It is the superbug that has claimed the lives of thousands EU citizens a year and nearly a million globally. Fighting against antibiotics until there is no treatment left to cure even a common illness. It can impact anyone, including yourself or your family and it is costing the EU €1.5 billion each year.
It is Antimicrobial Resistance and until now it has remained largely under the radar.
The European Union is hoping to change that with a recently announced action plan to fight Antimicrobial Resistance (AMR), the deadly superbug threatening the health and wellbeing of Europe and the world.
The new action plan proposed by the European Commission will be launched in 2017 and will promote cooperation amongst the member states in fighting AMR. The plan is a follow up to the first European action plan of 2011.
Health and Food Safety spokesman at the Commission, Enrico Brivio, is at the forefront of the EU superbug fight.
“It’s a big problem and it is becoming bigger and bigger…AMR is one of our priorities,” Brivio states.
AMR is causing serious economic troubles in the EU, largely due to increased medical costs and research.
AMR in Europe
Antimicrobial Resistance is the ability for micro-organisms to resist treatments from antibiotics. The ability to evolve and become immune to antibiotics has given AMR the nickname of the ‘Superbug.’
AMR affects both humans and animals and is caused naturally and by a variety of human factors. Most notably is the excessive or inappropriate use of antibiotics and poor infection control practice.
Common diseases that are associated with AMR range from tuberculosis, gonorrhoea malaria and typhoid fever. Treatment failure of antibiotics for gonorrhoea have been reported in Norway, Slovenia, Sweden, the UK and Ireland.
“It is a huge problem, you can just imagine the consequences of not being able to treat people anymore for simple infections and also not being able to perform surgical operations,” said World Health Organization (WHO) European AMR expert, Dr Danilo LO FO Wong.
“We have become dependent on antibiotics and it is very difficult to imagine not having that security anymore.”
In the EU, 25,000 patients die annually as a result of infections caused by AMR. This number is as high as 700,000 globally.
Utrecht University Medical Centre Doctor, M.B. Ekkelenkamp discusses the issues with treating and identifying AMR in patients.
“It is not possible to recognize upfront in a patient. If an infection does not respond to treatment with antibiotics, one of the causes may be AMR.”
The new action plan
The EU’s renewed action plan will see cooperation and support amongst the member states in the common goal of eliminating AMR to the best of their ability.
“That is the point of our strategy,” Brivio comments, “we want (to maintain) a single market for medicines and we need to have more coordinated strategies for the intake of medicines … even with the animals there is a free market.”
There are varying levels of AMR related cases member state to member state. In the EU, Malta and Spain use the most antibiotics, while Sweden has the lowest usage. Despite this, the member states will receive similar attention and will all prioritise AMR as a primary health concern.
“It will focus on supporting member states in establishing, implementing and monitoring their national action plans, bringing together EU funds and promoting research” Brivio explained.
Despite varying levels of cases between member states, AMR has no regard for borders and can impact anyone. This makes it vital for every member state to have a national action plan and to cooperate with each other.
“We are not focusing on who has bigger issues than others … the countries are aware that they need to be aware…it is not about singling out,” Said Dr LO FO Wong
Europe has made significant progress in health related issues over the past century which could all be undermined with the rise of AMR. The action plan will attempt to preserve Europe’s health standards and the ability to still be able to treat patients properly in the future.
‘One Health’, many Sectors
“The approach is the One Health approach. It is important to limit the use of antibiotics with animals and for sensible use with humans” Brivio said.
The issue of AMR is being fought with a focus on multiple different sectors.
These sectors range from emphasis on food safety, environment, research and innovation, public health, international cooperation and animal health and welfare.
The WHO has been focusing on AMR as one of their primary issues of concern and working with the EU on their new action plan.
“[The WHO] is helping to map out what needs to be done on a global level…helping countries understand where they are (in relation to AMR) and what they need to do to progress…the solution is tailored to the situations of the country,” Dr LO FO Wong explained.
This year the World Health Organization launched a Global Guidelines document for the prevention of surgical infection. The world first guidelines presents 29 actions that doctors should abide by to prevent infection. These guidelines include reducing the use of antibiotics unless absolutely necessary during surgery and reducing the continued use after.
The European Centre for Disease Control and Prevention (ECDC) are a primary partner assisting in the AMR fight.
“[Our] main areas of work include surveillance, epidemic intelligence, developing evidence-based guidance and systematic reviews, training, and support to the EU Member States.” an ECDC expert said.
“Diseases do not stop at country borders, and protecting the health of European citizens is a joint task. Tackling AMR is such a complex issue.”
Awareness is key for success
In a special Eurobarometer survey this year, only a third of Europeans polled had recalled receiving information about AMR and the importance of not taking antibiotics unnecessarily. This statistic hasn’t changed since 2013.
“There needs to be a strong EU voice at an international level for raising awareness” Enrico Brivio stated.
“This can be done with campaigns supported by the EU, at one level for the general public.”
However Brivio suggests a domino effect may be needed in order to flow information to the public.
“Improving communication, education and training … is important and on one side will address all the medical personnel and doctors and the other side the veterinarians and the farmers. You need to have specific targeted campaigns.”
The annual European Antibiotic Awareness day was launched in 2008 and brings together different European countries and health sectors to expand the knowledge of AMR and to discuss how the issue will be fought in the future.
This year the European Antibiotic Awareness day won the European Health Award which honours initiative aimed at improving public health.
Worldwide, less than 40% of countries have implemented plans or control measures in response to AMR, proving that awareness and the importance of the issue still has a long way to go.
The original action plan
“The European Union has been quite far ahead [in fighting AMR] to the rest of the world because it has been taking action since the turn of the century” Dr LO FO Wong explained.
The first action plan of the Commission against AMR was implemented from 2011 and proved to have some successes but also highlighted weak points in the plan that needed to be amended.
“The plan had a clear added value and was a symbol for political cooperation to stimulate actions…it did demonstrate the need for continuing cooperation and for an EU voice at an international level,” Brivio said.
“[The plan] showed that there is a clear need for assisting member states … health remains a national competency but Europe can do a lot to help.”
The original action plan identified seven key areas where measures were most needed. These included: appropriate use of antibiotics, preventing infections, developing new antibiotics, monitoring and surveillance of medicine and the promotion of research, innovation, education and communication.
The future is now
With AMR trends rising and awareness of the issue growing, the severity of AMR is being felt more than ever before.
On top of the European Union action plan being launched next year, the European region of 53 countries have been working together. The World Health Organization will continue to implement policies and the US, Canada and Norway are cooperating in the Transatlantic Taskforce for AMR.
Dr LO FO Wong states that now is the time for action. “This is getting urgent, we cannot ignore it anymore.”
“No action today, no cure tomorrow.”
Source: European Centre for Disease Control and Prevention