AMR: What are the alternatives for antibiotics?

Europe needs to lead the world on reducing antibiotics use, explains Mark Eyskens.
Photo credit: Adobe Stock

By Mark Eyskens

08 Jun 2018

Headlines have been filled with the news of 27 Ebola deaths in Africa. Yellow protective clothes clearly make an impression. Unlike 58,000 Indian new-borns a year dying because of antimicrobial resistance (AMR). You think this is just fiction? Think again.

During a recent event in the European Parliament, Lithuanian MEP Laima Andrikienė revealed that this number is a reality, partly caused by European companies buying the cheapest possible active pharmaceutical ingredients (APIs) from Indian companies. 

In India, the poorly regulated discharge of high levels of antibiotic waste into soils and rivers causes unprecedented antibiotic drug contamination, driving the development of resistance in bacteria.


More effective EU legislation such as the 2011 falsified medicines directive could have prevented this - but this was resisted by industry lobbying. Cheap APIs were simply too attractive. 

During the event, Dr Adam Roberts from the Liverpool School of Tropical Medicine said EU regulations should also protect people in developing countries. “So we should review the falsified medicines directive as soon as possible”, argued Andrikienė.

Professor Sirpa Kärenlampi, a former member of the European Commission’s 1999 scientific steering committee (SSC) on antimicrobial resistance, echoed Andrikienė’s comments and warned, “the release of antibiotics production liquid waste in the environment is a lasting threat to both animal and human health since it contains considerable amounts of resistance genes.” 

Dr Thomas Van Boeckel of ETH Zürich agreed explaining that over 90 per cent of all antibiotics end up in the environment.

Swedish MEP Fredrick Federley and his Czech colleague Pavel Poc warned that the global public health threat from AMR is potentially set to become the world’s largest cause of death by 2050. 

Poc revealed that China is set to overtake Europe, in tackling the AMR threat, with a proposed complete ban on antibiotics in animal feed from 2020. Therefore, he argued, Europe needs to regain the lead in fighting AMR.

This could be achieved by addressing inadequate business models, polluting production processes, ineffective trade regulations and low-priced lifesaving antibiotics that are still unfortunately being used in unreasonably large volumes in animal husbandry and human health.

Truly effective regulatory steps, focusing on delivering sharp antibiotics reductions starts with correct facts and figures “such as those obtained in the Netherlands with a reduction of some 64 per cent”, said Van Boeckel. 

France and the UK each report around 12,000 AMR related-deaths a year. However, the European Commission estimates that there are only 25,000 AMR deaths annually across the EU. This figure from the Commission just doesn’t add up given the statistics issued by Paris and London. 

Poc argued that “the time for half measures has run out. We must ensure that the European Commission stops and reduces AMR deaths and takes measures to prevent the unacceptable rise of AMR deaths outside the EU.”

Dr Michael Kuhn of COMECE, an influential Roman Catholic think tank, underlined that the alarming AMR developments are predominantly due to the decline of ethics and morality. 

Quoting Pope Francis, he said, “the misuse of antibiotics in human medicine, in livestock breeding as prophylaxis is just a symptom of something of a much deeper concern: it is the idea that we own the Earth and see it only as a commodity we can exploit.”

The updated EU AMR action plan was adopted by the European Commission in 2017 and claims to contain concrete actions to combat AMR.

However, highlighting that the main cause of AMR is the over-and misuse of antibiotics in animal husbandry, Van Boeckel said he regretted that the Commission had neglected the SSC’s advice in 1999 to impose stricter controls on the supply, production and distribution of antibiotics and to end financial inducements for veterinarians to sell antibiotics. 

To effectively combat the man-made threat of AMR, he argues that the EU should introduce a volume cap of 50 mg/PCU of antibiotics and to implement a user fee on the use of antibiotics in animal husbandry. The generated revenues could be used to fund research on alternatives for antibiotics. The Commission’s proposal to add a new label claim specifically for antibiotic alternatives within the feed additive Regulation was strongly supported by attendees at the event.

“Alternatives are indeed urgently needed”, said Irish deputy Matt Carthy, the European Parliament’s agriculture committee rapporteur on the EU’s AMR action plan. “The reason farmers use antibiotics is not because they want to, but because it’s the most efficient and effective way for them.” 

If available, he said, “farmers would be willing to use more expensive alternatives to antibiotics as long as effective protection from international, cheaper competitors could be ensured.”

AMR discussions over recent decades have to a certain extent been limited to ‘experts’ and society generally has been unaware of the “possible 400,000 European AMR deaths between 1999 and 2017”, explained Federley. Even nurses - the first responders for AMR patients - were kept in the dark about the AMR threat. 

Ber Oomen, Executive Director of the European Specialist Nurses Organisation (ESNO), revealed, “only a couple of years ago I had never heard of AMR”. 

ESNO, he said, is now seeking funding to help train nurses. “We call on the European Parliament and EU institutions to also help find funds for the establishment of a central registry of all AMR cases.”