On 16 November, the 2012 European Antibiotic Awareness Day (EAAD) was once again put in the spotlight in Brussels by the European Centre for Disease Prevention and Control (ECDC) and partners through a dedicated conference and social media event, highlighting its key messages on prudent antibiotic use. At the same time, worrying new developments in the areas of antibiotics consumption and antimicrobial resistance (AMR) were brought to light emphasising the urgent need for more comprehensive, multi-level cooperation to combat this major public health threat.
ECDC Director Marc Sprenger explained that thanks to the collaboration with the WHO Regional Office, over 43 EU countries marked the EAAD. while the United States, Canada and Australia joined forces as well. The point was to raise awareness of prudent use of antibiotics to slow down the development of AMR (see the EPHA Position and Briefing on Antimicrobial Resistance) and the rise of bacteria resistant to antibiotics.
He stated that the ECDC’s 2011 Surveillance Report showed some alarming data given that AMR was increasing in many EU countries. Worryingly, the percentage of last-line antibiotics resistance was also increasing. For instance, in Italy it rose from 15 to 27% within one year. As a consequence, such patients have fewer options available, and treatments, such as certain operations, cancer therapy, etc. are no longer possible. Moreover, hospital superbugs remained a serious problem. Overall, there were wide variations in antibiotic consumption patterns across Europe, with low annual per person consumption in Estonia and high rates in Greece and other Southern European countries in spite of the crisis. He recalled the Commission’s 2011 Action Plan which pursued a ’’one health approach’’ comprising humans and in animals.
Dominique Monnet . Senior Expert at the ECDC presented in-depth data on the spread of antibiotic resistance. He emphasised the principal actions to prevent and control AMR:
prudent use of antibiotics (only when needed, correct dose, correct dose intervals, correct duration)
infection control (hand hygiene, screening, isolation); and
creation of new antibiotics (with a novel mechanism of action, this required stepping up R&D)
DG SANCO Director General Paula Testori-Coggi stated that 25,000 patients died every year due to infections caused by multi-resistant bacteria, amounting to an annual cost of 1.5 billion Euro. A multi-level approach was needed, and she mentioned recent activities, i.e. the adoption of the report on patient safety in the EU. 26 countries had adopted Action Plans to fight hospital infections - between 13 and 16% of hospital costs are incurred because patients are not protected against AMR. In addition, the European Parliament supported the financing of a pilot project to understand the causes. New legislation would be presented by the Commission in May/June 2013 , to provide a legal basis to impose better control in animal treatment. In the area of surveillance, a new legal mechanism would serve to impose harmonised monitoring of AMR transmitted through food. International cooperation was crucial and hence the transatlantic task force would continue its work. The key elements to success were thus human health, animals, research, and international cooperation.
Robert-Jan Smits Director General of DG RESEARCH talked about the EU research strategy on AMR and noted that key actions in the Action Plan were about promoting public-private partnerships in research and reinforcing the R&D effort in general. Only 2 classes of new antibiotics were brought to market in the last 30 years; often the development cost of new antimicrobials were greater than their potential return. This situation put into jeopardy advanced surgery, chemotherapy, etc. In response, the Innovative Medicines Initiative (IMI) launched an AMR programme, ’’New drugs for bad bugs’’, to speed up delivery of new antibiotics to patients. There was also increased coordination of research efforts between national governments as a result of the Commission’s coordinated call launched in the summer 2012. It was now key to pull national research efforts to increase the impact of the various EU initiatives. An EU research area for AMR needed to be created, and a new joint programme marked one step towards this. Finally, AMR is also a Horizon 2020 research priority.
Anna Rosbach MEP (ECR, Denmark), the author of the ’’Microbial Challenge’’ announced that the vote on her EP report had been very favourable and that it would be followed by an EP vote in December or January. She recalled that half a million people were dying globally due to AMR and that in the EU alone 2.5 million extra days were spent in hospital. Disconcertingly, half of livestock might be sick even if only a few show symptoms; the problem is that all need to be slaughtered if only a few are infected since there are no tools to screen whether others are carriers of a disease. Both people and food-producing farmers needed to start acting more responsibly to stop spreading infections - if food brings into our bodies multiresistant disease then it is possible that we may not be able to treat it. In the end it is not one single drug but a ‘cocktail’ of drugs that makes us multiresistant. Prevention of disease largely begins in the home: e.g., children being taught to wash their hands. The best way would be to put all stakeholders at the same table, including ordinary citizens and schools, to find best practices and reach people.
Christophe Buhot of the Federation of Veterinarians of Europe (FVE) explained that FVE represents 43 national vet organisations in 38 countries, speaking on behalf of over 200,000 vets and supporting animal health, animal welfare and public health in EU. He stated that AMR is a complex issue with no single solution; it required a holistic approach embraced by all stakeholders including farmers and vets. The latter are gatekeepers for antibiotic use in animals, hence at the forefront of promoting responsible use. Moreover, he stated that proper and harmonised collection of data on use and consumption of antibiotics was needed so that specific countries, regions, and species could be targeted. FVE’s messages were that:
antibiotics should be prescription-only by vets
the use of critically important antibiotics should only occur as second choice after testing;
education and information are the cornerstones, and must be used strategically at different levels: to reach vets and vet students, citizens and animal owners, farmers and animal keepers
global context means that antibiotics need to remain effective to fight emerging diseases of zoonotic origin
To round off, Mads Koch Hansen of the Standing Committee of European Doctors (CPME) provided the doctor’s perspective, stating that AMR undermines high quality healthcare, limits treatment options, endangers clinical outcomes, contributes to preventable mortality/morbidity and transcends boundaries between human and animals. It was vital to promote responsible prescription practices and to promote good practice in containing its spread. There was also a need for evidence-based recommendations and guidelines and for informing patients of prudent use. Most importantly, he argued that economic incentives to prescribe antibiotics should be eradicated.
During the ensueing discussions, MEP Rosbach stated that the proper use of antibiotics was one of the weak links as it was difficult to monitor, and exceptions to the rule also posed a problem. Also, in certain places industry lobbies vets and doctors very heavily, incentivising them to buy certain products.
Dr Koch added that people are still able to buy drugs that should be prescription-only; even pharmacists were lobbied in certain places. It was also commented that most antibiotics outside of hospitals are generics now and hence relatively cheap to purchase. In Greece they could often be purchased at pharmacies and because of the crisis, people were bypassing the doctor. In hospitals meanwhile, lower budgets mean less personnel and less time to prevent transmission. However, reimbursement changes in Greece and elsewhere may have helped close the gap a bit.
For further information:
EPHA related articles:
European Parliament Environment, Public Health and Food Safety Committee adopts report on Antimicrobial Resistance (AMR) report
European Parliament Agriculture Committee adopts opinion on Antimicrobial Resistance (AMR) report
Council Conclusions on Antimicrobial Resistance: A first step in the right direction
Time for Action: Meeting the antimicrobial resistance challenge
Antibiotic resistance is "major public health threat"