Health Commissioner plans new EU attack on “super bugs”

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01 June 2017

by Ben Duncan, Senior Advisor, Health & Wellbeing

Official tells event in European Parliament that new EU Antimicrobial Resistance (AMR) Action Plan will be ready to launch this summer. It targets “antibiotic pollution” in the environment as well as overuse of antibiotics in human and animal medicine. The EU may also systematically raise AMR in bilateral relations with Third Countries as well as in international forums such as WHO and OIE.

Up until the mid-twentieth century it was common for Europeans to die of bacterial infections. Getting a cut on your leg could prove fatal if it got infected. A winter cold could progress to bronchitis, then pneumonia and then death. This was the era before the discovery of penicillin and other antibiotic drugs. The problem of Antimicrobial Resistance (AMR) comes loaded with complex terminology, unfamiliar acronyms and difficult to explain concepts (e.g. Antimicrobial Stewardship). The threat AMR poses, however, is surprisingly easy to grasp. Unless we take action, the drugs we currently use will stop working and we will end up back in the pre-antibiotic age – where you can end up dying from a winter cold.

The EU has been at the forefront of sounding the alarm about the threat from AMR. Its scientific agency the European Centre for Disease Prevention and Control has tracked the emergence of bacteria that are resistant to all available antibiotics. These bugs have unpronounceable names such as Carbapenem-resistant Klebsiella pneumoniae. But the bottom line is this: if you get sick with them either your body’s own immune system fights them off, or you die. There is little the doctors can do by way of treatment.

The EU has also led efforts to develop a policy response to this threat. In 2011 the European Commission launched a five year Action Plan against the rising threats from AMR. In 2016 an evaluation of the action plan concluded it had clear added value in stimulating national level action and coordinating research efforts (click here for more details). A European Parliament resolution on patient safety in 2015, Health Council Conclusions under the Netherlands EU Presidency in 2016 and indeed a recent public consultation all showed strong demand for a second EU Action Plan on AMR.

New EU AMR Action Plan is almost ready

On 31 May Arūnas Ribokas, Member of Cabinet of European Commissioner for Health and Food Safety, Vytenis Andriukaitis, delighted a meeting of MEPs and health stakeholders in Brussels by revealing that a new EU AMR Action Plan is nearly ready to launch. An advance draft of the Action Plan finished inter-service consultation in the Commission on 30 May. In other words, the plan has been agreed by the civil servants in the different Directorate-Generals of the Commission. The plan now needs to be reviewed at the political level, with cabinets of the 28 Commissioners reviewing it in the coming weeks. Mr Ribokas did not think the Action Plan will ignite a political controversy. He anticipated it should be formally adopted and launched on 29 June.

The new Action Plan follows the same twin track approach to fighting AMR as the previous one: action to safeguard the effectiveness of the antibiotics we currently have; and actions to boost research into new antibiotics. These actions are grouped under three policy headings:

  1. Making the EU a model of best practice in prudent use of antibiotics
  2. Stimulating research & innovation
  3. Shaping global action

Mr Ribokas explained how the new Action Plan builds on and extends the previous one by looking at each heading in turn. The new elements under each heading include:

  1. The EU’s "One Health" approach to prudent use of antibiotics is expanded beyond human medicine and animal health. Under the new Action Plan it will also include "antibiotic pollution" in the environment. This comes from various sources, including pharmaceutical manufacturing and hospital waste. There will be new, more detailed, data collection requirements for Member States (and industry) on antibiotic use in medicine, animal health and presence of antibiotics in the environment.
  2. Diagnostics are included as a research and innovation priority, along with new antibiotics, new treatments and vaccines
  3. The EU will systematically raise AMR in its bilateral relations with Third Countries, in addition to the work it does on AMR in WHO, OIE and the G7.

Diagnostics still face obstacles 

The Commission’s commitment to promoting research and innovation on diagnostics was particularly welcomed at the meeting. This was because it had been organised by the health advocacy group Health First Europe specifically to highlight the importance of diagnostics in fighting AMR. The case for this was convincingly set out in a Health First Europe White Paper on Rapid diagnostic technologies to tackle AMR launched at the event. One of the authors of this, Dr Jean Carlet of the World Alliance Against Antibiotic Resistance, shared an analysis he had done for the French Ministry of Health that showed respiratory infections accounting for 50% of antibiotic overuse. In other words, millions of patients with viral chest or throat infections are being needlessly treated with antibiotics (which only work against bacterial infections). This does not help the patients and boosts the long-term trend of bacteria developing resistance to antibiotics. Just doing the most basic diagnostic test to see whether a patient has a viral or a bacterial infection can make a major contribution to reducing overuse of antibiotics. More sophisticated tests, that identify exactly which bacteria a patient is infected with and which drugs will kill it most effectively can make an even bigger contribution. But with only 15% of family doctors in France making use of an existing diagnostic to see if a throat infection is bacterial, changing attitudes is as important as developing new technologies.

Barbara Kerstiens of the Commission’s DG Research put the dilemma nicely. Diagnostic tests have tended to be very expensive, while antibiotics are very cheap (most of the antibiotics doctors use today have been around since the 1970s or before). Changing the financial incentives to encourage greater use of diagnostics is therefore a key priority. Part of this is finding ways of lowering the price of diagnostic test kits. DG Research is using innovative financial mechanisms to support diagnostic companies make the leap to mass production (and lower unit costs) of their kits. But another, and more difficult, part of the equation is working with sickness funds and other healthcare payers to remove financial obstacles to greater use of diagnostics.

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