Most scientists don’t think about the U.S. Congress while pipetting. Yet, for microbiologists working in the U.S., the decisions made on Capitol Hill impact each pipette stroke, experiment and word written in a manuscript or grant. Microbiologists have the power to influence those decisions through expertise, voice and constituency.

Scientists can combat public health challenges like antimicrobial resistance (AMR) by developing solutions that introduce new AMR-fighting strategies across the microbial sciences. In areas such as microbiome research, for example, new therapies are being developed to treat antibiotic-resistant infections, and it is crucial to be engaged with members of Congress to advocate for good scientific policy that supports progress in the fight against AMR.

Misusing Antimicrobials: Penny-Wise, Pound-Foolish

As Charles Darwin stated in The Origin of Species: “One general law, leading to the advancement of all organic beings, namely, multiply, vary, let the strongest live and the weakest die.” While microbes are not Darwin’s finches, the same rules apply. Antimicrobial use has undoubtedly had a clear positive impact on humanity, but the consequences of antimicrobial use without proper stewardship are dire. The rapid rise in antimicrobial use since the beginning of the 21st century is driving a corresponding emergence of AMR that is precipitous and continues to increase. Inappropriate prescribing practices, community-based misuse and overuse in animal agriculture have contributed to the spread of antimicrobial resistance. 

By 2050, up to 10 million deaths per year may be attributable to AMR, causing a significant economic impact. While the accuracy of these estimates may be contested, the impacts of AMR are vast and undeniable. Many small-scale efforts, such as antibiotic stewardship programs, are highly effective in combating AMR, but significant challenges remain. The rise in antimicrobial use is distributed unevenly across the globe. The most rapid increase is in low- and middle-income countries (LMICs), where access to antimicrobials is less controlled and health care infrastructure for preventing AMR is less robust. Though it is easy to point to LMICs as a root cause of the increase in antimicrobial use, high-income countries (HICs) also contribute to antimicrobial misuse.

The issue of AMR is here to stay. Thus, humanity needs creative solutions and large-scale policies to combat the threat that AMR poses. Developing these policies requires the input of scientific experts, including ASM members and governmental bodies, for efficacy and scalability. One place where scientists can look for new ways to combat AMR and can, in turn, influence policy that helps support those AMR solutions is the microbiome.

Opportunity in Crisis: AMR and the Microbiome

The bacteria, viruses, fungi and eukaryotes that live in and on humans are critical determinants of health. Collectively known as the microbiome, these microbial communities populate the gut, lungs, mouth, genitourinary tracts and skin. There, they help provide energy, drive physiological development and protect against potential pathogens. Yet, the microbiome can also negatively impact health. For example, the gut microbiome is a reservoir of AMR genes, referred to as the gut resistome. Microbes encoding these AMR genes can escape the gut and cause infection or transfer AMR genes to other potential pathogens. A growing body of evidence suggests that exposure to antimicrobials increases the likelihood of harboring AMR genes and microbes in the gut.

But where there is a crisis, there is also opportunity. The gut microbiome is primarily composed of “healthy” microbes that protect us from potential pathogens by limiting access to essential resources and space and through direct inhibition and killing other microbes. They can also prevent pathogenic behavior from microbes already present in the microbiome. These healthy microbes can be leveraged to improve human health.

Fecal Microbiome Transplantation: The First FDA-Approved Microbiome-Based Therapy

Recently, the Food and Drug Administration (FDA) approved the first microbiome-based therapy for infection prevention, an orally administered fecal microbiota product. The target of this therapy is Clostridioides difficile, which infects the gut following disruption of the healthy gut microbiome by antibiotics. C. difficile can be highly resistant to antimicrobials and therefore extremely difficult to treat. In certain circumstances, C. difficile infections become recurrent, and the risk of recurrent infection increases with each previous infection. Restoration of the healthy gut microbes through fecal microbiota transplantation (FMT) prevents recurrent C. difficile infection, which demonstrates an opportunity to fight AMR through the gut microbiome. 

Where Science and Policy Meet

Does the success of FMT in combating C. difficile infection mean researchers can manipulate the microbiome to preventatively remove (decolonize) resistant microbes, making antimicrobials more effective in clinical settings? What microbes are the most important for preventing and combating resistant infections? Answering these, and other similar questions, is the goal of many research teams worldwide; however, these teams do not answer such questions in isolation. Policymakers play a critical role in determining the direction of research by setting broad scientific goals, allocating and administering funding and creating infrastructure for research and implementation. While researchers' primary focus should be the pursuit of science, there is a need for engagement in the policymaking process. Moreover, there is an explicit role for researchers in addressing the broader policy questions surrounding microbiome-based therapies, such as scalability, equitable access, regulation and the ethics of such therapies.

Speaking On Our Science

I often encourage other scientists to engage in legislative advocacy activities, but in my experience, most are hesitant. Governmental activity outside of the major funding institutions can often feel like someone else’s area of expertise, or at least a bigger problem than 1 person can reasonably address. This perception is understandable—scientists develop a keen sense that we need to stay in our lane. We know our fields deeply, we do our research and we engage in extracurricular activities that are close to those areas of expertise. Moreover, we know the damage that misinformation can cause, and we hesitate to accidentally cause similar harm. Yet, the collective voices of scientists are absolutely critical when advocating for and shaping positive policy. 

Recently, ASM members, including myself, spent 2 days in Washington, D.C., for ASM’s annual Hill Day, advocating for legislation focused on AMR. Graduate students, postdocs and faculty from New York to Hawaii met with lawmakers and their legislative teams to discuss positive policy solutions for faster antimicrobial drug development, enhanced AMR surveillance and antimicrobial stewardship and policy recommendations to address antimicrobial resistance, including a focus on the importance of the microbiome. Advocating for science policy is an energizing and fun experience. I met with congressional staff who look to experts within their constituency to shape their policies. It was also an opportunity to thank legislators who positively impacted my research. 

I am not an expert on all the AMR-related topics for which we advocate, but I am passionate about fighting AMR. And when topics were raised that were outside of my area of expertise, I turned to my colleagues, just as I would in the research space. As part of the 2023 Hill Day, we met with the Senate Committee on Health, Education, Labor and Pensions. One of the policy teams we met with had detailed questions concerning FDA policy. Though the specific policies were not my area of focus, I was accompanied by ASM Past President Robin Patel, M.D., and Amy Mathers, M.D., D(ABMM), associate professor of medicine and pathology at the University of Virginia. These incredible scientists deftly addressed the policy team’s questions effectively and eloquently. Leveraging the network of experts we know and work with is a great way to amplify our advocacy. Just as we would tackle a research question outside of our field through collaboration, we can tackle advocacy the same way.

If you want to get more involved in advocacy but aren’t sure where to begin, ASM provides excellent tools for getting started and crafting your message to help build your confidence and make the process less intimidating. Advocacy is easier than you might think. It can be as simple as contacting the office of your member of Congress or attending a constituent meeting to thank them for supporting something you care about, like increases in research funding.

Below are some specific actions you can take to get involved: 

• Email Your Representative: Time input, low; impact, low. Visit your representative's website for contact information.
• Call Your Representative's Legislative Office: Time input: low; impact, medium. Find your representative's contact information on their website or call the U.S. Capitol Switchboard at 202-224-3121.
• Attend a Constituent Meeting: Time input, medium; impact, high. Check your representative's website or social media to find upcoming constituent meetings.
• Participate in an ASM Advocacy Alert: Time input, medium; impact, high. Sign up to receive Advocacy Alerts.
• Visit Your Representative's Office In-Person: Time input, high; impact, high. Request a meeting with your representative online or by phone.
• Participate in an ASM Hill Day: Time input, high; impact, high. Sign up for the Advocacy Newsletter and stay tuned for information about upcoming Hill Days.

It is imperative to know that your voice matters. You don’t need to be an expert to advocate—you just need passion, direction and willingness to speak about your science to those who can implement public policy to help advance it.