It should be considered that the only reasonable way to resolve AMR in the long run is to reduce the reliance on antibiotics in the presence of infections.

Keeping patients healthy and making them more resilient to infections: Prevention strategies should be prioritised in EU health policies.

To successfully tackle the issue of Antimicrobial Resistance (AMR) it is paramount that health policies put more emphasis on health promotion in the European population^[1] and foster medical interventions that improve resilience of patients to infectious agents. This approach to resolving the AMR issue is currently insufficiently addressed.

An efficient immune system

Infectious illness arises when two factors come together: the contact with an infectious agent (microbe) and, more importantly, the susceptibility of the patient to the infectious agent. There is ample evidence that patients with a well-balanced active immune system are less susceptible to pathogens and fight off infectious diseases more effectively (health / patient resilience). Factors that help achieve resilient immune systems are for example the maintenance of balanced diets, healthy lifestyles, mental well-being, quality sleep, and regular physical activity.

Definition of health

In 1946, the World Health Organization defined health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’^[2], paving the way for a healthcare system founded on patient resilience. This patient-centred approach is also highlighted by the modern definition of health, emphasising that health is: ‘The ability to adapt and self-manage in the face of social, physical and emotional challenges.’^[3]. This meaning shifts the perception of health away from ‘a state of the absence of a disease’ and promotes a patient-centred care and positive health^[4] approach. In this approach, not only lifestyle choices but also treatments that improve the patient’s immune system responses play their role.

An effective and sustainable approach

A European health strategy founded on prevention, health promotion and patient resilience is an effective and sustainable approach in the fight of AMR:

1. Healthy populations put less pressure on health care;
2. Humans and animals resilient to infectious diseases will need fewer antibiotics and thus help reduce AMR;
3. Health promotion and patient resilience further a multisectoral One Health approach^[5] to AMR;
4. Medical research that invests in examining host factors will bring about a shift to health-oriented research and consequently health-promoting medicine.

The strategy to prevent and tackle AMR

Health promotion and patient resilience should thus be an integral part of any strategy to prevent and tackle AMR, alongside adequate preparedness, antibiotic stewardship, surveillance, and vaccine development. We propose the following actions:

1. Promoting healthy lifestyles in public education, through targeted campaigns and the inclusion of lifestyle coaches in primary healthcare;
2. Researching and investing in safe and effective non-antibiotic treatments and models that help prevent, treat and manage infectious diseases through improved patient resilience;
3. Fostering a proper One Health approach in multidisciplinary settings;
4. Researching and investing in non-antibiotic treatments that are environmentally friendly^[6].

Establishing effective and sustainable health and resilience-oriented healthcare system requires actions in the areas of policy, public education, research and development.

Brussels, January 2022

^[1]E.g. https://ec.europa.eu/health/system/files/2020-01/amr_2017_action-plan_0.pdf and https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32021R0522&from=EN

^[2] https://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf?ua=1

^[3] Huber M, Knottnerus JA, Green L, van der Horst H, Jadad AR, Kromhout D, Leonard B, Lorig K, Loureiro MI, van der Meer JW, Schnabel P, Smith R, van Weel C, Smid H. (2011) How should we define health? BMJ, 343():d4163. https://pubmed.ncbi.nlm.nih.gov/21791490

^[4] Huber M, van Vliet M, Giezenberg M, Winkens B, Heerkens Y, Dagnelie PC, Knottnerus JA. (2016). Towards a 'patient-centred' operationalisation of the new dynamic concept of health: a mixed methods study. BMJ open, 6(1), e010091. https://doi.org/10.1136/bmjopen-2015-010091

^[5] http://digitallibrary.un.org/record/842813/files/A_71_L-2-EN.pdf

^[6] https://ec.europa.eu/environment/water/water-dangersub/pdf/strategic_approach_pharmaceuticals_env.pdf