This article is part of our special report One Health approach: Time for implementation.
The European Commission’s list of antimicrobials to be reserved for human use only is based on sound scientific evidence, an EU official stressed after EU lawmakers dropped their objection to the act implementing it.
The list is meant to help avoid the development of resistance against antibiotics and other antimicrobials in Europe by reserving some crucial substances for humans and thus minimising their intake as they could no longer be used for animals.
“For us, it is an important first step to have this list – it is an important issue of principle,” Claire Bury, deputy director at the Commission’s directorate-general for health and food safety (DG SANTE), told EURACTIV on the sidelines of a recent event.
The EU’s medicines agency EMA has recently published the list, as required by the regulation on veterinary medicinal products, in a bid to combat the scourge of antimicrobial resistance (AMR).
According to a recent study published in the medical journal the Lancet, AMR caused more than 1.2 million deaths in 2019 worldwide while antimicrobial-resistant infections played a role in almost five million deaths.
EMA recommendations guided the Commission’s implementing acts to designate “antimicrobials or groups of antimicrobials to be reserved for the treatment of certain infections in humans.”
However, the Commission’s plans have drawn criticism not only from stakeholders but also from MEPs.
Initially, lawmakers in the Parliament’s health and environment committee voted in favour of an objection to the Commission’s draft implementing act that contains the contentious list of antimicrobials.
MEPs urged the Commission to withdraw the draft and propose a new one in line with the recommendations in the World Health Organisation’s list “Critically Important Antimicrobials for Human Use.”
During the committee debate, several MEPs slammed the proposal for being “unambitious” and maintaining the status quo.
However, last week the European Parliament plenary rejected the objection with 280 votes against 269 and 46 abstained, thus saving the Commission’s implementing act and the antimicrobials list.
List based on medical evidence
The Commission’s Bury insisted the list will “have an impact in practice,” especially as the rules are set to apply also to imports from third countries, where many of the antimicrobials in question are still used.
She also emphasised that the Commission’s decision about which substances make or do not make the list had been based on scientific assessments from the EMA.
“We have been very clear that this is based on medical evidence from EMA that was put together including both doctors and vets, so all sides of the issue have been factored in,” she said.
One of the main points of contention is the omission of colistin, an antibiotic currently used in human medicine but also for livestock animals like pigs and cattle.
However, Bury pointed out that “the use has declined very significantly over the last few years.”
Some EU countries have already phased out the use of colistin for animals, and the Commission is “encouraging and working with member states to keep going in that direction,” she added.
Moreover, the official stressed that the list would be actively monitored and regularly revised in the future, taking into account any additional information stakeholders will submit.
Thinking human and animal health together
Another way to tackle antimicrobial resistance by managing trade-offs and interactions between human and animal health – like in the case of the Commission’s list – is through the more holistic ‘One health’ approach.
Policymakers, stakeholders or other decision-makers following this approach try to incorporate human health, animal health, and a healthy environment into their policies and decisions.
“Improving our understanding of the complex linkages between the wider environment, biodiversity, climate change and emerging infectious disease is essential to improving health crises and reducing the risk of future pandemics,” Dieter Schillinger, deputy director-general at the International Livestock Research Institute, explained at a recent event.
While many institutions at the EU and national level today subscribe to the principle of one health, especially since the onset of the COVID-19 pandemic, how consistently it is applied can vary considerably.
“Obviously, one health is a principle that we in the Commission espouse too,” Bury stressed during the event, adding it was enshrined in the mission statement of Health Commissioner Stella Kyriakides.
At the same time, however, she admitted the EU executive could do more in this area than it is doing so far, pointing out that many of those working in DG SANTE were still approaching issues “from the perspective or the training that they have or the policy they are responsible for”.
“We need to get them to think out of the box a bit more,” she concluded.
[Edited by Gerardo Fortuna/Zoran Radosavljevic]
