The EU needs to upgrade its public information programme, encourage greater collaboration between States and expand the pressure on health professionals to prescribe antibiotics responsibly
Brian Edwards CBE
University of Sheffield, UK
HOPE (European Hospital and Healthcare Federation),
Opening a debate in the European Parliament just before Christmas 2012, Anna Rosbach (Denmark) talked about the problem of antimicrobial resistance exploding across European borders. Maria Sanchez-Schmidt (France) talked about the years rolling back to the days before antibiotics. Joao Ferreira (Portugal spoke about 25,000 deaths annually. The indiscriminate use of antibiotics must stop, he said. According to Zofig Kukovic (Slovenia), people now eat antibiotics like bread.
In most countries, antibiotics can only be supplied to patients via prescription, but it is not difficult for patients to purchase them directly in many countries in Europe.
There are some worrying reports that a gene has been isolated (New Delhi Metallo 1) that enables some strains of enteric bacterium to express a protein that causes rejection of attack by antibiotics and that this gene has now been isolated in other countries, including the UK and the US: is this better detection or is it spreading?
The use of antibiotics in the animal world is now well established and, in some countries, veterinarians can both prescribe the drug and sell it to farmers. Some MEPs would ban this practice but others, with large farming constituencies, argue that this would both be unnecessary and pose a real burden on rural communities.
The EU has poured a lot of cash into research and development in this area, both directly via the AMR action plan (€223 million) and via the most recent research frameworks (€147 million), and the Commission is working closely with the US on the search for an answer via a joint task force.
If the problem is as big as some suggest – a world threat – then the response has been weak and inadequate.
The EU needs to upgrade its public information programme, encourage greater collaboration between States and expand the pressure on health professionals to prescribe responsibly. But a really radical action plan would have three additional components:
- An effective ban on over-the-counter and internet access by the public
- Serious controls on the use of antibiotics by physicians, veterinarians and other prescribers. Special prescription pads for antibiotics with explicit warnings and messages for patients and prescribers might work. Every prescription should be logged and recorded with a follow-up audit. Sloppy prescribing should result in fines or, in extreme cases, the prescriber should be struck off their professional register and banned from practice
- There should be an even more determined attempt to encourage the pharmaceutical industry to expand its efforts to discover new antibiotics or alternative treatments. An attempt by the American Infectious Disease Society to discover ten new antibiotics by 2020 looks hopelessly optimistic and potentially dangerous, if it fails and ten years will have been lost.
Perhaps what needs to be considered is a worldwide competition with initial research costs being shared with the industry up front and only recovered on a long-term basis if effective new drugs or treatments emerge. A shared risk may be the only way forward. Given the estimated annual cost of antimicrobial resistance in the EU alone of €1.5 billion, a sizeable investment could be justified.
It would be even better if WHO and the World Bank could coordinate a worldwide contribution to such a programme.
Could it happen? It seems unlikely. The problem needs to reach a more serious crisis level first and 25,000 deaths annually in Europe is not enough.