Since 2009 the federal government started the process of replacing local computers with cloud platforms. A recent report from the Congressional Research Service (CRS) provides an interesting view into the progress of these investments. It reveals the benefits that public agencies gain when using cloud services and the barriers they face when making the transition.

Advantages of Cloud Computing

Cloud computers are superior to locally-run data centers for a variety of reasons. The CRS report identifies six specific cloud benefits:

• Cost- Cloud computer platforms use resources more efficiently than local servers. An organization that uses local Information Technology (IT) must invest in the infrastructure to support computer systems at times of peak demand. However, most times companies or government agencies require only a fraction of that computing power. Cloud computing allows organizations to pay for all of the resources they need and avoid costly investments in rarely used local IT systems.
• Energy Efficiency- Cloud computing data centers benefit from economies of scale to run more efficiently than local servers. In some cases this can result in huge energy savings. For a large cloud computing center it also makes economic sense to invest in green energy sources like wind or solar for power.
• Availability- Cloud computing systems make it easy for any device with an Internet connection to access files or software. However, if a facility temporarily loses Internet access the files on cloud system are inaccessible. Alternatively, a locally administered IT system could function without Internet connectivity.
• Agility- Cloud systems can make it easier to upgrade operating systems and applications. The available computing power also means that memory intensive software packages are cost effective.
• Security- Cloud providing companies also have the financial resources to purchase the tools necessary to ensure that networks remain safe.
• Reliability- Cloud systems can save data onto multiple servers. If a single server goes down due to a cyberattack or another issue, the data is available on another server.

Government Investments in the Cloud

Determining the exact size of government cloud computing expenditures is difficult. Government spending on IT has increased every year from 2001 to 2013 when it reached a peak of $81 billion. In the three subsequent years it has decreased. Cloud computing expenditures likely represent a tiny fraction of that total. Market research firms have estimated that the federal government spends between $1.4 billion and $7 billion on cloud computers annually.

Trends in Total Federal Investment in Information Technology

Source: Congressional Research Service

Challenges for Migrating to the Cloud

The federal government has encountered several barriers in its plan to shift more functions to cloud platforms:

• High Federal Security Requirements- The government faces new advanced persistent threats routinely. System-wide security updates are necessary more often than for private sector organizations. The short update cycle provides a unique challenge to cloud providers.
• Adopting New Technologies- Government agencies have ingrained cultures that are slow to change. This shift from locally-based servers to the cloud can be slow and tedious for this reason.
• Ancillary Technologies- Cloud technologies are known for their flexibility. However, government agencies may lack the necessary IT infrastructure or speedy Internet connections that leverage the maximum potential of the cloud.
• Technical Know How- Cloud platforms require specialized knowledge to administer. Many government agencies lack the necessary experts to oversee a migration to the cloud.
• IT Expenditure- Migration to the cloud can involve expensive initial costs. Additional funding is necessary to facilitate the shift to the cloud.

The Future of the Government Cloud

An analysis of the costs and benefits of cloud migration uncover a few specific barriers that the federal government must overcome to earn the full value from new technologies. First, lawmakers must be willing to spend more now to save money later. Cloud systems are cheaper to run than local administered servers but the initial transition costs are high. Current funding levels, which are trending down, are too low to finance such a change. Privacy and security are also major challenges. Government servers host troves of data that Americans expect to remain private. Converting these systems to the cloud will require the government’s full confidence that cloud systems are at least as secure. New legislation is likely necessary to achieve the complimentary goals of privacy and security.

More TechTank posts available here

       

       

       

       

Few issues are closer to President Obama’s vision of the global future than his convictions about reducing the role of nuclear weapons in U.S. national security strategy. Less than three months after entering office, in a major speech in Prague, he put forward an ambitious nuclear agenda, declaring that the United States (as the only state ever to employ nuclear weapons in warfare) had a “moral responsibility…to seek the peace and security of a world without nuclear weapons.”

Seven years later, despite the administration’s having advanced other goals in non-proliferation policy, the larger vision of a nuclear-free world remains very much unfulfilled. But President Obama apparently hasn’t given up. In late May, he became the first American president to visit Hiroshima, where the United States first employed a nuclear weapon in warfare. In his speech, the president declared that “nations like my own that hold nuclear stockpiles…must have the courage to escape the logic of fear and pursue a world without them.” Moreover, as President Obama approaches his final six months in office, senior officials are purportedly deliberating additional policy changes that they believe could be undertaken without congressional approval. As Deputy National Security Adviser Ben Rhodes said in a June 6 speech at the Arms Control Association, the president remains intent on advancing his “Prague agenda” before leaving office.

According to recent press reports, the policy options under consideration include U.S. enunciation of a nuclear “no first use” doctrine. Such a step would represent a profound shift in U.S. policy. Non-nuclear states living in the shadow of nuclear-armed adversaries have long relied on U.S. security guarantees, specifically the declared commitment to employ nuclear weapons should our allies be subject to aggression with conventional forces. They have based their own national security strategies on that pledge, including their willingness to forego indigenous development of nuclear weapons.

Northeast Asia presents a clear contradiction between President Obama’s non-nuclear aspirations and existing circumstances.

These issues bear directly on the credibility of U.S. guarantees to allies in Europe and Asia, with particular relevance in Northeast Asia. Since the end of the Cold War, the content of the U.S. extended nuclear deterrence pledge has already narrowed. Washington has long deemed any use of nuclear weapons a matter of absolute last resort. Since the early 1990s, Washington has also enunciated an unambiguous distinction between employment of conventional and nuclear weapons, including the unilateral withdrawal of all tactical nuclear weapons deployed on the Korean peninsula. 

The Obama administration itself has also moved closer to limiting nuclear weapons use exclusively to deter another state’s first use of such a weapon against the United States, its allies, and partners—in fact, the 2010 Nuclear Posture Review declared that this was a “fundamental role” of the American nuclear arsenal. At that time, it also pledged to “work to establish conditions” under which it was safe to adopt universally a policy where the “sole purpose” of U.S. nuclear weapons was to deter a nuclear attack by an adversary. The implication of such a “sole purpose” policy would be that North Korea need not fear American nuclear retaliation if it mounted only a conventional attack against South Korea. 

Whether it is “no first use” or “sole purpose use,” Northeast Asia presents a clear contradiction between President Obama’s non-nuclear aspirations and existing circumstances. The Republic of Korea and Japan (the only state ever subject to nuclear attack) confront the reality of a nuclear-armed North Korea. Pyongyang continues to enhance its weapons inventory and the means to deliver them. It also regularly threatens Seoul and Tokyo with missile attack, potentially armed with nuclear weapons. 

[A]ny indications that the United States might be wavering from its nuclear guarantees would trigger worst-case fears that the United States, above all, would not want to stimulate.

Both U.S. allies are therefore strongly opposed to a U.S. "no first use" pledge, and would likely have deep concerns about a sole purpose commitment. Though the United States possesses a wide array of non-nuclear strike options in the event of a North Korean attack directed against South Korea or Japan, any indications that the United States might be wavering from its nuclear guarantees would trigger worst-case fears that the United States, above all, would not want to stimulate. At the same time, choosing not to issue a "no first use" pledge should not in any way suggest that the United States favors nuclear use, which would play directly into North Korean propaganda strategy. Rather, the United States should not preemptively remove the nuclear option, especially when North Korea is in overt defiance of its non-proliferation obligations and is single-mindedly intent on a building a nuclear weapons capability.

The Obama administration must therefore balance its clear desire to advance a non-nuclear legacy with Northeast Asia’s inescapable realities. Enunciating a "no first use" doctrine or a sole purpose commitment in the administration’s waning months in office is a bridge too far. Though the United States can and should engage South Korea and Japan in much deeper consultations about extended deterrence, it cannot put at risk the security of allies directly threatened by attack from a nuclear-armed adversary. 

The next U.S. president will have to square this circle. In the meantime, the Obama administration should do all that it can to plan for the road ahead, even if it means policy pledges that might not be as visionary as it would prefer. 

       

       

       

       

The flight of humans from Syria has been rapid, massive and dynamic. The number of refugees has grown from 26,000 in the first year of the war to almost 4.2 million now, four years later. It is time for bold action from the world to support Turkey and the other countries of the region hosting the vast majority of refugees.

None of Syria’s neighbors – the primary hosts of refugees – expected the displacement to reach such a scale, nor for the crisis to last this long. Many believed in the early days of the Arab Spring that the oppressive regime of Bashar al-Assad would be replaced by a reformist-minded, popularly-elected government - mirroring the transition that had just taken place in Tunisia and Egypt. Instead, Syria became mired in a civil war between an ever-growing number of opposition groups and the regime, whose repression of civilians, regardless of any involvement in the crisis, has forced millions to flee in terror on either side of the country’s borders.

Until recently, the overwhelming majority of the refugees were fleeing the indiscriminate attacks of the Syrian government. More recently, ISIS has been a significant source of terror, while even more recently Russia’s entry into the conflict has triggered another wave of flight.

Today, the refugee populations registered in Lebanon, Jordan and Turkey total more than 4 million souls. Managing the presence of such large numbers of refugees has been costly on host countries economically, socially and politically. What was expected to be a temporary refugee influx has become a protracted crisis. With no signs of a resolution of the conflict in the foreseeable future, the refugees’ hope to return is diminishing.

The massive influx of refugees into Europe, often via extremely costly and life-threatening channels, reflects the despair and harsh living conditions that many refugees feel. Syrians constitute the majority of the 800,000 migrants that have crossed into Europe this year. As the crisis spills beyond Syria’s immediate neighbors, the EU is experiencing major challenges in managing a response. It is clear that attending to refugees is not only a concern of the immediate neighborhood – but that of a much wider region.

In looking at the challenges to Europe, it is important to underscore that neighboring countries have shouldered most of the burden of caring for the refugees, with inadequate assistance from the international community. Resettlement has been extremely limited, and roughly only a third of the pledges to U.N. response plans have been met.

Now is the time to adopt a comprehensive approach that will offer a better future for refugees and their hosts. Attention must be paid to two areas in particular: Education and access to employment. In this regard, it will be critical to move beyond a strategy focused on humanitarian relief to one explicitly structured around sustainable development and empowerment of refugees.

We need a globally-funded Recovery Program for the Middle East that brings about immediate action to mitigate the impact of the crisis on the economies and services of Syria’s neighbors. As part of that, we need to recognize the skills and income that refugees could contribute to the Turkish economy, if they were only allowed to do so. This program could not be carried out by the Turks alone, but would need the engagement of a range of actors – from the U.N. to the World Bank to the private sector and other donors.

Turkey and its neighbors have generously cared for more than 4 million refugees: But as the displacement crisis enters its fifth year, this burden needs to be shared out much more fairly and effectively.

Sadly, despite the desperate need for peace in Syria, we need to respond to the reality that Syrian refugees will not be able to return home for a while yet. As simultaneously the host of the world’s largest Syrian refugee population as well as host to the G-20 Summit, Turkey is in an ideal position to bring this reality to the attention of G-20 member-states – and leverage more resources to assist it and its neighbors to cope with the crisis.

G-20 leaders must commit to sharing Turkey’s burden and place increased emphasis on empowering refugees to shape their own destinies and become productive members of their host societies.

And it must be remembered: The majority of Syrians want to go home. Eventually they want to be able to contribute to rebuilding a stable and democratic nation for themselves and their families. But peace cannot be served while al-Assad drops barrel bombs on his people and ISIS beheads journalists on the steps of Palmyra. Our leaders must focus on a sustainable political solution to this conflict as the end goal of any plan for the region.

This piece was originally published by Hurriyet Daily News.

       

       

Event Information

Register for the Event

To build on its longstanding interest in the evolving transatlantic relationship and to address the serious differences that have emerged between America and Europe after the September 11 terrorist attacks and throughout the ongoing war on terrorism, Brookings announces the launch of its new Center on the United States and Europe. The center offers a forum for research, high-level dialogue, and public debate on issues affecting U.S.-Europe relations.

At the inaugural conference to launch the new center, experts discussed the theme "The United States and Europe: One Year after the War in Iraq." Panelists at this special event included Javier Solana, Robert Kagan, Charles Grant, Klaus Scharioth, Andrew Moravcsik, Martin Indyk, Ulrike Guerot, Pascale Andreani, Cesare Merlini, Reuel Marc Gerecht, Gilles Andreani and others.

Transcript

• Transcript (.pdf)

Event Materials

• cuse20040421

       

Event Information

Register for the Event

The crisis over Iraq was the latest in a series of international security crises that demonstrated that the European Union has not yet emerged as unified actor on difficult global security issues. Yet since the Iraq crisis, the member states of Europe have shown a renewed interest in creating EU institutions capable of coherent action on controversial foreign policy issues, in articulating a distinct European strategy for promoting security and stability, and in establishing a European role in issues well beyond the European continent.

The Center on the United States and Europe's annual conference brought together renowned experts and policymakers from both sides of the Atlantic to examine Europe's Global Role. The first panel looked at the ongoing efforts by the United Kingdom to steer a course between and "Atlanticist" and "European" foreign policy; the second panel examined the European Union's efforts to manage its relationships with a proliferating number of candidates to the east—at the same time that it sorts out its own political future; and the last panel looked at the integration of a rising China into the international system, an extra-European issue on which the European Union and the United States have already shown signs of discord.

Welcome and Introduction:
Philip H. Gordon, Director, Center on the United States and Europe

Britain Between America and the European Union:
Philip H. Gordon

Panelists:
Anatol Lieven, Carnegie Endowment
Gerard Baker, The London Times
Charles Grant, Centre for European Reform

Where Does Europe End?
Strobe Talbott, President, The Brookings Institution

Panelists:
John Bruton, EU Ambassador to the U.S.
Sylvie Goulard, Institut d'Etudes Politiques, Paris
Andrew Moravcsik, Princeton University
Vladimir Ryzhkov, Russian Duma

The Global Agenda:
James B. Steinberg, Vice President and Director, Foreign Policy Studies, The Brookings Institution

Panelists:
R. Nicholas Burns , Undersecretary of State for Political Affairs
Jean-David Levitte, French Ambassador to the U.S.

Transcript

• Transcript (.pdf)

Event Materials

• annualconf20050511

       

Event Information

Register for the Event

Welcome and Introduction:
Philip H. Gordon , Director, Center on the United States and Europe

Is the European Union Failing? Politics and Policy after the Referendums
Philip H. Gordon , Director, Center on the United States and Europe

Panelists:
Gerard Baker, The Times (London)
Joschka Fischer, Member of Bundestag and former German Foreign Minister
Noëlle Lenoir, President of the European Institute of HEC, former French Minister for European Affairs
Andrew Moravcsik, Princeton University/Brookings

Is Russia Lost? The Future of Russian Democracy and Relations with the West
Fiona Hill, Senior Fellow, The Brookings Institution

Panelists:
Daniel Fried, U.S. Assistant Secretary of State for European Affairs
Anatol Lieven, New America Foundation
Strobe Talbott, President, The Brookings Institution
Dmitri Trenin, Carnegie Moscow Center

Is America above the Law? A U.S.-Europe Dialogue about the War on Terror
Jeremy Shapiro, Director of Research, Center on the United States and Europe

Panelists:
Joschka Fischer, Member of Bundestag and former German Foreign Minister
Tom Malinowski, Human Rights Watch
Pauline Neville-Jones, Chair, British Conservative Party National and International Security Group
Victoria Toensing, former U.S. Justice Department Official
Ruth Wedgwood, Johns Hopkins-SAIS

       

Event Information

Register for the Event

On April 30, 2007, the Brookings Center on the United States and Europe held its fourth annual conference. As in previous years, the annual conference brought together scholars, officials, and policymakers from both sides of the Atlantic to examine the evolving roles of the United States and Europe in the global arena. Panel discussions covered some critical issues about Europe and the U.S.-Europe relationship: "The French Elections", "NATO and Afghanistan" and "Islam in Europe". Panelists included, among others, Lt. General Karl Eikenberry, Deputy Chairman of the NATO Military Committee; Ashraf Ghani, former Finance Minister of Afghanistan; Tufyal Choudhury of Durham University; Philip Gordon of the Brookings Institution; and Corine Lesnes from Le Monde.

8:30 a.m.		Continental breakfast available
8:50 a.m.		Welcome and Introduction Strobe Talbott, President, The Brookings Institution
9:00 - 10:30 a.m.		"The French Elections" Chair: Jim Hoagland, The Washington Post Panelists: Laurent Cohen-Tanugi, Skadden Arps; Notre Europe Corine Lesnes, Le Monde Philip Gordon, The Brookings Institution
10:30 - 10:45 p.m.		Break
10:45 a.m. - 12:15 p.m.		"NATO in Afghanistan" Chair: Carlos Pascual, The Brookings Institution Panelists: Lt. General Karl Eikenberry, Deputy Chairman of the NATO Military Committee Ashraf Ghani, former Finance Minister of Afghanistan Marvin Weinbaum, Middle East Institute
12:15 - 1:30 p.m.		Buffet Lunch (Saul/Zilkha)
1:30 - 3:00 p.m.		"Islam in Europe" Chair: Jeremy Shapiro, The Brookings Institution Panelists: Daniel Benjamin, The Brookings Institution Tufyal Choudhury, Durham University Jonathan Laurence, Boston College

The Center on the United States and Europe Annual Conference is made possible by the generous support of the German Marshall Fund of the United States

Transcript

• Transcript (.pdf)

Event Materials

• 20070430

       

Event Information

On May 20, 2008, the Center on the United States and Europe held its fifth annual conference. As is in previous years, the Conference brought together leading scholars, officials, and policymakers from both sides of the Atlantic to examine issues shaping the transatlantic relationship and to assess the evolving roles of the United States and Europe in the global arena.

Gary Schmitt of the American Enterprise Institute; Sir Lawrence Freedman of King’s College, London; Gideon Rachman of the Financial Times; former Norwegian Foreign Minister Jan Petersen; and Strobe Talbott, President of The Brookings Institution joined other prominent panelists and CUSE scholars for this year’s sessions. The series of panel discussions explored transatlantic relations beyond the Bush presidency, Sarkozy’s plans for France’s EU presidency, and the future of Russia under Medvedev.

Transcript

• Transcript (.pdf)

Event Materials

• 0520_europe

       

Event Information

Register for the Event

President Barack Obama has established a broad policy of engagement as a central feature of his administration’s foreign policy agenda. From the earliest days of his presidency, the president has reached out to Iran, Russia and other nations around the world, marking not only a turning of the page but possibly a whole new chapter in U.S. foreign policy. While Europeans have advocated for increased bi-lateral and multi-lateral dialogue for some time, several important questions remain. With which nations or groups should the United States and Europe engage and should there be limits to dialogue in some cases? What are the consequences if dialogue fails? Do Europeans and Americans now have the same agenda and goals for engagement?

On May 29, the Center on the United States and Europe at Brookings (CUSE) will host experts and officials from both sides of the Atlantic for the 2009 CUSE Annual Conference to address these issues. Panelists will examine the prospect of engagement with Iran and Russia, and how to deal with groups such as Hamas and the Taliban. After each panel, participants will take audience questions.

Transcript

• Uncorrected Transcript (.pdf)

Event Materials

• 20090529_cuse

       

Event Information

Register for the Event

With a U.S. Administration still popular across Europe and a new Lisbon Treaty designed to enhance the diplomatic reach of the European Union, transatlantic relations should now be at their best in years. But this is clearly not the case, with the strategic partners often looking in opposite directions. While the United States channels its foreign policy attention on the war in Afghanistan, counterterrorism and nuclear non-proliferation, Europe is turning inward. Despite its ambitions, the European Union has yet to achieve the great global role to which it aspires, or to be the global partner that Washington seeks. Moreover, the Greek financial crisis has raised questions about the very survival of the European project.

On June 2, the Center on the United States and Europe (CUSE) at Brookings and the Heinrich Böll Foundation hosted experts and top officials from both sides of the Atlantic for the 2010 CUSE Annual Conference. Panelists explored critical issues shaping the future of transatlantic relations in the post-Lisbon Treaty era, including Europe’s Eastern neighborhood and the role Russia plays, and the impact of the Eurozone crisis.

After each panel, participants took audience questions.

Audio

• From the Lisbon Treaty to the Eurozone Crisis: A New Beginning or the Unraveling of Europe?
• From the Lisbon Treaty to the Eurozone Crisis: A New Beginning or the Unraveling of Europe?
• From the Lisbon Treaty to the Eurozone Crisis: A New Beginning or the Unraveling of Europe?

Transcript

• Transcript (.pdf)

Event Materials

• 20100602_eurozone

       

       

Lynn Neary: I'm Lynn Neary in Washington, sitting in for Neal Conan.

John Kerry may not have clinched the Democratic nomination for president in yesterday's primaries and caucuses, but his victories in five of the seven races certainly completed his rehabilitation from an also-ran to a front-runner. John Edwards and Wesley Clark also won last night, Edwards in South Carolina, Clark in a tight race in Oklahoma, where Edwards came in second. Joe Lieberman dropped out of the race altogether. Howard Dean vowed to fight on despite a dismal showing. So did Al Sharpton, who placed third in South Carolina. Dennis Kucinich barely registered with voters. All the candidates now have their eyes on the future with contests in delegate-heavy states now up for grabs.

...

...

Lynn Neary:...With us to talk about money in politics is Anthony Corrado. He's a professor of government at Colby College in Waterville, Maine, and is spending this year as a visiting fellow at The Brookings Institution here in Washington.

Thanks for being with us.

Anthony Corrado: Well, thanks for inviting me, Lynn.

Lynn Neary: Do we know exactly how much money's been spent so far by the candidates?

Anthony Corrado: Well, so far the Democrats have raised about $170 million in private donations and public funding all together, and all of that money's now been spent. This very competitive contest has proved to be very expensive so that as we enter this crucial part of the nominating process, no candidate really has a large reservoir of cash that's available to be spent.

Lynn Neary: Yeah. Both Dean and Kerry used the same strategy, focusing on Iowa and New Hampshire, but came up with very different results, didn't they?

Anthony Corrado: Yes, they did, and it was particularly problematic for Howard Dean because what Dean decided to do was use the large store of cash that he had raised in 2003 to spend lots of money in the states that would be voting in February, as well as in Iowa and New Hampshire, and as a result spent over $3 1/3 million on television in states that were voting after New Hampshire. Whereas John Kerry basically took all of the money he had and put it into Iowa and New Hampshire and was able to get the victories he needed to spur additional fund-raising so that he right now is in the best position even though he ended up raising much less than Howard Dean prior to New Hampshire. He's now in the best position to raise and spend money in this next stage of the race.

Lynn Neary: Yeah. And what about Dean? Has he been able to--he was so well-known for his fund-raising. How has his fund-raising been since he has started losing?

Anthony Corrado: Well, his fund-raising has actually held up very well. He's raising about a million dollars a week. He's raised about $3 million since that now-infamous night in Iowa. But one of the problems that he has is that he built such a large organization that it's very expensive to maintain. And as a result he has not had money for television advertising this week. He's not doing any television advertising in the states this weekend. And he probably won't do any television advertising in Tennessee and Virginia. So he's basically gone off of the airwaves in terms of paid television, with the exception of looking towards Wisconsin, which isn't until February 17th.

...

Listen to this entire program, or purchase a transcript

      

After years of warnings from the public health community about the growing threat of antibiotic resistance, yesterday the White House announced a national strategy to combat the growing problem of antibiotic resistance within the U.S. and abroad. The administration’s commitment represents an important step forward, as antibiotic-resistant infections are responsible for 23,000 deaths annually, and cost over $50 billion in excess health spending and lost productivity.  The administration’s National Strategy on Combating Antibiotic-Resistant Bacteria includes incentives for developing new drugs, more rigorous stewardship of existing drugs, and better surveillance of antibiotic use and the pathogens that are resistant to them.  President Obama also issued an Executive Order that establishes an interagency Task Force and a non-governmental Presidential Advisory Council that will focus on broad-based strategies for slowing the emergence and spread of resistant infections. 

While antibiotics are crucial for treating bacterial infections, their misuse over time has contributed to a rather alarming rate of antibiotic resistance, including the development of multidrug-resistance bacteria or “super bugs.” Misuse manifests throughout all corners of public and private life; from the doctor’s office when prescribed to treat viruses; to industrial agriculture, where they are used in abundance to promote growth in livestock. New data from the World Health Organization (WHO) and U.S. Centers for Disease Control and Prevention (CDC) confirm that rising overuse of antibiotics has already become a major public health threat worldwide.

The administration’s announcement included a report from the President’s Council of Advisors on Science and Technology (PCAST) titled “Combatting Antibiotic Resistance,” which includes recommendations developed by a range of experts to help control antibiotic resistance. In addition, they outline a $20 million prize to reward the development of a new rapid, point-of-care diagnostic test. Such tests help health care providers choose the right antibiotics for their patients and streamline drug development by making it easier to identify and treat patients in clinical trials.  

The Need for Financial Incentives and Better Reimbursement

A highlight of the PCAST report is its recommendations on economic incentives to bring drug manufacturers back into the antibiotics market. Innovative changes to pharmaceutical regulation and research and development (R&D) will be welcomed by many in the health care community, but financial incentives and better reimbursement are necessary to alleviate the market failure for antibacterial drugs. A major challenge, particularly within a fee-for-service or volume-based reimbursement system is providing economic incentives that promote investment in drug development without encouraging overuse.

A number of public and private stakeholders, including the Engelberg Center for Health Care Reform and Chatham House’s Centre on Global Health Security Working Group on Antimicrobial Resistance, are exploring alternative reimbursement mechanisms that “de-link” revenue from the volume of antibiotics sold. Such a mechanism, combined with further measures to stimulate innovation, could create a stable incentive structure to support R&D. Further, legislative proposals under consideration by Congress to reinvigorate the antibiotic pipeline, including the Antibiotic Development to Advance Patient Treatment (ADAPT) Act of 2013, could complement the White House’s efforts and help turn the tide on antibiotic resistance. Spurring the development of new antibiotics is critical because resistance will continue to develop even if health care providers and health systems can find ways to prevent the misuse of these drugs.