Methodology for conducting One Health country visits on antimicrobial resistance in the Western Balkans
To increase health security in the EU, ECDC supports Western Balkan countries in strengthening their infectious disease prevention and control systems and public health workforce. Since 2011, ECDC has undertaken several national technical assessments and convened regional meetings to prepare for the participation of Western Balkan countries in ECDC activities, most recently focusing on a One Health approach to antimicrobial resistance.
Antimicrobial resistance (AMR) is an increasing public health problem that poses a serious threat to human and animal health, as well as to the environment, which is why it is currently a key priority for the European Centre for Disease Prevention and Control (ECDC). AMR also has substantial economic implications: it is estimated that in 2019 alone, over 38 710 deaths were attributable to bacterial infections with AMR in the European Union/European Economic Area (EU/EEA), with associated costs of nearly EUR 11.7 billion due to increased health expenditure and reduced work productivity.
In 2015, the Global Action Plan (GAP) on AMR was adopted by all World Health Organization (WHO) Member States through decisions at the World Health Assembly, the Food and Agriculture Organization of the United Nations (FAO) and the World Organisation for Animal Health (WOAH, founded as OIE). Countries agreed to have a National Action Plan (NAP) on AMR, aligned with the GAP, that coordinates action among human health, food production and animal health systems, and to implement relevant policies and plans to prevent, control and monitor AMR.
In 2016, the GAP was endorsed by all the WHO Member States who committed to the development and implementation of a collaborative and multisectoral NAP addressing individual national priorities for AMR, including disease burden, human-animal interactions and environmental practices, in line with the GAP. The GAP sets out five strategic objectives to address AMR:
- improved awareness of AMR and behaviour change in key sectors and the general population;
- strengthened knowledge and evidence base to inform decisions on policy and practice;
- reduced incidence of infections in humans and animals, as well as reduced environmental contamination;
- optimised use of antimicrobials in human and animal health, with growth promotion phased out; and
- increased research and development on new medicines, vaccines, diagnostics and other interventions.
In 2022, FAO, the United Nations Environmental Programme, WHO and WOAH published a One Health Joint Plan of Action (2022−2026) to respond to international requests to prevent future pandemics and to promote health sustainably through the One Health approach. Addressing the silent pandemic of AMR was one of the five key objectives which required action to strengthen national capacity, bolster global and regional initiatives and reinforce global AMR governance structures.
At ECDC, AMR is identified as one of three priority conditions, with the aim of supporting the European One Health Action Plan, intensifying cooperation with other international organisations, and continuing to coordinate the European Antibiotic Awareness Day.
To increase health security in the EU, ECDC supports Western Balkan countries in strengthening their infectious disease prevention and control systems and public health workforce. Since 2011, ECDC has undertaken several national technical assessments and convened regional meetings to prepare for the participation of Western Balkan countries in ECDC activities, most recently focusing on a One Health approach to AMR.
In 2019, the joint ECDC and European Food Safety Authority (EFSA) regional workshop on a One Health approach against AMR for EU pre-accession countries highlighted the urgent need to boost national responses to AMR to achieve the level of implementation required for relevant EU legislation in the region. National governments need to put in place regulatory requirements, laboratory infrastructure and techniques, comprehensive and interoperable electronic surveillance systems, training and additional human resources in human and animal health, while raising awareness and commitment to ensure sustainability of efforts. During this regional workshop, the Western Balkan IPA beneficiaries agreed upon and committed to a regional One Health approach to AMR, starting with One Health country visits to discuss AMR issues in each beneficiary country. This priority was reiterated at the meetings of the national ECDC correspondents in the Western Balkans and Türkiye in November 2022 and December 2023.
