Europe announces new action plan on AMR

European officials today released a new action plan on antimicrobial resistance (AMR) that builds on efforts to address the emergence and spread of drug-resistant pathogens in humans, animals, and the environment.

The plan, released by the European Commission, the body that devises common policies for the European Union (EU), takes a One Health approach, which recognizes that drug resistance effects not only human health, but also the health of animals and the environment.

The plan aims to establish a comprehensive framework to strengthen EU efforts to reduce the spread of AMR in humans and animals, help individual states strengthen their national AMR policies, promote development of new antibiotics and diagnostics, and establish the EU as a global leader in addressing the AMR threat.

"It's not too late to turn the tide on antimicrobial resistance, but we need to make sure that we act now," Andrea Ammon, MD, MPH, director of the European Centre for Disease Prevention and Control (ECDC), said in a press release.

Strengthening efforts across the continent

The new action plan, based on an evaluation of the 2011 action plan by experts and on public consultation with citizens and stakeholders, includes concrete steps building on three main pillars:

  • Making the EU a "best practice" region
  • Boosting research, development, and innovation
  • Shaping the global agenda

The evaluation concluded that while the 2011 plan stimulated action within EU member states and symbolized political commitment to fighting AMR, the efforts need scaling up, given the continued increase in bacterial infections that are resistant to multiple antibiotics and last-resort treatments.

AMR is estimated to cause 25,000 deaths a year in the EU and cost 1.5 billion Euros ($1.7 billion) annually in healthcare costs and productivity losses. And despite EU efforts to address the problem dating back to 2001, AMR continues to rise. A January 2017 ECDC report based on surveillance data from 30 EU and European Economic Area countries found rising resistance to broad-spectrum antibiotics and to multiple classes of antibiotics, particularly in gram-negative bacteria such as Escherichia coli and Klebsiella pneumoniae.

One problem addressed in the plan is the fact that resistance levels and efforts to combat AMR vary greatly across the EU. That's reflected in the latest ECDC report, which showed that countries in northern and western Europe generally have much lower levels of drug resistance than those in southern and eastern Europe. The authors of that report noted that these differences are likely due to variation in antimicrobial use, infection control practices, and healthcare utilization. Antibiotic use in agriculture also varies greatly among EU countries.

The action plan aims to address these discrepancies by taking several steps to help member states tackle AMR in several key areas. The steps include improving the EU's surveillance of resistant bacteria and antimicrobial use in humans and food animals to address current gaps, raising public awareness of AMR, helping individual member states develop and coordinate national One Health action plans based on successful strategies, supporting good practices in infection prevention and control, and promoting prudent use of antimicrobials in human and veterinary medicine.

"The Commission will concentrate on key areas with the highest added value for member states, while respecting the limits of EU competence and bearing in mind that member states remain primarily responsible for the definition of their health policies," the plan states.

The plan also calls for efforts to improve the understanding of how the environment contributes to the spread of AMR in humans and animals. While scientists increasingly believe that antibiotic residues and resistance elements are affecting soil and water, more data are needed to understand the extent of this impact and the risk it poses to human and animal health. One specific action called for is an EU-wide strategic approach to pharmaceuticals in the environment.

Research into new antibiotics, diagnostics

Under the second pillar, the plan calls for the European Commission to work in partnership with member states and industry to support research into interventions that prevent and spread the development of AMR in humans and animals. Such interventions include new diagnostic tests to detect drug-resistant pathogens at the point of care, new antimicrobials and alternative treatments for bacterial infections, and new vaccines. It also recommends the creation of new economic models to encourage pharmaceutical and biotech companies to develop new antibiotics and diagnostic tests.

"Such models would need to reflect the long-term benefit of these medicinal products and the societal value of limiting the use of antimicrobials while promoting the use of novel diagnostics," the authors write.

Finally, the plan urges the EU to play a larger role in the global fight against drug resistance by supporting the World Health Organization, the World Organization for Animal Health Organization, and the United Nations Food and Agriculture Organization in their efforts to build international frameworks for the prudent use of antimicrobials in human and animal health. In addition, it calls for the EU to advocate for AMR-related standards and One Health policies in other countries through bilateral trade agreements and to assist in the development of AMR strategies in low-income countries.

One example of an EU domestic AMR policy that could be promoted globally is the ban on the use of antimicrobials as growth promoters in food-producing animals. The EU adopted that policy in 2006.

"The Commission is confident this new One Health action plan can make a difference and will improve the EU performance in combatting AMR," the plan concludes.

EU officials say they will closely monitor the effectiveness and performance of steps taken under the action plan at regular intervals.

See also:

Jun 29 European Commission action plan against AMR

Jun 29 ECDC press release

Feb 1 CIDRAP News story "Report: Antibiotic resistance rising in Europe"

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