Combating Antimicrobial Resistance in EU
There are lessons to be learned from the EU’s responses to the Covid-19 crisis. The pandemic reveals the absolute need for further cooperation in the EU if the member states are to manage these types of health crises effectively. Importantly, the crisis has shown that the social and economic costs of not being able to react – or reacting too late – can be enormous for the EU and its member states.
What is clear is that Covid-19 is unlikely to be the last of this type of health challenge to EU countries and its citizens. Antimicrobial resistance – AMR – is increasingly seen a problem that will become one of the biggest challenges for global and European public health during the next twenty to thirty years. Like Covid-19, AMR, knows no borders. Resistant bacteria move across countries along with people, animals and goods.
It is estimated that AMR causes around 33,000 deaths per year in the EU, and global AMR deaths are estimated to reach 10 million deaths per year by 2050. More people are expected to die due to AMR in 2050 than due to cancer.
In humans, antimicrobials – like antibiotics – are being used to combat various types of bacterial infections (e.g., pneumonia) and for prophylactic purposes in connection with surgery (e.g., heart transplants or hip replacement surgery). In the veterinary sector, antimicrobials are used to combat or prevent bacterial infections among livestock animals (pigs, cattle, chickens, etc.), and even among our pets. Use of antimicrobials is an integral part of modern human medicine and modern livestock production.
Approximately one-third of the consumption of antimicrobials in the EU is used within the human sector, while two-thirds is used in the veterinarian sector. However, every time antimicrobials are used to combat bacterial infections, the bacteria tends to become more resistant. Today, most bacterial infections can still be treated with antimicrobials, but in the near future, there is good reason to believe that we will be facing ‘superbugs’ for which antimicrobials will have no effect.
Over the past decade, the EU has taken a number of steps to combat AMR at the global and European level. In many ways, the EU is taking the lead in this effort, collaborating with UN organizations like the World Health Organization (WHO). The European Commission has launched two actions plans to combat antimicrobial resistance within the EU countries. The first Action Plan was launched in 2011, and the second in 2017. Both action plans contain a number of initiatives that can help ameliorate the AMR threat.
The basic aim of these initiatives has been to reduce overall consumption of antimicrobials in the EU. These include a proposal to increase testing of patients before they are given antimicrobials, increased antimicrobials stewardship systems at hospitals, and limiting the use of antimicrobials in livestock production. There is a close correlation between the level of antimicrobial use and the level of AMR. Countries with high levels of antimicrobial use, such as Italy, have high levels of AMR, while countries with low levels of use of antimicrobials, such as Denmark, also have low levels of AMR. Reducing overuse of antimicrobials is therefore a central goal in the EU Commission’s action plans.
A major challenge to the development of a common EU AMR policy is that health policy is primarily an area of national competence. The national control over health policy is explicitly stated in the Treaty of the Functioning of the European Union (Art. 168 No. 7 TFEU). This national competence has also been the case for EU policies aimed at reducing the risk of developing AMR.
Consequently, the Commission is prevented from initiating regulation on antimicrobial use unless there is clear support from the member states. The Commission has thus based a number of their initiatives in the AMR action plans on ‘soft law’. Hence, instead of laws and directives, they use ‘recommendations’ and ‘methods of open coordination’ as the regulatory instrument for reducing overuse of antimicrobials among, for example, physicians or pig farmers. Binding legislation such as EU ‘regulations’ or ‘directives’ are seldom used in the AMR context, unless these can be directly related to the single market. From the Commission’s perspective, the use of soft law within the field of AMR can be seen as a strategic way of dealing with the lack of EU competence in this policy field in situations where there is a clear need for transnational initiatives.
The action plans to combat AMR launched by the Commission have definitely increased focus on AMR problems among the EU member states. Most member states have developed their own plans for how to reduce the use (and overuse) of antimicrobials at national level.
Yet, the overall consumption of antimicrobials in the EU remains high. One explanation for continued overuse of antimicrobials is probably that the EU actions plans are rather new, and that a number of member states until now have not been so active in the combat against AMR. Another reason could be that the use of soft law reduces the effects of the EU initiatives. Member states might feel a normative pressure to act in line with the Commission’s recommendations, but at the end of the day, they decide for themselves whether they wish to follow the recommendations. In that respect, pressure is on the member states as they have the main responsibility for reducing the consumption of antimicrobials.
The Covid-19 crisis has laid bare the interdependence of the EU member states when it comes to vulnerability to different types of transnational health challenges. Both Covid-19 and in the long term the risk of AMR have put pressure on the member states in order to accept a higher degree of EU policy development in relation to health policy.
This blog post draws on Carsten Strøby Jensen, ‘While We Are Waiting for the Superbug: Constitutional Asymmetry and EU Governmental Policies to Combat Antimicrobial Resistance,’ published in JCMS.
Carsten Strøby Jensen is an associate professor at the Department of Sociology, University of Copenhagen. His work has mainly focused on political sociology, labour market and processes of EU integration. Recently he has increasing worked with different societal aspect of the consequences of antimicrobial resistance.