No country alone can tackle antimicrobial resistance and therefore an effective EU response is needed, backed up by policies and funds, writes Nina Renshaw.
Nina Renshaw is secretary seneral of the European Public Health Alliance.
“I’d never heard of resistant bacteria before. Colectiv has brought them to the surface,” said Eugen Iancu, father of 22-year-old Alexandru who died following a fire at the Colectiv nightclub in Bucharest, Romania just over a year ago. Sixty-four people died. The majority of the young victims including Alexandru would likely have survived their injuries but died days or even weeks after the fire as a result of infections, many of them resistant to one or more types of antibiotics.
As hospitals in Romania were overwhelmed, especially as the victims’ conditions deteriorated with drug-resistant infections, the patients were sent to specialist burns units around Europe. Thirty-nine victims were transferred for treatment abroad, including eight to Brussels, others to the Netherlands, France, Germany, the UK, and Austria, amongst others. All eight who arrived in Brussels were carrying multi-drug resistant bacteria. The situation was described as a “bacteriological bomb” by a surgeon.
As EU institutions mull their own future, the scenarios presented by President Juncker mean much more than political life or death. European cooperation on health has saved countless lives. The EU should take credit where it’s overdue on health: EU rules have ensured that our medicines are safer in the wake of the thalidomide scandal; removed poisonous and carcinogenic substances from products, air and water; coordinated measures that have prevented tens of thousands of road deaths and many more from tobacco; installed food hygiene standards that means that the likes of salmonella scandals are today few and far between; and supported world-leading research into prevention and treatment of cancer and dementia, for example. The EU’s Health Security Committee coordinates preparedness against health threats, including Ebola, Zika, and many much closer to home like flu epidemics, tuberculosis and HIV/AIDs.
A painful lesson not yet learned from the Colectiv tragedy is that closer European cooperation is inevitably and urgently needed to avoid catastrophes of an even greater scale in the near future.
Romania is far from alone in facing multi-drug resistant ‘superbugs’. The problem of drug-resistant infections, a.k.a antimicrobial resistance (AMR), is present in every country in Europe. Romania is, however, “in the red zone” amongst the worst performers according to the annual surveys by the European Centre for Disease Prevention and Control (ECDC). Causes of resistance are manifold, including unnecessary overconsumption of antibiotics by people and in livestock and dumping of active antimicrobial waste by pharmaceutical factories around the world.
Thanks to European cooperation, treatment abroad prevented the Colectiv death toll from climbing even higher. As patients, we have the right to seek treatment outside our home countries, and to receive emergency care throughout Europe. Even if we didn’t, the bacterial spread cannot be contained by borders. Resistance is spreading around the world faster than predicted. The extremely valuable work of the ECDC has sounded the alarm that resistance to Colistin – a drug used for multi-drug resistant infections as a very last resort, which was used for some of the Colectiv patients – is becoming more widespread in Europe.
Recently the press reported widely on the case of an American woman who died as a result of an infection acquired whilst travelling that was resistant to every known treatment. The horror scenarios predicted in the AMR Review for the UK government presented to the UN just last year are already becoming reality. The projections of the review are almost incomprehensible – a post-antibiotic world where routine medical procedures become too risky and commonplace infections kill 10 million people every year by 2050. Where 10 million people die because of a lack of effective antibiotics, like Alexandru.
The European Commission will publish a new Action Plan against antimicrobial resistance on 29 June. The evaluation of the previous 2011-2016 Action Plan was unable to show any results in reducing the prevalence of AMR or curbing excess antibiotics use. It said nothing at all about industrial pollution.
Whilst several national governments, notably the Netherlands and Sweden and more recently France, have made impressive strides via national action plans in reducing both excess antibiotics consumption in patients and animals, and in curbing the prevalence of drug-resistant infections, they remain the exception. Their progress will be swiftly undone by inaction in neighbouring countries. Whilst all governments have been asked to report their plans to the UN and WHO this year, and will exchange information in the EU’s One Health Network, there are no guarantees that action will be sufficiently coordinated, quick enough or backed up with enough resources to curb the biggest threat to health and to the medical systems that we rely on. Italy has just announced their action plan is delayed again, Belgium is lagging behind its neighbours, and action in Romania – where antibiotic over-consumption in patients is second only to Greece – is interrupted yet again by government change.
The average tenure of a Romanian health minister in recent years has been less than nine months. One government was toppled by the Colectiv scandal, even before the real toll of the tragedy for the health system – and its international implications – became known.
A new EPHA study, based on interviews with experts from healthcare practice and policy in Romania identifies needs for structured long-term support which transcends political terms of office, in the form of European expertise, targets and funding to reduce antibiotic over-consumption, training for health workers on how to more effectively control infections and use rapid diagnostic tests, lab equipment, set up of isolation units and public information campaigns.
Whilst the EU has an impressive track record of life-saving policy actions to be proud of, many policies only came about in response to fatal scandals. The Colectiv case is a truly European tragedy that requires a coordinated European response, to contain a threat of enormous magnitude.
An effective EU AMR response must be backed up with policies and funds, starting with the weakest link. No country can go it alone. Lack of action in one country or region will ultimately hurt us all. There is no better case for ‘more Europe’.