Future proofing the EU AMR Action Plan

Gloved hand holding a bacteria culture on an agar plate, photo by AndreasReh/Getty Images

Photo by AndreasReh/Getty Images

Researchers identified how the European AMR Action Plan can be strengthened to mitigate against future threats, take advantage of future opportunities and move towards a better future in relation to AMR.

What is the issue?

Antimicrobial resistance (AMR) occurs when pathogens develop resistance to existing antimicrobials, complicated treatment. AMR is a serious public health concern and has been identified as a priority by public health authorities internationally. In 2017, the European Commission published the European One Health Action Plan against AMR. This plan takes a One Health approach, meaning that it recognises the intersections between human health, animal health and the environment.

How did we help?

RAND Europe, along with partners at ICF and the Romanian Health Observatory, were commissioned to conduct a future-proofing analysis of the One Health Action Plan, including a preliminary outcome assessment.

RAND Europe led the future-proofing analysis, which looked at factors that may affect how AMR develops, how equipped the current EU AMR Action Plan is for these potential changes and how the Action Plan can be strengthened. Findings are based on desk research, expert interviews, a survey and a workshop with stakeholders from across sectors. During the workshop, participants discussed future scenarios that RAND Europe developed describing how AMR may develop over the next ten years.

What did we find?

We identified a range of inter-related factors that may influence how AMR develops in the next ten years, which span: science, technology and innovation; wider changes in society; human health and healthcare; animal health and agriculture; and environmental factors.

Some of these factors may make the fight against AMR easier — for example, there may be advancements in basic science that allow us to better understand how resistance is transferred from the environment to humans and animals, or advancements in laboratory techniques that lead to more use of point of care diagnostics and antimicrobial susceptibility testing in human and animal health. However, other factors may complicate the fight against AMR, such as low levels of public awareness and political commitment for public health issues, challenges related to the innovation pipelines for antimicrobials, and wider societal factors such as conflicts or wars that contribute to the large-scale movement of people.

The COVID-19 pandemic has also affected AMR. There have been advancements that can be used to strengthen the fight against AMR (e.g. vaccines, rapid diagnostics, wastewater surveillance), although the pandemic has also brought challenges (e.g. supply chain issues, economic difficulties). The degree to which we are able to learn from the global response to COVID-19 will likely impact how AMR is dealt with in the future.

What can be done?

Our study identified how the European AMR Action Plan can be strengthened to mitigate against future threats, take advantage of future opportunities and move towards a better future in relation to AMR.

One priority our study identified is to strengthen and harmonise incentives to encourage innovation and investment related to AMR. While there is not agreement around which push and pull incentives would be best, there's a need to ensure that the geographic scope of incentives takes into account the global nature of the market for pharmaceuticals. Increased direct funding for basic research and support for EU Member State R&D infrastructure may also help to move the field forward.

The 'One Health' approach requires cross-sectoral collaboration, which can be challenging. Providing more opportunities for stakeholders from across human health, animal health and the environment to come together, and generating evidence that clarifies how these domains are connected, may be helpful. Creating an integrated surveillance system with data from across all these domains is also crucial to addressing AMR.