Barriers to the effective implementation of One health policies against AMR in the EU

Funded by the EU4Health 2021 Programme, Tetra Tech conducted a study for the European Commission on the “Barriers to the effective implementation of policies against antimicrobial resistance (AMR)” in the EU Member States, Norway and Iceland. The study provides input to support the EU's overall goal to combat AMR by improving the development and implementation of One Health national action plans (NAPs) which, in turn, shall contain effective measures in infection prevention and control and prudent use of antimicrobials. The research was conducted under the following study areas: development and implementation of One Health NAPs, infection prevention and control (IPC) measures in hospitals and long-term care facilities (LTCFs); antimicrobial stewardship measures (AMS) in hospitals, LTCFs, primary care and pharmacies. The research revealed some common problems across all countries, such as insufficient funding to deliver on the measures foreseen in the NAPs, the shortages of qualified staff at all levels of care, the lack of measures targeting LTCFs specifically, the limited involvement of pharmacies in AMS, and the disruptions caused by the COVID-19 pandemic in the health sector. The barriers affect each country differently but they are nevertheless common to all, independently of their size and socio-economic situation. Limitations to deliver on the NAPs objectives were also due to lack of other resources besides funding and staff: old infrastructure, insufficient material and equipment, as well as testing capacity, inadequate information systems. Other barriers identified include: limited political focus and awareness of the challenges brought by AMR; lack of operational plans for delivering on the NAPs; lack of harmonised indicators for monitoring the implementation of plans; limited coverage of AMR, AMS and IPC in education and training; and limited public awareness of AMR. KEY MESSAGES: • Countries face common barriers to the effective implementation of One health policies against AMR, such as lack of dedicated funds, shortages of qualified staff, and disruptions caused by the pandemic. • Actions are needed for improving the implementation of One Health national action plans in the EU, including effective measures in infection prevention and control and prudent use of antimicrobials.