Press Release 08/2016

Ethics Council discusses ways out of antibiotic resistance

Antibiotic resistance leads to an estimated 25,000 fatalities per year in Europe and is currently increasing rapidly worldwide. Experts warn that even simple microbial infections could once again become acute threats for individuals and the population at large. The German Ethics Council discussed the ethical and societal challenges arising from this for patients and doctors on 23 November 2016 in Berlin during a public event in the "Forum Bioethics" series.

Among the causes for antibiotic resistance are deficiencies in hygiene; over- or misuse of antibiotics; excessive demand by patients; the massive use of antibiotics in livestock production; and the increasing global flows of humans and goods.

There have already been political reactions: Since 2008, the German Federal Government has pursued a national Antimicrobial Resistance Strategy; since 2011, there has been an EU action plan against the rising threats from Antimicrobial Resistance; and in 2015, the World Health Organization adopted a Global Action Plan on Antimicrobial Resistance. Even the United Nations has recently set this topic on the agenda of the General Assembly.

Against this backdrop, the German Ethics Council does not consider it as its duty "to give a moral blessing to the many measures or call for further measures in a morally indignant manner, but rather to review the decisions taken or to be taken for their respective accountability, now and for future generations, here and for other regions of this world, for humans and for the non-human shared environment", said Peter Dabrock, Chair of the Council, in his introduction.

The problem of antibiotic resistance will presumably not be solved in a purely technical manner, according to Lothar H. Wieler, President of the Robert Koch Institute, because bacteria are too diverse and too adaptive. In addition to the development of new antibiotics and new diagnostic tests, doctors and patients have to be better informed about the risks of antibiotic resistance; epidemiological surveillance has to be improved in order to be able to analyze precisely the scope of the problem and its development. Moreover, hygiene and prevention measures have to be strengthened, to help reduce the risk of infection. "Lastly, we must also ask ourselves," according to Wieler, "how we can organize the use of antibiotics as effectively and as much evidence-based as possible in order to prevent unnecessary usage".

Stephan Rixen from the University of Bayreuth sees the legislature more strongly under obligation. In view of the behaviour-influencing effects that the aforementioned "strategies" and "plans" could have on relevant basic rights – especially on the right to life, to physical integrity, to the subsistence minimum in terms of health, to therapeutic and academic freedom – the legislature should not be allowed to shift responsibility onto the executive authority of health services.

In the subsequent panel discussion moderated by Ethics Council member Alena Buyx, the chances and consequences of solution strategies were discussed by Jasper Littmann of the Robert Koch-Institut, Petra Gastmeier of the Charité – Universitätsmedizin Berlin and Wolf-Dieter Ludwig of the Drug Commission of the German Medical Association.

Antibiotics are a precious asset, according to Littmann, and it is also a societal duty, with a view to future generations, to preserve and protect their effectiveness. At the same time, a reliable supply of antibiotics continues to be lacking in many countries. "For this reason, we have to face the additional challenge of improving access to antibiotics and simultaneously fighting against their excessive use," Littmann said.

Petra Gastmeier pled for preventive measures, which ought to be applied equally in dealing with all patients. Infections could, for example, be prevented through consistent hospital hygiene, such as hand disinfection. Gastmeier recommended sensitizing doctors with regards to their prescription habits and writing "info-scriptions instead of prescriptions", as well as investing more strongly into targeted information and communication with the public.

Wolf-Dieter Ludwig criticized the often indiscriminate use of antibiotics in human and veterinary medicine. Hence, in addition to infection prevention, antibiotic stewardship programmes are of great importance in order to promote a rational handling of antibiotics and attain optimal treatment outcomes. If one wants to achieve, for example, a restrained prescribing of antibiotics, the public has to be informed more strongly about the judicious use of antibiotics. Moreover, according to Ludwig, there need to be "targeted incentives for pharmaceutical entrepreneurs to overcome the innovation deficit in this area through the development of new antibiotics – above all for the treatment of resistant pathogens."

The discussion showed the high ethical relevance of the topic in questions concerning fairness – ranging from the need for public facilitation of research to potential competition over resources between different affected patient groups, effective information for the public and professionals, and an increase of single rooms in hospitals. There was agreement especially to not primarily press negative sanctions in dealing with antibiotic resistance, but rather of creating a bundle of positive incentives for its prevention.

From the audience, which participated intensely in this discussion, there were calls to invest not only in those areas of pharmaceutical research that promised quick successes. There were also reminders to focus to an increasing extent on vaccinations in order to reduce the use of antibiotics. Furthermore, the focus should not remain limited only to human medicine; rather, the use of antibiotics in industrial animal husbandry should also be drastically reduced.

The event programme as well as the talks and discussion contributions of the participants can be accessed here (in German).