Mariano Votta, Director of the Active Citizenship Network/Cittadinanzattiva, and Neda Milevska-Kostova, Vice Chair of the International Alliance of Patients Organisations, discuss the threat of antimicrobial resistance in the context of COVID-19 and the recent European Patients’ Rights Day, explaining that a One Health approach is being planned and that multi-stakeholder actions are required.
Antimicrobial resistance (AMR) is one of the ten most urgent threats facing global health, and yet it remains totally underestimated by much of the population. AMR is more dangerous than car accidents and even cancer, but is still not being prioritised at either the EU or Member State levels within public health policies. Furthermore, AMR is interlinked with the COVID-19 pandemic, a fact which has been all-but ignored by the media.
The world is losing its most powerful healthcare tool, antibiotics; by 2050, super bacteria could cause 350 million deaths. Meanwhile, the research sector is still waiting for EU incentive mechanisms as well as an overall strategy to integrate the development of – and access to –affordable and quality antimicrobials.
The fight against AMR requires policies focused on prevention, as well as on the extension of vaccination programmes; and yet expenditure for prevention programmes are the ‘Cinderella’ of public health budgets. Furthermore, patient engagement efforts to increase awareness around the importance of AMR are not accompanied by more widespread initiatives targeted towards citizens. For instance, how should people react to and behave towards foods labelled as having been produced ‘without the use of antibiotics’? What lies behind this label? Why is it important? How can we value our informed choices as consumers?
European Patients’ Rights Day
These are some of the paradoxes around the issue of AMR that were addressed during the 14th edition of the European Patients’ Rights Day, organised on 18 and 19 November 2020 in a digital format by Active Citizenship Network (ACN), the European branch of the Italian NGO Cittadinanzattiva (and for which Health Europa acted as a Media Partner) during the World Antimicrobial Awareness Week (WAAW), when the world turns its attention to this silent killer which is threatening to revert a century of medical progress in terms of treating infectious diseases. This two-day initiative was realised thanks to the scientific support of the European Joint Action on Antimicrobial Resistance and Healthcare-Associated Infections (EU-JAMRAI).
Considering the huge discrepancy between the severity of the situation and the low level of awareness on the part of European citizens, discussing AMR now could potentially help to ensure that we do not return to the same situation that we saw prior to COVID-19. Indeed, this was, in essence, the main message to emerge from the event which saw the speakers share concrete initiatives about patients’ engagement and stakeholders’ actions to tackle antimicrobial resistance and sustain EU progress in the area, something that is crucial in the context of the pandemic.
AMR and COVID-19
Antibiotics have been widely prescribed to patients affected by Sars-Cov-2/COVID-19. And this, according to the WHO, is exacerbating AMR trends. To report some data:
- In the United States, some 70-80% of hospitalised COVID-19 patients received antibiotic treatment, according to one report, even though less than 10% actually had secondary bacterial infections
- In Italy, the Italian National Institute of Health affirms that of 3,335 patients who died from COVID-19, 86% of them had undergone antibiotic treatment, despite only 12% of them having had a superimposed bacterial infection
The impact that this empirical use of antibiotics will have in terms of a potential increase of AMR certainly needs to be taken into consideration. It is clear that ‘without effective action, AMR will take us back to a pre-antibiotic age when death by infection was much more common,’ as was recently affirmed by MEPs who have called on the European Commission to tackle antimicrobial resistance (AMR) through the new Pharmaceutical Strategy for Europe.
A potential wake-up call
However, the current pandemic may also serve as something of a wake-up call to fostering more action on AMR, amongst all stakeholders, both in terms of ensuring a positive economic environment for the development of new antibiotics, as well as for raising awareness on the importance of saving existing ones.
Last July, an AMR Action Fund of nearly $1bn was established by more than 20 leading biopharmaceutical companies, with a mission to bring two-to-four new antibiotics to patients by 2030, and, moreover, to replenish the collapsing antibiotic R&D pipeline. This fund complements other initiatives, such as the WHO’s Global Antibiotic Research and Development Partnership, and its added value is in creating market conditions that enable sustainable investment in the antibiotic pipeline.
During the WAAW, the Wellcome Trust launched its report ‘The Global response to AMR: Momentum, successes and critical gaps’, underlining the fact that AMR is not only reversing recent progress in controlling infectious diseases, but is also undermining improvements in healthcare provision in general, threatening to disproportionately affect low- and middle-income countries. The Tripartite Coalition of the WHO, the Food and Agriculture Organization (FAO) and the World Organization for Animal Health (OIE) also launched the ‘One Health’ Global Leaders Group on Antimicrobial Resistance, co-chaired by the Prime Ministers of Bangladesh and Barbados, to advocate for urgent action among heads of state, government ministers, private sector, and civil society.
In Europe, public involvement and awareness are also part of the European Joint Action on Antimicrobial Resistance and Healthcare-Associated Infections agenda, which this year organised a contest for a global antimicrobial resistance symbol that is easy to create and proudly worn by everyone who wants to demonstrate support for the fight against AMR.
European Patients’ Rights Day
Against this background, several positive developments were also highlighted during European Patients’ Rights Day, which was realised thanks to the support of MSD, Pfizer, Boehringer Ingelheim, Teva, Copma, and which was hosted by MEP Brando Benifei and supported by MEP Tiemo Wölken, Vice-chair of the MEP Interest group on AMR.
During the event, both MEPs stated that the European Union needs to show leadership and ensure the highest quality and equitable care for all its citizens. In this context, the commitment of the Members of the European Parliament from two different Interest Groups active on health issues, the MEPs Interest group European Patients’ Rights & Cross-Border Healthcare, and the Interest Group on Antimicrobial Resistance, is essential for wider political support, as the European Parliament can play a key role in boosting action on AMR at the European level and can also ensure that the European Commission and Member States deliver on their commitments and implement effective policy responses to the AMR threat, a key cross-border health issue for Europe.
In addition to both the high level of attention being paid to the issue by members of the EU Parliament and the private sector’s increasing commitment to the topic, a further important aspect highlighted during the conference was the promising ‘EU4Health Programme’, which is being promoted by the EU Commission. This multi-annual programme aims to increase protection against global health threats, reduce inequalities in accessing health care, and advocate the prudent and efficient use of medicines such as antimicrobials. In this context, the civic monitoring of how public resources will be spent and the level of institutions’ accountability will be crucial.
Towards an AMR citizens’ alliance
During the second day of the event, entitled ‘Towards an AMR citizens’ alliance, the International Alliance of Patients’ Organizations (IAPO) officially announced the ‘AMR Patient Alliance’ and its commitment, together with Active Citizenship Network, other PAGs, and relevant international experts, to draft a Global Patient Consensus Statement and Call to Action on Antimicrobial Resistance.
Through the Consensus Statement and A Call to Action, patient communities pledge to support actions to address AMR through four pillars:
- Raising the awareness of AMR and strengthening health literacy
- Advocating for evidence-based solutions
- Ensuring a patient-centred approach in antimicrobial development and access
- Strengthening public health measures
The aim of this advocacy initiative is to call on patients first, and then also on civil society in general, to commit to a more significant engagement in terms of advocacy, education, awareness-raising, and everyday activities related to this fight because, as was underlined during the conference, ‘AMR is a battle we must fight together, and it is one that we have to start now.’
The problem is not a simple one, and solutions are certainly complex and interrelated. We knew that progress would be slow, and the current pandemic has only made achieving our goal more challenging. Our own generations have enjoyed the 20th century discovery of antibiotics. We now need to ensure their efficacy will serve future generations, too. Appropriate antibiotic use is everybody’s business and must be seen as such if we want to preserve the effectiveness of antibiotics and other antimicrobials for as many patients as possible, for as long as possible.