°®¶¹´«Ã½

Secretary Xavier Becerra U.S. Department of Health and Human Services 200 Independence Avenue SW Washington, D.C. 20201

Dear Secretary Becerra, 

Antimicrobial stewardship and other measures to combat AMR are most successful within the context of a strong public health system. Addressing AMR will require multilateral commitments to public health and strengthening laboratory systems. On behalf of the American Society for °®¶¹´«Ã½ (ASM), we urge the U.S. delegation to the UN General Assembly high-level meeting on AMR to address the gaps, challenges and opportunities to combat AMR in low-and middle-income countries (LMICs), where the threat is greatest. 

AMR disproportionately affects LMICs. Yet, many of these countries lack the infrastructure and resources to perform surveillance required to assess AMR. Laboratories are the backbone of public health systems, yet according to a recent study by the African Society for Laboratory Medicine, only 1.3% of the 50,000 medical laboratories across 14 participating countries conduct bacteriology testing. Further exacerbating this issue is the shortage of ~850,000 diagnostics workforce members. Financing researching of medical products and diagnostics for diseases endemic in LMICs is another challenge that warrants more attention. 

Research, development and uptake of affordable, novel diagnostics that can test bacteria for susceptibility to antibiotics are critical to ensuring we detect resistant strains quickly and accurately. The currently available diagnostic solutions are insufficient (both domestically and globally) which means we often find out about resistant strains only after treatment failure. The U.S. must continue investing in global programs that strengthen health systems and build resilient laboratory capacity. For example, with funding from the Centers for Disease Control and Prevention's Global AR Lab & Response Network, ASM currently supports programs in Mexico and Brazil to improve the detection of AMR threats. This global network also responds to AMR threats and informs global prevention strategies. 

In addition to this program, ASM has identified several opportunities for strengthening policies, emphasizing microbiology’s role in both assessing challenges and creating One Health solutions. 

1. Support innovative research into antimicrobial resistance to better understand the science of microbes, how resistance emerges and is spread and how pathogens react to countermeasures. 
2. Champion solutions to the challenging antimicrobial marketplace and work with regulators to improve approval pathways for antimicrobials and other countermeasures. 
3. Improve rapid detection to identify outbreaks before they spread, whether on the farm, in the hospital or in communities. 
4. Foster stewardship models for antimicrobial prescribing that ensure the right person, animal or crop get the right drug for the right infection, while preserving the effectiveness of currently available antimicrobials long term. 
5. Harmonize domestic and global policy frameworks to bolster antimicrobial stewardship and increase lab capacity in low- and middle-income countries, in coordination with the °®¶¹´«Ã½ Nations, the World Health Organization and global partners. 

ASM’s Global Public Health Programs strengthen laboratory capacity in resource-limited settings and empower microbiology laboratories to integrate clinical care and population surveillance. Over the past few years, we have supported more than 20 countries and responded to over 30 infectious diseases by training over 12,000 laboratorians across 400 facilities. This has resulted in accreditation of laboratories and increased data submission into global databases for both human and animal health. We urge the U.S. delegation to the UNGA HLM on AMR to uphold this program as an effective example of how global partnerships can amplify progress in the fight against AMR. 

In closing, ASM appreciates your commitment to amplifying these concerns. We need end-to-end policies that catalyze both research and development of novel medical products and equitable access for, and uptake by, global populations. With more than 32,000 members in the U.S. and around the globe, ASM’s mission is to promote and advance the microbial sciences, and we and our members stand ready to help. If you have any questions or would like to further discuss these comments, please contact Amalia Corby, ASM Director of Federal Affairs, at acorby@asmusa.org. 

Sincerely, 


Stefano Bertuzzi, Ph.D., MPH
CEO, American Society for °®¶¹´«Ã½