EPA - Ireland's Environment, An Integrated Assessment - 2020

Chapter 14: Environment, Health and Wellbeing Figure 14.10  Ireland’s first National Action Plan on AMR (iNAP) (Source: Government of Ireland, https:// www.gov.ie/en/publication/ec1fdf-irelands-national-action-plan-on-antimicrobial-resistance-2017-2020/) STRATEGIC OBJECTIVE 1: Improve awareness and knowledge of AMR STRATEGIC OBJECTIVE 2: Enhance surveillance of antibiotic resistance and antibiotic use STRATEGIC OBJECTIVE 3: Reduce the spread of infection and disease STRATEGIC OBJECTIVE 4: Optimise the use of antibiotics in human and animal health STRATEGIC OBJECTIVE 5: Promote research and sustainable investment in new medicines, diagnostic tools, vaccines and other interventions The first detection of the AMR bacteria carbapenemase- producing Enterobacterales (CPE) in European seawater was reported in Ireland in 2017 (Mahon et al. , 2017). Untreated sewage discharged in the area was found to be the likely source of the CPE detected in this study. CPE is currently one of the superbugs that is most difficult to treat and, in October 2017, it was declared a public health emergency in Ireland. 6 Sewage, which contains pooled urine and faeces from the surrounding population, is a significant transmission route of AMR to the environment. This finding again highlights the absolute urgency and increased pace required for Irish Water to address the major issue of untreated sewage from the equivalent of 77,000 people being released into the Irish environment every day. In October 2019, the European Centre for Disease Prevention and Control and the European Commission’s Directorate-General for Health and Food Safety carried out a country audit to review policies and activities relating to AMR in Ireland. The EPA, with support from the Department of Housing, Local Government and Heritage, arranged a dedicated environment-focused day that provided a broad overview of progress and goals in various areas relevant to the international audit delegation. The unpublished report concluded that: ‘In general, the commitment of actors, in all sectors and at all levels, to the control of AMR in Ireland is a positive example for other countries. There has been progress in AMR control on many levels and, while AMR will likely remain a significant 6 https://www.hse.ie/eng/about/who/healthwellbeing/our-priority- programmes/hcai/european-antibiotics-awareness-day/public-health- emergency/ challenge for the country, there are several achievements to build upon for future actions.’ More specifically for the environmental sector, the report concluded that: ‘In relation to the environmental sector, the monitoring of watch list substances under the Water Framework Directive is being carried out. The competent authorities are also working to address the issues with the quality of the water supply, untreated wastewater and the correct disposal of medicines. Additionally, the environmental and veterinary sectors have undertaken multiple actions on awareness raising, surveillance of AMR and research.’ Monitoring antimicrobial use and resistance trends is vital to inform policy developments and monitor the impact of interventions over time. While there is established surveillance of antimicrobial use and AMR in the human and animal health sectors (Government of Ireland, 2019a), there is currently a lack of systematic surveillance of antimicrobials and AMR in the environment, other than the EU Water Framework Directive ‘watch list’, which all Member States currently undertake to monitor. This means that there are no baseline data on which to track changes or assess the extent of AMR in the environment. Ireland is not alone in this regard and has an opportunity to take action on this. A systematic surveillance system for AMR in the environment, integrated with existing human and animal surveillance systems, would be a solid basis for safeguarding the health of humans, animals and ecosystems against the threat of AMR. 375