Antimicrobial resistance (AMR) is one of the most pressing global health challenges of our time, with Germany facing serious impacts as well. Antibiotic resistance is making infections harder to treat, endangering patient safety and the healthcare system’s effectiveness. The World Health Organisation (WHO) ranks AMR as a top public health threat in the 21st century, and the data in Germany underlines this urgency.

AMR Challenges in Germany
In 2022, the Robert Koch Institute (RKI) reported that approximately 9,700 people in Germany died from infections caused by resistant pathogens. The overuse and misuse of antibiotics in human and veterinary medicine are major drivers of resistance. Antibiotic use in animal husbandry, for example, has been shown to contribute significantly to resistance, which can transfer to humans via food or the environment.

Current challenges include:

• Excessive Antibiotic Use: Antibiotics are often not used in a targeted way in both human healthcare and animal husbandry.
• Pathogen Transmission: Resistant pathogens can spread to humans via food and environmental exposure, leading to infections that are challenging to treat.
• Antibiotic Supply Shortages: Since 2022, Germany has experienced shortages of key broad-spectrum antibiotics, like amoxicillin, which presents additional challenges for ensuring treatment availability.

Germany’s Antibiotic Resistance Strategy (DART)
Since 2008, the German government has pursued an extensive approach to combat AMR through its German Antibiotic Resistance Strategy (DART). Updated multiple times, DART takes a cross-sectoral, One Health approach that integrates human and animal health as well as environmental considerations.

Key steps in the DART strategy include:

1. DART Launch (2008): Establishing a surveillance system, promoting clinical guidelines, and providing training for healthcare professionals.
2. DART 2020 (2015): Expanding One Health approaches to address resistance across healthcare, agriculture, and environmental sectors with a focus on early detection and targeted antibiotic use.
3. DART 2030 (2023): The latest update focuses on six core areas, emphasising international cooperation and enhanced measures:
   • Prevention: Infection control and vaccination campaigns aim to reduce infection rates, thereby lowering the need for antibiotics.
   • Surveillance and Monitoring: Systematic tracking of antibiotic use and resistance.
   • Antibiotic Stewardship and Diagnostics: Improving the targeted use of antibiotics with precise diagnostics and tailored treatment decisions.
   • Communication and Collaboration: Awareness campaigns and networks to connect key stakeholders.
   • European and International Cooperation: Prioritising global collaboration in addressing resistance.
   • Research and Development: Supporting research into alternatives like vaccines, antimicrobial peptides, and personalised therapies.

Recommended Actions: Key Steps Against AMR
In a globalised world, AMR can spread rapidly across borders. To counteract this, stakeholders must focus on prevention and effective treatment strategies. Germany’s DART strategy offers a strong foundation for businesses to actively engage in shaping AMR policy. The upcoming Bundestag elections, which will be brought forward due to the collapse of the government coalition, also presents opportunities to spotlight this growing, invisible threat on the political stage.

Key recommendations for companies in the pharmaceutical and medical technology sectors:

1. Promote Alternative Therapies

• Advocating: Advocate for increased investment in alternative AMR research, such as bacteriophage therapy and personalised medicine, during election campaigns.
• Partnerships: Foster collaborations with universities and start-ups to secure political support for joint research projects.

2. Engage in Antibiotic Stewardship Programme Development

• Political Dialogue: Engage with policymakers to underscore the need for precise diagnostics and controlled antibiotic use.
• Diagnostics Funding: Push for political funding to support faster and more accurate diagnostics in healthcare.

3. Strengthen International AMR Collaboration

• Position AMR in the Election Debate: Raise awareness of AMR as a global health priority and advocate for international standards during the Bundestag election cycle.
• Engage in Global Initiatives: Support unified AMR standards through collaborations with WHO and EU programmes.

At RPP, we closely monitor developments in this field, leveraging the expertise of our European network of colleagues. If you would like to learn more about DART 2030 and European perspectives on antimicrobial resistance, please reach out to our Head of Office in Berlin, Raphael Podselver.