The policy brief "Fighting antimicrobial resistance in EU and EEA countries: embracing a One Health approach" examines the health and economic burden of antimicrobial resistance across European Union and European Economic Area countries and evaluates policies for reducing it. Drawing on OECD modelling, it shows that antimicrobial resistance remains widespread despite progress in reducing veterinary antibiotic use. The brief projects future trends in antibiotic consumption and resistance, quantifies additional hospital use and economic losses, and assesses 11 One Health interventions spanning human health, animal health, agri-food systems and the environment. It concludes that coordinated policy packages can prevent infections and deaths while producing substantial economic returns.
Key Insights
In 2019, average antibiotic sales for human health stood at 22.2 defined daily doses per 1,000 inhabitants per day, 7.5% lower than in 2009 but still 3.4% above 2000 levels.
Without stronger policy action, OECD projections suggest that antibiotic sales in human health could increase by 5.1% by 2035 compared with 2019.
Veterinary antibiotic sales in chicken, cattle and pig production more than halved since 2000, but still represented about 60% of total sales of active antimicrobial substances across the region.
Average resistance across 12 priority antibiotic-bacterium combinations reached nearly 22% in 2019, meaning more than one in five bacterial infections were caused by resistant organisms.
The brief reports an almost eightfold difference in estimated average resistance levels between EU/EEA countries with the highest and lowest prevalence.
Resistance to second-line antibiotics is projected to increase by nearly 45% by 2035 compared with 2005, while resistance to third-line antibiotics such as carbapenems could reach 3.2 times the 2005 level.
Patients with resistant infections spend more than 9.5 million additional days in hospitals each year across EU/EEA countries. Italy alone accounts for about 2.67 million of these extra hospital days.
More than 865,000 resistant infections occurred across EU/EEA countries in 2020, and more than 35,000 people die from resistant infections every year, according to ECDC estimates cited in the brief.
Antimicrobial resistance costs EU/EEA economies nearly EUR PPP 11.7 billion annually, equivalent to almost EUR PPP 24 per person.
About 56% of the total economic burden, approximately EUR PPP 6.6 billion per year, comes from additional health expenditure, while the remaining 44% reflects reduced workforce participation and productivity.
Although all EU/EEA countries had national AMR action plans, only 2 of 27 had allocated a budget for implementation; 12 had limited budgets and 13 had no dedicated budget.
Hospital-based antimicrobial stewardship could prevent nearly 2,700 deaths annually, while improved hand hygiene and environmental hygiene could prevent around 1,600 and 1,750 deaths respectively.
Several One Health interventions offer high economic returns: improved hand hygiene has an estimated return-on-investment ratio of 11.9, delayed prescribing 6.3 and pneumococcal vaccination 6.
Investing EUR PPP 3.4 per person annually in a mixed One Health policy package could prevent nearly 613,000 infections and more than 10,000 deaths, save over EUR PPP 2.5 billion in health expenditure and generate about EUR PPP 2.3 billion in productivity gains, returning nearly EUR PPP 3 for every EUR PPP 1 invested.