The European Parliament adopted by 588 votes to 16, with 23 abstentions, a resolution on “the Microbial Challenge – Rising threats from Antimicrobial Resistance”.
Parliament recalls that resistance to antibiotics for certain bacteria is as high as 25 % or more in several Member States and that much of the antimicrobial resistance (AMR) problem stems from the misuse – in particular the excessive use – of antibiotics. It recalls that in the EU, Iceland and Norway alone, antimicrobial resistant bacteria cause some 400 000 infections and 25 000 deaths annually, with at least EUR 1.5 billion spent on extra healthcare costs and productivity losses. It also highlights the fact that many Member States do not have a solid legal and regulatory framework to mandate and support the rational use of medicines. As a result, Parliament calls for the complete and rapid implementation of measures in this area.
Although welcoming the Commission’s five-year strategic Action Plan on tackling AMR and viewing it as generally going in the right direction, Parliament notes that many of the action points reiterate measures prescribed over a decade ago, and that it is not sufficient for tackling the growing risk presented by AMR at international level.
In this context, Members call for an integrated roadmap outlining relevant policy responses, including possible legislative action.
Parliament calls in particular for the Action Plan to:
- cover all animals under the EU animal welfare strategy, including, for instance, companion animals and animals used for sports, and
- emphasise the logical connection between animal health and the use of antimicrobials, as well as the link between animal health and human health.
Prudent use of antimicrobials in human and veterinary medicine: Parliament calls for the prudent use of antimicrobials. The key objective of any AMR strategy is to maintain the efficiency of existing antimicrobials by using them responsibly at the correct therapeutic level only when strictly necessary and prescribed over a specific time at the appropriate dosage (and not for treating viral infections). Similar prudence needs to be exercised in veterinary medicine. Parliament calls on the Member States to use electronic recording systems to ensure that usage patterns on individual farms are appropriate, thus ensuring responsible and minimal use. It also suggests to the Commission that current provisions on maximum animal density in livestock farming be re-evaluated as herd sizes today often present obstacles to the treatment of individual or smaller groups of animals, providing incentives for the prophylactic use of antimicrobials. It calls for a legislative proposal to be presented for the veterinary sector to limit its use of third- and fourth-generation Critically Important Antimicrobials (CIAs) for humans.
Parliament considers that the pending revision of Directive 2001/82/EC offers an important opportunity to take effective measures to reduce AMR through strengthening the provisions for veterinary medicines, such as:
- limiting the right to prescribe antimicrobials to professionally qualified veterinarians only;
- separating the right to prescribe from the right to sell antimicrobials, thereby eradicating economic incentives to prescribe.
Measures are called for to encourage efforts to study hospital outbreaks, to improve diagnostics but also to assess and monitor the Member States' implementation of relevant EU legislation on antimicrobials, in particular with regard to the prescription-only use of antibiotics in the human health and veterinary sectors.
Prevention: Parliament calls for more effective measures to be introduced to prevent both the appearance and the spread of antimicrobial resistance. These measures include better monitoring and better notification of micro-organisms resistant to antimicrobials, as well as a more effective combating of infections, in particular by means of vaccinations. Among other measures that it calls for are limits on uncontrolled access to antimicrobial agents, in particular via the growing number of illegal sales on the internet, and their inappropriate use. It calls on the Member States to improve infection control, and to raise and promote good standards of hygiene – especially hand hygiene, – in order to prevent the spread of infections and reduce the need for antibiotics.
Parliament also invites the Commission to classify, in the forthcoming review of the European veterinary pharmaceuticals legislation, medicated feeding stuffs as ‘pharmaceuticals’ and not as ‘feeding stuffs’, in order to ensure that, in future, the sensitive area of medicated foodstuffs is monitored under pharmaceuticals legislation and that official inspections are carried out accordingly, while ensuring that medicated foodstuffs fall into the ‘prescription only’ category.
Development of new antimicrobials or alternatives for treatment: Parliament considers it vital to limit the emergence of bacteria that are resistant to antimicrobials. In this context, it is necessary to develop new antimicrobial agents. In parallel, it stresses the advantages of public-private partnerships because these can contribute to reaching this objective by dissociating sales transactions from investment in research and development. In this area, Parliament calls on the Commission and the Member States to accelerate R&D activities in order to provide new tools to fight tuberculosis and drug-resistant tuberculosis.
Parliament also underlines the need to examine new regulatory approaches that would result in stimulating industrial research and the development of new antimicrobials while safeguarding patient safety. It also calls on the Commission to ensure the development and availability of more on-farm tools for early, rapid diagnosis and control of diseases, as well as for a broad and effective diagnostic system at Member State level.
Monitoring and reporting: in this regard, Parliament calls on the Commission and the Member States to seek greater cooperation and coordination on early detection, alert and coordinated response procedures regarding pathogenic antimicrobial resistant bacteria in humans, animals, fish and foodstuffs. It calls on Member States to compile clear, comparable, transparent and timely reference data on antimicrobial drug usage so that effective action can be undertaken. It considers, however, that data gathered on the use of antibiotics should be made accessible only to the experts, authorities and decision-makers concerned. It calls on the Member States to ensure separate monitoring and control of resistance among livestock, domestic animals and racing animals.
Communication, education and training: Parliament notes that one of the most common uses for antibiotics is as treatment against the common cold, and that much would be gained if the public could be made aware of the fact that the common cold is a viral infection whereas antibiotics only provide protection against bacterial infections. It calls on the Commission to compile a best practice list with regard to the implementation of effective communication campaigns and professional training courses aimed at raising AMR awareness. It believes that effective information and awareness campaigns must be developed with a view to heightening awareness of the dangers of the unintentional spread of antimicrobial pathogens in hospitals and in the home, and awareness of the means of avoiding this. Campaigns along the lines of "Please take this antibiotic medicine only if it is prescribed by a doctor to you and take it as prescribed” should be promoted and included in the package leaflet.
International cooperation: lastly, Parliament believes that concerted and timely international action that avoids overlap and builds critical mass is the only way forward in minimising the threat to public health that AMR poses globally. It considers that the work undertaken by the Transatlantic Task Force on Antimicrobial Resistance (TATFAR) should be used as a model for international cooperation on antimicrobial resistance. Other similar multilateral and bilateral commitments for the prevention and control of AMR should also be encouraged, in accordance with the guidelines laid down by the WHO (in particular in regard to the control of counterfeit antimicrobials).