ReportOur Mission – Your AMR Website
Antimicrobial or, better, antibacterial resistance (AMR) is mainly caused by overuse of antibiotics, both in animal husbandry and agriculture and in human health. It is a complex and continuously evolving issue that by 2050 will have killed 300 million people if no action is taken today. We aim to provide the most current information with constant updates to ensure that readers are well informed on the latest changes and developments. The StopAMR team takes the utmost care to factcheck any information posted on the platform and communicates regularly with its science advisory board to track the latest research. Outside of this, you are encouraged to contribute to the website. If you notice something is inaccurate, missing or incomplete, please contact us and let us know. While the goal of StopAMR is to provide a comprehensive resource center to combat AMR, this site can never be totally complete as new developments happen every day. With your help it can get as close as possible. And that is necessary to save lives.
The urgency of the AMR crisis now requires all possible human efforts. We therefore aim for an ‘AMR Information Hub’ assisting any and all stakeholders: patients, healthcare professionals, policymakers, farmers, animal health experts, pharmaceutical companies, business and tourist travelers, etc. This holistically integrated website will grow to be a powerful and influential One Health policy tool to help shape legislation on AMR at EU level and worldwide.
Why AMR?
The world we live in faces numerous challenges to Human Rights every day. Matters of ethics and morality become also questionable when global public health threats such as antimicrobial resistance (AMR) put millions of lives at stake all over the world. Is legislation the solution to address this matter at the EU level? What is the relationship between AMR and the Declaration of Human Rights?
AMR is the biggest public health threat of our time
AMR is the ability of microbes (such as bacteria, viruses, fungi) to counteract the effectiveness of antimicrobial drugs (such as antibiotics, antivirals, antifungals) used against them. Even when used appropriately, antimicrobials can create a selective pressure for resistant microorganisms. However, the development of resistance is accelerated by the misuse and overuse of antimicrobials in human, animal, and plant health along with the pollution of the environment with antimicrobials and antimicrobial resistance genes.
In light of the most recent UN report (UN IACG, 2019), drug-resistant infections already claim 700,000 lives a year, including 230,000 deaths from drug-resistant tuberculosis. Unless drastic measures are taken to contain the proliferation of drug-resistant microbes, resistant infections could kill 10 million people annually by 2050 and lead to an economic slowdown comparable to the global financial crisis of 2008.
Antimicrobial resistance threatens our ability to achieve Universal Health Coverage and hinders our progress on the Sustainable Development Goals (SDGs). Of the SDGs, growing resistance directly impacts our ability to work towards health goals, food security, clean water and sanitation, responsible consumption and production, as well as to address poverty and inequality (UN IACG, 2019).
Any of us could be the next victim of AMR. According to United Nations experts, in the next 30 years 2.4 million people in Europe, North America, and Australia could die from drug-resistant infections. As life-saving antibiotics stop being effective, AMR could end our capacity to combat infections and halt all surgical procedures. Thus, the only time to act is now.
Antimicrobial resistance has substantial negative implications for the health insurance sector as well as investors in the pharma sector, food producers, and food retailers. The macroeconomic implications of the antibiotic resistance crisis are tremendous. Drug-resistant infections are foreseen to cost the world more than the current global economy – the predicted amount is as high as $100 trillion (EUR 88 trillion) in lost output between now and 2050 (World Bank Group, 2016). The World Health Organization (WHO) states that infections due to multidrug-resistant bacteria costs the European Union (EU) alone more than EUR 1.5 billion per year in healthcare expenses and productivity losses (WHO, 2016). These numbers are so high that you may spontaneously reject the consequences. But the truth is that the consequences can hit you and your family. AMR is not only a global concern, it is your personal concern, whoever and wherever you are.
Despite the alarming predictions, comprehensive legislation to address the multifaceted causes of AMR is lacking all over the world. According to the European Court of Auditors (ECA, 15 November 2019), at the EU level, the European Commission has historically exhibited slow and ineffective action in addressing AMR. The 1999 Scientific Steering Committee report advocated for a stark decrease in the overproduction, distribution, and use of antibiotics (HCWH Europe, 2018); however, the Commission’s One Health action plan, published in 2017, is much less stringent in its requirements. Although more than EUR 1 billion was invested in combating AMR, the threat is still increasing (ECDC, February 2019).
The continuous use of antibiotics in animal husbandry accelerates the development and spread of AMR. In spite of the advice of the UN’s Inter-Agency Coordination Group (IACG) to phase out the use of antimicrobials for growth promotion (UN IACG, 2016), animal medicine producers such as Elanco use the pork crisis due to African Swine Fever in China and South-East Asia to maximise antibiotics sales at the expense of public health (NYT, 2019). Moreover, due to the fact that veterinarians throughout the European Union continue to be allowed to sell antibiotics even in larger volumes without any scrutiny (Parliamentary Question, 4 November 2015), farms from North to South and East to West continue to use antibiotics in a preventive way. By consequence, only certain EU Member States have been able to reduce the use of antibiotics in husbandry. Veterinarians inside and outside the European Commission continue to claim that the use of antibiotics in husbandry has no effect on AMR. This is contrary to formal positions and statements of virtually all UN and other expert organisations.
Hospitals are the main hubs for the development of antimicrobial resistant agents, particularly the ones critical for human health. Therefore, the control and prevention of healthcare-associated infections (HAIs) play a crucial role in the effort to contain the spread of multidrug-resistant bacteria within and outside of healthcare environments. However, for example in Europe, it is still not legally binding that all EU Member States report on the level of resistant infections at the national level through the European Antimicrobial Resistance Surveillance Network (EARS-Net). Nurses may now play a crucial role in reporting, correctly yet anonymously, AMR cases. To relieve nurses of such an important burden, legislation is needed to enforce that all hospitals within the EU have HAI surveillance systems and infection control committees in place to be able to cope with AMR challenges.
The global challenges of resistance
Resistant bacteria in humans have never been hindered by geographical constraints. Various types of (totally) resistant bacteria have been reported in Thailand, Venezuela, India, the United States, and China; one type of resistant bacteria in India has even been found in the High Arctic (CNN, 2019). Therefore, Europeans are not at all immune to the dangers of AMR; for example, in the Netherlands, where antibiotic use in husbandry has even been reduced by 64% (All About Feed, 2017), a patient died due to a urinary tract infection caused by drug-resistant bacteria. This was the first outbreak of this bacterium carrying the NDM (New Delhi metallo-beta-lactamase) gene in the Netherlands, infecting 38 patients over a period of 16 months (NOS, 2019). Globally the threat of AMR is on the rise: in the first study to cover the entire supply chain of broiler meat in Indonesia, researchers found the (totally resistant) MCR-1 gene in 89.66% of colistin-resistant E. coli. More research into this topic should be encouraged as AMR was responsible for 130,000 deaths in 2013 in Indonesia alone as per sources of the Health Ministry (Jakarta Post, 2019).
While experts seek out the causes and offer recommendations, resistance is also bolstered by another looming threat – climate change. New research done by the European Congress of Clinical Microbiology and Infectious Diseases in Amsterdam has demonstrated a link between AMR and climate change (Gorey, 2019). Earlier researchers had noted that antibiotic resistance in the United States increased as temperatures increased; this study sought to investigate whether the same held true for Europe with its varied healthcare systems (Gorey, 2019).
From their 30-country sample the authors conclude that “climatic factors significantly contribute to the prediction of AMR in different types of healthcare systems and societies, while climate change might increase AMR transmission” (Scheithauer, et al., 2019). To see the real-life effects, take Legionnaires disease, a pervasive and devastating form of pneumonia that can be spread through air-conditioning units and drinking water. In March 2017 Politico reported on such cases in the home of European democracy, the European Parliament. Climbing temperatures are creating the ideal environments for Legionella bacteria to grow, causing between 16,000 and 30,000 cases in Germany alone, of which 90% required hospitalisation (Fortuna, 2019). While the research on climate change’s effect on AMR is just beginning, the early signs show that increasing global temperatures could spell trouble for healthcare systems and the proliferation of AMR.
The antibiotics we need are not profitable to make
Discovering new antimicrobials and using them effectively nevertheless encompasses the risk for those new drugs to develop resistance over time. Ideally, the newly discovered antimicrobials should be restricted for last-resort use only, which makes the market unattractive for the private sector in terms of sales volumes and profitability. This has led the British AMR expert Lord Jim O’Neill to speculate about the de-commercialisation of antibiotics production through State-Owned Enterprises. Another option is to create new legislation including specific incentives for pre-competitive organisations and competitive industries to develop and produce new molecules for antimicrobials. A total stakeholder alliance may be required to push through such legislation on the basis of the philosophy behind the current Orphan Drugs Regulation (Letter from MEPs to Commission, 13-05-2019; Experts’ Statement on AMR, April 2019).
According to experts, around 10 new antibiotics are required to prevent devastating AMR outbreaks. According to WHO, currently effective antibiotics may lose efficacy within the next three to ten years, causing the start of the Post-Antibiotic Era. Developing a new antibiotic can take over a decade and cost over €850 million (Drive-AB Report, 2018). The AMR Industry Alliance reports investment of around 2 billion into AMR research across 22 companies in 2018 (AMR Industry Alliance, 2018). While a number of companies are producing antibiotics (IFPMA, 2015; Access to Medicine Foundation, 2018), many of them are variations on existing antibiotics. These are a safer bet for companies to invest in because less research is needed and approvals are faster due to similarities to existing approved drugs. However, slightly modified antibiotics only overcome resistance for a short period of time and research into novel antibiotic classes is very low.
As our last-resort antibiotics, such as colistin and carbapenem, lose their efficacy (CIDRAP, 2017; Ther Adv Infect Dis., 2016), it is imperative that antibiotic R&D is prioritised so that we may have new and effective antimicrobials in time. While stewardship of the use of antimicrobial drugs needs to remain an aggressively maintained priority, particularly new antimicrobials also need to be developed, as stated in Article 81 of the European Parliament resolution of 13 September 2018 on a European One Health Action Plan against Antimicrobial Resistance (AMR)(European Parliament, 2018). The mass exodus of pharmaceutical companies (Wired, 2019) away from antimicrobial R&D indeed indicates that novel approaches are needed in order to overcome market failure and deliver new antibiotics.
Within their Resolution of 13 September 2018, the European Parliament has demanded an AMR legislative framework to address the multifaceted causes of resistance. The Parliament is now considering specific legislation promoting the required funding and off-take environment; firstly, the legislation aims to promote the development of new molecules and, subsequently, to secure a minimally acceptable return on investment for the relevant pharmaceutical industries. A possible solution, apart from taxing the use of antibiotics and incentivizing the production of new antimicrobial molecules, would be for EU Member States to buy strategic reserves of newly developed last-resort antibiotics that can then be used in crisis situations.
What is more important to the implementation of Human Rights than to radically reduce the threat to human life of antimicrobial resistance? Politicians throughout the European Union are expected to add AMR to the top of their political agenda to safeguard generations to come and to stop the current tide that already claimed 400,000 European lives between 1999 and 2017.
