See also: press release
What is the cause of growing antimicrobial resistance in the EU?
The rise in AMR is due to a number of factors such as excessive and inappropriate use of antibiotics in humans, veterinary overuse in livestock, and poor hygiene conditions in healthcare settings or in the food chain. Lack of awareness also remains a key factor: 57% of Europeans are unaware that antibiotics are ineffective against viruses, 44% are unaware that they're ineffective against cold and flu (Source: Eurobarometer, June 2016).
What is the scale of the challenge of AMR in the EU and globally?
AMR is responsible for an estimated 25,000 deaths and €1.5 billion in extra healthcare costs every year in the EU alone. Infections resistant to multidrug therapies and last-resort treatments have significantly increased in Europe in recent years.
Worldwide, an estimated 700,000 people die each year from antibiotic resistant infections, and the World Bank has warned that, by 2050, drug-resistant infections could cause global economic damage on a par with the 2008 financial crisis. Inaction is projected to cause millions of deaths globally each year and by 2050 AMR has the potential to become a more common cause of death than cancer.
What did the first Action Plan (2011-2016) achieve?
The first action plan served as a symbol of political commitment and stimulated actions within EU countries. For example, many countries adopted national action plans with activities relating to the prudent use of antimicrobial agents, surveillance of AMR and surveillance of antimicrobial use.
On the animal side, in 2015 the Commission adopted legislative proposals on veterinary medicines and medicated feed - critically important in tackling AMR. They are currently under discussion in the European Parliament and in the Council, with a view to binding EU Regulations being adopted in 2018.
Since 1999, the EU has spent more than €1.3 billion on transnational collaborative AMR research to ensure antimicrobials are used appropriately. EU-funded research and projects study how AMR develops and is transmitted, and support the development of rapid diagnostic tests, new antimicrobial therapies and alternatives like vaccines, and strategies for the responsible use of antibiotics in all areas.
As a reaction to the first Action Plan, the world's biggest public-private partnership New Drugs for Bad Bugs (ND4BB) programme was launched in May 2012 within the Innovative Medicines Initiative (IMI). With this programme, academic and other public partners and pharmaceutical companies team up to advance the development of new antibiotics with a total budget of about € 700 million. The Joint Programming Initiative on AMR (JPIAMR) was also established to integrate research efforts across national borders via alignment and research funding, and to create a common research agenda. The JPI AMR involves today 23 countries.
What's new in the Action Plan adopted today?
The new action plan sets out a comprehensive framework for more extensive action to reduce the emergence and spread of AMR and to increase the development and availability of new effective antimicrobials inside and outside the EU. It focuses on activities with a clear EU added value and, where possible, on measurable and concrete outcomes. Whilst ensuring the continuation of EU actions that are still needed, the new action plan will enhance its support to help EU countries deliver innovative, effective and sustainable responses to AMR. For example, it aims to scale up collaboration and surveillance efforts to reduce data gaps and to create more synergies and coherence between different policies according to the One Health approach.
How will the new Action Plan make the EU a 'best practice region'?
There are significant differences between EU countries in antimicrobial use, occurrence of resistance, and the extent to which effective national policies deal with AMR have been implemented. With the new Action Plan, the Commission aims to reduce these gaps and raise the level of all EU Member States to that of the highest performing country. To this end, and within the limits of EU competences, actions will focus on the areas with the highest added value for specific Member States, e.g. promoting the prudent use of antimicrobials, enhancing coordination and implementation of existing EU rules, improving infection prevention and extending surveillance of AMR and antimicrobial consumption.
What will the research pillar of the plan focus on?
Actions under the research pillar aim to boost research and further incentivise innovation, provide valuable input for science-based policies and legal measures to combat AMR and address knowledge gaps such as the role of AMR in the environment. Using different funding instruments and partnerships under its current and future Framework Programmes for Research and Innovation the Commission will ensure that established initiatives like ND4BB and JPIAMR reach their full potential, and support actions in the areas of detection, infection control and surveillance, new therapeutics and alternatives, vaccines, diagnostics, new economic models and incentives and, last but not least, environment and transmission prevention.
Why is the EU in a good position to shape the global agenda?
Firstly, the EU's 'One Health' approach has already been accepted as best practice at international level, and many of the EU's domestic AMR policies, such as the ban on using antimicrobials as growth promoters in feed for food-producing animals, already contribute towards international goals.
Secondly, as one of the largest markets for agricultural products, the EU can play a major role in promoting its AMR-related standards, measures in food production, and standards on animal welfare, especially through its bilateral Free Trade Agreements (FTAs). The inclusion of AMR-related provisions is now a current practice for the Commission in all new FTAs.
Thirdly, large research initiatives such as the European and Developing Clinical Trial Partnership (EDCTP) and the JPIAMR that act beyond Europe have been established successfully, which makes the EU well placed to further promote the alignment and collaboration of research efforts and initiatives on AMR.
Finally, in lesser developed countries, where the threat of AMR to public health and the economy is even greater, the EU can continue to help raising awareness, support capacity building and policies to fight AMR wherever possible.
Who was consulted for the development of the new Action Plan?
As a first step, from 24 October 2016 to 28 March 2017 stakeholders had the opportunity to provide their feedback on a Commission roadmap on a One Health action plan against AMR.
The Commission then conducted an extensive open public consultation on possible activities to be included in the action plan between 27 January and 28 April 2017. The consultation targeted citizens and stakeholders with an interest in animal and human health policy, animal health, public health, healthcare and/or the environment in Europe. 421 citizens from 22 EU countries as well as some from third countries participated in the consultation in addition to 163 stakeholders representing public or private administrations, NGOs, the pharmaceutical industry and human healthcare providers, participated.
How will the Commission measure success?
One of the actions is to determine a limited number of key outcome indicators, based on data already collected, so that EU systems can measure EU and Member States' progress. These indicators will be developed with the support of the EU scientific agencies. They will allow Member States to assess progress made in the implementation of their national One Health action plans, and help them set measurable goals to reduce AMR in humans and food-producing animals, and to improve appropriate use of antimicrobials in both sectors. This progress will be discussed at regular intervals in the One Health network on AMR, to guide individual Member States and to determine if new actions are needed at EU level.
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 For example, resistance to carpabenems – last-line antibiotics used to treat pneumonia, increased from 6.2% in 2012 to 8.1% in 2015 (Source: ECDC).