Antimicrobial Resistances (AMR) are an urgent health issue – the European Commission now analysed National Action plans and found potential for improvement.
Antimicrobial Resistance (AMR) poses a major threat to human health around the world already and will worsen in the future. The O’Neill report on AMR forecasts for 2050 about 10 million deaths per year caused by resistant bacteria, which would also lead to a cumulative economic output loss of about $100 trillion. Already today, more than 1.2 million deaths worldwide are caused by AMR each year. The Health Emergency Preparedness and Response Authority (HERA) of the European Commission (EC) lists AMR as one of the top 3 health threats to prepare against and the new pan-European survey on antimicrobial resistance from the ECDC supports this. Highlighted is the importance also by the Panel for the Future of Science and Technology (STOA) of the European Parliament and its publications on fighting antibiotic resistance.
In 2015, the WHO published a global action plan on Antimicrobial resistance outlining five objectives: i. awareness and training, ii. strengthening knowledge through surveillance, iii. infection prevention and control, iv. optimisation of the use of antimicrobials and v. research, collaborative work and innovation. Only a year later, EU council conclusions were adopted, calling for a comprehensive EU action plan and national action plans (NAPs) in the member states until 2017. The EU action plan created a framework for continued and more comprehensive actions to reduce the emergence and spread of AMR and support the development and availability of new antimicrobials. It is based on the One Health approach. This integrated and unifying approach aims to sustainably balance and optimise the health of people, animals and ecosystems. It considers that humans, domestic and wild animals, plants and the wider environment are closely linked and interdependent; therefore, a holistic approach is needed to solve emerging problems, mobilising multiple sectors, disciplines and communities.
Six years after the adoption of the Council conclusion asking for NAPs, the EC reviewed the status of the NAPs in the Member States as of 1 September 2021. The ‘Member States’ One Health National Action Plans against Antimicrobial Resistance‘ report was published on 17 November 2022, 1 day before the World Antimicrobial Awareness Week started. It assessed that in all states, national action plans were in place, 23 of them are at least partly based on the One Health approach, while some of these plans only consist of sectoral plans. Even if the environment was already recognised as a key element to address AMR fully, only 13 NAPs included it besides human and animal health. Moreover, the report identified that all plans included a strategic part, while many missed operational, monitoring, reporting or evaluation parts. Budgeting information is absent in most of the plans. With this, it is questionable whether effective implementation is even possible. The NAPs showed high variation, representing the different statuses of the countries in the fight against AMR.
The report also recognised that the fight against AMR was affected by the Covid-19 pandemic in various ways. On the one hand, negatively by diverting resources from NAPs; on the other hand positively, because there are important lessons learnt in regard of epidemiology of infectious diseases while raising awareness in health crises, the importance of control measures, vaccines and diagnostic tools.
The report revealed significant potential for improvement of the NAPs and showcased which efforts and synergies could contribute to optimisation. Already during the time of evaluation, almost half of the member states are working on developing or updating their NAPs. There are some major limitations of the report, like the differing practice of antimicrobial use in the countries, the fact that NAPs are comprising only some actions against AMR or the missing evaluation of the implementation activities.
Based on the report, the EC plans to further support the fight against AMR on different levels, complementing ongoing efforts. By formalising the EU AMR One Health network 2021 as a Commission expert group, it should be reinforced that its biannual meetings help to renew the actions to tackle AMR by strengthening the network, building working groups, opening parts of the meetings to stakeholders and gathering sound knowledge across the EU. Furthermore, the Commission provides technical assistance to Member States through the Technical Support Instrument and fosters the recurring joint analysis by ECDC, EFSA and EMA on antimicrobial consumption and AMR in humans, animals and food.
The last joint action on AMR funded by the EC called JAMRAI ended 2021, but there is a new joint action under EU4Health already in preparation, which should start in 2023 with a budget of €50 million. Besides, there is also a joint call coming up in January 2023 coordinated by the ERA-NET Cofund JPIAMR.
Moreover, the Commission prepares a package of initiatives against AMR, including a proposal for Council recommendations addressing the environmental dimension of AMR, which should be adopted in early 2023, the upcoming partnerships on Animal Health and Welfare and One Health/AMR and the European Health Union. AMR is also a prominent part of the AMR One Health approach under the EU Global Health Strategy adopted on 30 November 2022. In the global context, a chapter on AMR is foreseen in the international treaty on pandemic prevention and preparedness, and the EU plans to be involved in the international AMR multi-stakeholder partnership platform and the AMR Multi-Partner Trust Fund.