Pulling together to thwart the superbug tsunami

By Laura Cigolot

Antimicrobial resistance (AMR) is recognized as being among the world’s most serious threats for humankind. Antibiotics and similar drugs, also called antimicrobial agents, have been used for the last 78 years to cure patients with infectious diseases, significantly reducing illness and death rate. However, they have been used so broadly and for so long that the infectious organisms the antibiotics are designed to kill have adapted to them, making drugs less effective.

Antimicrobial resistance is a consequence of natural selection and genetic mutation, which is then passed on conferring resistance. The natural selection process has been intensified by human factors, such as inappropriate use of antimicrobials in human and veterinary medicine, poor hygiene conditions and practices in healthcare settings or in the food chain facilitating the transmission of resistant microorganisms. This has eroded antimicrobials’ efficacy and antibiotic-resistant bacteria have emerged and spread across the globe, like a silent tsunami decreasing the effectiveness of treatment options.

As enshrined in the latest report[1] released by the European Food Safety Authority (EFSA) and the European Centre for Disease Prevention and Control (ECDC) on 27 February 2018, bacteria from humans and animals continue to show resistance to antimicrobials. According to the report, among the new results, based on data from 2016, are detection of resistance to carbapenems in poultry and of ESBL-producing Salmonella Kentucky with high resistance to ciprofloxacin in humans, which was reported for the first time in four countries.

It is estimated that by 2050 AMR could potentially kill one person every three seconds and become a more common cause of death than cancer[2]. It is precisely to avoid this alarming scenario that the EU stands at the forefront for addressing AMR, and remarkable strides have been made possible so far. It is worth remembering the latest EU One Health Action Plan against AMR[3] of June 2017 and the adoption of the first deliverable of the plan, the EU Guidelines on the prudent use of antimicrobials in human health[4]. September saw the launch of the European Joint Action on Antimicrobial Resistance and HealthCare-Associated Infections[5] (EUJAMRAI), involving 28 countries, and, just a few weeks later, ECDC, EFSA and EMA adopted a Scientific Opinion[6] setting out indicators addressing both the human and animal sectors to measure progress in the EU and its countries.

Despite all accomplishments, there is still considerable room for improvement, particularly at the national level. Mr Vytenis Andriukaitis, European Commissioner for Health and Food Safety highlighted that “levels of antimicrobial resistance still differ significantly from one EU country to another[7].

The European Parliament INI Report on AMR

Tackling human health impacts of AMR is everybody’s task. Here comes the need to join hands and share best practices and policies on the use of antibiotics across sectors to cope with this cross-border resistance and not to undermine progress made in certain regions and countries. Proper action can mitigate the negative impact of AMR on the economy and, therefore, contribute to economic growth, to sustainable healthcare budgets by reducing healthcare costs and to a productive and healthy population within a country.

At EU level, the European Parliament is currently developing an Own-Initiative Report on Antimicrobial ResistanceIn some years’ time things that are currently harmless could result in a fatal illness, emphasised MEP Kadenbach (S&D, Austria), rapporteur of the EP dossier during the ENVI Committee held on 26 February 2018. From this remark, amongst key actions and solutions, enshrined in the report, are the following takeaways:

  • Better training and education of people working in the health sector, improved health literacy and advancement of clear, educational plans for citizens as well as doctors.Educating health workers about how to prevent infections is vital, but it is equally relevant – and more challenging – to educate them about best practices in prescribing antibiotics. In many cases, doctors do not hesitate to prescribe high-power antibiotics even for the simplest of complaints, such as colds and fevers. In this regard, a reformulation of antibiotics in the market needs to be undertaken along with the development of new antibiotics by means of economic incentives.
  • Prevention is also of utmost importance to spread awareness and stop such resistance. Implementing safe hygiene practices among hospital staff, immunisation and vaccination measures, and active screening programs are only one of the numerous ways to make a huge different in the fight against AMR.
  • The uptake of innovative technologies represents a significant advancement in national healthcare systems. For instance, diagnostics can truly transform the way we use antimicrobials in humans and animals, while reducing unnecessary use, identify the organisms causing disease and reduce reliance on traditional antibiotics.

The draft report lies now in the hands of the ENVI Committee, whose Members of the European Parliament are giving their opinions discussing the most important issues with a view to express their final vote in the coming months.

AMR is a serious, complicated puzzle, in the EU and globally, but one that can be solved. To win the fight, policymakers and all interested representatives need to work together and act swiftly to achieve proper, binding measures so that Member States and the EU will be able to go in the right direction and help make this public health, social and economic concern a distant memory.