COMMUNICATION FROM THE COMMISSION TO THE COUNCIL AND THE EUROPEAN PARLIAMENT A European One Health Action Plan against Antimicrobial Resistance (AMR)
Date: 2017-06-29
Institutions: Directorate-General for Health and Food Safety, European Commission
Subjects: action programme, animal disease, antibiotic, cooperation policy, drug surveillance, infectious disease, innovation, public health, research and development, veterinary drug

EN 

   EN 

   EUROPEAN COMMISSION  Brussels, 29.6.2017  COM(2017) 339 final   COMMUNICATION FROM THE COMMISSION TO THE COUNCIL AND THE EUROPEAN PARLIAMENT A European One Health Action Plan against Antimicrobial Resistance (AMR) {SWD(2017) 240 final}  
 
 
1  THE NEED FOR EU ACTION AGAINST ANTIMICROBIAL RESISTANCE (AMR) 

1.1  State of play 

Since  penicillin  was  first  discovered  in  1928,  life-saving  antimicrobials  have  revolutionised 
our society and economy. Previously deadly diseases have become routine ailments, requiring 
little more than a brief treatment. These achievements are now at risk mainly because of the 
excessive  or  inappropriate  use  of  antimicrobials,  which  has led  to  the increasing emergence 
and spread of multi-resistant bacteria. Without effective action to reverse current trends, we 
could  face  a  return  to  the  pre-antibiotic  era,  with  simple  wounds  and  infections  causing 
significant harm and even death and routine medical procedures becoming very high risk. 

Antimicrobials:  include  antibiotics,  antivirals,  antifungals  and  antiprotozoals.  They  are  active 
substances of synthetic or natural origin which kill or inhibit the growth of microorganisms. Used in 
every-day medicine (e.g. urinary tract infections, surgery and care of premature babies), they are vital 
to preventing and treating infections in humans and animals. 

Antimicrobial  resistance  (AMR):  is  the  ability  of  microorganisms,  such  as  bacteria,  to  become 
increasingly  resistant  to  an  antimicrobial  to  which  they  were  previously  susceptible.  AMR  is  a 
consequence  of  natural  selection  and  genetic  mutation.  Such  mutation  is  then  passed  on  conferring 
resistance. This natural selection process is exacerbated by human factors such as inappropriate use of 
antimicrobials in human and veterinary medicine, poor hygiene conditions and practices in healthcare 
settings or in the food chain facilitating the transmission of resistant microorganisms. Over time, this 
makes antimicrobials less effective and ultimately useless. 

AMR  is  a  serious  challenge,  in  the  EU  and  globally.  According  to  the  World  Health 
Organization (WHO)1, AMR has already reached alarming levels in many parts of the world. 
High  levels  of  AMR  in  bacteria  linked  to  numerous  common  infections  (e.g.  urinary  tract 
infections, pneumonia, tuberculosis and gonorrhoea) have been observed in all WHO regions. 
Resistance to antivirals, such as those used to treat HIV, is also increasing. 

Global efforts include the 2016 United Nations Political Declaration on AMR2 and the 2015 
WHO Global Action Plan on AMR3, which was subsequently adopted by the World Animal 
Health Organisation (OIE) and the Food and Agriculture Organization (FAO). AMR has also 
been addressed in the G7 and G20 forums. 

AMR already presents a serious social and economic burden. It is estimated to be responsible 
for 25,000 deaths per year in the EU alone4 and 700,000 deaths per year globally. Inaction is 
projected to cause millions of deaths globally:  it has  been  estimated that AMR  might  cause 
more deaths than cancer5 by 2050. 

1 http://www.who.int/entity/drugresistance/documents/surveillancereport/en/index.html  
2 United Nations, 2016. Political Declaration of the high-level meeting of the General Assembly on antimicrobial 
resistance. New York, USA. 
3 WHA 68.7 
 http://www.wpro.who.int/entity/drug_resistance/resources/global_action_plan_eng.pdf 
4 http://ecdc.europa.eu/en/publications/Publications/0909_TER_The_Bacterial_Challenge_Time_to_React.pdf 
5 https://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf 

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Apart from the human suffering caused by that development, AMR also pushes up the cost of 
treatment and diminishes productivity due to illness. In the EU alone it is estimated that AMR 
costs EUR 1.5 billion annually in healthcare costs and productivity losses4. The World Bank6 
has warned that, by 2050, drug-resistant infections could cause global economic damage on a 
par  with  the  2008  financial  crisis.  AMR  also  threatens  the  achievement  of  several  of  the 
United  Nations’  sustainable  development  goals,  particularly  the  targets  for  good  health  and 
well-being7 (goal 3). 

Effective action against the rise of AMR will mitigate its negative impact on the economy and 
can  therefore  be  considered  a  contribution  to  economic  growth,  to  sustainable  healthcare 
budgets by reducing healthcare costs and to a productive and healthy population.  

The  EU  was  quick  to  recognise  the  importance  of  tackling  AMR,  as  the  2001  Community 
strategy against AMR8 shows. This policy was reinforced with the 2011 Commission action 
plan9, notable for its One Health approach, addressing AMR in both humans and animals. 

One Health: is a term used to describe a principle which recognises that human and animal health 
are  interconnected,  that  diseases  are  transmitted  from  humans  to  animals  and  vice  versa  and  must 
therefore be tackled in both. The One Health approach also encompasses the environment, another link 
between  humans  and  animals  and  likewise  a  potential  source  of  new  resistant  microorganisms.  This 
term  is  globally  recognised,  having  been  widely  used  in  the  EU  and  in  the  2016  United  Nations 
Political Declaration on AMR. 

Since  1999,  the  Commission  has  invested  over  EUR  1.3  billion  in  AMR  research,  making 
Europe  a  leader  in  this  domain.  EU  achievements  include  the  launch  of  the  New  Drugs  for 
Bad  Bugs  (ND4BB)  programme10,  the  world’s  biggest  public-private  AMR  research 
partnership, forming part of the Innovative Medicines Initiative (IMI)11. The EU has also set 
up the Joint Programming Initiative on AMR (JPIAMR)12 which aims to better coordinate and 
align worldwide AMR research efforts. 

Despite  all  this,  incidences  of  infections  resistant  to  multidrug  therapies  and  last-resort 
treatments13 have significantly increased in the EU14 in recent years. 

The development and spread of AMR in the environment is also a growing concern, requiring 
further research. A number of scientific studies have identified the potential negative impacts 
of resistant microorganisms or antimicrobials on the environment. 

6 World Bank, 2016, ‘Drug-Resistant Infections: A Threat to Our Economic Future’, Washington, DC. 
7 http://www.un.org/sustainabledevelopment/sustainable-development-goals 
8 COM (2001) 333 final 
9 COM (2011) 748 
10 http://www.imi.europa.eu/content/nd4bb 
11 http://www.imi.europa.eu 
12 http://www.jpiamr.eu 
13 Treatments that are tried after all other options have failed to produce an adequate response in the patient 
14 http://ecdc.europa.eu/en/publications/Publications/antimicrobial-resistance-europe-2015.pdf 

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At  the  same  time,  the  discovery,  development,  manufacture  and  marketing  of  new 
antimicrobials has significantly slowed down in the past 20 years. Historical data show a low 
success rate: only 1 out of 16 antibiotics from early-stage research reaches clinical application 
for patients15. 

1.2  Recent developments and way forward 

In  the  face  of  regional  and  global  AMR  challenges,  the  EU  stands  at  the  forefront  for 
addressing AMR. However, no single action will, in isolation, provide an adequate solution. 
Resistant bacteria and infectious diseases do not respect borders. No individual Member State 
or the EU can tackle the problem on its own. The EU is nevertheless in a strong position to act 
given  its  high  degree  of  economic  development,  and  commitment  to  a  high  level  of  human 
health protection. 

As requested by the Member States, the Council conclusions of 17 June 201616 call for a new 
and comprehensive EU action plan on AMR based on the One Health approach. 

This  new  action  plan  builds  on  the  2011  action  plan,  its  evaluation17,  the  feedback  on  the 
roadmap18 and an open public consultation19. 

The evaluation concluded that the 2011 action plan had clear EU added value, was a symbol 
of  political  commitment,  stimulated  action  within  the  Member  States  and  strengthened 
international cooperation. The evaluation also confirmed that the issues addressed in the 2011 
plan are still relevant today. However, initiatives need to be broadened, such as extending the 
One Health approach to include the environment and tackling AMR more comprehensively on 
the  basis  of  improved  data  collection,  monitoring  and  surveillance.  Further  support  and 
assistance to EU Member States to address differences and foster cooperation, more efficient 
and coordinated research to improve knowledge and develop solutions, and a continued strong 
EU voice at global level, were also recommended. 

The roadmap on a new EU action plan on AMR received contributions from 22 stakeholders 
from 24 October 2016 to 28 March 2017. The open public consultation took place between 27 
January and 28 April 2017. It consisted of two separate online questionnaires: one for citizens 
and one for administrations, associations and other organisations. In total 421 responses were 
received  from  citizens  and  163  from  administrations,  associations  and  other  organisations. 
The  synopsis  report  accompanying  this  Communication  provides  an  overview  of  the 
contributions  received  and  how  they  have  been  taken  into  account  in  defining  concrete 
actions. Overall, the replies submitted confirm the strong support for a new One Health action 
plan and the importance of a comprehensive approach. 

This new One Health action plan against AMR is motivated by the need for the EU to play a 
leading  role  in  the  fight  against  AMR  and  to  add  value  to  Member  States'  actions.  Its 

15 Payne et al. Drugs for bad bugs: confronting the challenges of antibacterial discovery  Nature Reviews Drug 
Discovery 6, 29-40 (January 2007) 
16http://www.consilium.europa.eu/en/press/press-releases/2016/06/17-epsco-conclusions-antimicrobial-
resistance 
17 SWD(2016) 347 final 
18 http://ec.europa.eu/smart-regulation/roadmaps/docs/2016_sante_176_action_plan_against_amr_en.pdf 
19 https://ec.europa.eu/health/amr/consultations/consultation_20170123_amr-new-action-plan_en 

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overarching goal is to preserve the possibility of effective treatment  of infections in humans 
and  animals.  It  provides  a  framework  for  continued,  more  extensive  action  to  reduce  the 
emergence  and  spread  of  AMR  and  to  increase  the  development  and  availability  of  new 
effective antimicrobials inside and outside the EU. 

The key objectives of this new plan are built on three main pillars: 

1. 

2. 

3. 

making  the  EU  a  best  practice  region:  as  the  evaluation  of  the  2011  action  plan 
highlighted, this will require better evidence, better coordination and surveillance, 
and better control measures. EU action will focus on key areas and help Member 
States in establishing, implementing and monitoring their own national One Health 
action  plans  on  AMR,  which  they  agreed  to  develop  at  the  2015  World  Health 
Assembly20; 

boosting  research,  development  and  innovation  by  closing  current  knowledge 
gaps, providing novel solutions and tools to prevent and treat infectious diseases, 
and improving diagnosis in order to control the spread of AMR; 

intensifying  EU  efforts  worldwide  to  shape  the  global  agenda  on  AMR  and  the 
related risks in an increasingly interconnected world. 

The  new  plan  contains  concrete  actions  with  EU  added  value  that  the  Commission  will 
develop and strengthen as appropriate in the coming years. All these actions are important in 
themselves, but they are also interdependent and need to be implemented in parallel in order 
to achieve the best outcome. 

2  MAKING THE EU A BEST PRACTICE REGION 

Within the EU, the situation across Member States with regard to AMR varies greatly. This 
includes  patterns  of  antimicrobial  use,  occurrence  of  resistance,  and  the  extent  to  which 
effective national policies to deal with AMR have been implemented. In order to tackle this 
situation,  the  Commission  will  concentrate  on  key  areas  with  the  highest  added  value  for 
Member  States,  while  respecting  the  limits  of  EU  competence  and  bearing  in  mind  that 
Member States remain primarily responsible for the definition of their health policies. 

The Commission will continue to bring together all relevant EU scientific agencies – notably 
the  European  Food  Safety  Authority  (EFSA),  the  European  Medicines  Agency  (EMA),  and 
the European Centre for Disease Prevention and Control (ECDC) – to jointly take appropriate 
actions.  This  will  enable  Member  States  to  benefit  from  the  most  effective  support  and 
resources  for  reducing  AMR  and  preserving  the  effectiveness  of  antimicrobials.  Agencies’ 
supportive  actions  will  include  infection  prevention,  biosecurity  measures  and  control 
practices  in  human  healthcare  and  in  animal  husbandry,  including  aquaculture,  in  order  to 
reduce infections and thus the need for antimicrobials. 

20 World Health Organization, 2015. 68th World Health Assembly: WHA resolution 68.7. Geneva, Switzerland; 
the  commitment  to  have  national  AMR  action  plans  in  place  before  mid-2017  was  confirmed  in  the  Council 
conclusions on the next steps under a One Health approach to combat antimicrobial resistance. 

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EU  actions  will  focus  on  the  areas  with  the  highest  added  value  for  Member  States,  e.g. 
promoting  the  prudent  use  of  antimicrobials,  enhancing  cross-sectorial  work,  improving 
infection prevention and consolidating surveillance of AMR and antimicrobial consumption. 

2.1  Better evidence and awareness of the challenges of AMR 

Strengthen One Health surveillance and reporting of AMR and antimicrobial use 

Resistant  microorganisms  exist  in  humans,  animals,  food,  and  the  environment.  This  makes 
AMR  a  complex  epidemiological  issue.  The  main  cause  of  AMR  is  antimicrobial  use.  A 
comprehensive,  collaborative  and  coordinated  collection  and  analysis  of  data  from  multiple 
domains, i.e. a One Health AMR surveillance system, is therefore essential to understand the 
magnitude of the problem, identify trends, determine how the use of antimicrobials and AMR 
are  linked,  evaluate  policies  and  set  priorities.  Although  in  the  EU  a  wide  range  of 
surveillance  programmes  and  activities  across  different  sectors  exist,  gaps  in  surveillance 
remain.  A  more  integrated  surveillance  system  is  needed  to  have  a  complete  picture  of  the 
AMR epidemiological situation in the EU and to better identify critical control points. In the 
animal health area, a new regulatory framework (Animal Health Law21), offers a better basis 
to develop detailed rules for controlling resistant bacteria. 

The Commission will: 

- 

- 

- 

- 

review EU implementing legislation on monitoring AMR in zoonotic and commensal 
bacteria in farm animals and food22, to take into account new scientific developments 
and data collection needs; 

review EU implementing legislation on reporting communicable diseases in humans23 
to take into account new scientific developments and data collection needs; 

identify and assess under the Animal Health Law and with the support of the EFSA, 
resistant bacteria that cause transmissible animal diseases and, if necessary, develop 
harmonised rules for their surveillance; 

improve  AMR  detection  in  the  human  health  sector  by  providing  EU  support  for 
networking collaboration and reference laboratory activities; 

-  consider  options  for  the  harmonised  monitoring  of  AMR  in  the  environment, 
including  through  the  network  of  national  reference  laboratories  in  the  veterinary 
sector. 

21 Regulation (EU) 2016/429 of the European Parliament and of the Council of 9 March 2016 on transmissible 
animal diseases and amending and repealing certain acts in the area of animal health (‘Animal Health Law’), OJ 
L 84, 31.3.2016, p.1. 
22 Commission Implementing Decision 2013/652/EU of 12 November 2013 on the monitoring and reporting of 
antimicrobial resistance in zoonotic and commensal bacteria, OJ L 303, 14.11.2013, p. 26. 
23  Commission  Decision  2002/253/EC  of  19  March  2002  laying  down  case  definitions  for  reporting 
communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament 
and of the Council, OJ L 86, 3.4.2002, p. 44. 

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Benefit from the best evidence-based analysis and data 

High-quality research, data and analysis are crucial as a basis for new measures against AMR 
and to help policymakers improve existing measures. Some information is already available to 
Member States, but additional reliable information needs to be generated. 

The Commission will: 

-  provide evidence-based data, with the support of the ECDC, the EMA and the EFSA, 
on possible links between the consumption of antimicrobial agents and the occurrence 
of antimicrobial resistance in humans and food-producing animals; 

-  define, with the support of the ECDC, the EMA and the EFSA, a limited number of 
key outcome indicators for AMR and antimicrobial consumption to measure the EU’s 
and Member States’ progress in the fight against AMR; 

-  develop, with the support of the OECD, a model aimed at helping Member States to 
assess  the  economic  burden  of  AMR  imposes  on  people  and  to  estimate  the  cost-
effectiveness of their national policies to reduce it. 

Increase awareness and understanding 

Several  Eurobarometer  surveys  on  AMR  carried  out  since  201024  show  that  the  level  of 
awareness  of  the  relationship  between  the  use  of  antimicrobials  and  the  development  and 
spread of AMR is still low. This is a major cause for the inappropriate use of antimicrobials in 
humans and animals. More must be done to raise awareness and education about AMR. EU-
level  communication  initiatives  should  support  Member  States  in  improving  public  and 
professional understanding of AMR, promote prudent use and support more informed clinical 
decision-making and judicious prescribing. 

The Commission will: 

-  provide  insights  into  reported  public  use  of  and  knowledge  about  antimicrobials 

through Eurobarometer surveys; 

- 

support  Member  States’  national  awareness-raising  efforts  with 
specific 
communication  tools  targeting  key  audiences  and  contribute  to  the  annual  European 
Antibiotic Awareness Day (EAAD). 

24  Special  Eurobarometer  338  (April  2010),  Special  Eurobarometer  407  (November  2013)  and  Special 
Eurobarometer 445 (June 2016) 

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2.2  Better coordination and implementation of EU rules to tackle AMR 

Improve the coordination of Member States’ One Health responses to AMR 

With  AMR  on  the  rise  in  the  EU,  it  is  vital  to  ensure  that  lessons  learnt  from  successful 
strategies  are  made  accessible  to  all  Member  States.  To  deal  with  the  cross-border  health 
threat of AMR25, it is crucial to identify and share best practices and policies, so that a lack of 
action in one region or sector does not undermine progress made in others. To assist with and 
accelerate  this  collaboration,  in  early  2017  the  Commission  set  up  an  AMR  One  Health 
network  of  government  experts  from  the  human  health,  animal  health,  and  environmental 
sectors, as well as the EU scientific agencies working in the human and animal health sectors 
(ECDC, EMA, and EFSA). Within the AMR One Health network, its members work towards 
facilitating mutual learning, sharing innovative ideas, building consensus, comparing progress 
made in key areas and, where necessary, accelerating national efforts to tackle AMR. 

The Commission will: 

-  make available regular information on AMR in the context of the AMR One Health 
network, which gives an overview of the AMR epidemiological situation at Member 
State and EU level;  

- 

- 

support the implementation of national One Health action plans against AMR through 
joint Commission and the ECDC visits to Member States upon request; 

launch a joint action26 to support collaborative activities and policy development by 
Member States to tackle AMR and healthcare-associated infections; 

-  make  increased  use  of  the  EU  Health  Security  Committee  and  the  Commission 
Working Group on AMR in the veterinary and food areas to strengthen coordination 
and to share information; 

- 

seek  to  co-fund  and  collaborate  with  the  WHO  on  activities  to  help  EU  Member 
States develop and implement national One Health action plans against AMR. 

Better implementation of EU rules 

In  order  to deliver  long-lasting results and  create  the necessary  impetus,  it is  important  that 
the EU legislation related to AMR (e.g. rules on AMR monitoring in food-producing animals, 
on use of veterinary medicinal products and medicated feed) is adequately implemented. This 
implies  properly  training  of  Member  States’  staff  involved  in  official  control  activities  and 
keeping them up to  date on all aspects  of EU legislation related to  AMR in  order to ensure 
that controls are carried out uniformly and objectively in all Member States. 

25 Decision 1082/2013/EU of the European Parliament and of the Council of 22 October 2013 on serious cross-
border threats to health and repealing Decision 2119/98/EC, OJ L 293, 5.11.2013, p.1 
26 JA-04-2016 - Antimicrobial resistance and Health Care Associated Infections 

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The Commission will: 

-  assess  the  effectiveness  of  the  implementation  of  EU  legislation27  on,  inter  alia, 
monitoring  AMR  in  food-producing  animal  populations  and  food  by  continuing  to 
carry out regular audits in Member States; 

-  develop training programmes on AMR for Member State competent authorities under 
the  Better  Training  for  Safer  Food  (BTSF)  initiative  and  for  health  professionals 
through the ECDC and the EU health programme; 

-  advise Member States on the possibility to use the Structural Reform Support Service 
(SRSS)  funding  to  Member  States  for  designing  and  implementing  policies  against 
AMR. 

2.3  Better prevention and control of AMR 

Strengthen infection prevention and control measures 

Infection prevention, biosecurity measures and control practices are critical in the control of 
all infectious microorganisms as they reduce the need for antimicrobials and consequently the 
opportunity for microorganisms to develop and spread resistance.  

The availability of new and more coherent surveillance data, research and technologies will 
inform  innovative  approaches  and  improvements  in  infection  prevention  and  control 
measures. Other control measures, such as vaccination, could also reduce the occurrence and 
spread  of  certain  diseases,  limiting  the  need  for  antimicrobials.  In  addition,  immunisation 
through  vaccination  is  a  cost-effective  public  health  intervention  with  proven  economic 
benefits28. 

The Commission will: 

-  help to address patient safety in hospital environments by supporting good practices 

in infection prevention and control; 

- 

support  activities  jointly  funded  by  the  EU  and  Member  States  for  infection 
prevention  and  control  in  vulnerable  groups,  in  particular  to  tackle  resistant 
tuberculosis strains; 

-  promote  the  uptake  of  vaccination  in  humans  as  a  public  health  measure  to  prevent 

infections and subsequent use of antimicrobials; 

-  continue to  promote  animal  husbandry,  including  aquaculture  and  livestock  farming 
systems, and feeding regimes which support good animal health and welfare to reduce 
antimicrobial consumption. 

27 Commission Implementing Decision 2013/652/EU of 12 November 2013 on the monitoring and reporting of 
antimicrobial resistance in zoonotic and commensal bacteria, OJ L 303, 14.11.2013, p. 26. 
28 http://www.gavi.org/about/value/ 

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Promote the prudent use of antimicrobials 

The  appropriate  and  prudent  use  of  antimicrobials  is  essential  to  limiting  the  emergence  of 
AMR in human healthcare and in animal husbandry. 

Cross-sectorial  and  coordinated  actions  to  promote  the  prudent  use  of  antimicrobials  in 
humans and animals are necessary to slow down the development of AMR and preserve the 
effectiveness of antimicrobials. Such actions, often referred to as ‘antimicrobial stewardship’ 
actions, are in place in some sectors (e.g. EU guidelines for the prudent use of antimicrobials 
in  veterinary  medicine29)  but  are  not  sufficiently  developed  for  all  situations  in  which 
antimicrobials are used. 

The Commission will: 

-  work towards EU implementing and delegated acts under the forthcoming veterinary 
medicinal  products  and  medicated  feed  Regulations  (once  adopted  by  the  European 
Parliament and the Council)30, including rules on reserving antimicrobials for human 
use, drawing up a list of antimicrobials that cannot be used off-label, and methods for 
data gathering and reporting on the sales and use of antimicrobials; 

-  develop EU guidelines for the prudent use of antimicrobials in human medicine;  

-  assist Member States implement EU guidelines for the prudent use of antimicrobials 

in veterinary medicine, including identifying and disseminating good practices; 

-  encourage  the  EMA  to  review  all  available  information  on  the  benefits  and  risks  of 
older antimicrobial agents and consider whether any changes to their approved uses in 
the Member States are required. 

2.4  Better addressing the role of the environment 

The  environment  is  increasingly  acknowledged  as  a  contributor  to  the  development  and 
spread of AMR in humans and animals, in particular in high risk areas due to human, animal 
and  manufacturing  waste  streams,  but  strong  evidence  is  still  required  to  better  inform 
decision-making in this area. Specific actions to improve the knowledge base are considered 
in  section  3.  Once  relevant  monitoring  and  research  data  become  available,  risk  assessment 
methodologies should be developed to evaluate the risks to human and animal health. 

29 http://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:52015XC0911(01)&from=EN 
30 COM(2014) 558 final, COM(2014) 556 final 

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The Commission will: 

-  adopt an EU strategic approach to pharmaceuticals in the environment31; 

-  maximise the use of data from existing monitoring, e.g. Watch List monitoring under 
the Water Framework Directive32, to improve knowledge of the occurrence and spread 
of antimicrobials in the environment, including by using the Information Platform for 
Chemical Monitoring (IPCheM) to access relevant monitoring data33; 

- 

reinforce  the  role  of  the  Scientific  Committee  on  Health  and  Environmental  Risks 
(SCHER) in providing the expertise on environment-related AMR issues.  

2.5  A stronger partnership against AMR and better availability of antimicrobials 

Actions  against  AMR  cannot  succeed  without  the  sustained  involvement  of  stakeholders, 
including  industry,  civil  society,  academia,  and  non-governmental  experts  but  also  the 
European  Economic  and  Social  Committee  (EESC),  throughout  policy  development  and 
implementation.  The  Commission  takes  note  of  existing  commitments  and  collaborative 
efforts  such  as  the  declaration  by  the  pharmaceutical,  biotechnology  and  diagnostics 
industries  on  combating  AMR34.  It  provides  a  roadmap  for  further  collaboration  efforts 
between  industry,  governments  and  non-governmental  organisations  in  the  global  fight 
against  AMR.  In  line  with  this  initiative,  regular  discussions  among  stakeholders  will 
encourage them to develop and share their strategies against AMR. Cooperation with industry 
is  also  crucial  to  promote  the  development  of  other  promising  alternatives  to  antimicrobials 
and  to  address  reduced  availability  issues,  including  antimicrobial  withdrawals  from  the 
market that may lead to antimicrobial shortages and inadequate replacement treatments. 

It  is  also  crucial  to  prevent  falsified  or  counterfeit  antimicrobial  products  from  entering  the 
supply chain and harming humans or animals. 

The Commission will: 

-  engage  with  and  support  collaboration  among  key  stakeholders  in  the human  health, 
animal health, food, water and environmental sectors to encourage the responsible use 
of  antimicrobials  in  the  healthcare  sector  and  along  the  food  chain,  as  well  as  the 
appropriate handling of waste material; 

-  work  with  stakeholders  to  ensure  the  availability  of  human  and  veterinary 
antimicrobials  and  continued  access  to  established  products;  provide  incentives  to 
increase the uptake of diagnostics, antimicrobial alternatives and vaccines; 

31 Directive 2013/39/EU of the European Parliament and of the Council of 12 August 2013 amending Directives 
2000/60/EC and 2008/105/EC as regards priority substances in the field of water policy, OJ L 226, 24.8.2013, p. 
1 
32  Directive  2000/60/EC  of  the  European  Parliament  and  of  the  Council  of  23  October  2000  establishing  a 
framework for Community action in the field of water policy, OJ L 327, 22.12.2000, p. 1 
33 https://ipchem.jrc.ec.europa.eu/RDSIdiscovery/ipchem/index.html  
34  http://www.ifpma.org/partners-2/declaration-by-the-pharmaceutical-biotechnology-and-diagnostics-industries-
on-combating-antimicrobial-resistance-amr/  

11 

 
 
                                                            
- 

reduce the scope for falsified medicines by assisting Member States and stakeholders 
in  the  successful  implementation  of  the  safety  features  (unique  identifier)  that  will 
appear by 2019 on the packaging of medicinal products for human use35; 

-  discuss  the availability of veterinary antimicrobials to tackle AMR in  the Veterinary 

Pharmaceutical Committee. 

3  BOOSTING RESEARCH, DEVELOPMENT AND INNOVATION ON AMR 

Research,  development  (R&D)  and  innovation  can  provide  novel  solutions  and  tools  to 
prevent and treat infectious diseases, improve diagnosis and control the spread of AMR. This 
One  Health  action  plan  not  only  aims  to  boost  research,  but  also  to  further  incentivise 
innovation, provide valuable input into science-based policies and legal measures to combat 
AMR and address knowledge gaps such as the role of AMR in the environment. 

The proposed AMR research strategy covers the full One Health spectrum, addressing human 
and animal health as well as the role of the environment. It takes into account the priorities set 
out  in  the  WHO  Global  Action  Plan  on  AMR,  the  JPIAMR  and  national  action  plans.  The 
Commission will work in partnerships with Member States and industry, including small and 
medium-sized enterprises (SMEs) and the IMI, to tackle AMR in bacteria, viruses, fungi and 
parasites. Special attention will be given to the WHO priority list of pathogens as well as to 
tuberculosis,  HIV/AIDS,  malaria  and  neglected  infectious  diseases.  Using  different  funding 
instruments and partnerships under its current and future framework programmes for research 
and innovation, the Commission will focus on the following actions. 

3.1 

Improve knowledge on detection, effective infection control and surveillance 

Greater efforts are needed to better understand the epidemiology, emergence, prevalence and 
burden of infectious diseases,  to further investigate  how resistance develops and spreads, to 
improve  early  detection;  and  to  better  understand  AMR-related  challenges  in  the  European 
healthcare, animal husbandry and food production sectors. 

Technology  today  enables  to  collect  and  use  data  from  the  healthcare  (hospitals,  health 
centres, laboratories, etc.) and agri-food sectors but also from society in general (the internet 
of  Things,  social  networks,  etc.).  Combining  these  data  makes  it  possible  to  detect  disease 
outbreaks much earlier and helps to understand how infectious diseases are transmitted. The 
development of IT solutions for such operations has great potential to improve surveillance, 
prescription practices, self-management of health, care solutions, and awareness of AMR. 

35 Commission Delegated Regulation (EU) 2016/161 of 2 October 2015 supplementing Directive 2001/83/EC of 
the European Parliament and of the Council by laying down detailed rules for the safety features appearing on 
the packaging of medicinal products for human use, OJ L 32, 9 February 2016, p. 1. 

12 

 
 
 
 
 
 
                                                            
The Commission will: 

- 

- 

- 

- 

support research into the development and assessment of interventions that prevent the 
development and spread of AMR in different settings such as hospitals, communities 
and animal husbandry; 

support  research  into  understanding  the  epidemiology  of  AMR,  in  particular  the 
pathways of transmission between animals and humans, and their impact; 

support research into the development of new tools for early (real-time) detection of 
resistant pathogens in humans and animals, taking account of advances in IT solutions; 

support  research  into  new  eHealth  solutions  to  improve  prescription  practices,  self-
management of health, care solutions, and improve awareness of AMR. 

3.2  Develop new therapeutics and alternatives  

Despite  great  efforts  made  in  the  past  years,  including  through  public-private  partnerships, 
there  are  not  enough  antimicrobials  in  the  pipeline  to  meet  expected  needs.  The  spread  of 
AMR  has  also  contributed  to  the  declining  effectiveness  of  existing  antimicrobials.  More 
research is needed to develop new medicinal products, therapeutics and alternative treatments, 
as  well as  innovative anti-infective approaches and products  for humans and animals.  More 
research  is  also  needed  to  advance  the  repurposing  of  old  antimicrobials,  improving  their 
activity and to develop new combination therapies, including those to treat multidrug resistant 
tuberculosis (MDR-TB). Digital technologies for testing biomedical products and innovation 
in eHealth should also be scaled up, e.g. by supporting innovation procurement36 as well as 
supporting SMEs. 

The Commission will: 

- 

- 

- 

- 

- 

support research into the development of new antimicrobials and alternative products 
for  humans  and  animals  as  well  as  the  repurposing  of  old  antimicrobials  or  the 
development of new combination therapies; 

support SMEs in their R&D efforts towards innovative and/or alternative therapeutic 
approaches  for  the  treatment  or  prevention  of  bacterial  infections,  together  with  the 
EMA; 

facilitate sharing of antimicrobial research data among relevant stakeholders37 to guide 
future antimicrobial medicinal product discovery and development; 

support  the  establishment  of  a  European-wide  sustainable  clinical  research  network, 
which  should  speed  up clinical  studies  on  medicinal  products,  lower  their  costs, and 
improve coordination of clinical research; 

support research and innovation to promote the use of digital technologies supporting 
the development of new therapeutics and alternatives. 

36 https://ec.europa.eu/digital-single-market/en/innovation-procurement 
37 Such as researchers in academia and industry, regulators, etc. 

13 

 
 
 
                                                            
3.3  Develop new preventive vaccines 

Vaccines have proven to be crucial and very cost-effective in preventing the onset and spread 
of  infectious  diseases.  They  also  have  great  potential  to  reduce  the  incidence  of  AMR.  For 
example  universal  coverage  by  a  pneumococcal  vaccine  could  not  only  save  many  of  the 
estimated  800,000  children  who  die  each  year  of  pneumonia,  it  would  also  reduce  by  an 
estimated  47%  the  use  of  antimicrobials,  counteracting  the  development  of  AMR.  Vaccines 
already  play  an  important  role  in  preventing  disease  in  farm  animals  and  aquaculture.  This 
should be boosted even further to decrease the use of antimicrobials in those sectors. 

The Commission will: 

-  continue  to  support  research  into  the  development  of  new  effective  preventive 

vaccines for humans and animals; 

- 

support increasing the knowledge base concerning the barriers that influence the wider 
use of vaccination in medical and veterinary practice. 

3.4  Develop novel diagnostics 

Novel, rapid and reliable diagnostics are crucial for differentiating between bacterial and viral 
infections  and  identifying  AMR,  so  that  the  most  appropriate  treatment  can  be  given  in  a 
timely  manner.  By  tailoring  the  treatment  to  the  nature  of  the  infectious  pathogen  and  its 
resistance  pattern,  diagnostics  help  reduce  the  unnecessary  use  of  antimicrobials  in  humans 
and animals. 

Such novel diagnostics are in the process of entering the market but more tests are needed to 
guide a more efficient use of existing antimicrobials in the human and animal health sectors. 
Novel diagnostics will also make it possible to recruit the right patients in clinical trials for 
new treatments, making the trials more efficient. 

The Commission will: 

- 

- 

support  research  into  the  development  of  new  diagnostic  tools  in  particular  on-site 
tests in humans and animals to guide practitioners regarding the use of antimicrobials;  

support the use of IT solutions in developing tools for diagnosing human and animal 
infections; 

-  encourage  the  uptake  of  diagnostics  in  medical  and  veterinary  practice,  e.g.  through 

innovation procurement. 

3.5  Develop new economic models and incentives  

Developing  new  antimicrobials  or  alternative  therapies  requires  significant  and  long-term 
investments. In the classic business model, pharmaceutical companies recuperate research and 
development investments selling large volumes of their medicinal products. However, when 
any  new  antimicrobial  treatment  enters  the  market  and  is  sold  and  used  in  large  quantities, 
resistance can be expected to develop quickly. As the use of new antimicrobials needs to be 
restricted to minimise the risk of resistance development, the current business model results in 

14 

 
 
 
a  market  failure  for  antimicrobials,  and  works  against  efforts  to  conserve  effective 
antimicrobials. 

New  economic  models  need  to  be  developed  to  incentivise  antimicrobial  discovery  and 
development  while  reconciling  these  incentives  with  responsible  use.  Similarly,  in  the 
diagnostics sector, the development and uptake of novel diagnostics requires new models that 
take account of the relatively high price of diagnostics compared to the currently low price of 
antimicrobials.  Such  models  would  need  to  reflect  the  long-term  benefit  of  these  medicinal 
products and the societal value of limiting the use of antimicrobials while promoting the use 
of  novel  diagnostics.  This  would  be  in  line  with  the  increasing  trend  of  developing  new 
therapies combined with a diagnostic. 

Health  Technology  Assessment  (HTA)  methods  to  evaluate  the  added  value  of  such  new 
technologies  and  economic  analysis  to  understand  the  costs  and  benefits  of  different 
investments  to  fight  AMR  are  needed  to  provide  an  evidence  base  for  the  uptake  of 
interventions in the healthcare system and services. The involvement of HTA bodies in AMR-
related  discussions  could  raise  their  awareness  on  AMR  when  assessing  the  added  value  of 
new antimicrobials and alternatives, diagnostics or a combination thereof. 

The Commission will: 

- 

- 

increase  the  evidence  base  for  understanding  the  societal  costs  and  benefits  of 
different  strategies  for  fighting  AMR,  including  understanding  factors  that  influence  
the uptake of interventions such as novel diagnostics or preventive measures; 

support  research  into  the  development  of  new  economic  models,  exploring  and 
analysing  incentives  to  boost  the  development  of  new  therapeutics,  alternatives, 
vaccines and diagnostics; 

-  analyse  EU  regulatory  tools  and  incentives  –  in  particular  orphan  and  paediatric 
legislation – to use them for novel antimicrobials and innovative alternative medicinal 
products (e.g. vaccines, antibacterial, antifungal, antiviral agents) that currently do not 
generate sufficient returns on investment; 

-  encourage  Member  States  to  explore  results  and  recommendations  of  EU  research 

projects on new economic business models; 

-  develop new or improved methodological HTA approaches and foster methodological 
the  development  of  combinations  of 

consensus-building.  This  could  benefit 
technologies and co-dependent technologies including in the area of AMR. 

15 

 
 
 
3.6  Close  knowledge  gaps  on  AMR  in  the  environment  and  on  how  to  prevent 

transmission 

AMR is a good example of a One Health matter in which human health is connected to that of 
animals  and  the  environment.  Only  a  multidisciplinary  effort  can  provide  an  adequate 
response.  There  is  a  major  lack  of  knowledge  about  the  release  and  spread  of  resistant 
organisms in the environment and the threats and risks this poses to human and animal health. 
For example, the release of antimicrobials into the environment through human, animal and 
manufacturing  waste  streams  should  be  assessed  and  new  technologies  developed  to  enable 
efficient  and  rapid  degradation  of  antimicrobials  in  wastewater  treatment  plants,  organic 
waste streams or the environment. 

The  feasibility  and  implementation  of  monitoring  programmes  need  to  be  further  studied, 
including  the  development  of  harmonised  monitoring  of  antimicrobials  and  microorganisms 
resistant  against  antimicrobials  in  the  environment.  Using  harmonised  monitoring  and 
research data, risk assessment methodologies should be developed to evaluate risks to human 
and animal health. In the agri-food sector, the links between farming practices, animal health 
and AMR development and spread need to be further investigated. 

The Commission will: 

- 

support research into knowledge gaps on the release of resistant microorganisms and 
antimicrobials into the environment and their spread; 

-  explore  risk  assessment  methodologies,  with  the  support  of  scientific  agencies  and 
bodies,  and  use  them  to  evaluate  the  risks  to  human  and  animal  health  from  the 
presence of antimicrobials in the environment; 

- 

- 

support research into and the development of new tools for monitoring antimicrobials 
and microorganisms resistant against antimicrobials in the environment; 

support the development of technologies that enable efficient and rapid degradation of 
antimicrobials in wastewater and the environment and reduce the spread of AMR  

4  SHAPING THE GLOBAL AGENDA 

The EU and its Member States are part of an increasingly interconnected world characterised 
by  an  intensive  exchange  of  people  and  commodities  where  policies  implemented  in  one 
region can have significant impacts elsewhere. 

The  spread  of  AMR  across  borders  has  been  recognised  globally  and  areas  for  action  have 
been  internationally  agreed  and  outlined  in  the  WHO  Global  Action  Plan  on  AMR,  which 
serves as the global blue-print for AMR activities and has been endorsed by the OIE and the 
FAO.  The  Political  Declaration  of  the  United  Nations  General  Assembly  of  21  September 
2016  committed  high-level  support  to  the  international  implementation  of  the  WHO  Global 
Action Plan on AMR. 

The evaluation of the 2011 EU action plan recognised the positive effects of EU interventions 
at global level. Continued effort is necessary and is outlined below. 

16 

 
 
4.1  A stronger EU global presence 

Many  of  the  EU’s  domestic  AMR  policies  (e.g.  the  ban  on  using  antimicrobials  as  growth 
promoters in feed for food-producing animals) are already contributing to the achievement of 
international objectives against AMR. Nevertheless, it continues to develop and spread across 
the  world.  EU  involvement  and  collaboration  with  multilateral  organisations  such  as  the 
WHO, the OIE, the FAO and international forums should therefore be intensified in order to 
contribute to regional and global action on AMR, following the One Health approach. 

The Commission will: 

-  continue to actively contribute to the normative work of the WHO, the OIE, the FAO, 
and  the  Codex  Alimentarius  on  the  development  of  ambitious  international 
frameworks and standards/norms/guidelines/methodologies related to AMR; 

- 

reinforce  technical  cooperation  with  the  WHO  and  its  members  in  key  areas  of  the 
WHO Global Action Plan on AMR (e.g. the development of monitoring systems under 
the WHO Global Antimicrobial Resistance Surveillance System (GLASS), awareness-
raising, infection prevention and control); 

-  boost  support  for  the  International  Conference  on  the  Harmonisation  of  Technical 
Requirements for the Registration  of Pharmaceuticals for Human Use (ICH)  and the 
Veterinary  International  Conference  on  the  Harmonisation  (VICH)  on  relevant 
international guidelines/standards/norms related to AMR; 

-  work towards continued high-level political attention and commitment to AMR action, 

including in the United Nations forums, the G7 and the G20; 

- 

look  for  synergies  with  the  UN  Strategic  Approach  to  International  Chemicals 
Management’s  work  on  the  emerging  policy  issue  of  pharmaceuticals  in  the 
environment;38 

-  analyse  the  feasibility  of  setting  up  a  global  AMR  clinical  studies  network  in 

collaboration with G7 members39; 

-  continue and  strengthen  ongoing  collaboration within  the  Transatlantic Taskforce  on 
Antimicrobial Resistance (TATFAR), which includes the EU, the USA, Canada, and 
Norway; 

-  promote international regulatory convergence between the EMA and other regulatory 
agencies  such  as  the  US  Food  and  Drug  Administration  (FDA)  and  the  Japan 
Pharmaceuticals and Medical Devices Agency (PMDA) on development plans for new 
promising antimicrobials. 

38http://www.saicm.org/EmergingPolicyIssues/Pharmaceuticalnbsp;Pollutants/tabid/5477/language/en-
US/Default.aspx 
39 http://www.mhlw.go.jp/seisakunitsuite/bunya/hokabunya/kokusai/g7kobe/KobeCommunique_en.pdf 

17 

 
 
 
                                                            
4.2  Stronger bilateral partnerships for stronger cooperation 

The EU has gained valuable expertise and experience in relation to AMR, while some of its 
trading partners have taken different approaches and chosen different priorities in this regard. 
There is scope for more collaboration and closer ties with these partners to build consensual 
activities,  share  experiences  and  align  approaches,  for  the  benefit  of  all  sides.  Candidate 
countries  and  potential  candidates  benefiting  from  a  pre-accession  strategy  have  also  made 
commitments regarding alignment and implementation of EU legislation related to AMR, as 
have the neighbouring countries to which the European Neighbourhood Policy (ENP) applies 
or who have an Association Agreement with the EU. The Commission – with the help of EU 
agencies – will continue to support these countries through visits, best practice exchanges and 
capacity building. 

As  one  of  the  largest  markets  for  agricultural  products,  the  EU  can  play  a  major  role  in 
promoting its AMR-related standards, measures in food production, and standards on animal 
welfare, e.g. through its bilateral Free Trade Agreements (FTAs). The systematic inclusion of 
AMR-related  provisions  is  now  a  current  practice  for  the  Commission  in  all  new  FTAs. 
Further actions may also be considered to ensure a level playing field between EU producers 
and EU trading partners, e.g. so that efforts made by EU farmers are not compromised by the 
non-prudent  use  of  antimicrobials  in  EU  trading  partners.  This  could  include  linking 
concessions  made  to  EU  trading  partners  with  compliance  with  specific  EU  AMR  policy 
objectives. 

The Commission will: 

-  advocate  EU  standards  and  measures  for  tackling  AMR  in  trade  agreements  and 

incorporate them into cooperative arrangements in trade agreements; 

-  engage  with  major  global  players  and  strategic  countries  (e.g.  Brazil,  China,  India), 
contributing  towards  achieving  objectives of the  WHO Global Action Plan on AMR 
by sharing experiences, advocating best practices and thus stimulating actions outside 
the EU; 

- 

- 

support  EU  candidate  countries,  potential  candidate  countries  and  neighbouring 
countries  to  which  the  ENP  applies  in  the  alignment  with,  and  capacity  building  for 
the implementation of EU legislation related to AMR and EU standards; 

invite  the  European  Parliament,  Member  States  and  stakeholders  to  share  views  on 
actions  to  be  taken  to  ensure  that  efforts  to  combat  AMR  made  by  EU  producers, 
including farmers, do not place them at a competitive disadvantage. 

4.3  Cooperating with developing countries 

The AMR threat to public health and the social and economic burden it entails is even greater 
in developing countries. This is due to political, social, epidemiological and economic factors 
which may vary from those in developed countries. The EU’s development policy can play an 
important role in raising awareness, sharing experiences and supporting capacity  building in 
developing countries in order for them to be better equipped to control infectious diseases and 
prevent AMR. This process can be supported through dialogue, aid and cooperation activities, 
taking account of partner countries’ individual policy  priorities to strengthen health systems 

18 

 
 
 
 
and implement the sustainable development goals, in particular the third goal on good health 
and well-being. Particular attention should be given to lower income countries, where support 
is most needed. 

The Commission will: 

-  continue  to  contribute  to  reducing  AMR  in  least  developed  countries  through 
infectious  disease  programmes  such  as  the  Global  Alliance  for  Vaccines  and 
Immunisations (GAVI); 

-  assist  in  the  development  of  AMR  strategies  in  the  areas  of  food  safety  and  animal 
health through regional training workshops on AMR organised under the BTSF World 
initiative; 

- 

- 

support  partner  countries’  policy  initiatives  on  AMR,  where  appropriate,  through 
international  cooperation  and  development  instruments  (e.g.  Global  Public  Goods  & 
Challenges, the European Development Fund); 

support  the  development  of  resilient  health  systems  in  partner  countries,  e.g.  by 
strengthening the knowledge and evidence base, infection prevention and control and 
the quality and use of antimicrobials. 

4.4  Developing a global research agenda 

A  stronger,  more  interconnected  and  more  globally  oriented  AMR  research  environment  is 
needed. There are great benefits to be gained from further coordination between the European 
research agenda and its global counterparts. Many international initiatives have been launched 
during the last few years that would benefit from stronger collaboration in order to increase 
their impact, as expressed by the G739 and G2040 Health Ministers. 

The Commission will: 

- 

improve  global  coordination  of  research  activities  by  promoting  dialogue  and 
collaboration between international research initiatives; 

- 

support the establishment of a virtual research institute under JPIAMR; 

-  continue  collaborative  research  with  Sub-Saharan  Africa  in  the  context  of  the 
European and Developing Countries Clinical Trial Partnership (EDCTP) in particular 
in relation to tuberculosis, HIV/AIDS, malaria and neglected infectious diseases; 

- 

foster international research collaboration on AMR in the animal health sector in the 
STAR-IDAZ International Research Consortium.41 

40 https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/3_Downloads/G/G20-
Gesundheitsministertreffen/G20_Health_Ministers_Declaration_engl.pdf 
41 http://www.star-idaz.net/ 

19 

 
 
 
 
                                                            
5  MEASURING SUCCESS 

To  obtain  the  desired  effect,  it  will  be  important  to  closely  monitor  the  effectiveness  and 
performance of certain  key actions  under this action  plan at regular intervals and to  modify 
them if necessary. 

The  WHO,  the  OIE,  the  FAO,  and  the  Codex  Alimentarius  are  setting  up  systems  and 
developing standards to monitor global effects. 

The EU systems will measure EU and Member State effects. This can be done by determining 
a limited number of key outcome indicators, based on data already collected. These indicators 
will  be  developed  with  the  support  of  the  EU  scientific  agencies  (see  point  2.1)  and  will 
enable  Member  States  to  assess,  in  a  clear  and  simple  way,  the  progress  made  in  the 
implementation  of their national One Health action plans on AMR.  The indicators will also 
help Member States to set measurable goals to reduce infections by key antimicrobial resistant 
microorganisms in humans and food-producing animals, to improve the appropriateness of the 
use of antimicrobials in the human and veterinary sectors and to combat AMR in all sectors. 

This  progress  will  be  discussed  at  regular  intervals  in  the  One  Health  network  on  AMR,  to 
guide individual Member States and to determine if new actions are needed at EU level. 

6  CONCLUSION 

This Communication provides a framework for future actions against AMR and aims to make 
the best possible use of the EU legal framework and policy instruments, focusing on the real 
added value the EU can bring to the fight against AMR. 

Most  of  the  actions  can  be  done  by  adapting  and  reinforcing  existing  actions  for  a  more 
integrated, comprehensive and effective approach to combating AMR. Other actions focus on 
identified  gaps  in  the  EU  response  so  far  that  requires  new  activities,  the  discovery  of  new 
knowledge and the creation of new partnerships. 

The Commission is confident that this new One Health action plan can make a difference and 
will improve the EU performance in combatting AMR.  

The  action  plan  will  strengthen  collaboration  and  surveillance,  will  reduce  data  gaps  and 
allow  for  the  sharing  of  best  practices  within  the  EU.  It  will  create  more  synergies  and 
coherence between different policies according to the One Health approach. The action plan 
will  thus  support  the  EU  and  its  Member  States  in  delivering  innovative,  effective  and 
sustainable responses to AMR.  

The  action  plan  will  also  strategically  reinforce  the  research  agenda  on  AMR  and  actively 
promote global action.  

The Commission invites the European Parliament and the Council to endorse this One Health 
action  plan  and  calls  on  Member  States  and  all  those  involved  to  ensure  that  measures  to 
combat AMR are swiftly implemented. Only sustained ambition, continued commitment and 
concerted action can turn the tide and diminish this global threat. 

20