STOA – Antibiotic resistance

June 17, 2007

The project was commissioned by the STOA Panel (Scientific Technological Options Assessment Panel) of the European Parliament. It was carried out by an international working group under the leadership of the Danish Board of Technology on behalf of the ETAG Group (European Technology Assessment Group).

The project was carried out from January to October 2006.

 

Background

Antibiotics are used to fight infectious diseases and are an indispensable form of medical treatment – not the least when it comes to potentially terminal infectious diseases.
Resistance to antibiotics is, however, an increasing problem involving human as well as financial costs and the problem has become increasingly distressing since the 1980’s. And since micro organisms spread across borders this is not only a national but also a global concern.
Although antibiotic resistance is nature’s unavoidable answer to the use of antibiotics, the speed of the process and the spread of the resistance is influenced by the way antibiotics are used, misused and disposed of. As a general rule, an increased use of a certain antibiotic will result in an increased risk of resistance to the particular antibiotic.
The use of antibiotics within the fields of human and veterinary medicine has been and still is extensive as there has been a tendency to view antibiotics as a panacea. For instance, antibiotics have been used in the treatment of viral infections although antibiotics are completely ineffective against viruses. Such erroneous medication is caused, among other things, by the insufficiency of the available diagnostic methods. Since many of these methods are slow and inefficient, antibiotics are often prescribed ‘just in case’.
The diminished effectiveness and reduced reliability of the antiquated antibiotics makes it necessary to develop new antibiotic drugs. In the last couple of decades the development of new antibiotics has been significantly slower than the emergence of resistant bacteria. The pharmaceutical industry evidently does not have the necessary economical incentive to undertake research into new antibiotics. Research into new antibiotics is very expensive and sales window – the period of time between the product launch and until the bacteria becomes resistant to the new drug – is relatively short. When the pharmaceutical industry chooses to conduct antibiotic research they usually focus on broad-spectrum antibiotics that may be used in the treatment of a variety of diseases. This, however, may contribute to the problem, as broad-spectrum antibiotics are particularly vulnerable to resistance. Due to fear of multi resistant bacteria and to the fact that the best way of keeping new antibiotics effective is not to use them, some governments advice doctors not to prescribe broad-spectrum antibiotics. This discourages, though, also the interest that the pharmaceutical industry may have in conducting research into broad-spectrum antibiotics.

 

Scope of the project

The purpose of the project was to develop a set of policy options on how to establish a coordinated effort to redress the problem of antibiotic resistance. The options should include concrete suggestions for political initiatives.

The project took its point of departure in the following questions:

  • Which regulations are necessary to reduce the unwarranted use of antibiotics for humans as well as for animals?
  • Which initiatives, aside from regulations, may contribute to a reduction in the use of antibiotics?
  • How is it possible to ensure research in new, narrow-spectrum antibiotics or other technologies for anti-bacterial treatment?

Methodology

A fast working, interdisciplinary working group of five experts met five times to compose an action plan with a set of policy options.

The working group members were:

Frank Aarestrup
Research professor in Antimicrobial Resistance at the Danish Institute for Food and Veterinary Research, Copenhagen, Denmark.
Fernando Baquero
Professor of Clinical Microbiology at the Department of Microbiology and Infectious Diseases at the Ramon y Cajal Hospital, Madrid, Spain.
Joanna Coast
Professor of Health Economy at the University of Birmingham, UK.
Niels Frimodt-Møller
Associated professor in Microbiology). Head of antibiotic research at the National Center for Antimicrobials and Infection Control, department of Antimicrobial Resistance and Hospital Hygiene, Denmark.
Anne-Laure Ropars
Master of Political Economy and International Relations. Senior Policy Analyst, Pharmaceutical R & D Policy Programme, The George Institute for National Health, UK.

The first major task for the working group was to prepare an interim report with a set of preliminary policy options. The interim report was discussed at an extended meeting with additional five international experts from various disciplines. The experts were:

Christina Greko
Swedish National Veterinary Institute
Patrice Nordmann
Hospital Bicêtre South-Paris Medical School
Richard Smith
University of East Anglia
Henri A. Verbrugh
Erasmus University, Rotterdam
Marcelo I. Sosa
Department of Scientific Policies, European Parliament

Based on the results from the extended meeting the working group prepared a second edition of the interim report. This edition was presented by the members of working group and discussed at a workshop at the European Parliament on September 14th. Another four experts were invited to speak at the workshop and to comment on the report. The experts were:

Peet Tüll
European Centre for Disease Prevention and Control (ECDC)
Kathleen Holloway World Health Organization (WHO)
Anna Lönnroth
European Commission, DG Research
Herman Goossens
Antwerp University and co-ordinator of the European Surveillance of Antibiotic Consumption (ESAC), and Genomics to Combat Resistance against Antibiotics in Community-acquired LRTI in Europe (GRACE).

Taking the remarks from the workshop into account the working group finalized the report in October 2006.