Belgium "One Health" national action plan to fight against antimicrobial resistance.
Download the action plan and the operational plan
Antimicrobial resistance, also known as AMR, is one of the greatest threats to public health today and in the future. For many years, Belgium has been active in the fight against AMR, both in the field of human health and in the field of animal farming, and aims to reduce and improve the use of antimicrobial agents (and antibiotics in particular), in order to avoid the development and spread of resistant germs. However, our figures regarding the use of antimicrobial agents and the resistance show that more leadership and ambition are needed to reverse the situation.
Furthermore, evidence shows that there is transmission of resistant bacteria between humans, animals and the environment, and that a cross-sectoral and multidisciplinary approach is required. This national plan is based on a common “One World, One Health” approach, in which everyone is responsible for part of the problem and works together to provide the best possible care for people and animals, safe food and a healthy environment for all citizens.
The development of the plan is coordinated by the FPS Public Health, Food Chain Safety and Environment, which works in close collaboration with Sciensano, the Federal Agency for Medicines and Health Products (FAMHP), the Federal Agency for the Safety of the Food Chain (FASFC), the National Institute for Health and Disability Insurance (NIHDI), BAPCOC (Belgian Antibiotic Policy Coordination Committee) and AMCRA (Knowledge Centre for the Use of Antibiotics and Antibiotic Resistance in Animals).
- International organisations, including the Food and Agriculture Organization of the United Nations (FAO), the World Health Organization (WHO) and the World Organisation for Animal Health (OIE) who are working in partnership in tackling antimicrobial resistance (AMR), urge Member States to take action against AMR. Given the obvious and numerous interactions linking the human, animal and environmental aspects of this issue, any newly-implemented action plan should incorporate the "One World One Health" approach.
- AMR is a sensitive issue, since in addition to public and animal health, it could undermine public trust in the safety of healthcare, food (of animal origin in particular) and the environment, when for example multidrug resistant organisms spread through healthcare-associated infections or foodstuffs. As such, the public expects the government to take care of this problem
- Besides the human costs, AMR also entails considerable economic costs, for hospitals, for health insurance systems, as well as for the agricultural sector. As a result, a wide range of stakeholders are affected by this issue and need to work together to achieve a common goal.
- Various activities and initiatives to fight AMR have been organised in Belgium in recent decades, including the creation of BAPCOC in 1999, AMCRA in 2011, the MDRO Task Force in 2013, and the antibiotic convention on veterinary medicine in 2016 and 2021. Nevertheless, recent indicators show that additional efforts are necessary in several areas and that a renewed approach, enhancing the coordination and collaboration between the human and animal sectors and taking into account the environmental aspects.
Together with our partner administrations, at federal, community and regional level, and with the help of many experts and organisations such as BAPCOC and AMCRA, we have combined our strengths and knowledge and developed a new and ambitious action plan for the years 2020-2024. This Belgian national action plan has been validated the 17th of November 2021 and is based on the three pillars of health (human health, animal health and environmental health) and suggests concrete actions to fight AMR in a comprehensive and coordinated way. We are now ready to give new impetus to the fight against antibiotic and other antimicrobial resistance.
This plan was based on the recommendations Belgium received:
- during the joint visit of the ECDC (European Centre for Disease Prevention and Control).
Read the recommendations here: : https://www.ecdc.europa.eu/sites/portal/files/documents/ECDC-AMR-country-visit-report_Belgium-2017.pdf
- the recommendations of the European Commission (DG Health) in Belgium in 2017.
Read the recommendations of the European Commission : http://ec.europa.eu/food/audits-analysis/audit_reports/details.cfm?rep_id=3995
- during the Policy Dialogue. See the most recent event: #PolicyDialogue
- via the report of the KCE (Belgian Health Care Knowledge Centre) published in April 2019, "Proposals for a more effective antibiotic policy in Belgium"
Read the proposals : https://kce.fgov.be/sites/default/files/atoms/files/KCE_311B_Antibiotique_Politique_synthese_0.pdf
- during the assessment of the memorandum of understanding on MDRO,
Read the report of the assessment of the MoU (French only): https://www.health.belgium.be/fr/rapport-devaluation-du-protocole-daccord-concernant-le-plan-national-multidrug-resistant-organismes
- Via certain working groups of the BAPCOC.
- The contributions from the public consultation that was held from May 12 to July 10, 2021
Belgium publishes its "One Health" annual report on AMR
Download the BELMAP report 2022
Surveillance is a key tool for guiding infection prevention and control policies, defining intervention strategies, improving the quality of care and guiding research programs. To this end, there are well-established national surveillance programs for both the consumption of antimicrobial agents and the monitoring of the emergence of antimicrobial resistance (AMR) in humans, food-producing animals, the food chain and the environment. The different programs are organized with different objectives and it was until now difficult to get a clear overview of the Belgian situation for all sectors. The BELMAP report, the first Belgian "One Health" report on AMR, aims to summarize the results and trends of the existing monitoring programs, identify potential gaps and make overall recommendations for improving monitoring.
AMR in human health
- BAPCOC, the Belgian Antibiotic Policy Coordination Committee, has been working since its creation in 1999 to tackle antimicrobial resistance. To achieve this, BAPCOC relies on several working groups (ambulatory medicine, hospital medicine, platforms for hospital hygiene, awareness-raising, and veterinary medicine). Currently, most of its activities are related to human health. BAPCOC has recently published the 2019 version of the Belgian guide to anti-infectious treatments in ambulatory practice (French only) (link to: http://www.cbip.be/fr/chapters/12?frag=8000010
For more information: https://organesdeconcertation.sante.belgique.be/fr/organe-d'avis-et-de-concertation/commissions/bapcoc
- Sciensano, the Belgian scientific institute One health, resulting from the merger between the former Veterinary and Agrochemical Research Centre (CERVA) and the former Scientific Institute of Public Health (ISP), carries out various missions relating to the monitoring of antibiotic resistance and healthcare-associated infections.
For more information: : https://www.sciensano.be/fr/sujets-sante/resistance-aux-antibiotiques/role
- The NIHDI, the National Institute for Health and Disability Insurance, is also involved in the fight against antimicrobial resistance, in particular by laying down the conditions for the reimbursement of medicines, collecting data on antibiotic prescriptions anddrafting 'antibiotic feedback' reports for GPs. For more information (French only): : https://www.inami.fgov.be/fr/recherche/pages/default.aspx?k=antibiotiques
- For more information on the activities of the FAMHP (Federal Agency for Medicines and Health Products) in the fight against antibiotic resistance: : https://www.afmps.be/fr/info_patients/Antibiotiques
- The Communities and Regions also implement activities relating to the fight against antimicrobial resistance
In October 2019, the Federal Public Service Public Health, Food Chain Safety and Environment (FPS PHFCSE) finalised an assessment report of the "National Strategic Plan to tackle MDROs" (MultiDrug Resistant Organisms). The aim of this plan is to prevent the further spread of MDRO and to reduce incidences of MDRO contamination. The terms of this agreement are set out in a memorandum of understanding which was published on 21/11/2013 in the Belgian Official Journal.
The FPS has consulted the institutional partners in the fight against MDROs on the implementation, interest, associated difficulties, and possible recommendations for the future of the various elements provided for in this memorandum of understanding, via a questionnaire. This assessment is part of the drafting of a One Health national action plan for antimicrobial resistance, to be established by December 2019, although it also goes beyond this.
Read this report (French only) : https://www.health.belgium.be/fr/rapport-devaluation-du-protocole-daccord-concernant-le-plan-national-multidrug-resistant-organismes
AMR in animal health
- The AMCRA, lthe knowledge centre for the use of antibiotics and antibiotic resistance in animals, is a non-profit organisation financed by the government (FASFC and FAMHP) and sectoral partners, and has been working since its creation in 2011 to reduce the use of antibiotics in the livestock sector.
More information: https://amcra.be/fr/home/
- For more information on the activities of the FASFC (Federal Agency for the Safety of the Food Chain) in the field of antimicrobial resistance (French only) : http://www.favv-afsca.fgov.be/productionanimale/antibioresistance/
- For more information on the activities of the FAMHP (Federal Agency for Medicines and Health Products) in the fight against antibiotic resistance (Dutch only) : https://www.fagg-afmps.be/nl/DIERGENEESKUNDIG_gebruik/geneesmiddelen/geneesmiddelen/goed_gebruik/Antibiotica_Resistentieproblematiek
- Sciensano, the Belgian scientific institute One health, resulting from the merger between the former Veterinary and Agrochemical Research Centre (CERVA) and the former Scientific Institute of Public Health (ISP), carries out various missions relating to the monitoring of AMR. For more information: https://www.sciensano.be/fr/sujets-sante/resistance-aux-antibiotiques/role
AMR and environment
The Directorate-General Environment of the FPS Public Health, Food Chain Safety and Environment (DGEM) coordinates the environmental activities of the action plan in collaboration with the Federal Agency for Medicines and Health Products (FAMHP). The Regions also implement activities relating to the fight against AMR (e.g. groundwater and surface water analyses).
Past events :
- 18 November 2021: Webinar 1W1H: Antimicrobial drugs : Spread awareness, stop resistance:
On November 18, the One World, One Health team at the FPS Public Health informed you about this topic during a webinar in which several experts participated.
- 12 May - 10 July 2021: Public consultation :
Between 12 May and 10 July 2021, the FPS Health, Food Chain Safety and Environment organized a public consultation on the "Draft Belgian national action plan "One Health" to combat antimicrobial resistance". For more information : Consultation publique sur le projet de plan d'action national belge "One Health" de lutte contre la résistance aux antimicrobiens (FR)
- 22 november 2019 : Stakeholders dialogue : Presentation of the draft of the Belgian national action plan One Health against antimicrobial resistance (AMR)
- Program : Progamme.doc
- Presentations : Présentations.doc
- Rapport : forthcoming
- 22-23 November 2018 ‘Policy Dialogue’ in Brussels :
A 'Policy Dialogue' on AMR was organised by the FPS PHFCSE and the European Observatory on Health Systems and Policies on 22 and 23 November 2018. This meeting brought together around fifty Belgian actors active in the fight against antimicrobial resistance from the human health, animal health and environment sectors (representatives of the competent Ministers, competent administrations, knowledge centres and academics) as well as a dozen or so international experts. The aim was to develop a common understanding of the challenges related to AMR in Belgium, and to identify strategic objectives and priority actions. The programme and report of this policy dialogue can be found in the documents available below.
ECDC Report PDF document - 652.99 KB
European Commission : Final Report of a One Health Country Visit to Belgium with ECDC PDF document - 370.08 KB
Propositions pour une politique antibiotique plus efficace en Belgique - KCE PDF document - 924.95 KB
Rapport d'évaluation MDRO PDF document - 1.11 MB
Policy Dialogue : Final Programme PDF document - 564.99 KB
Policy Dialogue : Rapport final PDF document - 758.11 KB
Stakeholders Dialogue - Final Presentation PDF document - 6.7 MB
Programme Stakeholders Dialogue 22 novembre 2019 PDF document - 117.96 KB
Belgian "One Health" National Action Plan PDF document - 1.38 MB
Litterature Review - AMR PDF document - 1.05 MB
AMR : Plan opérationnel PDF document - 819.14 KB
BELMAP 2021 PDF document - 22.7 MB