Preparing for the Next Pandemic in the Era of Antimicrobial Resistance Image Access the Recommendation Report Preparing for the Next Pandemic in the Era of Antimicrobial Resistance* Executive Summary The COVID-19 pandemic has highlighted the many challenges faced in preparing for and responding to modern public health emergencies, and it has spurred efforts to prevent future ones; these efforts, however, have largely focused on viral pathogens. It must not be forgotten that secondary bacterial infections have also played an important role in exacerbating morbidity and mortality during viral pandemics. With the diminishing power of antibiotics to treat infections due to increasing antimicrobial resistance, the threat of a bacterial pandemic or a viral pandemic – accompanied by secondary bacterial infections resistant to our available stock of antimicrobials – remains possible. Recognizing the interconnectedness of public health emergency preparedness and efforts to combat antimicrobial resistance, U.S. Department of Health and Human Services Secretary Xavier Becerra tasked the PACCARB with providing recommendations on how to augment current national pandemic preparedness policies to strengthen our defenses against antimicrobial-resistant pathogens. In response to this task, the PACCARB identified opportunities for which federal policy can better address issues that contribute to morbidity and mortality from resistant infections and the spread of AMR through enhancement to routine, or steady-state, operations in public health, healthcare, animal care, and agriculture that would create more robust systems that are better able to withstand the stresses of an emergency and more prepared to adapt and respond to emergency conditions. The PACCARB identified four major areas in which improvements can strengthen our preparedness for future public health emergencies: infection prevention and control & antimicrobial stewardship, workforce expansion, data sharing and security, and product innovation and development. Additionally, the PACCARB acknowledges the critical role equity, trust, and communication plays in antimicrobial resistance, preparedness and emergency response activities. These concepts are purposefully listed separately from the four major improvement areas for distinction and attention, and they should be applied when implementing all recommendations. Associated PACCARB Working Group This report was compiled by the Pandemic Preparedness Working Group, and was voted on and approved by the full council at the 23rd PACCARB Public Meeting on March 24, 2023. This working group was established in response to a Task Letter from U.S. Department of Health and Human Services Secretary Xavier Becerra. *People using assistive technology may not be able to fully access information in these files. For assistance, contact the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria by emailing CARB@hhs.gov.