With a particular focus on tackling antimicrobial resistance this year, we speak to the European Centre for Disease Prevention and Control about how it is working to improve public health preparedness among Member States.
The European Centre for Disease Prevention and Control (ECDC) is an agency of the European Union tasked with increasing Member States’ public health preparedness and disseminating scientific advice and guidance on infectious disease prevention and control. Part of its key focus areas for 2022 is tackling antimicrobial resistance and supporting the European Commission and Member States in their resilience to cross-border health threats. With this in mind, Health Europa spoke to the team at ECDC about the barriers facing AMR research and treatment innovation in Europe and how it is addressing challenges that can arise as part of national and regional disparities in approaches to AMR prevention and care.
What would you say are the primary factors that are slowing down progress in AMR research and interventions across Europe?
As highlighted in the joint report of ECDC and the WHO Regional Office for Europe on Antimicrobial resistance surveillance in Europe, high-level commitment is still lacking and important programmes and interventions on infection prevention and control, antimicrobial stewardship and surveillance remain under-resourced in many European countries. In addition, and as further detailed in the European Commission’s pharmaceutical strategy for Europe, current incentive models for pharmaceutical research and development do not provide a sustainable solution; new business approaches are required, including new incentives to develop antimicrobials as well as new pricing systems.
How do you hope the findings from the recently published ‘Antimicrobial resistance surveillance in Europe’ report will help to shore up awareness around the burden and prevention of AMR?
This joint report of ECDC and the WHO Regional Office for Europe, for the first time, provides an overview of the AMR situation in the whole European region as well as the information required for different actors across Europe to be able to take action against AMR. It highlights how robust investments in interventions to address AMR are urgently needed and would have a significant positive impact on population health and future healthcare expenditures in the region.
When working at the European level, what are the key challenges that arise from national and regional disparities in approaches to AMR prevention and care and how do you manage this as an organisation?
Resources for monitoring and responding to AMR differ greatly between European countries, including within the EU/EEA. ECDC collects routine surveillance data that can be used for benchmarking purposes, by using a standardised reporting protocol and collaboration with national counterparts through networks such as the European Antimicrobial Resistance Surveillance Network (EARS-Net) and the European Surveillance of Antimicrobial Consumption Network (ESAC-Net). However, risk management of AMR and of outbreaks remains the responsibility of each individual country. ECDC supports countries in this by monitoring alerts on emerging AMR issues and publishing rapid risk assessments of the situation as well as providing option for response. ECDC, to a limited extent, is also able to provide EU/EEA countries with access to whole-genome sequencing services, primarily for investigating potential multi-country outbreaks. Upon invitation, ECDC – together with the European Commission – can visit a country to discuss AMR issues in a One Health perspective and provides conclusions to guide future actions in the visited country.
Since 2008, ECDC coordinates the European Antibiotic Awareness Day, a European health initiative to support countries and raise awareness of prudent use of antibiotics and more generally AMR among the general public and health professionals. European Antibiotic Awareness Day takes place on 18 November each year and is, since 2015, organised in partnership with the World Antimicrobial Awareness Week (18-24 November).
As well as AMR surveillance data, can you highlight other initiatives that have proved effective in strengthening AMR monitoring and reporting?
The joint inter-agency report on integrated analysis of antimicrobial agent consumption and occurrence of antimicrobial resistance in bacteria from humans and food-producing animals in the EU/EEA (JIACRA). Through a collaboration between ECDC, the European Food Safety Agency (EFSA) and the European Medicines Agency (EMA), surveillance data on antimicrobial consumption and AMR from both the human and food-producing animal sectors are jointly presented in a One Health approach. The findings demonstrate links between antimicrobial consumption in both food-producing animals and humans and the occurrence of AMR in bacteria from food-producing animals and from humans. This suggests that further interventions to reduce antimicrobial consumption would have a beneficial impact on the occurrence of AMR, which underlines the need to promote prudent use of antimicrobial agents and infection prevention and control in both humans and food-producing animals.
Other initiatives include the ECDC point prevalence surveys of healthcare-associated infections and antimicrobial use in European acute care hospitals and long-term care facilities (see: www.eurosurveillance.org/content/10.2807/1560-7917.ES.23.46.1800393)
The European Antimicrobial Resistance Genes Surveillance Network (EURGen-Net) which is a network for genomic-based surveillance of multidrug-resistant bacteria of public health importance, coordinated by ECDC, is working to determine the geographic distribution and population dynamics of multidrug-resistant clones and transmissible resistance elements to inform risk assessment, prevention and control polices and to support countries in developing technical capability and proficiency for genomic-based surveillance of multidrug-resistant bacteria with epidemic potential.
How else would you like to see policymakers and health professionals respond to the threat of AMR?
It should be noted that simple measures, such as improving hand hygiene and, in general, infection prevention and control practices in healthcare facilities more than halve the risk of death and decrease the health burden of AMR – measured in DALYs – by about 40%. Antibiotic stewardship programmes are similarly effective. Outside of hospitals, interventions designed to tackle AMR, such as the use of rapid diagnostic tests, delayed prescriptions and mass media campaigns would have a more limited health impact but remain important policies to address a multifaceted and complex phenomenon. For more information see the OECD’s 2018 ‘Stemming the Superbug Tide: Just a Few Dollars More’ report.
European Centre for Disease Prevention and Control
This article is from issue 21 of Health Europa Quarterly. Click here to get your free subscription today.