The Commission's 2011 Action Plan against the rising threats from AMR contains 12 actions for implementation with EU Member States and identifies 7 areas where measures are most needed:

• making sure antimicrobials are used appropriately in both humans and animals
• preventing microbial infections and their spread
• developing new effective antimicrobials or alternatives for treatment
• cooperating with international partners to contain the risks of AMR
• improving monitoring and surveillance in human and animal medicine
• promoting research and innovation
• improving communication, education and training

The evaluation of the Action Plan - published in October 2016 by the Commission (please find here the Executive Summary) - shows that this had a clear added value acting as a symbol of political commitment, stimulating several actions within Member States, and has served to strengthen international cooperation. The Action Plan has also provided a framework to guide and coordinate activities on AMR at international level in the area of monitoring and surveillance and on R&D. This factsheet summarizes the main points of this evaluation.

Furthermore, there is also an external report available regarding the Evaluation of the EC Action Plan against the rising threats from antimicrobial resistance (and appendices).

Prior to this evaluation a Progress Report on the AMR Action Plan (2011-2016) was published in February 2015 which showed the state of play of the steps taken to address this issue.

The Commission has also compiled a detailed overview of the 12 Actions covered by the Action Plan in a Road Map (updated on November 2016), including the operational objectives, the concrete activities and the deadlines.

In May 2015, the Sixty-eighth World Health Assembly adopted the global action plan on antimicrobial resistance. The World Health Assembly called all Member States of the World Health Organization to put in place by mid-2017 national action plans against AMR that are aligned with the objectives of the global action plan.

The Council conclusions adopted in June 2016 under the Dutch Presidency of the Council of the European Union reiterated the importance that Member States put in place national action plans against AMR, based on the One Health approach i.e. encompassing human health, animal health and the environment.

The available national action plans and strategies developed at national level in EU countries, Iceland, Norway and Switzerland can be found here.

Reducing the overuse and misuse of antimicrobial medicines is vital to stop the appearance of resistant microorganisms. Among other good practices, the following ones are key to tackle this problem:

• Better prescribing practices (including prescribing antibiotics only when required)
• Stop self-medication in countries in which antimicrobial medicines are freely available
• Respect the dosages
• Stop the overuse and misuse of antimicrobial medicines in agriculture and the veterinary field

To raise awareness about this issue, the European Centre for Disease Prevention and Control (ECDC) founded the European Antibiotic Awareness Day (EAAD) which aims to provide a platform and support for national campaigns about prudent antibiotic use. Over the years, European Antibiotic Awareness Day - marked annually in November together with the World Antibiotic Awareness Week organised by WHO - has developed into a platform of global reach, partnering up with many countries outside the EU as well as relevant stakeholders, in line with the Commission's "One-Health" approach to AMR.

Videos

• The EU Action Plan against Antimicrobial Resistance
• Antibiotic resistance animation video by the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR)
• Explainer/infographic about Antimicrobial resistance (ECDC)
• Antimicrobial resistance & food safety (ECDC)
• What is antimicrobial resistance? How is it related to food safety? (EFSA)
• The threat of antibiotic resistance (Euronews Science, in cooperation with ECDC)
• 1/6 of Europeans are not aware that the misuse of antibiotics makes them less effective (ECDC)
• Joint Programming Initiative on AMR

Infographics

• How can we reduce the use of antimicrobials in food-producing animals? (EMA and EFSA 2017)
• Antimicrobial resistance in Europe (EFSA and ECDC 2017)
• Europe's Fight Against AMR (updated with 2014 data, ECDC)
• How safe is your food (ECDC, EFSA)
• Salmonellosis, just the tip of the iceberg (ECDC)
• Antimicrobial Resistance in Europe (ECDC)
• Antibiotics: be responsible (ECDC)
• Growing Resistance to last-line antibiotics (ECDC)

Factsheets

• Innovation in Antibiotic Drug Discovery and Development (05-02-2016, EUNL2016)
• A major European and Global challenge (EC)
• For general public (ECDC)
• For experts (ECDC)
• For primary care providers (ECDC)
• For hospital providers (ECDC)
• Antimicrobial Resistance (EFSA)

Publications & Documents

• Policy Briefing: Last-line antibiotics are failing: options to address this urgent threat to patients and healthcare systems (ECDC 2016)
• Proposals for EU guidelines on the prudent use of antimicrobials in humans
• International and European Initiatives Targeting Innovation in Antibiotic Drug Discovery and Development (Report for the 2016 Dutch Presidency of the European Union)
• AMR Next - EU Antimicrobial Resistance, One Health ministerial conference 2016
• Dutch veterinary good practices (28-01-2016)
• Dutch report with human health business cases
• Good practices on AMR from EU Member States (05-02-2016, EUNL2016)
• ECDC Publications
• Research strategy to address the knowledge gaps on the AMR effects of biocides (January 2010)
• The European Community Strategy Against Antimicrobial Resistance (January 2004)

Eurobarometers

Antimicrobial Resistance Awareness (16 June 2016)

• Report
• Summary
• General Factsheet on the Eurobarometer results
• National Factsheets

Antimicrobial Resistance (November 2013)

• Report
• Summary
• Country factsheets

Antimicrobial Resistance (April 2010)

• Report
• Summary
• Country factsheets

European NGOs

• Standing Committee of European Doctors
• Pharmaceutical Group of the European Union
• Health First Europe (HFE)
• European Public Health Alliance (EPHA)

The EU - active on AMR for more than 15 years - strives to bring about behaviour change and tackle this pressing issue within a "One Health" approach.

The Commission aims to substantially reinforce existing good practices and support Member States in preventing the further spread of resistances and preserve the ability of antibiotics to combat microbial infections. Over the years, the EC has endorsed the following key initiatives:

• 2017: EFSA and ECDC: The European Union summary report on antimicrobial resistance in zoonotic and indicator bacteria from humans, animals and food in 2015
• 2017: EMA and EFSA: Joint Scientific Opinion on measures to reduce the need to use antimicrobial agents in animal husbandry in the European Union, and the resulting impacts on food safety (RONAFA)
• 2016: Prudent use of antimicrobial agents in human medicine: third report on implementation of the Council recommendation
• 2016: Council conclusions on the next steps under a One Health approach to combat antimicrobial resistance
• 2016: EFSA and ECDC: The European Union summary report on antimicrobial resistance in zoonotic and indicator bacteria from humans, animals and food in 2014
• 2015: Publication of Guidelines on the prudent use of antimicrobials in veterinary medicine (September, 2015) + ( Annex)
• 2015: Current ongoing revision of the legislation on veterinary medicines and medicated feedingstuffs. A new Animal Health Law has also been adopted which emphasises the prevention of disease rather than cure (by using antibiotics)
• 2015: Publication of the first joint report (January 2015) by the EU agencies ECDC, EMA and EFSA who explored associations between consumption of antimicrobials in humans and food-producing animals, and AMR in bacteria from humans and food-producing animals
• 2014: EC Report on the implementation of Council Recommendation 2009/C 151/01 on patient safety, including the prevention and control of healthcare associated infections (June 2014)
• 2013: Publication of an updated decision on harmonised monitoring of AMR in commensal bacteria (Commission Implementing Decision 2013/653/EU, November 2013)
• 2012: Council conclusions on the impact of antimicrobial resistance in the human health sector and in the veterinary sector – a "One Health" perspective (June 2012)
• 2010: Second Report from the EC to the Council on the implementation of the Council Recommendation (2002/77/EC) on the prudent use of antimicrobial agents in human medicine (April 2010) + (Detailed Analysis)
• 2010: The Commission mandated EMA to create the European Surveillance for Veterinary Antimicrobial Consumption (ESVAC), which started to operate in 2010 and published four reports so far
• 2009: The Commission requested several EU institutions to provide a common scientific report on a number of AMR-related questions. A joint report from the bodies was duly published (October 2009) and made a number of important recommendations
• 2009: Council Recommendations of 9 June 2009 on patient safety, including the prevention and control of healthcare associated infections
• 2005: Report from the Commission to the Council on the basis of Member States' Reports on the implementation of the 2001 Council Recommendation (2002/77/EC)
• 2003: The Zoonoses Directive introduced requirements for all Member States to monitor AMR in salmonella and campylobacter
• 2003: Regulation (EC) No 1831/2003 of the European Parliament and of the Council of 22 September 2003 on additives for use in animal nutrition
• 2001: Council Recommendation (2002/77/EC) of 15 November 2001 on the prudent use of antimicrobial agents in human medicine
• Late 1990s/2000: On the basis of the Precautionary Principle and Scientific Advice (namely from the Scientific Steering Committee, who also presented a second opinion in 2001), as from 2000 began the phasing out of the use of antimicrobials in food producing animals for performance enhancement

One of the main activities on AMR performed at EU level is surveillance. The European Centre for Disease Prevention and Control (ECDC) coordinates and funds two networks of surveillance:

• EARS-Net: European Antimicrobial Resistance Surveillance Network
• ESAC-Net: European Surveillance of Antimicrobial Consumption (includes data on antimicrobial consumption in human medicine in Member States between 1997-2012)

Furthermore, ECDC also publishes Eurosurveillance, a peer-reviewed scientific journal providing information on communicable diseases, to accelerate effective prevention and to promote international awareness across Europe.

The European Medicines Agency (EMA) is also a main player regarding monitoring and evaluating the AMR risks to human and animal health. In 2010, EMA presented the European Surveillance of Veterinary Antimicrobial Consumption (ESVAC) project that collects information on how antimicrobial medicines are used in animals across the EU. The latest annual ESVAC report was published in October 2016.

The European Food Safety Agency (EFSA) is also involved in the surveillance efforts across the EU. EFSA publishes yearly - since 2010 - specific summary reports on the occurrence of AMR in both zoonotic and indicator bacteria from food-producing animals and foodstuffs in the EU. Prepared in joint collaboration with ECDC since 2011, the summary reports have also addressed the resistance in zoonotic isolates from human cases since then.

In order to improve the surveillance systems on AMR, the Commission asked EFSA to revise the existing technical specifications on the monitoring of AMR and issue scientific reports, as it has been laid by the Commission Implementing Decision 2013/652/EU39 (which entered into force on 1 January 2014). The new legislation ensures harmonised monitoring systems in Europe, fosters comparability between the Member States and between the human and veterinary sectors and facilitates the monitoring of patterns of multi-drug resistance in the EU.

In September 2009, EMA published a joint report together with ECDC and the international network ReAct - Action on Antibiotic Resistance. This report highlights the gap between infections due to resistant bacteria and the development of new antibiotics.

Audits and information gathering activities are another important part of EU's work on tackling AMR. The Commission carries out regular audits to verify the execution of the mandatory monitoring of AMR in animals. The Commission also performs fact-finding missions on the prudent use of antibiotics in animals and carries out country visits on One Health aspects concerning AMR (jointly with ECDC). Analysis of the policies and measures to address AMR in non-EU countries is yet another activity executed by the Commission.

The outcomes of these actions are available at the overview reports and at the individual reports for the countries concerned. (NB: to facilitate the identification of the relevant overview and individual reports, we recommend inserting the term ‘AMR’ when using the Search engine).