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MONITORING ANTIMICROBIAL RESISTANCE IN THE EU Addressing the challenges and supporting effective action  HEALTH ACTION INTERNATIONAL MONITORING ANITMICROBIAL RESISTANCE IN THE EU Addressing the challenges and supporting effective action Rafael Gómez-Coronado Independent Advisor Dr Gaby Ooms Research Manager, Health Action International For correspondence: [email protected] March 2025 Funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or European Health and Digital Executive Agency (HADEA). Neither the European Union nor the granting authority can be held responsible for them. Publisher Copyright Health Action International This report is licensed under a Creative Commons Overtoom 60 (2) | 1054 HK Amsterdam Attribution-NonCommercial 4.0 International Licence. The Netherlands View a copy of this licence at www.creativecommons.org/ +31 (0) 20 412 4523 licenses/by-nc/4.0. HAIWEB.ORG  HEALTH ACTION INTERNATIONAL CONTENTS BACKGROUND 4 PART 1: Reduce overall antibiotic use in humans by 20% 5 Current Status and Trends 5 Key Takeaways 6 Action 6 PART 2: At least 65% of human-used antibiotics are in the access category 7 Current Status and Trends 7 Key Takeaways 9 Action 9 PART 3: Decreasing bloodstream infections caused by drug-resistant microorganisms 10 Current Status and Trends 10 Key Takeaways 14 Action 14 REFERENCES 15 MONITORING ANTIMICROBIAL RESISTANCE IN THE EU 3  HEALTH ACTION INTERNATIONAL BACKGROUND Antimicrobials, medicines crucial for the treatment of infections caused by bacteria, viruses, fungi and parasites, are becoming less effective due to overuse and misuse, which has led to the rising tide of antimicrobial resistance (AMR). Referred to as ‘the silent pandemic’, AMR burdens healthcare systems financially and causes over 35,000 deaths annually in the European Union (EU) alone.1,2 Indeed, it is considered one of the EU’s top three health threats.3 The EU’s efforts to combat AMR have been Based on 2019 benchmarks, the Council aims to extensive and multifaceted, reflecting a achieve the below goals by 2030.9 commitment to public health that spans several decades. Since the recognition of AMR as a The aim of this booklet is to increase awareness critical health issue, the EU has approved a series about the importance of monitoring and of strategic interventions, legislative reforms, addressing AMR in the EU, and to support more and collaborative efforts.4 These include the effective action against AMR. It provides an Community Strategy against Antimicrobial overview of EU targets for key pathogens, the Resistance published in 2001, decisive legislation current AMR status at country- and EU-level, banning antimicrobials as growth promoters and progress towards targets for managing and in animal feed, and comprehensive AMR action containing AMR. plans addressing human and animal health, and environmental factors.5,6 In Part 1, we focus on the progress towards achieving the first target: Reducing overall EU AMR Targets and Recommendations antibiotic use in humans by 20% by 2030. In Part In recent years, the EU has further solidified 2, the focus is on the second target: Ensuring its approach to AMR through revisions of its at least 65% of antibiotics used in humans fall pharmaceutical legislations, including AMR in the Access category. In Part 3 targets three mitigation strategies within these documents.7 to five will be covered: Reducing bloodstream It has also proposed specific AMR targets to infections caused by methicillin-resistant be reached by 2030, highlighting its continued Staphylococcus aureus (MRSA), third-generation efforts to address this critical global health cephalosporin-resistant Escherichia coli (E. coli) threat.8 Specifically, in 2023 the EU Council and carbapenem-resistant Klebsiella pneumoniae adopted targeted measures to tackle AMR (CRKP) by 5% to 15%. through a comprehensive One Health approach. * The Access category refers to antibiotics that are recommended as first or second-choice treatments for specific infections and are generally more available and affordable. This classification is part of the WHO AWaRe (Access, Watch, and Reserve) antibiotic categorization framework aimed at promoting the appropriate use of antibiotics to combat AMR.10 MONITORING ANTIMICROBIAL RESISTANCE IN THE EU 4  HEALTH ACTION INTERNATIONAL PART 1 REDUCE OVERALL ANTIBIOTIC USE IN HUMANS BY 20% An overview of the EU’s progress towards achieving an overall reduction in antibiotic use of 20% by 2030 Current Status and Trends Figure 2 presents an overview of antibiotic Figure 1 provides an overview of the average consumption across EU/European Economic consumption of antibiotics in the EU from 2013 Area (EEA) countries, highlighting three key to 2022, as well as the target of a 20% reduction data points: 2019 consumption (grey bars), 2022 in consumption from 2019 to 2030. From 2013 consumption (dark blue bars), and 2030 20% to 2022, average consumption of antibiotics has consumption reduction targets (light blue bars). decreased gradually, from 21.6 defined daily dose (DDD) per 1,000 inhabitants per day in 2013 to Four different reduction targets have been 19.4 DDD/1,000 inhabitants/day in 2022. Notably, set. For countries with already relatively low there was a significant drop to 16.4 DDD/1,000 consumption levels (less than 12 DDD/1,000 inhabitants/day in both 2020 and 2021, likely inhabitants/day) in 2019 (Austria, Estonia, the influenced by the COVID-19 pandemic and related Netherlands and Sweden), the target is a 3% health measures. In 2022, the DDD increased reduction. For countries with consumption levels again to 19.4; higher than the previous two years between 12 and 20 DDD/1,000 inhabitants/ but slightly lower than in 2019. A 20% reduction day, the target is a 9% reduction. Countries in antibiotic consumption in 2030 compared to with consumption levels between 20 and 22 2019 would mean the average use in 2030 would DDD/1,000 inhabitants/day have a reduction be 15.9 DDD/1,000 inhabitants/day, a target that, target of 18%, and countries with consumption considering current trends, seems unlikely to be levels of 23 DDD/1,000 inhabitants/day or higher met.11 need to reduce their consumption by 27%.8 Figure 1. EU average antibiotic consumption over As can be seen in the figure, Austria, Finland, time, and the 2030 target. the Netherlands and Sweden already met their 2030 target in 2022 (highlighted in green). On the other hand, in 12 of 26 countries (highlighted in red) – Bulgaria, Croatia, Cyprus, Czechia, Estonia, Ireland, Italy, Latvia, Lithuania, Malta, Romania and Slovakia – consumption levels increased from 2019 to 2022, making it unlikely that the 2030 targets will be met. Further, while slight decreases in consumption can be seen in Belgium, Denmark, France, Greece, Hungary, Poland, Portugal and Spain, more concerted efforts are likely needed to reach their 2030 targets as well.11 MONITORING ANTIMICROBIAL RESISTANCE IN THE EU 5  HEALTH ACTION INTERNATIONAL Figure 2. Antibiotic consumption in EU Countries: 2019, 2022, and 2030 targets. Key Takeaways Reducing AMR through targeted and measurable ACTION goals is a critical step in combating one of the most pressing health threats. The EU’s target to Continuous and sustained monitoring is reduce antibiotic consumption to 15.9 DDD per essential to evaluate countries’ performance 1,000 inhabitants by 2030 is a significant and and contextualise strategies based on current ambitious goal. The gradual decrease in antibiotic conditions. Using data to create a more dynamic consumption seen from 2013 to 2022, including and adaptive approach to target-setting is the notable drop during the COVID-19 pandemic, crucial to ensure as much as possible is done to shows that achieving this target is possible with combat AMR. For countries already meeting their continued efforts and strategic interventions. In targets, periodic reassessment of goals should line with this, the progress of several countries be considered. Additionally, using incentives in meeting or exceeding their 2030 targets is such as funding opportunities for research, promising. Austria, Finland, the Netherlands and public health awareness campaigns, and Sweden have shown significant success, with support for improved healthcare- and workforce 2022 antibiotic consumption levels already below infrastructures could help countries achieve 2030 targets. However, among the 26 countries 2030 targets. Such measures can help maintain analysed, 20 could be said to either be lagging momentum and ensure sustained progress behind or struggling to meet their 2030 targets. across the EU. This highlights the need for intensified efforts and customised strategies to address specific Overall, the EU’s AMR strategy is moving in the challenges countries are facing in reducing right direction, but ongoing adaptation and antibiotic use. support will be critical to achieve and sustain the desired reductions in antibiotic consumption, thereby mitigating the threat of AMR. MONITORING ANTIMICROBIAL RESISTANCE IN THE EU 6  HEALTH ACTION INTERNATIONAL PART 2 AT LEAST 65% OF HUMAN-USED ANTIBIOTICS ARE IN THE ACCESS CATEGORY Insight into the EU’s progress towards achieving the target of at least 65% of antibiotics used in humans fall into the World Health Organization’s (WHO) Access category for antibiotics use AWaRe Classification The AWaRe classification is a strategic framework developed by the WHO to guide the use of antibiotics in an effort to combat AMR. As an integral part of the WHO's Global Action Plan on AMR, it aims to optimise antibiotic use and improve stewardship practices by categorising antibiotics into three groups: Access, Watch, and Reserve. The Access category includes the antibiotics that should be widely available and affordable, and are used for first-line treatment of the most common and serious infections. These antibiotics are considered to be safe, effective, and at relatively low risk of leading to AMR when used appropriately. The Watch group contains antibiotics that have a higher potential for Current Trends developing resistance and should therefore only Figure 1 provides an overview of average be prescribed for specific, limited indications antibiotic use in the EU/EEA from 2015 to 2022. in order to reduce the risk of resistance. The It shows very gradual progress towards the Reserve category includes antibiotics that should 2030 target of at least 65% of antibiotics used be used very sparingly and only as a last resort. for humans are from the Access category. Over These antibiotics are reserved for treatment of the eight year timespan shown here, the use confirmed or suspected infections caused by of antibiotics from the Access category only multi-drug-resistant organisms, and their use is increased from 59.5% to 61.0%. While the trend restricted to ensure they remain effective in the seems to be moving in the right direction, a slight most critical situations.10 decline in the use of Access antibiotics can be seen from 2019 to 2022 (from 61.5% to 61.0%). On The AWaRe classification is a crucial tool in the top of that, if over the next eight years the same global strategy to manage antibiotic use, mitigate percentage increase in use of Access antibiotics the development of AMR, and safeguard the occurs, by 2030 the 65% target will not be met. effectiveness of existing treatments. It supports The apparent continued use of antibiotics from healthcare providers in making informed the Watch, Reserve, and Unclassifieda categories decisions about antibiotic prescribing, thus suggests that further efforts are needed to contributing to better patient outcomes and optimise antibiotic prescribing practices across overall public health. the region.11 a Consumption of ‘Unclassified’ mainly consisted of benzathine phenoxymethylpenicillin, combinations of benzylpenicillin/ procaine-benzylpenicillin/benzathine-benzylpenicillin and methenamine. MONITORING ANTIMICROBIAL RESISTANCE IN THE EU 7  HEALTH ACTION INTERNATIONAL Figure 1. EU/EEA average antibiotic use according to WHO AWaRe classification, in percentages (2015 – 2022). Country-specific data mirrors the slow the 65% Access target, many of the other 27 improvement seen at the regional level, as shown countries still fall significantly short. In Bulgaria, in Figure 1. In Figure 2, antibiotic use across Greece, Hungary, Italy and Slovakia not even the Access, Watch, Reserve, and Unclassified 50% of the antibiotics used are from the Access categories is shown per EU/EEA country in category. The continued high use of antibiotics 2022, including the 2030 target of achieving 65% from the Watch category, which should be antibiotic use within the Access category. As can minimised, underscores the ongoing challenge be seen, the use of Access category antibiotics of achieving widespread, effective antibiotic varies widely across countries. While Belgium, stewardship in the EU/EEA. It highlights Denmark, Finland, France, Iceland, Ireland, Latvia, the necessity for improved stewardship and Lithuania and the Netherlands have already met controlled prescribing practices.11 Figure 2. 2022 EU/EEA average antibiotic use according to WHO AWaRe classification, in percentages. MONITORING ANTIMICROBIAL RESISTANCE IN THE EU 8  HEALTH ACTION INTERNATIONAL Key Takeaway Using the AWaRe classification as part of efforts ACTION to combat AMR reflects the EU’s commitment to public health, yet challenges remain. If we The EU’s approach, while comprehensive, consider the current AMR trends in the EU and needs further enhancement to ensure its target the slow incremental progress from 2015 to 2022 will be met. Enhanced antibiotic stewardship, in using Access category antibiotics – only a stricter regulations on antibiotic prescriptions, 1.5% increase – than the EU's target of 65% use and increased public awareness are critical. of Access category antibiotics by 2030 may not Furthermore, the EU could benefit from setting even be reached. And this target may not even be more ambitious targets, especially in countries ambitious enough. where the 65% target has already been met, and providing greater support to achieve them. It is also crucial for EU Member States to work together more closely, both within the EU and with others States, harmonising their policies and practices to combat AMR more effectively. Establishing shared targets and goals across all countries would drive uniform policy-making, promote harmonisation, and reduce discrepancies in antibiotic usage between regions. This alignment would ensure that all Member States work towards the same objectives, thereby enhancing the overall effectiveness of AMR strategies. Additionally, collaboration with international bodies to harmonise antibiotic usage policies could also play a key role. By adopting a more ambitious and integrated strategy, the EU can better safeguard the efficacy of existing treatments, reduce the burden of AMR, and protect public health in the long term. MONITORING ANTIMICROBIAL RESISTANCE IN THE EU 9  HEALTH ACTION INTERNATIONAL PART 3 DECREASING BLOODSTREAM INFECTIONS CAUSED BY DRUG- RESISTANT MICROORGANISMS Focusing on three microorganisms that have become resistant to many antibiotics and are the cause of serious infections: MRSA, third-generation cephalosporin-resistant E. coli, and CRKP. By 2030, the EU aims to reduce the total number of bloodstream infections caused by MRSA by 15%, by E. coli by 10%, and by CRKP by 5%, compared to the number of infections in 2019 Health Impact Current Status and Trends Resistant bacteria have a significant impact on Figure 1 shows the trends in AMR for S. aureus, E. the care of patients, especially vulnerable patients coli and K. pneumoniae from 2017 to 2021 at EU with weakened immune systems or severe regional level. In 2017, methicillin resistance in S. illnesses. They complicate treatments, increase aureus isolates was 18.4%, gradually decreasing failure rates, and require last-resort medications. to 15.8% in 2021 (Figure 1, left graph). A 15% Moreover, resistance raises healthcare costs, decrease in infections with MRSA from 2019, extends hospital stays, and increases mortality when methicillin resistance in S. aureus was rates. Resistant bacteria often cause severe 17.2%, to 2030, would mean 14.6% or less of S. complications, such as bloodstream infections, aureus isolates would be methicillin resistant. sepsis, and rapid hospital outbreaks, posing major While the downtrend seen from 2017 to 2021 is public health challenges and restricting treatment promising and suggests that interventions and options.12,13,14,15 Below, a detailed look is taken at policies to combat MRSA are having a positive the trends in resistance and progress towards impact, current efforts need to be sustained and reaching the EU’s set 2030 targets. evaluated regularly to ensure the 2030 target is met.16 MONITORING ANTIMICROBIAL RESISTANCE IN THE EU 10  HEALTH ACTION INTERNATIONAL In 2017, 15.6% of E. coli isolates were resistant to In 2017, 8.1% of K. pneumoniae isolates were third-generation cephalosporins (Figure 1, middle reported to be resistant to carbapenem, with graph). In 2018 and 2019, the number of isolates resistance rising to 9.0% in 2019 and 11.7% in 2021 resistant to third-generation cephalosporins (Figure 1, right graph), illustrating a worrying stayed about the same, decreasing in 2020 to upward trend. To meet the modest 2030 target 14.9% and in 2021 to 13.8%. The EU's target for of a 5% reduction from the 2019 rates, which 2030–to achieve a 10% reduction compared to translates to a target of 8.6%, urgent and effective 2019 levels–would mean that third-generation measures are crucial to reverse the current cephalosporins resistant E. coli levels should be trajectory.16 14.0% lower, levels that had already been reached by 2021.16 Figure 1. Percentage of bacterial isolates with AMR phenotyping in EU/EEA, by bacterial species. Figure 2 shows the 2019 and 2021 levels of MRSA consumption by 18%.8 Twelve of 27 countries prevalence per EU/EEA country, as well as the (Austria, Belgium, Czechia, Denmark, Estonia, 2030 10% EU reduction target. Four different Germany, Ireland, Latvia, Luxembourg, Malta, country-specific reduction targets have been Portugal and Slovakia) had already reached set. Six countries with relatively low incidence their reduction target by 2021. On the other of MRSA (between 0.4 and 1.5 per 100,000 hand, nine countries–Bulgaria, Croatia, Cyprus, population) in 2019, had a target reduction of Finland, Greece, Poland, Slovenia, Spain and 3%. For countries with incidence levels ranging Sweden–reported increases in MRSA from 2019 between 1.9 and 3.1 per 100,000 population, to 2021. Further, the figure shows significant the target is a 6% reduction. Countries with discrepancies in MRSA within the EU, with incidence levels ranging from 3.6 to 5.0 per countries in Northern and Western Europe doing 100,000 population set a reduction target of 10%, much better in keeping MRSA infections low and countries with incidence levels of 5.6 per compared to Eastern and Southern Europe.16 100,000 population or higher aim to reduce their MONITORING ANTIMICROBIAL RESISTANCE IN THE EU 11  HEALTH ACTION INTERNATIONAL Figure 2. Percentage of S. aureus isolates with methicillin-resistant phenotyping in EU/EEA countries in 2019 and 2021, and the 2030 target. Figure 3 shows the 2019 and 2021 levels of seem to be doing well with decreasing infections third-generation cephalosporin-resistant E. caused by third-generation cephalosporin- coli prevalence per EU/EEA country, as well as resistant E. coli, as 17 of 27 countries – Austria, the 2030 10% EU reduction target. Again, four Belgium, Bulgaria, Czechia, Denmark, Estonia, different country-specific reduction targets have Finland, Germany, Hungary, Ireland, Italy, Latvia, been set. For countries with already relatively Lithuania, Malta, the Netherlands, Portugal and low incidence of resistant E. coli (less than 6 per Romania – had already reached their reduction 100,000 population) in 2019, which were Belgium, target by 2021. In five countries (Hungary, Croatia, Greece, Latvia and the Netherlands, no Cyprus, Greece, Poland and Slovakia) increases reduction was recommended (0%). For countries in third-generation cephalosporin-resistant E. with incidence levels between 6 and 7 per coli infections were reported from 2019 to 2021. 100,000 population, the target is a 5% reduction. Again, the figure shows significant discrepancies Countries with incidence levels between 7 and 10 in third-generation cephalosporin-resistant E. per 100,000 population have a reduction target coli infections within the EU, with countries of 10%, and countries with incidence levels of in Northern and Western Europe doing better 12 per 100,000 population or higher need to compared to Southern Europe, and much better reduce their consumption by 12%.8 EU countries than Eastern Europe.16 MONITORING ANTIMICROBIAL RESISTANCE IN THE EU 12  HEALTH ACTION INTERNATIONAL Figure 3. Percentage of E. coli isolates with third-generation cephalosporin-resistant phenotyping in EU/EEA countries in 2019 and 2021, and the 2030 target. Figure 4 shows the 2019 and 2021 levels of target of 4%, and countries with incidence levels carbapenem-resistant K. pneumoniae prevalence of 2.61 per 100,000 population or higher aim to per EU/EEA country, as well as the 2030 5% reduce their consumption by 5%.8 Eighteen of EU reduction target. Four different country- 27 countries are below–or even far below–the specific reduction targets were again developed. EU average target of 8.6%. On the other hand, For countries with very low incidence of in seven of the remaining countries (Bulgaria, resistant K. pneumoniae (less than 0.05 per Croatia, Cyprus, Greece, Italy, Poland and 100,000 population) in 2019, no reduction was Romania) the levels of carbapenem-resistant K. recommended (0%). For countries with incidence pneumoniae are far above the average EU levels, levels ranging between 0.05 and 0.27 per highlighting a significant problem with this type 100,000 population, the target is a 2% reduction. of resistance in K. pneumoniae in Eastern Europe Countries with incidence levels ranging from 0.52 and parts of Southern Europe.16 to 2.29 per 100,000 population set a reduction Figure 4. Percentage of K. pneumoniae isolates with carbapenem-resistant phenotyping in EU/EEA countries in 2019 and 2021, and the 2030 target. MONITORING ANTIMICROBIAL RESISTANCE IN THE EU 13  HEALTH ACTION INTERNATIONAL Key Takeaways This disparity highlights the need for a more The data on AMR resistance among three types tailored approach in setting and pursuing national of bacteria shown here suggest that the EU's targets. strategy against AMR, while comprehensive, can benefit from a critical assessment of its It is also important to note that the current ambitions. The successes booked by multiple EU targets focus on only three critical countries in exceeding the 2030 targets by 2021 microorganisms — S. aureus, E. coli and K. raises the question about the ambitiousness pneumoniae. This narrow focus does not fully of these targets. Nevertheless, the decision to address the spectrum of AMR, as many other establish specific targets reflects a significant pathogens also pose significant threats due to step forward in addressing a longstanding call their resistance capabilities. Additionally, even from healthcare professionals, researchers, within these three targeted microorganisms, the policy makers and advocates.17 This proactive set goals do not tackle all types of resistances. approach is commendable as it aligns with For instance, while there have been successes in recommendations from various stakeholders who reducing resistance to certain types of antibiotics, have long emphasised the need for quantifiable other antibiotic-resistant strains remain a and ambitious goals to combat the spread of AMR serious concern, underlining the need for more effectively.18 comprehensive and diverse targets. As shown here, the challenge of addressing AMR is not uniform across the EU, and the set ACTION targets, while providing a clear directive for national efforts, might not catch the complexity While the EU’s efforts in combating AMR are of achieving these goals for all countries. significant and have shown promising results, The difficulty in reducing AMR rates varies a broader and more ambitious approach is significantly depending on the baseline levels of necessary. Setting more ambitious targets, resistance. For instance, reducing resistance from as well as expanding the scope of targeted 18% to 16% might not present the same level of pathogens and addressing the full range challenge as reducing it from 5% to 2%. of resistances, will be crucial in effectively combating AMR and safeguarding public health. Limitations The European Council has set a target to reduce the incidence of AMR. However, we were unable to access the specific incidence data required to align our calculations with those of the EU. Consequently, our efforts to calculate the incidence did not match the EU’s figures. To simplify and make our findings more understandable for the reader, we provided the percentage of AMR among all isolates. The targets were then calculated based on these percentages. MONITORING ANTIMICROBIAL RESISTANCE IN THE EU 14  HEALTH ACTION INTERNATIONAL REFERENCES 1. European Centre for Disease Prevention and Control. 10. Web Annex C. WHO AWaRe (access, watch, reserve) Assessing the health burden of infection with antibiotic- classification of antibiotics for evaluation and monitoring resistant bacteria in the EU/EEA, 2016-2020. Stockholm: of use, 2023. In: The selection and use of essential ECDC; 2022. medicines 2023: Executive summary of the report of 2. European Centre for Disease Prevention and Control, the 24th WHO Expert Committee on the Selection and Organisation for Economic Co-operation and Use of Essential Medicines, 24 – 28 April 2023. Geneva: Development. Antimicrobial Resistance: Tackling the World Health Organization; 2023 (WHO/MHP/HPS/ Burden in the European Union. Stockholm: ECDC; 2019. EML/2023.04). Licence: CC BY-NC-SA 3.0 IGO. 3. Health Emergency Preparedness and Response Authority 11. European Centre for Disease Prevention and Control. (HERA). Health Union: Identifying top 3 priority health Antimicrobial consumption in the EU/EEA (ESAC-Net) - targets. Brussels: European Commission; 2022. Annual Epidemiological Report 2022. Stockholm; 2023. 4. European Commission. EU Action on Antimicrobial 12. Murray CJL, Ikuta KS, Sharara F, Swetschinski L, Robles Resistance [Internet]. [cited 2024 Jun 16]. Available from: Aguilar G, Gray A, et al. Global burden of bacterial https://ec.europa.eu/health/antimicrobial-resistance/ antimicrobial resistance in 2019: a systematic analysis. eu-action-antimicrobial-resistance_en The Lancet. 2022 Feb;399(10325):629–55 5. Council of the European Union. Council Recommendation 13. Abushaheen MA, Muzaheed, Fatani AJ, Alosaimi M, Mansy of 15 November 2001 on the prudent use of antimicrobial W, George M, et al. Antimicrobial resistance, mechanisms agents in human medicine (2002/77/EC) [Internet]. 2002 and its clinical significance. Disease-a-Month. 2020 [cited 2024 Jun 16]. Available from: https://eur-lex.europa. Jun;66(6):100971. eu/legal-content/EN/TXT/?uri=CELEX%3A32002H0077 14. WHO. Antimicrobial resistance [Internet]. [cited 2024 Jun 6. European Commission. A European One Health Action 17]. Available from: https://www.who.int/news-room/ Plan against Antimicrobial Resistance (AMR) [Internet]. fact-sheets/detail/antimicrobial-resistance 2017 [cited 2024 Jun 16]. Available from: https://ec.europa. 15. Laxminarayan R. The overlooked pandemic eu/health/sites/health/files/antimicrobial_resistance/ of antimicrobial resistance. The Lancet. 2022 docs/amr_2017_action-plan.pdf Feb;399(10325):606–7. 7. European Commission. Pharmaceutical Legislation 16. European Centre for Disease Prevention and Control Reform [Internet]. 2024 [cited 2024 Jun 16]. Available and World Health Organization. Antimicrobial resistance from: https://ec.europa.eu/commission/presscorner/ surveillance in Europe 2023 - 2021 data. Stockholm: api/files/document/print/en/ip_23_1843/IP_23_1843_ ECDC; 2023. EN.pdf 17. EU, JAMRAI. The need to develop indicators and targets 8. Council of the European Union. Council Recommendation for AMR action plans in the EU [Internet]. [cited 2024 Jun on stepping up EU actions to combat antimicrobial 29]. Available from: www.eu-jamrai.eu resistance in a One Health approach (2023/C 220/01) 18. R. Gomez-Coronado. Antimicrobial resistance in the EU: [Internet]. 2023 [cited 2024 Jun 16]. Available from: A comparative Analysis of National Action Plans in Italy, https://eur-lex.europa.eu/legal-content/EN/ the Netherlands and Spain. Amsterdam: Health Action TXT/?uri=CELEX%3A32023H0622%2801%29 International; 2023. 9. Council of the European Union. Council Recommendation on stepping up EU actions to combat antimicrobial resistance in a One Health approach (legal basis proposed by the Commission: Article 168(6)TFEU) - Adoption [Internet]. 2023 [cited 2024 Jun 16]. Available from: https://www.eumonitor.nl/9353000/1/j4nvgs5kjg27kof_ j9vvik7m1c3gyxp/vm3l6tsuw6x3/f=/9581_23.pdf MONITORING ANTIMICROBIAL RESISTANCE IN THE EU 15  HEALTH ACTION INTERNATIONAL MONITORING ANTIMICROBIAL RESISTANCE IN THE EU 16 Wednesday, 19 March 2025 Open Letter to European Union Ministers of Health Dear Minister, As you prepare to attend the informal meeting of Ministers of Health hosted by the Polish Presidency of the European Union (EU) in Warsaw next week (24-25 March), we call on you to act on the growing crisis of antimicrobial resistance (AMR) that is already claiming the lives of tens of thousands of EU citizens each year. Efforts from across the bloc to combat AMR have been extensive and multifaceted, with a combined series of strategic interventions, legislative reforms, and collaborative efforts. The adoption of 2030 targets to address AMR through a One Health approach sent a signal of the importance placed by the EU on this critical health issue and showed leadership in the face of a global crisis. A number of countries have already made significant progress against the targets, raising the expectation that they will meet or even exceed these by 2030. Evidence that the targets, while ambitious, are certainly achievable. Yet, most Member States are still lagging behind and current rates of progress would put their target attainment in jeopardy. This highlights the need for intensified efforts and customised strategies to address specific challenges countries are facing in reducing antibiotic use. We are therefore pleased to share with you a new report (attached) from Health Action International that puts an emphasis on the importance of continued monitoring and addressing AMR in the EU, and supports more effective action against this deadly threat. It provides an overview of the above-mentioned EU targets for key pathogens, the current AMR status at country- and EU-level, and progress towards targets for managing and containing AMR. Finally, the report gives specific recommendations for governments to ensure that momentum is not lost in the fight against AMR, and that those Member States currently struggling to meet targets are able to focus efforts and interventions to get back on course. Given the commitments already made by your governments, we are confident that tackling AMR will remain at the top of your agenda. Through our findings on progress made against targets, and our recommendations, we hope to contribute to this effort. We remain at your disposal and would be happy to talk to your teams to follow up about the findings and actions emanating from this report. Yours faithfully, Health Action International EVIDENCE Overtoom 60 (2) 1054 HK Amsterdam +31 (0) 20 412 4523 [email protected] ADVOCACY The Netherlands www.haiweb.org CHANGE Saatja: Jaume Vidal <[email protected]> Saadetud: 19.03.2025 12:26 Adressaat: Jaume Vidal <[email protected]> Koopia: Alex Lawrence <[email protected]> Teema: Monitoring AMR in the EU- report and open letter. Tähelepanu! Tegemist on välisvõrgust saabunud kirjaga.Tundmatu saatja korral palume linke ja faile mitte avada.Tähelepanu! Tegemist on välisvõrgust saabunud kirjaga.Tundmatu saatja korral palume linke ja faile mitte avada.FAO: Office of the Minister of Health Dear Minister,Please find attached an and from regarding the growing challenge posed by antimicrobial resistance in Europe, which we trust will be on the agenda of the informal meeting of Health Ministers on Warsaw next week.Please do not hesitate to contact me if you have any questions.Kind regards, Jaume Vidal JAUME VIDAL (HE/HIM)Senior Policy Advisor Health Action International Working days: Monday to FridayM/WA: &#43;31 (0) 628 318 884| Overtoom 60 (2) | 1054 HK Amsterdam | The Netherlands