One Health approach against antibiotic resistance: Country visit to North Macedonia


From 29 January to 2 February 2024, a team of experts from the European Commission (EC), the European Centre for Disease Prevention and Control (ECDC), the European Food Safety Authority (EFSA), Epiconcept and the Integrated Quality Laboratory Services (IQLS) will visit North Macedonia.

Country visit North Macedonia
Experts from the European Commission (EC), the European Centre for Disease Prevention and Control (ECDC), the European Food Safety Authority (EFSA), Epiconcept and the Integrated Quality Laboratory Services (IQLS) visiting North Macedonia.

Antibiotic resistance (AMR) represents one of the most significant public health challenges in Europe and around the world. Each year in the European Union/European Economic Area (EU/EEA), more than 35 000 people die from infections with antimicrobial-resistant bacteria. 

The five-day visit to North Macedonia constitutes the second in a series of country visits to the Western Balkans, which all aim to contribute to the advancement of a ‛One Health’ approach against the spread of antibiotic resistance (AMR) in the region, as these countries prepare for their future participation in ECDC. 

The team will reflect on the work done by North Macedonia on surveillance, prevention, and control of AMR, in collaboration with national public health, animal health and food safety authorities.  

The country visit experts will be divided into two teams, one led by ECDC and the other by DG SANTE and EFSA. The teams will meet with representatives and stakeholders from key national authorities and institutions. They will also visit hospitals, healthcare facilities, pharmacies, laboratories, and long-term care facilities, as well as meet with general practitioners and paediatricians. 

The visits and meetings will provide an excellent opportunity to discuss the prudent use of antibiotics, AMR prevention and control measures, and for the national health experts to explain the current situation and needs to tackle AMR in North Macedonia going forward.  

The specific objectives of the visit to North Macedonia are: 

  • To provide a comprehensive overview of the efforts currently being made by North Macedonia to tackle AMR, including strengths, vulnerabilities and needs, and potential plans of action; 

  • To better understand the existing structures, systems, tools and processes involved in national control of AMR; 

  • To gather background information for the development of a ‘One-Health’ country roadmap on AMR;  

  • To identify areas for improvement, including aspects that might benefit from ECDC’s technical support; and 

  • To determine the current status and suitability of systems for electronic surveillance as a background for the development of the guidance for electronic surveillance of AMR. 


ECDC is supporting countries in the Western Balkans and Türkiye to prepare them to participate in the Centre’s activities, as part of a project funded by the Directorate-General for Neighbourhood and Enlargement Negotiations (DG NEAR) of the European Commission. 

In this context, ECDC and EFSA organised in 2019 a regional workshop on a One Health approach against antimicrobial resistance in EU pre-accession countries in Belgrade, Serbia. The workshop concluded that ‘One-Health’ country visits to discuss AMR issues in each of the Western Balkan countries would help to identify gaps in the individual countries and support the development of roadmaps on AMR in different sectors, such as human health, animal health, and patient safety. 

Work Stream 2 of the ECDC accession support project focuses on the advancement of a ‘One-Health’ approach against AMR in the Western Balkans. It is the sixth ECDC project with external financial assistance by DG NEAR under the Instrument of Pre-Accession Assistance (IPA).