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Community strategy against antimicrobial resistance
The aim of this communication is to develop a global approach to the concerning phenomenon of antimicrobial resistance in humans and animals.
Communication from the Commission of 20 June 2001 on a Community strategy against antimicrobial resistance [COM(2001) 333 final, Volume I - not published in the Official Journal].
Antimicrobial substances are synthetic or natural substances used to destroy or inhibit the growth of viruses, bacteria, etc. (antibiotics are a form of microbial agent which react exclusively against bacteria). There is no doubt that these substances have contributed to improvements in the health of the population. However, certain micro-organisms have developed a resistance to them as a result of their excessive and uncontrolled use, thus jeopardising the medical conquests achieved.
This is a worrying global phenomenon. The Commission has therefore decided to formulate an overall approach in order to augment and reinforce the existing legislation. The Communication is accompanied by a proposal for a Recommendation on the prudent use of antimicrobial agents in human medicine.
It should be noted that humans are exposed to antimicrobial agents not only through medicinal products but also through food. The same goes for animals. The strategy therefore embraces both human and veterinary medicine. It comprises action priorities in four key areas, namely:
- surveillance: monitoring the evolution and the effects of interventions;
- prevention of communicable diseases, and infection control to reduce the need for antimicrobial agents, partly through the prudent use of such agents;
- research and development of alternative products;
- international cooperation.
Key area 1: surveillance
This is based on two priorities:
- Develop surveillance networks at European level and encourage the participation of non-EU countries;
- Put in place and improve the collection of data on consumption of antimicrobial agents in all sectors.
As regards the surveillance networks, these need to keep track not only of resistance to antimicrobial agents but also of trends in communicable diseases, infections such as salmonella and infections contracted during hospitalisation (nosocomial infections) etc. Disease outbreaks can be a sign of resistance to antimicrobial agents. A network for the epidemiological surveillance and control of communicable diseases at Community level was set up in 1999. The specific networks set up within this framework are numerous and include the EARSS - the European Antimicrobial Resistance Surveillance System. These networks need to be improved to make them more cohesive and more coordinated. Similar networks exist in the field of veterinary medicine.
Key area 2: prevention
Several key activities have been proposed in this area, including the following:
- Increase the importance of antimicrobial resistance information for the market authorisation process in all fields.
- Support, at Community level, educational campaigns directed at professionals and the general public to avoid overuse and misuse of antimicrobial agents.
- Make sure that antibacterial substances are available in human and veterinary medicine by prescription only and distributed in a controlled way in agriculture, and assess whether the prescription-only rule should be applied to all antimicrobial agents.
- Reinforce and promote infection prevention programmes, in particular immunisation programmes.
- Reinforce the food monitoring system as regards methods of analysis, sanctions and reporting systems.
- Phase out and replace antimicrobial agents used as growth promoters in feed (this action has already been undertaken, in part, under existing or proposed legislation).
- Review the use of the two authorised antimicrobial agents in food (Nisin (E 234) and Natamycin (E 235)) - food preservation agents).
- Give particular attention to GMOs which contain genes expressing resistance to antibiotics used for medical or veterinary treatment, with a view to identifying and eliminating those GMO genes which may have adverse effects on human health and the environment.
Key area 3: Research and product development
There are three key actions in this area:
- Encourage the development of new antimicrobial agents.
- Encourage the development of alternative treatments and vaccines.
- Support the development of rapid and reliable diagnostic and susceptibility tests.
Research targeted at antimicrobial resistance has already been going on at Community level for a number of years, chiefly within the Framework Programme for Research and Technological Development (the Fifth Framework Programme (1998-2002) is currently in progress).
Key area 4: International cooperation
Antimicrobial resistance is no respecter of frontiers and the expansion in global trade and travel has increased the speed of its spread. The Community has therefore established links with numerous international organisations, including the WHO. It has also put the problem on the agenda in its external cooperation forums such as Euro-Med and the Northern Dimension Action Plan and in the EU enlargement process.
The two priority actions in this area are as follows:
- Encourage strongly the development of co-operation, co-ordination and partnership at international level.
- Pay special attention to candidate and developing countries by helping them put in place the appropriate structures.