FAQ

AMR is global: Indeed, with globalisation and the movement of people and animals across the globe, microbes that ‘hitch a ride’ can also spread globally. If resistant bacteria develop somewhere in Europe, Asia etc., they could very quickly be transported by a carrier (human, animal, food) to another continent. A Swiss study demonstrated that 75% of 38 tourists travelling to India returned home with antibiotic-resistant bacteria in their guts. In addition, 11% of tourists had bacteria resistant to the last-resort antibiotic colistin (Bernasconi O, et al. 2016).

AMR is a multisectoral issue: The causes of AMR have roots in a variety of sectors, including health, food safety, agriculture, environment, and trade, making it a truly multisectoral issue. If these sectors do not act on the threat of AMR, it will not be solved (WHO,2018). To this end, the WHO has proposed their “One Health” approach which is designed to facilitate communication and cooperation between all relevant sectors in order to implement programmes, policies, legislation, and research to combat AMR (WHO).

In 2010, the World Health Organisation (WHO) identified AMR as one of the top 10 public health crises that need to be addressed (WHO, 2010). At a United Nation General Assembly in 2016, world leaders committed to take a broad, coordinated approach to address AMR and its root causes (including but not limited to human health, animal health and agriculture) (WHO, 2016).

This is mirrored by the European Union with the EU One Health Action Plan coordinated by the European Commission as well as with the creation of National Action Plans by Member States (EC, 2017). However, because the EU One Health Action Plan is not legally binding, adoption of its recommendations has been a mixed bag. In a 2019 EPHA study, researchers found only 51% of surveyed EU countries had established a national action plan (NAP) that follows the One Health Plan (EPHA, 2019). While this was a necessary first step to place AMR on member state’s political agendas, further coordination with member states at the national level is still needed to fully implement these actions plans.

In 2014, G7 leaders committed to working alongside the WHO to establish a global action plan on AMR (European Observatory on Health Systems and Policies, 2015). The following year, WHO introduced the Global Action Plan that presented strategic objectives for governments to work towards in their policies against AMR (WHO, 2015). In Europe, several countries stand out for their commitment to fighting AMR. Of those, the UK, the Netherlands, France, Germany, and Sweden are prime examples. Since 2006, antibiotic usage in animal husbandry as growth promoters has been banned in all EU member states (Regulation IP/05/1687).

Under the Swedish EU presidency in 2009, antimicrobial development was made a priority (European Observatory on Health Systems and Policies, 2019). The UK, Denmark, Sweden, and Norway already publish joint annual AMR surveillance reports that are meant to facilitate cooperation and data sharing. The Netherlands has routinely had the lowest average systemic consumption of antibiotics as well the lowest mean consumption in hospitals within the EU/EEA population; the highest being Greece and Malta respectively (European Observatory on Health Systems and Policies, 2019).

Outside of Europe, the US, China, and India have also taken necessary strides to put political emphasis on the issue. All three countries as well as European countries have established an AMR surveillance system to track the progression of resistance in animals and humans (WHO, 2019). According to the WHO, both the US and China have enacted targeted nationwide policies that attempt to change the behaviours of key stakeholders over the last 2-5 years (WHO, 2019).

Individual countries that have put AMR at the top of their political agenda include:

• UK
• Denmark
• The Netherlands
• Germany
• France
• Sweden
• USA
• China
• India
• Japan

You can follow WHO Worldwide Country Situation Analysis for specific data on your country. Additionally, the websites and publications from your national health ministries as well as local health agencies and organisations may be a helpful source of information.

Policymakers are in one of the most crucial positions to aid in combatting AMR. As illustrated in the recommendations given by the 2016 AMR Review, policy makers must enact binding legislation that follows the path set forth by the EU One Health Action Plan. Any policy goals proposed should ensure that concrete, quantifiable steps are taken to regulate and spark innovation within the antibiotic industry as well as create awareness across relevant sectors and the general public to insist on proper antibiotic usage. You can find out more about your role in the fight against AMR here

Important steps to be taken at hospital level to contain AMR are:

• Establish an infection prevention and control committee (IPC).
• Whenever available, use rapid point-of-care diagnostics to support clinical decisions and further develop where inadequacies persist.
• Promote rational antimicrobial use.
• Develop standardised antibiotic surveillance systems for antibiotic resistance and antibiotic use.
• Purchase food raised without routine antimicrobials
• Improve sanitation in hospitals to prevent healthcare associated infections
• Improve waste management to efficiently remove pharmaceuticals and microbes
• Hand hygiene with soap or alcohol-based rub are key to protect patients from avoidable infections contracted in health-care settings and prevent the spread of AMR (WHO, 2017)
• Include environmental criteria in antimicrobial drugs’ procurement decisions to improve transparency along the supply chain.
• Report AMR cases and resistance patterns to the regional and international levels, such as through the EARS-Net EU reporting network

Antibiotics are a common treatment for human infections, however, sometimes bacteria can develop a resistance to antibiotics that renders the treatment ineffective. Resistance is developed through the natural, adaptive reactions of the bacteria which can then spread if a patient carries these antibiotic resistant bacteria. The most common vectors for bacteria spread are dirty hands or contaminated objects; eventually patients will be sent home and can spread resistant bacteria to others outside the hospital as well (ECDC).