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.