appointment decisions (up to 30 members, not specified)
  • Annual reporting timeline is relative to Action Plan release date, which itself depends on meeting February 2015 deadline
  • Stewardship program requirements use 'propose new regulations' language rather than direct mandates, leaving implementation gap
  • Multiple agencies with overlapping jurisdiction (USDA, EPA, FDA on agriculture; DoD, HHS, VA on healthcare) may create coordination challenges
  • Vague 'as appropriate' qualifiers throughout reduce enforceability of many directives
Executive Order 13676: Combating Antibiotic-Resistant Bacteria · Executive Orders