Minister for Health marks European Antibiotic Awareness Day
The Minister for Health, Simon Harris TD today (Saturday 18th November 2017) acknowledged European Antibiotic Awareness Day as part of the World Health Organisation’s (WHO) World Antibiotic Awareness Week and welcomed Ireland’s continuing active engagement in this important initiative.
The Minister noted that European Antibiotic Awareness Day has been a very successful event across Europe since its launch in 2008 and is now part of the WHO’s wider third annual global week of action to highlight the growing problem of Antimicrobial Resistance (AMR).
Minister Harris stated: “Ireland’s participation each year in EAAD underlines the commitment of both the Health and wider community in tackling the threat of antimicrobial resistance. The Department is engaged in and fully supports the work to promote understanding and prudent use of our precious antibiotic treatments in order to preserve their value and effectiveness for treatment today and into the future”.
Dr Tony Holohan, Chief Medical Officer (CMO) noted the ongoing work both in Ireland and internationally to address AMR, stating:”We know that the emergence of AMR worldwide is a real and growing public health crisis and requires a ‘One Health’ approach to addressing its spread, that is, multi-sectoral action across human and animal health sectors, agriculture and the wider environment. Given that AMR is recognised as a global health issue, it is accepted that sectors on their own cannot properly address this concern and a co-ordinated response from all stakeholders is required”.
In Ireland the prevention and control of healthcare associated infections (HCAIs/AMR) has been a significant patient safety and public health priority for the Department of Health for numerous years. A wide range of initiatives has been put in place in the Irish health system over several years including improved surveillance of infections and prescribing, infection prevention and control processes, antimicrobial stewardship initiatives, public and professional awareness raising and with a significant emphasis on the education and training of healthcare professionals.
Launch of Ireland’s National Action Plan on Antimicrobial Resistance 2017-2020 (iNAP)
Ireland’s National Action Plan on Antimicrobial Resistance 2017-2020 (iNAP) was launched on Wednesday 25th October last. The Plan, jointly launched by Minister Harris and Minister Michael Creed TD, Minister for Agriculture, Food and the Marine (DAFM) has been a cross-Departmental initiative, requiring a cross sectoral and whole of Government approach to addressing the world wide threat of AMR. The HSE Clinical Advisory Group has been a major contributing stakeholder in the development of the Plan.
iNAP was developed following the WHO Global Action Plan on AMR 2015 which required all countries to have in place a national action plan in 2017 and by the European Commission which also required Member States to develop a national action plan in 2017. iNAP is Ireland’s response to international calls to produce a multisectoral action plan to tackle AMR.
iNAP aims to ensure the development and implementation of multifaceted interventions which will safeguard against inappropriate prescribing, dispensing and consumption of medicines, while simultaneously promoting rational use in patients and animals that are expected to benefit from treatment.
In relation to the emergence of ‘superbugs’ worldwide, Minister Harris said: “We have a stark and on-going reminder of the consequences of AMR when we consider the increasing number of outbreaks of an infection, called CPE, a so called superbug, in the Irish healthcare system. The limited treatment options available for this infection are a reality on the ground for our healthcare providers and patients”.
On the considered advice of the Chief Medical Officer (CMO) the Minister activated the Public Health Emergency Plan on 25th October 2017 to further address CPE in the Irish health system.
The National Public Health Emergency Team (NPHET) on CPE, chaired by the CMO, held its first meeting on 2nd November last.
NPHET will meet on a weekly basis and continually evaluate the readiness of the health service to manage and sustain the containment of CPE as part of ordinary operations with a view to standing down the Team at the appropriate time. NPHET will direct and ensure an effective communications system at local, regional and national levels. Regular updates including summary minutes of meetings will be via a dedicated webpage, hosted on the Department of Health website.
Notes to the Editor
What is AMR?
Antimicrobial resistance (AMR) is resistance of a microorganism to a drug that was originally effective for treatment of infections caused by that microorganism. Resistant microorganisms (including bacteria, fungi, viruses and parasites) are able to withstand attack by antimicrobial drugs, such as antibacterial drugs (e.g., antibiotics), antifungals, antivirals, and antimalarials, so that standard treatments become ineffective and infections persist, increasing the risk of spread to others.
The evolution of resistant strains is a natural phenomenon that occurs when microorganisms replicate themselves erroneously or when resistant traits are exchanged between them. The use and misuse of antimicrobial drugs accelerates the emergence of drug-resistant strains. Poor infection control practices, inadequate sanitary conditions and inappropriate food handling encourage the further spread of AMR.
What is the effect of AMR?
A European Centre for Disease Control/European Medicines Agency (ECDC/EMEA) 2009 Report estimated that in 2007 drug-resistant bacteria were responsible for about 25,000 human deaths per annum in the EU alone, with associated healthcare costs and productivity losses of €1.5bn. The Report also stated that approx. 4 million patients are estimated to acquire a healthcare associated infection in the EU every year. (ECDC JOINT TECHNICAL REPORT ‘The Bacterial Challenge: time to react’ (2009)).
What is CPE?
CPE are bugs that live in the bowel and that cannot be treated by certain antibiotics, known as carbapenem antibiotics. CPE is the newest in a long line of ‘superbugs’ or bacteria that are hard to kill with
Why is CPE a patient safety concern?
The World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC) all identify that infections with CPE are a serious threat to patient safety due to their resistance to multiple antimicrobials, meaning that there are very few therapeutic options which to treat infected patients.
They are associated with poorer patient outcomes, increase morbidity, mortality and higher hospital costs. Infections with CPE are associated with mortality rates exceeding 40-50%. Outbreaks can result in bed closures and operations being postponed. CPE is not confined to hospitals and can cross all health sectors including the community.
What does ‘One Health’ mean?
The ‘One Health’ concept is a worldwide strategy for expanding interdisciplinary collaborations and communications in all aspects of health care for humans, animals and the environment. Recognising that human health, animal health and ecosystem health are inextricably linked, ‘One Health’ seeks to promote, improve and defend the health and well-being of all species by enhancing cooperation and collaboration between physicians, veterinarians, other scientific health and environmental professionals and by promoting strengths in leadership and management to achieve these goals.
There is international consensus through the ‘One Health’ Initiative to which the WHO (World Health Organisation), FAO (Food and Agriculture Organisation) and the OIE (World Health Organisation for Animal Health) are signatories, that tackling the global public health threat of AMR requires action across human and animal health sectors, agriculture and the wider environment.
The multi-sector harmonisation of strategies and measures to address the challenge of AMR are necessary at a global, regional, and national level. There has been global intersectoral collaboration since 2010, with the World Organisation for Animal Health (OIE), the World Health Organisation (WHO) and the Food and Agriculture Organisation of the United Nations (FAO) establishing tripartite actions to coordinate strategies to ensure antimicrobials maintain their efficacy, and are used responsibly. These agencies are signatories to a ‘One Health’ worldwide initiative.
The European Commission has also promoted a holistic and multi-sectoral approach involving many groups such as the public health, food safety, animal health and welfare, research and innovation, bio-safety and environment sectors. The EU at both Council and Parliament levels has developed its Community Strategy against AMR having regard to the ‘One Health’ concept.
At a national level the Chief Medical Officer (CMO) and the Chief Veterinary Officer (CVO) established the National Interdepartmental Antimicrobial Resistance Consultative Committee in 2014 as part of the ‘One Health’ initiative, and to advance a holistic national approach in working together to ensure that effective antibiotics remain available into the future. The Committee is co-chaired by the CMO and CVO and has a clear role and mandate across the human and animal health sectors. Committee membership consists of representatives of both Departments, relevant HSE agencies, EPA, HPRA, FSAI and other key stakeholder groupings in the human and animal health sectors. The Committee’s next meeting is scheduled for Wednesday 22nd November next.
What is the World Health Organisation (WHO) Global Action Plan 2015?
In May 2015, delegates at the World Health Assembly endorsed a global action plan to tackle antimicrobial resistance – including antibiotic resistance, the most urgent drug resistance trend.
The plan sets out 5 Strategic Objectives:
1. Improve awareness and understanding of antimicrobial resistance;
2. Strengthen surveillance and research;
3. Reduce the incidence of infection;
4. Optimize the use of antimicrobial medicines;
5. Ensure sustainable investment in countering antimicrobial resistance.
The WHO called on member countries to develop their own national action plans on antimicrobial resistance in line with the Global Action Plan.
What are the other developments at the international level in relation to AMR?
In June 2016, the European Council adopted a set of conclusions in relation to AMR entitled ‘The next steps under a ‘One Health’ approach to combat antimicrobial resistance’. The Council called on Member States to develop national action plans in line with the WHO Action Plan
In September 2016, the UN General Assembly adopted a Political Declaration on Antimicrobial Resistance which reaffirmed that the blueprint for tackling AMR is the WHO Global Action Plan on AMR and its five overarching strategic objectives. The General Assembly reaffirmed countries commitments to produce national action plans based on the five strategic objectives in the WHO Action Plan.
In June 2017 the European Commission published its second AMR action plan entitled ‘A European One Health Action Plan against Antimicrobial Resistance (AMR)’. This second action plan builds on the political commitment and actions achieved by the first EU action plan (2011-2016). The overarching goal of the new plan is to preserve the efficacy of antimicrobials so that they remain effective disease treatment options for humans and animals into the future.
The plan outlines a range of activities under three strategic headings as follows:
(1) Making the EU a best practice region
(2) Boosting research, development and innovation in order to better control the spread of AMR
(3) Strengthening the role of the EU on the global stage to drive actions to address AMR in the context of the ‘One Health’ approach
The Plan provides a ‘framework for continued, coherent and more extensive action to tackle AMR’.
Ireland is fully committed to and engaged in addressing resolution of the problem of AMR. We will continue to collaborate at international, EU and national levels to this end.