On Thursday 27 October 2022, Health First Europe’s European Patient Group on Antimicrobial Resistance organised a Parliament Roundtable Debate under the title “Engaging with patients and closing knowledge gaps to fight antimicrobial resistance: the role in infection prevention and antimicrobial stewardship”. The event took place in the European Parliament, hosted by MEP Ondřej Knotek (Renew Europe, Czech Republic) and held under the patronage of the Czech Presidency of the Council.
Dr Roberto Bertollini, President of Health First Europe, kicked off the event by describing antimicrobial resistance as one of the major issues that the public health community will face in the next few years. He warned that without proper solutions, common illnesses might become untreatable or only treatable with a significant risk to the patient. On top of the human suffering AMR causes, Dr Bertollini also highlighted the significant economic costs it causes. By 2030, the World Bank estimates a $3.4 trillion global GDP fall due to AMR and its consequences among the population. He then welcomed the speakers and asked them to reflect on past experiences dealing with AMR to help identify lessons for the future.
This introduction was followed by a message from MEP Knotek, who further underlined that the inappropriate use of antibiotics leads to the development of a “silent pandemic”. He called for AMR to be addressed at every level, asking EU and global institutions to continue monitoring it and to issue recommendations on how to tackle it. He also commended the work of the members of the AMR Patient Group. He asked authorities to work with them to bridge the knowledge gap on the use of antibiotics among citizens at the local level.
After these introductory interventions, Dr Andrea Ammon, Director of the European Centre for Disease Prevention and Control (ECDC) set the scene for the exchange by sharing some key facts about AMR in Europe at present. Dr Ammon mentioned that while antibiotic consumption and AMR decreased in 2020 as a result of the exceptional measures taken to control Covid-19, there are still high levels of resistance for several important bacterial species-antimicrobial group combinations. She pointed out that the burden of AMR remains very high, as it is similar to the burden of influenza, tuberculosis and HIV/AIDS combined. According to ECDC estimates, 70% of this burden is related to health care-associated infections. Dr Ammon added that the ECDC is working with other global and EU-institutions and Member States towards finding solutions. For instance, the ECDC supports national AMR reference laboratories in building capacity on whole genome sequencing to integrate it as part of AMR surveillance, which has greatly helped the ECDC’s risk assessments. Furthermore, in cooperation with the European Commission’s Directorate General for Health and Food Safety (DG SANTE), they undertake joint One Health country visits to interested Member States. This helps them identify areas of improvement in their human and animal health sectors, which they use for national actions plans.
Dr Ammon finished her intervention by asking participants to mark the 15th European Antibiotic Awareness Day on 18November under the theme “Preventing Antibiotic Resistance Together”, which highlights everyone’s important role in this fight.
In line with this Call for Action, Céline Ledoux and Julia Langer, from DG SANTE, then presented the latest actions the EU has taken in the fight against AMR. They both underlined the Commission’s One Health approach to AMR, which acknowledges that efforts are needed across sectors (i.e., human, animal, and environmental health) to address the AMR crisis adequately. Ms Ledoux emphasised that the upcoming Proposal for a Council Recommendation on AMR, planned for the beginning of 2023, will use the lessons learnt from the 2017 EU One Action Plan against AMR, extending and complementing it. Ms Langer remarked that the European Health Union initiative reinforces the EU’s role in addressing AMR. This initiative includes the revised legislation on cross-border health threats, recently adopted by the Council; the extension of the mandate of the ECDC; and the creation of the Health Emergency Preparedness and Response Authority (HERA). Moreover, she added that the revised Pharmaceutical Strategy for Europe includes measures for the prudent use of antimicrobials and explores options for developing new antimicrobials addressing AMR.
The presentations from EU representatives were followed by an address from Dr Malin Grape, Sweden’s Ambassador on Antimicrobial Resistance. Dr Grape presented the Swedish experience with AMR and the country’s plans for its forthcoming Presidency of the Council of the EU in the first half of 2023. She explained that her country’s Public Health Agency and the Board of Agriculture have been spearheading intersectoral cooperation since 2012 to address the development of resistance. Cooperation between the local, national, and international governance levels plays a key role in Sweden’s actions on AMR. She highlighted the importance of integrating surveillance, stewardship, and infection control. She then presented Sweden’s national stewardship programme, known as Strama, which among other measures, includes monitoring prescriptions of antibiotics, sets national targets, and ensures both a bottom-up and a peer-to-peer approach. When Sweden takes the helm of the Council, they will continue the work on the AMR policy package, and on the Strategy for Global Health, which will strengthen EU leadership worldwide.
Following the institutional panel, attendees heard the emotional testimony of patient advocates. Ms Vanessa Carter, a South African Patient Advocate for Antimicrobial Resistance who suffered a resistant infection after being a victim of a car accident, shared her personal story of dealing with AMR. She is actively engaged with the WHO, the Africa Centres for Disease Control and Prevention, and other institutions in educating patients about AMR. Mr Jonathan Pearce, CEO of the Antibiotic Resistance UK charity, also provided examples of patient stories and highlighted the work he does in the UK as the only UK patient support service for patients with AMR and their families. Both speakers called for greater support for victims of resistant infections and asked the institutions to improve communication on the topic, as well as research, infection prevention, and antibiotic stewardship actions at every level.
The patients’ perspective part of the event was complemented with the healthcare professionals’ point of view. Dr Christiaan Keijzer, President of the Standing Committee of European Doctors (CPME), spoke on their behalf. He stated that while doctors have a basic knowledge about the prudent use of antibiotics and the risk of resistance, they often lack resources or time to provide appropriate advice to their patients. He emphasised the need to increase the uptake of antibiotic stewardship teams so that information about antibiotics is passed on to healthcare professionals and patients in a more systematic way. He argued that national guidelines on antibiotics must enshrine that doctors diagnose the patient in person before prescribing antibiotics, performing a clinical and diagnostic examination before initiating therapy. Doctors should ascertain that the patient most probably has a bacterial infection, and a real effect can be expected by treatment with antibiotics. Finally, they must choose as specific a narrow-spectrum antibiotics as possible as first choice.
Subsequently and in line with Dr Keijzer’s arguments, Miriam D’Ambrosio, External Affairs – Manager Communications at MedTech Europe, stressed that the effective use of diagnostic tests and medical devices can help address these health challenges throughout the entire patient pathway: before admission to the hospital or in the community, at the arrival at the ward, in the operating room, during the hospital stay and recovery, and when the patient is discharged and sent back home.
Furthermore, she emphasised that behavioural change and strict adherence to clear guidelines are needed to reduce antibiotic demand. Medical technologies give specific guidance on how to prevent and control infections. If effectively implemented, the medical technology solutions address the spreading of infections by detecting and identifying bacterial infection and the susceptibility to medication, monitoring and tracking resistance, management, and containment outbreaks. Finally, Ms D’Ambrosio called for more coordination between stakeholders to address this global health threat.
Throughout the event, attendees had the chance to participate in an online poll about AMR. The majority identified a lack of information as the main reason citizens are unaware about AMR. Most of them held that the use of antibiotics by GPs and patient self-medication are the main areas to target to successfully slow the development of resistance. In addition, participants said that further training of healthcare professionals is key to combat AMR in their local communities.
In conclusion, the event revealed that AMR is a topic that raises interest from a wide array of stakeholders, who are making their contributions within their capacities to better address this silent pandemic. Better coordination is needed between global, EU, national, and local authorities as well as with patient representatives who have a direct impact in their communities. Infection prevention was mentioned by keynote speakers and attendees as a key aspect of the fight against AMR. Better prevention measures can be adopted by patients and healthcare professionals alike, improving outcomes for individuals and for society as a whole. The debate was an excellent opportunity to learn from each other and to create bridges between all actors, setting the foundations for future cooperation across Europe.
On this World Patient Safety Day 2022, we are reminded of how unsafe medical practices can exacerbate existing medical conditions or even create additional health issues. This is particularly the case in the use of medication, where errors can significantly harm patients. This year, the WHO has chosen the slogan “Medication without harm” to raise awareness about this major problem, and the circumstances and conditions that give rise to it. These include poor training of both of healthcare professionals and patients, staff shortages, and a lack of infection prevention and control measures, among other factors.
One of the most far-reaching and impactful consequences of these errors, to a large extent, is Antimicrobial Resistance (AMR), where the inappropriate use of antibiotics leads to bacteria becoming resistant to them. This makes regular medical interventions increasingly dangerous, in particular intensive care, cancer treatment, and organ transplantation. The development of so-called “superbugs”, bacteria resistant to the most used antibiotics, represents a threat to modern medicine and could go so far as to push back decades of medical advances. AMR does not discriminate in its potential to harm patients: complications from drug-resistant bacteria can affect anyone, no matter their health status, of any age, and in any country, leading to increased medical costs, prolonged hospital stays, greater demands on healthcare infrastructure and capacity, and increased mortality. This is to say nothing of the implications of AMR beyond human health: resistance can build as medication cycles across humans, animals, and the environment, with antibiotics in livestock and in agricultural uses contributing to AMR in humans and vice versa.
Several factors lead to this misuse or overuse of antibiotics. To begin with, there is a general lack of awareness among the public. A 2015 WHO survey conducted in 12 countries revealed that while 64% of people knew about antimicrobial resistance, around the same number incorrectly believed antibiotics can be used to treat colds and flu. As viral infections, antibiotics have no effect as the health of the patient is concerned – although attempting to treat viruses with antibiotics does exacerbate AMR. Additionally, while most healthcare professionals are aware of the risk of excessive antimicrobial use, there are still some gaps. A 2019 ECDC survey showed that only 75% of healthcare professionals were aware of the link between treatment with antibiotics and an increased risk of antibiotic-resistant infection. Many also recognised that they have prescribed antibiotics to patients when they would have preferred not to, for “fear of patient deterioration” or “fear of complications”.
Several measures need to be implemented urgently to address this truly global public health threat. First, better infection prevention measures are needed. During the Covid-19 pandemic, citizens around the world came to realise the importance of their own actions in preventing infections, and how individual efforts can make a widely felt difference. Similar measures to the ones taken during that health emergency, building on this awareness and sense of shared mobilisation, can also be applied to AMR. First, better hand hygiene, particularly in healthcare settings, is essential. Local advocacy groups, working together with healthcare professionals, should help create and disseminate checklists with key hygiene measures that can easily be followed by everyone. Second, to avoid unnecessary consumption of antibiotics, healthcare professionals should make sure that a specific antibiotic is needed before prescribing it when a patient shows symptoms of infection. A better use of point-of-care rapid testing could reassure them about whether and which antibiotics are needed. Existing medical technologies are already effective in determining the relevant pathogen, but further investment is necessary to make them even more accurate and to reduce the instances of healthcare professionals who felt compelled to unnecessarily prescribe out of fear or uncertainty. Finally, awareness raising among the public is also indispensable. If patients are better informed, they will be aware that they should only be taking antibiotics if prescribed to them and in the manner prescribed to them (i.e., they should follow the antibiotic treatment as prescribed, not stop it prematurely once the symptoms disappear).
AMR is a serious health concern, but it is one where greater leadership from policy makers, healthcare professionals, and patient advocates can help reduce harm, improve outcomes, and make global progress. World Patient Safety Day remains a positive occasion to reflect on where that leadership is most needed and what we can do to find solutions that would help everyone address the major public health threat that Antimicrobial Resistance represents. In Europe, both the EU and Member States, together with all relevant stakeholders, should work together to find a common approach to urgently address this problem, doing the necessary work to raise awareness and promote best practices, gathering and sharing key health data, and endorsing a comprehensive “One Health” approach that brings all sectors together.
Brussels, 28 June 2022
The European Patient Group on Antimicrobial Resistance is happy to announce its new visual identity and its new website: amrpatientgroup.eu. Given the growth of the group in the past few months with new patient organisations joining it from all over Europe, we are excited to present a new rebranding to consolidate their work.
The patient group, through its various advocacy and communication activities, will continue to advocate for effective measures to address the threat of Antimicrobial Resistance. Our recent contribution to the European Commission’s Call for Evidence for a Recommendation for Further Action on Antimicrobial Resistance summarises our main policy proposals, that include raising awareness about AMR and healthcare-associated-infections (HAIs), improving infection prevention and control measures, empowering patients through stewardship programmes, and investing in medical technologies to prevent AMR and HAIs.
To ensure action is taken at every governance level in Europe, we are organising a Parliamentary Roundtable Debate in October with stakeholders from the EU institutions, member states, healthcare professionals and, most importantly, patient representatives. It will be titled “Engaging with patients and closing knowledge gaps to fight antimicrobial resistance: the role in infection prevention and antimicrobial stewardship” and will be a hybrid event to boost participation and availability so any person can follow it. More information on this will be coming soon and we look forward to putting together this exciting event.
About the European Patient Group on Antimicrobial Resistance
The first European AMR Patient Group was officially launched on the 18th November 2020 to coincide with European Antibiotic Awareness Day 2020 and World Antimicrobial Awareness Week (18-24 November). The AMR Patient Group is an initiative by Health First Europe and is comprised of national patient associations from across Europe. The group aims to address the gap in awareness at the patient-level about the danger of antibiotic misuse and the lack of effective infection prevention measures. The AMR Patient Group will empower patients across Europe with the necessary knowledge about antimicrobial resistance so that everyone understands when it is appropriate to take antibiotics and how to take them responsibly.
If you are interested in our activities or want to join the European AMR Patient Group, please contact us at firstname.lastname@example.org
Author: Ilaria Galetti, Vice President GILS ODV – Gruppo Italiano per la Lotta alla Sclerodermia.
Milan, Spring 1996. I was studying at the University, in an ancient cloister, when I noticed the first sign of the disease that would be my unfriendly and undesired partner of my life: systemic sclerosis, also known as scleroderma. Systemic sclerosis is a rare, autoimmune, and very complex condition, that can affect the skin, lungs, heart, gastrointestinal tract, joints, and overall, the whole body. One medicine has been approved for its treatment, but only for lung fibrosis and nothing else.
Clinical practice guidelines recommend immunosuppressive therapies to lower the immune system, but no selective or personalised therapies are available. This means that the whole immune system is affected, exposing the body to many infections. The disease causes digital ulcers, very painful and often infected, that need to be treated with topic or systemic antibiotics. A swab should always be performed to use the right antibiotics.
Immunosuppressive therapies are still too generic, meaning that they inhibit the whole immune system, paving the way to several infections (mainly lung infections). This can be difficult to treat and can require hospitalisation. A careful evaluation of which antibiotics or specific treatments must be used, should always be performed, targeting the right bacteria, viruses, or fungi.
The last two and a half years have taught us many things regarding prevention that should become routine in our daily life. Prevention plays an extremely important role. Hand hygiene, the use of masks when meeting people with the flu, meeting people who are not perfectly healthy, and when going to the hospital for check-up visits or infusion therapies, should be a must for the so-called fragile patients and their families. The lower the risk of infections, the lower the need to use antibiotics.
Another important issue is the adherence to the prescribed therapy. In too many cases the antibiotic therapy is halted by the patient when symptoms and signs of the illness disappear. Prescribers and pharmacists should stress the importance of adhering to the therapy in order to get a full healing and prevent a relapse. On top of this, patients often spontaneously use the pills that remain in their stock, with a sort of self-prescription to cure “potential” infections diagnosed by themselves.
In my experience at national and European level I would encourage a programme on the correct use of antimicrobics in the wider community of connective tissue diseases. A few tips to prevent the spread of antimicrobial resistance:
These recommendations can help save lives including your life and the lives of those close to you.