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Take action on Antimicrobial Resistance (AMR)
9 February 2017
Antimicrobial resistance (AMR) is a recurring topic in EU policy circles, with mentions in important European Parliament and Commission publications in 2006 [i], 2012 [ii], 2015 [iii] and featured again high on the policy agenda last 18 November 2016 with the 9th European Antibiotic Awareness Day coinciding with the second WHO Antibiotic Awareness Week. During this week, Commissioner for Health and Food Safety, Vytenis Andriukaitis announced a second Action Plan on AMR to be launched in 2017 [iv]. AMR is widely recognised as a multifaced issue that needs a multiple stakeholder approach as well as each stakeholder engagement through looking at different intertwined policies, e.g. HCAI and prescribing protocols. From EHMA’s point of view, raising awareness on AMR is fundamental and we have identified the key information, support research and materials on this central topic.
What is AMR
Antimicrobial Resistance (AMR) is the ability of microorganisms to resist antimicrobial treatments, especially antibiotics [1]. It may occur naturally but the phenomenon is mostly increased by excessive and inappropriate use of antimicrobial medicines and poor infection control practices in animals and humans [2].
More specifically, AMR is said to be accelerated by:
- An antibiotics consumption and prescription culture where antibiotics are taken for health issues when in fact they have no proven benefit (e.g. for viruses);
- Irresponsible disposing of pharmaceuticals during the production process [3] or by consumers [4];
- Overuse of antibiotics in livestock, and specifically the last line antibiotic for human treatment called Colistin [5].
What are the risks
With resistance to antimicrobials increasing, treatments for common bacterial diseases will take longer and will become more expensive. Eventually, all available treatments might become ineffective resulting in increased mortality. Multi-drug resistance is currently observed worldwide in HIV/AIDS, malaria, sexually transmitted diseases, urinary tract infections, pneumonia, blood-stream infections and food poisoning, and in Europe particularly in TB and Gonorrhoea. However, borders no longer restrict the spread AMR to regions or continents. To illustrate the speed AMR is progressing, researchers found that resistance to last line antibiotics that treat pneumoniae (carbapenem) increased from 6.2% in 2012 to 8.1% in 2015 [6].
The Commission highlighted the urgency of the threats of AMR, estimating €1.5 billion in costs each year due to extra healthcare costs and productivity losses in the EU [7]. And more importantly, if no action is taken, AMR will result in 10 million deaths globally each year.
Some argue a solution to AMR can be found in the development of new, potent antibiotics. However, development of new antibiotics has slowed down significantly, in part due to the limited profitability to pharmaceutical companies, says MEP Glenis Willmot [8]. Moreover, experts predict that no new strands of antibiotics will be effective against the most dangerous forms of antibiotic-resistant bacteria in the future [9]. Therefore, although investments into new antibiotics should be stimulated, this alone is no sustainable answer to the issue of AMR.
Stressing the urgency of the situation, MEP Glenis Willmot (S&D, UK) wrote for Parliament Magazine: “There is still time to act to prevent a global catastrophe that could see medicine plunged back into the dark ages but it will require genuine commitment and leadership, and we must take action now [10]”.
Take action
The path towards a sustainable solution requires good practice in all relevant industries. The WHO published the following steps for health professionals, policy makers and industry to reduce the impact and limit the spread of resistance [11], integrated by EHMA with health management focused suggested actions.
Policy makers
- Ensure a robust national action plan to tackle antibiotic resistance is in place.
- Improve surveillance of antibiotic-resistant infections.
- Strengthen policies, programmes, and implementation of infection prevention and control measures.
- Regulate and promote the appropriate use and disposal of quality medicines.
- Make information available on the impact of antibiotic resistance.
Health management
- Assess current situation regarding systems and infrastructure focussed on minimising organisational impact of AMR.
- Review best practice on systems for operational response to risk of AMR.
- Ensure boards considers problem, policies and monitoring, making links to HCAI, procurement, prescribing policies, etc.
- Assess training and information needs.
Health professionals
- Prevent infections by ensuring your hands, instruments, and environment are clean.
- Only prescribe and dispense antibiotics when they are needed, stay up-to-date on current guidelines.
- Report antibiotic-resistant infections to surveillance teams.
- Talk to your patients about how to take antibiotics correctly, antibiotic resistance and the dangers of misuse.
- Talk to your patients about preventing infections (for example, vaccination, hand washing, safer sex, and covering nose and mouth when sneezing).
Healthcare industry
- Invest in research and development of new antibiotics, vaccines, diagnostics and other tools.
Additionally, MedTech Europe has drawn attention to the benefits eHealth and mHealth solutions can play in tackling AMR [12].Useful applications of Technology are proposed for the dissemination of information, better diagnosis through personalised medicine, and efficient monitoring of prescribed antibiotic use with eHealth devices.
Learn more?
EHMA has selected these documents as must reads if you wish to learn more. The first is a Commission factsheet for the time-pressed health manager; it highlights key information about the cause, consequences and prevention measures to AMR in the EU and worldwide, and is suitable for printing and redistribution in your organisation.
If you have longer to spare, this thirteen-page read by the WHO gives a more inclusive oversight of global risks and actions to AMR:
Finally, for further study the European Commission hosts a library of studies into AMR on its website here:
The European Centre for Disease Prevention and Control (ECDC) can help you to plan your campaign against AMR. The ECDC provides a large range of materials for all professionals in the health industry in all languages to help increase knowledge about AMR (e.g. info sheets, videos, ppt presentations), which can be accessed here:
- http://ecdc.europa.eu/en/EAAD/ (the language drop-down is slightly hard to see and can be found in the top right corner next to the ECDC logo)
Engage with the AMR community
The European Commission recently opened a public consultation on AMR open for both citizens and organisations. Contribute to the EU AMR policy discussion here:
If you or your organisation is interested in actively participating, consider subscribing to the newsletter of an ongoing international project on AMR under the name Joint Programme Initiative on Antimicrobial Resistance (JPIAMR). Visit the website to subscribe to the newsletter, participate in workshops, or submit research papers.
This blog was written by Maurice Hameleers
[1] http://ec.europa.eu/dgs/health_food-safety/docs/amr_factsheet_en.pdf
[2] http://europa.eu/rapid/press-release_IP-16-3805_en.htm
[3] https://www.euractiv.com/section/health-consumers/news/pharma-pollution-is-overlooked-cause-of-antimicrobial-resistance/
[4] https://noharm-europe.org/sites/default/files/documents-files/2616/Pharm%20Report_WEB.pdf
[5] https://www.food.gov.uk/science/research/foodborneillness/b14programme/b14projlist/fs102127/a-systematic-review-of-amr-in-pork-and-poultry-dairy-products-seafood-and-fresh-produce
[6] http://europa.eu/rapid/press-release_IP-16-3805_en.htm
[7] http://europa.eu/rapid/press-release_MEX-16-3529_en.htm#6
[8] https://www.theparliamentmagazine.eu/articles/opinion/amr-global-problem-requiring-global-response
[9] http://www.who.int/mediacentre/factsheets/antibiotic-resistance/en/
[10] https://www.theparliamentmagazine.eu/articles/opinion/amr-global-problem-requiring-global-response
[11] http://www.who.int/mediacentre/factsheets/antibiotic-resistance/en/
[12] http://www.medtecheurope.org/sites/default/files/resource_items/files/AMR%20New%20Position%20Paper.pdf
[i] http://www.europarl.europa.eu/RegData/etudes/etudes/join/2006/375884/IPOL-JOIN_ET(2006)375884_EN.pdf
[ii] http://www.europarl.europa.eu/news/en/news-room/plenary/2012-12-10/10
[iii] http://www.europarl.europa.eu/RegData/etudes/STUD/2015/542223/IPOL_STU(2015)542223_EN.pdf
[iv] http://europa.eu/rapid/press-release_IP-16-3805_en.htm
Recent News
Putting patients first: the commitment of health management to uphold patients’ rights
Developing educational materials for health professionals to reduce the spread of antimicrobial resistance – The AMR-EDUCare project kicks off
Promoting risk-reduction interventions in Rare Tumour Risk Syndromes – The PREVENTABLE project kicks off
What our Members say
I have been active in EHMA since the first years of the '90s and I have seen its evolution from a small association of members interested in sharing knowledge on health management practices to the current status of reference and advisory key player for EU, health systems and organisations, stakeholders associations, industry and universities. EHMA is now a unique knowledge hub, policy advisor, community of practice and network of best in class organisations involved in health policy and management. A place where health managers can build their competences, policy-makers and stakeholder associations envision how to implement and sustain change through health management, industry leaders understand how to engage more effectively with health organisations and systems. The right place to nurture and grow health management capabilities and capacity for every stakeholder of health systems.
Prof. Federico Lega, University of Milan, Italy
Health management has a crucial function in shaping public health and health system challenges. The Medical University of Varna, Bulgaria had success in collaborating with EHMA on EU-funded projects that has resourced us to create new health management competencies for the future workforce. In addition to all classical definitions, health management is a science dealing with individuals, groups, and society at large. It is an art contributing to the beauty of our lives and an interactive communication process at all levels of institutions and human energy. I have also had the pleasure to chair the South Eastern European Special Interest Group which gives members a space to discuss and tools to address how health systems are managed in our regions.
Prof. Todorka Kostadinova, Medical University of Varna, Bulgaria
I enjoy the high level of interaction and engagement in EHMA’s activities, in particular during the annual conference where the panel discussions are rich and well prepared. As a hospital manager and professor of health management, EHMA motivates and inspires me to be creative. You go back home feeling energised from seeing old friends and making new connections, as well as being convinced of serving as EHMA’s ambassador. It’s a strong feeling of interdisciplinary engagement, but it also feels like being part of family-like community.
Prof. Sandra C. Buttigieg, University of Malta, Malta
EHMA is a pre-eminent organisation for everyone working in planning, managing and delivering health services across Europe. As a long standing member of EHMA I have always been impressed by the vibrant community of managers, researchers and academics it has created and by the many opportunities for sharing knowledge and funding opportunities it has brought to its members. Its international scope is impressive and its impact is often felt in management and research across European and national health systems.
Prof. Axel Kaehne, Edge Hill University, UK
Health workforce has become more essential in operating, managing and maintaining health systems lately, particularly in crisis and emergency situations. European healthcare professions and the workforce need to be high on the agenda of managers and decision makers. The Health Services Management Training Centre, Semmelweis University in Hungary is a longstanding EHMA member, because it connects us with collaborators and experts, with whom we can have complex debates, from whom we can learn and at the end find solutions in various challenging fields of healthcare management.
Dr Eszter Kovács, Health Services Management Training Centre, Semmelweis University, Hungary
As a hospital administrator and health management professor, I see on a daily basis that the healthcare challenges require talented and skilled managers to transform it. the EHMA membership has been beneficial to bring healthcare management research and education to the demanding healthcare services world, promoting healthcare management competencies and knowledge creation.
Dr Alexandre Lourenco, APAH - Association of Portuguese Hospital Managers, Portugal
Many healthcare systems in Europe and beyond are facing similar challenges which require innovative and creative solutions. EHMA’s annual conference, webinars, Programme Directors’ group and other activities and resources provide incredible opportunities for networking, connecting and sharing experiences. A distinct feature of EHMA is the diversity of members with representation from many countries, sectors and different communities of practice – academic, policy-makers, practitioners, managers, leaders and students. The annual conference is a highlight in the calendar year, offering a friendly, fun and learningful environment for emerging and established members to engage, collaborate and meet up with old and new friends. I am proud to be a member of the EHMA Board.
Prof. Ann Mahon, University of Manchester, UK
Society evolution, pandemics and ageing modify health needs. So, health policies and services are to change dramatically. EHMA, through webinars, workshops and annual conference provides an excellent insight to a professional changing world, favouring closeness to management innovation and the protagonists of these changes. As a primary care services’ manager, participating in EHMA activities is really worth it and allows to involve oneself in the innovation processes.
Dr Antoni Peris Grao, Consorci Castelldefels Agents de Salut (CASAP), Spain