Antimicrobial Resistance: A One Health Approach

1. Antimicrobials are medicines
2. Antimicrobial Resistance
3. The One Health approach to Antimicrobial Resistance
4. National Interdepartmental AMR Consultative Committee

5. Ireland’s National Action Plan on Antimicrobial Resistance 2017-2020 (iNAP1)
6. Ireland’s second One Health Action Plan on Antimicrobial Resistance 2021-2025 (iNAP2)
7. Ireland’s second One Health National Action Plan on Antimicrobial Resistance 2021-2025 (iNAP2) – Human Health Midterm Review.
8. Building One Health Action Under iNap 2

Antimicrobials are medicines

Antimicrobials are medicines such as antibiotics used to prevent and treat infections in humans, animals, plants, and crops. These medicines are very useful drugs and save lives. Antimicrobial medicines help people to live longer. They also help to protect people from infections when having surgery, giving birth and when receiving treatment for diseases including cancer.

Microorganisms are tiny living things that are found all around us. They are too small to be seen by the naked eye. Some microorganisms can make us sick. The most common types of microorganisms are bacteria, viruses, and fungi. Antimicrobial medicines work by killing harmful microorganisms or stopping the growth of microorganisms that cause infections.

Antimicrobials include medicines such as antibiotics, antifungals, antivirals and antiprotozoals.

Antimicrobial Resistance

When an antimicrobial medicine that previously worked to treat an infection or disease caused by a microorganism stops working or does not work as well as it did before, this is called antimicrobial resistance. Antimicrobial resistance means that there are less treatment options available. This makes the most common infections more difficult to treat. If infections cannot be treated the risk of diseases spreading, severe illness and death increases.

Antimicrobial resistance happens naturally over time. However, the rate of antimicrobial resistance is increasing because a huge amount of antimicrobials are being used across the world in humans, animals, and the environment. Antimicrobial resistance is being made worse by overusing antimicrobial medicines and by not using antimicrobial medicines correctly. The result of this is that common infections are becoming more difficult to treat and so called ‘superbugs’ are developing. This is a problem because many antimicrobial medicines do not work to treat ‘superbugs’. Antimicrobial medicines should only be used when they are needed to fight serious infections.

To help reduce antimicrobial resistance it is important to:

Only using antimicrobial medicines when they are needed.
Increase access to sanitation- making sure there is access to clean toilets and hand washing facilities.
Practice good infection and disease prevention and control in health-care facilities and farms.

The One Health approach to Antimicrobial Resistance

The ‘One Health’ concept recognises that the health of people is connected to the health of animals and the environment. One Health is a collaborative, multisectoral, and trans-disciplinary approach. One Health works at local, regional, national, and global levels to achieve the best health and well-being outcomes.

Ireland is fully committed to and engaged in addressing the issue of AMR and continues to collaborate at national, EU and international levels to progress this agenda. Ireland contributes to the European Antimicrobial Resistance Surveillance System and is a member of the EU AMR One Health Network.

Ireland’s One Health activities at national level led to the publication of the first One Health Report on Antimicrobial Use and Antimicrobial Resistance (2019) which brings together usage and resistance surveillance data in both the human and animal health sectors for the first time.

National Interdepartmental AMR Consultative Committee

In recognition of the serious and increasing threat of antimicrobial resistance, the Department of Health’s Chief Medical Officer (CMO) and the Department of Agriculture, Food, and the Marine’s Chief Veterinary Officer (CVO) established the National Interdepartmental AMR Consultative Committee in November 2014. This committee meets Ireland’s requirements to have an intersectoral co-ordinating system for addressing AMR at European Level.

Committee membership consists of representatives from both departments and across the human health, animal health and the environmental sectors. The Committee meets at least twice a year, or more if needed.

Ireland’s National Action Plan on Antimicrobial Resistance 2017-2020 (iNAP1)

Ireland’s first National Action Plan on Antimicrobial Resistance 2017 – 2020, known as iNAP1, was published jointly by the Departments of Health (DOH) and Agriculture, Food, and the Marine (DAFM) in October 2017. This was Ireland’s first roadmap for tackling Antimicrobial Resistance on a national level. The ways to deal with AMR are broadly covered under antimicrobial stewardship, infection prevention and control, research, surveillance, and communications. The 3-year plan was developed and implemented in line with the One Health approach.

More information on AMR

Ireland’s second One Health Action Plan on Antimicrobial Resistance 2021-2025 (iNAP2)

Ireland’s second One Health National Action Plan on Antimicrobial Resistance 2021-2025 (iNAP2) was published jointly by the Departments of Health (DOH) and Agriculture, Food, and the Marine (DAFM) in November 2021. iNAP2 is the successor plan to Ireland’s first National Action Plan on Antimicrobial Resistance 2017-2020 (iNAP1) and outlines over 150 actions to tackle the threat of AMR.

The development of iNAP2 was informed by a number of external stakeholder engagements; the learning from two public health emergencies, COVID-19 and CPE ; recommendations received as a result of thejoint monitoring visit from the European Commission and European Centre for Disease Control ; and learning and experience from the implementation of iNAP1. iNAP2 also adopts a One Health approach and aligns with the Resilience and Recovery 2020-2021: Plan for Living with COVID-19 (September 2020 ), the Department of Health Statement of Strategy 2021-2023 , the Programme for Government: Our Shared Future .

Both iNAPs follow the five strategic objectives outlined in the WHO Global Action Plan 2015:

Improve awareness and knowledge of AMR – through information campaigns, education, intelligence, and data
Enhance surveillance of antibiotic resistance and antibiotic use - through surveillance systems that facilitate greater standardisation of data collection, data linkage and sharing of real time information.
Reduce the spread of infection and disease - through infection or disease prevention and control measures, including national guidelines and standards in relation to hygiene and biosecurity practices.
Optimise the Use of Antibiotics in Human and Animal Health - through development and implementation of antimicrobial stewardship programmes, promotion of prudent prescribing practices and access to rapid diagnostics.
Promote research and sustainable investment in new medicines, diagnostic tools, vaccines, and other interventions - through measuring evaluable costs of HCAI/AMR, identifying research opportunities and working with key stakeholders to develop alternative disease treatment tools.

Ireland’s National Action Plans on Antimicrobial Resistance will ensure a sustained focus on responding to AMR.

Ireland’s Second One Health National Action Plan on Antimicrobial Resistance 2021-2025 (iNAP2)

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Ireland’s second One Health National Action Plan on Antimicrobial Resistance 2021-2025 (iNAP2) – Human Health Midterm Review.

Ireland’s Second One Health National Action Plan on Antimicrobial Resistance 2021-2025 (iNAP2) – Midterm Review Report

As it was developed in a time of change and challenge for the health and social care services, iNAP2 contained a commitment to a mid-term review of the human health actions. This allowed provision of refinement of the actions for the remaining lifetime of the plan. This is now complete and was published on 11th May 2023.

iNAP2 Human Health Midterm Review – Infographic

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iNAP2 Human Health Midterm Review

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Building One Health Action Under iNap 2

A joint Departmental event was held on Thursday 23rd June 2022 at Farmleigh House to acknowledge the work done under Ireland’s National Action Plan on Antimicrobial Resistance 2017-2020 (iNAP1) in tackling AMR and promote even greater ambition under Ireland’s second One Health Action Plan on Antimicrobial Resistance 2021-2025 (iNAP2).

There were speakers from across the One Health sector and our keynote address was given by Ms Emer Cooke, Executive Director, European Medicines Agency.