Many of the Barriers to Combating Antimicrobial Resistance Are Common to All European Countries

A lack of funding, of capacity building and of political focus are some of the barriers to the effective implementation of antimicrobial resistance strategies, according to a detailed analysis in which ISGlobal researchers participated. The report, prepared for the European Commission under the EU4Health programme, also identifies actions and best practices to overcome these barriers, many of which are common to all countries.

Antibiotic-resistant bacteria are responsible for around 670,000 infections and 35,000 deaths each year in the European Union. Worldwide, antimicrobial resistance causes 1.27 million deaths each year, and this figure could rise to 10 million by 2050 if no action is taken.

The report recently published on the European Commission's website will be of great use in guiding policies and initiatives to combat this problem. The study was coordinated by a panel of experts, including Jordi Vila, Director of the Antimicrobial Resistance Initiative, and carried out by a working group where Sara Soto, Director of the Bacterial and Viral Infections Programme, participated as thematic lead.

The team carried out literature reviews, interviews, surveys and workshops involving nearly 500 stakeholders from the 29 countries of the European Union plus Norway and Iceland to provide a detailed analysis of the barriers to the effective implementation of national action plans on antimicrobial resistance and infection prevention and control in hospitals, long-term care facilities, primary care, and pharmacies.

Common barriers at the policy, clinical and behavioural level

The analysis revealed common issues across countries, regardless of size or socio-economic status, at all levels: policy and institutional (including funding), clinical (including use of guidelines and practices) and behavioural (of healthcare professionals and patients). The main barriers identified include: insufficient funding to implement the measures foreseen in the national action plans, lack of trained staff, lack of specific measures for long-term care facilities and limited involvement of pharmacies in antibiotic stewardship. They also highlight a lack of political focus, a lack of harmonised indicators to monitor the implementation of the plans, and a lack of education and awareness on the issue.

"Almost all countries have action plans, most of them with a One Health approach, but their implementation varies widely and the environmental dimension is not sufficiently covered," says Sara Soto.

At the clinical level, there is great heterogeneity in the quantity and quality of data collected and in how antimicrobial resistance is monitored and reported. Shortcomings are even more pronounced in long-term care facilities, where there is a severe shortage of trained staff.

Primary care and pharmacies play a key role in ensuring appropriate antibiotic use and changing people's behaviour, but are rarely included in national plans. A major behavioural barrier is pressure from patients for doctors to prescribe antibiotics.

Recommendations and good practice

But the report not only points out problems. It also suggests a number of actions to overcome them and identifies examples of good practice in different countries. For example, a high-level position in the ministry of health to coordinate the fight against antimicrobial resistance, a national surveillance system to collect data from all clinical microbiology laboratories, the establishment of local groups for health workers to share best practices in antibiotic prescribing, and the use of tools (tests or apps) in primary care to facilitate diagnosis.

"This study aims to support the preparation of future EU initiatives and policies against antimicrobial resistance, including the implementation of the One Health Action Plan," says Jordi Vila.

Referencia:

Study on the barriers to effective development and implementation of national policies on antimicrobial resistance. Final report. June 2023. Publications Office of the European Union. doi:10.2925/826400.