European One Health action plan against antimicrobial resistance (AMR)

PURPOSE: to present a new European action plan to strengthen the fight against antimicrobial resistance (AMR).

BACKGROUND: according to the World Health Organization (WHO), AMR already presents a serious social and economic burden. It is estimated to be responsible for 25,000 deaths per year in the EU alone and 700,000 deaths per year globally, and might cause more deaths than cancer by 2050. In the EU alone it is estimated that AMR costs EUR 1.5 billion annually in healthcare costs and productivity losses

The EU was quick to recognise the importance of tackling AMR. The 2001 Community strategy against AMR was reinforced by the 2011 Commission action plan, notable for its One Health approach, addressing AMR in both humans and animals.

In view of the challenges of antimicrobial resistance at regional and global levels, the Union is at the forefront of combating this phenomenon. Since 1999, the Commission has invested more than EUR 1.3 billion in antimicrobial resistance research.

Responding to the request of the Member States set out in the Council conclusions of 17 June 2016, the new plan proposed by the Commission is based on the first action plan, implemented from 2011 to 2016. It is based on the recommendations of an independent external evaluation, as well as the views expressed by stakeholders in an open public consultation.

Based on the "One health" approach, the plan is motivated by the need for the Union to play a leading role in the fight against the phenomenon of antimicrobial resistance and to add value to the actions Member States.

Its overarching goal is to preserve the possibility of effective treatment of infections in humans and animals. It provides a framework for continued 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.

CONTENT: the main objectives of this new plan revolve around the following three major pillars:

Pillar 1: making the EU a best practice region: as the evaluation of the 2011 action plan highlighted, this will require better evidence, better coordination and surveillance, and better control measures. EU action will help Member States in establishing, implementing and monitoring their own national One Health action plans on AMR, which they agreed to develop at the 2015 World Health Assembly.

The Commission's support will include:

• providing evidence-based data, with the support of the Union agencies, on possible links between the consumption of antimicrobial agents and the occurrence of antimicrobial resistance in humans and food-producing animals;
• reviewing EU implementing legislation on monitoring AMR in zoonotic and commensal bacteria in farm animals and food;
• supporting Member States in raising awareness at national level through specific communication tools;
• co-funding projects and collaborate with WHO to assist EU Member States in the development and implementation of national action plans to combat antimicrobial resistance;
• developing training programmes for the competent authorities of Member States and health professionals;
• contributing to improving patient safety in hospitals by supporting good practices in infection prevention and control;
• developing EU guidelines for the prudent use of antimicrobials in human medicine;
• adopting a Union policy on pharmaceuticals in the environment.

Pillar 2: boosting research, development and innovation: the aims are to: (i) close current knowledge gaps, (ii) provide novel solutions and tools to prevent and treat infectious diseases, and (iii) improve diagnosis in order to control the spread of AMR. The Commission will work in partnership with Member States and industry, including small and medium-sized enterprises (SMEs), to tackle AMR in bacteria, viruses, fungi and parasites. Special attention will be given to the WHO priority list of pathogens as well as to tuberculosis, HIV/AIDS, malaria and neglected infectious diseases.

In particular, the Commission intends to support research with a view to:

• improving early detection and better understanding the problems of antimicrobial resistance in the European health care, livestock and food production sectors;
• developing new drugs and treatments, including alternatives, as well as innovative anti-infective approaches and products for both humans and animals;
• developing new and effective preventive vaccines and new diagnostic tools in particular on-site tests in humans and animals;
• filling gaps in knowledge about the release of resistant microorganisms and antimicrobials into the environment.

Pillar 3: intensifying EU efforts worldwide to shape the global agenda: in an increasingly interconnected world, the Commission will:

• strengthen the global presence of the Union by contributing to the normative work of multilateral organizations such as WHO, the World Animal Health Organisation (OIE), the Food and Agriculture Organisation (FAO) and international fora;
• promote standards and measures taken by the Union to combat antimicrobial resistance in the context of trade agreements;
• contribute to the reduction of antimicrobial resistance in least developed countries through programs to control infectious diseases.

Progress will be reviewed at regular intervals as part of the One Health network on antimicrobial resistance, to guide individual Member States in their actions and to decide on the appropriateness of further action at Union level.