Intersectoral Coordinating Mechanism against antibiotic resistance
The Swedish government has appointed to the Public Health Agency of Sweden and the Swedish Board of Agriculture to chair an intersectoral coordinating mechanism that brings together representatives from national authorities and organisations. More information on the Intersectoral coordinating mechanism against antibiotic resistance, including Sweden's One Health National Action Plan, is available on the Swedish website of the Public Health Agency of Sweden.
These organisations are members of the group:
The Swedish Work Environment Authority is a regulatory authority with a mandate to ensure that laws about work environment and working hours are followed by companies and organisations. The authority issues regulations concerning preventive measures that the employer must take against infection risks in the work environment. Examples of such regulation are requirements for hygiene procedures, disinfection, provision of personal protective equipment and offer of free vaccination to workers.
In the capacity of supervisory authority inspector, the Swedish Work Environment Agency supervises microbiological work environment risks, for example infection risks with antibiotic resistant bacteria. The authority must ensure that employers prevent risks and reduce illness through systematic work environment work at the workplace.
The Swedish eHealth Agency coordinates the government's e-health initiatives and monitors developments in the e-health field, both nationally and internationally. The eHealth Agency is responsible for registers and IT services used by individuals, healthcare providers and pharmacies. The agency is also responsible for a national registry of electronic prescriptions for humans and animals, and a national product- and article registry of medicines, as well as for consumables and foodstuffs included in drug benefits.
According to its instructions, the authority has to ensure quality, manage, produce and provide national drug statistics as well as be responsible for providing a system for analyzing drug statistics that is available for, among other things regions and authorities. The agency is also responsible for collecting sales information and statistics on for example antibiotics to humans and animals and statistics.
Through cooperation between the eHealth Agency and other authorities, researchers and organizations, relevant statistics are produced with the aim of making visible the antibiotic sales and its change over time, difference between regions and the effect of new guidelines.
The Public Health Agency of Sweden is an independent public authority under the Swedish Government. The agency works to ensure good public health and to ensure that the population is protected against communicable diseases and other health threats. The mission within the area of antibiotics and antimicrobial resistance involves:
- working to preserve the effect of antibiotics on bacterial infections in humans and animals
- compiling and actively imparting knowledge to the health services, social services, and the general public on issues related to antibiotic resistance.
- participating in ensuring that prescribers, other concerned professional groups, and the general public apply available knowledge on antibiotic resistance.
- promoting initiatives at local and regional level on issues related to antibiotic resistance.
- highlighting issues related to the emergence and spread of resistance in other microbes than bacteria, and issues related to healthcare associated infections and infection prevention and control, which are included in the responsibilities of the Agency.
Forte is a government agency that promote and support basic and needs-driven research within working life, social and public health.
Fortes assignments include identifying research gaps and evaluating research. Collaboration with the research community, authorities and relevant actors in society is another important task. Forte also works actively to stimulate research collaborations across borders, both within the EU and in the rest of the world. Research questions within Forte's areas are often multidisciplinary in nature and include several sectors of society. Forte promotes knowledge transfer and dialogue about the research they fund. In this way, Forte wants to contribute to research results being disseminated and benefiting society.
FORTE – Swedish Research Council for Health Work and Welfare (forte.se)
Formas is a government research council for sustainable development. The council fund research and innovation, develop strategies, perform analyses and conduct evaluations. The areas of activity include the environment, agricultural sciences and spatial planning. Formas conduct evidence syntheses analyses that aim to facilitate Sweden’s endeavours to to achieve its environmental objectives. Formas funds research in strategic and research initiated calls within animal welfare and animal health. Many of the funded projects address AMR. Formas is also participating funder in the Partnership Animal Health and Welfare that funds projects and activities that challenges the issue of AMR.
The Swedish Board of Agriculture (SBA) is the administrative authority in the agriculture policy area, and is responsible, among other things, for matters of agriculture, horticulture, fishery and rural development. SBA is contributing to a living countryside and for Sweden to produce food in a sustainable and profitable way. SBA works for responsible use of antimicrobials and for reducing the risk of spread of resistance through efforts for a sustainable society with a healthy environment for people and animals. SBA participates in international work at EU level, in the Nordic Council of Ministers and in other international contexts such as WOAH, IPPC, FAO and OECD in matters concerning animal health and welfare, plant health and antimicrobial resistance.
SBA is responsible for national regulations in several areas. These regulations aim, among other things, to preserve good animal health and welfare and good hygiene in animal health and medical care, in the feed chain, in farm animals as well as in other animal species. This is regulated through various preventive measures, prevention and eradication of infectious animal diseases and obligation to report infectious agents in animals. These regulations regulate the use of antimicrobials and limit the possibility of using critically important antimicrobials for animals. Similarly, implementation of plant health regulations aiming at preventing the introduction and spread of plant pests as well as a framework to achieve the sustainable use of pesticides contribute to less antimicrobials and more healthy plants. All together contributing efforts to ensure safe food.
SBA compiles data on the use of antimicrobials in animals and manages a reporting system for this data. SBA also monitors issues of antibiotic resistance genes in genetically modified organisms within our areas of responsibility, mainly feed and plants. SBA supports the industry organizations in their work with infection prevention measures at the farm level and participates in the monitoring of antibiotic resistant bacteria. Within international development cooperation, SBA contributes with expertise in its area of operation.
The Health and Social Care Inspectorate (IVO) is a government agency responsible for supervising health care, social services and activities under the Act concerning Support and Service for Persons with Certain Functional Impairments. As part of the supervision mandate, IVO examines complaints against the health and medical care and its staff according to the provisions of the Patient Safety Act. The inspectorate is also responsible for controlling permits in the areas specified above with the overall objective to ensure that the population receives care of good quality and is conducted in accordance with laws and other regulations. IVO's supervision is planned and carried out based on risk analyses, unless otherwise stated by law, regulation or special decision from the government.
The Swedish Chemicals Agency is the responsible authority for assessing risks to health and the environment from chemical products, including pesticides and substances in goods. The Agency provides support to the government during the negotiation of proposals for new legislation, evaluates applications for authorisations of certain chemical products and carries out enforcement to ensure that companies comply with current chemical regulations. The Agency examines applications for permission to sell and use pesticides, including biocides and participates in the EU-wide review of active substances in biocidal products. Access to effective biocidal products can be a prerequisite for infection prevention and control in, for example, care environments. There are concerns, however, that they, like other pesticides, can contribute to the emergence and spread of antimicrobial resistance/antibiotic resistant bacteria. The rules on biocidal products and biocidal-treated goods are EU-wide.
The National Board of Trade is Sweden's authority for foreign trade, the EU's internal market and trade policy. The board works for free and open trade and the mission includes to integrate Agenda 2030 and the global goals for sustainable development in the policy. The authority follows and monitors Swedish interests within the framework for the free trade agreement negotiations that the EU conducts with third countries and provides government documentation before and during the negotiations. The National Board of Trade also works with trade policy that supports work against antibiotic resistance. Specifically, it means that the agency, the EU and third countries, within the framework of trade agreement with Sweden, must cooperate on reduced antibiotic use in animal husbandry to counteract antibiotic resistance.
The Swedish Food Agency works to ensure that the food, including drinking water, that is produced, sold and served in Sweden is safe, and that there is security in the supply of food both on a daily basis and in times of crisis. The agency works to prevent spread of antibiotic resistant bacteria via food. As part of its sustainability work the agency’s efforts includes contributing to reducing unnecessary use of antibiotics in food production. The agency:
- participates in various international contexts in the work against antibiotic resistance, both within the EU Commission and Codex Alimentarius.
- carries out surveys and assesses risks of resistant bacteria in food, and participates in knowledge-building projects together with other authorities
- gives advice and information about foodborne antibiotic resistance and countermeasures
- is the responsible authority for controlling antibiotic residues in food.
The Swedish Medical Products Agency acts for public and animal health, working to ensure that individual patients and the healthcare system have access to safe and effective medicinal products. The Swedish Medicines Agency works to promote environmental responsibility in the development, manufacture and use of medicines, medical technology and cosmetic products. A large part of the Swedish Medicines Agency work takes place in collaboration with other EU countries.
The Swedish Civil Contingencies Agency (MSB) is responsible for issues concerning civil protection, public safety, emergency management and civil defence in areas where other authorities have limited responsibility. This refers to measures taken before, during and after an emergency or crisis. MSB works via knowledge enhancement, support, training, exercises, regulation, supervision in close cooperation with the municipalities, county councils, other authorities, the private sector and various organisations to achieve greater security and safety at all levels of society.
The Swedish Environmental Protection Agency is the responsible authority for environmental issues in the areas of climate and air, land, biodiversity, contaminated sites, cycles and waste, environmental monitoring and research, both nationally and internationally.
The Swedish Environmental Protection Agency provides support by developing and conveying knowledge, formulating requirements, monitoring and evaluating. The agency contributes to the monitoring of the state of the water environment for occurrence of metals and various types of organic substances, including pharmaceuticals and pesticides. The agency also produces regulations, exercises supervisory guidance and is responsible for international reporting.
Swedish Environmental Protection Agency (naturvardsverket.se)
The National Board of Health and Welfare is a government agency with a wide range of activities and many different responsibilities within the fields of social services, health and medical services, patient safety and epidemiology. At the Board the field of antibiotic resistance and prevention control are important components of the national patient safety work. Within this field, the agency works to increase knowledge and awareness of antibiotic resistance and basic hygiene routines, for healthcare and care professionals and decision-makers inside the health system. The National Board of Health and Welfare's patient safety work spans across the agency and aimed to coordinate and support the implementation of the National Action Plan for increased Patient Safety in cooperation with several different authorities and parties.
The Swedish Veterinary Agency provide expert advice and monitor resistance and consumption of antibiotics as well as developing strategies for prudent use and strategies to reduce resistance. Specifically, SVA's activities include disease surveillance, preparedness, diagnostics, research, and communication. SVA is a risk assessment authority that follows and evaluates the risks for the spread of infectious animal diseases between animals, and between animals humans and the environment. This also applies to antibiotic resistance. SVA is also national veterinary medicine reference laboratory and in the expert area of antibiotic resistance the agency has a range of assignments, collaborations and networks within the EU and internationally.
Specific assignments in the field of antibiotics include:
- follow and analyze the development of resistance to antibiotics and others antimicrobial agents among microorganisms in animals and foodstuffs (instruction)
- work for a rational use of antibiotics for animals (instructions)
- report how the authority's activities have contributed to combating antibiotic resistance (regulation letter).
Sida is Sweden's government agency for development cooperation and we strive to create better living conditions for people living in poverty and oppression. Sida contributes to giving more people in the world access to equitable health care. The agency works with antimicrobial resistance within various thematic areas such as health, environment and climate, and agriculture and food supply. Examples include support to the ReAct network, the AMR Multi-Partner Trust Fund and the international training programme Healthy livestock – safe food. Sida also supports research and innovation, for example through JPIAMR and Global Health EDCTP3.
Swedish International Development Cooperation Agency (sida.se)
SLU is responsible for the only Swedish veterinary and animal husbandry programs and ensures that relevant knowledge related to antibiotic resistance is included in the training courses. SLU runs 12 environmental analysis programs. SLU also has a global commitment, mainly through SLU Global, to provide support, continuing education and other activities for sharing knowledge with a focus on low- and middle-income countries. SLU also has a broad field of antibiotic resistance research related to animal health and the environment.
The Dental and Pharmaceutical Benefits Agency, TLV, is a central government agency whose responsibilities includes determining whether a pharmaceutical product shall be subsidised within the pharmaceutical benefits scheme. As such, in the fight against antimicrobial resistance, TLV is seeking to ensure sustainable access to narrow spectrum antibiotics as well as to design and assess incentives for developing novel antibiotics – based on public needs and rational use of public resources.
The Swedish Research Council (VR) finances research and research infrastructure in all scientific fields, and is the largest state funder of research at Swedish universities and institutes. VR runs the National Research program on Antibiotic resistance. Within this program, VR participates in JPIAMR's annual calls and in bilateral calls with other countries. VR also finances research related to resistance development, both within the regular project grants without a thematic focus and within special calls. VR administrates JPIAMR's international secretariat and coordinates several EU projects in the field of antibiotics and antibiotic resistance.
Vinnova is Sweden's innovation agency. The agency brings together actors from different parts of society towards common objectives, identifies important needs and finances research and innovation for sustainable and competitive development. Vinnova finances several research and innovation projects aiming to reduce antibiotic resistance and health-care associated infections, such as Antibiotikasmart Sweden, Platinea, ENABLE-2, GENSAM and Availability of Antibiotics. Vinnova also has a national responsibility for participation in the Innovative Medicines Initiative (IMI), with a focus to produce new antibiotics in cooperation between the European pharmaceutical companies and the European Commission.
This professional association, part of the Medical Association, unifies Swedens 21 County Medical Officers. The County Medical Officers and their staff are responsible for planning, organizing, and leading communicable disease control in their regions. The office of the County Medical Officers has the authority of a governmental agency. They perform epidemiological surveillance of notifiable diseases and are responsible for outbreak control in the region. In addition, they provide guidelines to patients and medical health care professionals about necessary actions to prevent further spread of notifiable diseases and they are involved in contact tracing. An important part of their work is preventing communicable diseases such as sexually transmitted infections, where County Medical Officers cooperate with the society and health care providers. Furthermore, there are collaborations with local hygiene units regarding prevention of healthcare-associated infections and participation in antibiotic resistance efforts through local and regional Strama initiatives.
The County administrative boards, CAB, are state authorities that must ensure that the national goals the government sets up have an impact and reach out to residents regionally in each of Sweden's 21 counties. The governor of each county is appointed by the government and is tasked with follow-up on developments and informing the government about the county's needs.
In the area of antibiotic resistance, the role of the CABs is to carry out official controls concerning animal protection and welfare, medicinal use on farms, animal health staff including drug prescription, drug use and infection control in animal hospitals and clinics. The county veterinarians also interact with infectious disease physicians on issues related to One Health.
The CABs have a coordinating role in maintaining contact and cooperation with veterinarians, infection control physicians and municipalities (department of environment, health protection and food control). In relation to notification of animal diseases, epizootics or zoonoses, the county veterinarian is a link between animal keepers, primary producers, food industry, practicing veterinarians, The Swedish Board of Agriculture, The Swedish Veterinary Agency, The Swedish Food Agency, infectious disease physicians and municipalities.
Created in 2005, ReAct is one of the first international independent networks to articulate the complex nature of antibiotic resistance and its drivers. ReAct was initiated with the goal to be a global catalyst, advocating and stimulating for global engagement on antibiotic resistance by collaborating with a broad range of organizations, individuals and stakeholders.
ReAct’s work is based on four central goals:
- Support countries to develop and implement national action plans
- Engage and collaborate with civil society organizations, researchers, governments and international organizations such as the WHO.
- Work to ensure that global governance and coordination takes place in an efficient and inclusive way.
- Promote the development new antibiotics with a focus on global public health needs, and that these benefit everyone who needs them, in a sustainable way.
Strama is a national network of healthcare professionals that interacts with antibiotic prescribers, other actors in the healthcare system and the community, to promote learning and working methods for the responsible use of of antibiotics. Strama is a nationwide organisation with one national coordinating Strama group and at least one Strama group working in each of the 21 regional health and medical care administrations (regions).
Strama has been one of the main drivers for initiating political initiatives to support the Swedish work on antibiotic resistance nationally and internationally.
Strama is a trusted, evidence-based resource for guidance on the responsible use of antibiotics in healthcare facilities in Sweden. Beyond healthcare, Strama has also raised awareness and injected education about antibiotic resistance in schools, pre-schools, child care and nursing homes.
Strama – the Swedish Strategic Programme Against Antibiotic Resistance (strama.se)
The Swedish Association of Local Authorities and Regions is an employers' organisation that represents and advocates for the interests of local government in Sweden. All of Sweden's municipalities and regions are members. The regions organize, operate and finance the large part of the public sector healthcare in Sweden, and the municipalities have a responsibility for home-based care,care for the elderly and child care. The organisation supports and collaborates with regions and municipalities in the area patient safety, including iInfection prevention and control.
Swedish Association of Local Authorities and Regions (skr.se)