Copenhagen, 23 November 2023 - Antimicrobial resistance (AMR) is recognized by the World Health Organization as one of the ten major global public health threats, with an estimated 5 million deaths annually associated with bacterial AMR worldwide, of which more than half a million occur in the WHO European Region, comprising 53 Member States in Europe and Central Asia.   AMR occurs when microorganisms develop the ability to resist the antimicrobial drugs that are typically used to kill them and treat infections.  There are different types of antimicrobials, such as antibiotics for bacteria, antivirals for viruses, and antifungals for fungi, each targeting specific types of microorganisms. While AMR is a natural phenomenon, the development and spread of superbugs is being accelerated by the misuse of antimicrobials, rendering infections more challenging to treat effectively.   The alarming reality is that, without immediate intervention, AMR could result in up to 10 million deaths a year by 2050. Moreover, this burden falls disproportionately on low- and middle-income countries, exacerbating global health inequalities.  New data  WHO/Europe has conducted a standardized survey across more than a dozen countries of the WHO European Region, namely in the Western Balkans, the Caucasus, and Central Asia (including Türkiye), shedding light on the knowledge, attitudes, and behaviours surrounding antibiotic use and AMR. The survey is the first of its kind to be conducted in these countries, all of whom gave the research their full support. The results have been published in the journal Frontiers. The survey used the same methodology and questions as an established survey that is periodically carried out in the EU. Conducting surveys in this way, in close collaboration with the European Commission, enables WHO to achieve its goal of having a pan-European overview. Having a clear picture of the current situation makes it possible to monitor progress and evaluate interventions in the future.  The survey involved 8,221 participants from 14 countries, half of whom reported taking oral antibiotics in the past 12 months. Medical practitioners prescribed or directly administered the majority (67%) of the antibiotics. The reasons cited for taking the antibiotics included colds (24%), flu-like symptoms (16%), sore throat (21%) and cough (18%). This gives cause for concern because these symptoms are often caused by viruses against which antibiotics are not effective. Medical expertise is essential to make a correct diagnosis to determine whether antibiotics are the correct course of treatment.  The survey further highlighted a lack of enforcement around the use of a medical prescription for every course of antibiotics. Across the 14 countries, a third (33%) of respondents consumed antibiotics without a medical prescription. In some countries more than 40% of the antibiotics were obtained without medical advice. In contrast, the equivalent survey conducted across the EU in 2022 revealed that only 8% of respondents consumed antibiotics without a prescription.    WHO/Europe’s survey also highlights gaps in people’s knowledge. Just 16% of respondents were able to respond correctly to all of four awareness questions, which could indicate that people are taking antibiotics for the wrong reasons without realizing it. A majority of respondents (67%) were aware that unnecessary use of antibiotics can make them less effective, however nearly half of the respondents (43%) incorrectly said antibiotics are effective against viruses (they are not).   Equally worrisome is the fact that only 37% (and just 23% in the EU research) reported receiving any information about the importance of avoiding unnecessary antibiotic use in the past year, highlighting the urgent need for clearer and more targeted public health communication.  “This research clearly shows the need for education and awareness raising,” said Robb Butler, WHO/Europe’s Director for Communicable Diseases, Environment and Health. “All countries in our Region have regulations in place to protect precious antibiotics from misuse, for example preventing over the counter sales without prescription.  Enforcing these regulations would solve most antibiotic misuse among humans. Other drivers of AMR have their roots in the social and cultural norms learned in communities, for example not completing a course of antibiotics in order to save some for the next time you fall ill or share with a sick relative or neighbour. This learned behaviour can take time to change and it’s imperative that behavioural and cultural insights are used to the full when planning interventions.”  Behavioural and cultural insights    As global efforts to control AMR intensify, social and behavioural sciences are emerging as crucial, yet underutilized areas of knowledge and expertise that can guide interventions in AMR control, radically increasing impact.   “The use of antimicrobial medicines is intrinsically tied to human behaviour and deeply entrenched in social and cultural contexts, shaped by our attitudes, policies, and available choices,” commented Dr Danilo Lo Fo Wong, Regional Adviser for the control of antimicrobial resistance. “Conserving the effectiveness of antimicrobial medicines requires interventions at many levels, such as timely vaccination, improving hygiene or reducing inappropriate prescribing. Behavioural science and cultural context analysis have a pivotal role to play in understanding and addressing all these behaviours. They can provide critical insights into the barriers and drivers of behaviour, aiding in the development of effective interventions. We encourage and support countries to design and conducting targeted behavioural interventions, using the guidance provided in our ‘Tailoring antimicrobial resistance programme’.”    ENDS Link to newly published ‘WHO Europe Antimicrobial Consumption report 2020-2021’ https://www.who.int/europe/publications/i/item/9789289060042  Link to article on Roadmap adoption: https://www.who.int/europe/news/item/26-10-2023-countries-in-the-who-european-region-commit-to-action-on-antimicrobial-resistance-by-endorsing-a-new-european-roadmap Link to global BCI resolution: https://www.who.int/europe/news/item/20-06-2023-new-global-resolution-calls-for-establishment-of-behavioural-science-units-or-teams Link to regional BCI resolution: https://www.who.int/europe/teams/behavioural-and-cultural-insights    Notes to editors:   Countries participating in the WHO/Europe survey: Albania (ALB), Armenia (ARM), Azerbaijan (AZB), Bosnia and Herzegovina (BIH), Belarus (BLR), Georgia (GEO), Kazakhstan (KAZ), Kyrgyzstan (KGZ), Montenegro (MNE), North Macedonia (MKD), Republic of Moldova (MDA), Tajikistan (TJK), Türkiye (TUR) and Uzbekistan (UZB).  To address the lack of data on knowledge, attitudes and behaviour from the above-mentioned countries, the WHO Regional Office for Europe conducted a survey using the same questionnaire used by the European Commission for the Eurobarometer survey, Antimicrobial Resistance - November 2022 - - Eurobarometer survey (europa.eu), which is conducted regularly, most recently in 2022. The survey aims to establish harmonized baseline data on KAB (knowledge, attitudes, and behaviours) on antibiotic use and AMR in 14 WHO European Region Member States. The data are expected to support participating Member States in the development of targeted awareness raising and education interventions, and subsequently the evaluation of their impact. This survey combined with the Eurobarometer data gives WHO/Europe a pan-European overview making it possible to monitor progress and evaluate the effectiveness of interventions.  Several factors contribute to the development and spread of AMR including: the misuse and overuse of antimicrobials in the human health, veterinary and agricultural sectors; inadequate access to clean water, sanitation and hygiene for both humans and animals; suboptimal infection prevention and control practices in health-care facilities and farms; limited availability of quality, affordable medicines, vaccines and diagnostics; inadequate awareness and knowledge among healthcare providers and the public; and inadequate enforcement of legislation to regulate antimicrobial use.  A 2022 study in the Lancet estimated 4.95 million deaths associated with bacterial AMR in 2019 worldwide. Likewise, more than 35,000 people reportedly die from antimicrobial-resistant infections in the European Union and European Economic Area (EU/EEA) annually while another publication estimated 541,000 deaths associated with bacterial AMR and 133 000 deaths attributable to bacterial AMR in the WHO European Region in 2019.  'One Health' is an integrated, unifying approach to balance and optimize the health of people, animals, and the environment. It is particularly important to prevent, predict, detect, and respond to global health threats such as the COVID-19 pandemic. One Health involves the public health, veterinary, and environmental sectors. The One Health approach is particularly relevant for food and water safety, nutrition, the control of zoonoses (diseases that can spread between animals and humans, such as flu, rabies, and Rift Valley fever), pollution management, and combatting antimicrobial resistance (the emergence of microbes that are resistant to antibiotic therapy).    Press contacts:  Stephanie Brickman, brickmans@who.int   Bhanu Bhatnagar, bbhatnagar@who.int   Press Office, eupress@who.int  

This campaign is supported by new evidence from “The Global Tobacco Industry Interference Index 2023”, published by STOP and the Global Center for Good Governance in Tobacco Control, which shows that efforts to protect health policy from increased tobacco industry interference have deteriorated around the world. ​​WHO’s campaign aims to amplify youth voices, expose tobacco industry tactics and increase public awareness on the need to defend health policies and protect the health of future generations. Youth groups around the world called on countries to “...adopt decisions that shield us from the manipulative practices of tobacco and related industries.” “WHO stands with young people globally who have demanded governments protect them against a deadly industry that targets them with new harmful products while outright lying about the health impacts. We call on all countries to safeguard health policies from this deadly industry by not letting them have a seat at the policy-making table,” said Dr Ruediger Krech, Director of Health Promotion, WHO. The tobacco industry tries to interfere with countries’ right to protect people’s health by taking governments to court, or offering financial and in-kind incentives to be able to influence tobacco control policies, even at the upcoming WHO FCTC Conference of Parties. WHO supports countries in defending evidenced based tobacco control measures in the face of industry interference. The tobacco industry continues to lie to the public, using different ways to spread misinformation, including through: Front groups and third parties Social media influencers Sponsored events Funding scientists and biased research Supporting corporate social responsibility initiatives Recognizing the tobacco industry’s relentless efforts to market its products to vulnerable groups, especially young people, WHO is committed to expose the industry's attempts to weaken health policies and call on policy makers to stand firm against tobacco industry influence. There are 183 Parties to the Framework Convention on Tobacco Control that have committed to do this under the global health treaty.   The tobacco industry has a long history of lying to the public, even insisting that smoking does not cause lung cancer. Today we know that tobacco causes 25% of all cancers and kills over 8 million people each year, but the industry persists with marketing what they call ‘new’ and ‘safer’ products that we know are harmful to health, while still producing trillions of cigarettes each year. With half of smokers dying prematurely because of tobacco smoking, the maintenance of the tobacco and nicotine market relies heavily on recruiting new, young users, and tobacco companies employ multiple tactics to gain the trust and interest of young people at an early age. Menthol and flavoured cigarettes and candy-flavored e-cigarettes with eye-catching designs have further contributed to the popularization of these products among the young generation, all while leaving many consumers largely unaware of the negative effects on their health. The tobacco industry invests enormous amounts of money in lobbying against tobacco control policies and funds organizations that promote its interests. These tobacco tactics, when left unchecked, inflict immeasurable harm on public health. Moreover, the production and use of tobacco and nicotine products have a cascading damaging effect on other critical issues such as the environment, mental health, and child labor.\

Based on the assessment findings, members of the Interdepartmental Working Group reviewed IOM’s recommendations for improvement of the national legal framework on countering human trafficking in compliance with the international standards and best practices. The recommendations specifically covered the areas relating to criminalization of trafficking in persons and related offenses, investigation and prosecution, victim identification, status and access to support services, as well as prevention of human trafficking through safe migration and socio-economic empowerment of women and youth. The presentation of recommendations also featured examples of best practices on countering human trafficking from Asia and Europe that focus on survivor-centered approach in identification, referral, prosecution, protection and rehabilitation of trafficking survivors. According to IOM’s international expert Ms. Irina Urumova, who conducted the assessment, “Turkmenistan has key legal provisions in place on countering human trafficking, yet there is still a room for further improvement to ensure that the relevant legal framework is enforceable, which requires strong supporting regulations.” The presentation participants also reviewed issues relating to interagency cooperation and promoting the greater engagement of civil society stakeholders in combatting human trafficking. The event was a good opportunity to gain valuable insights into the capacity building needs of relevant government agencies and civil society stakeholders that will inform the design of capacity building activities for relevant national partners and stakeholders. The assessment findings will also inform the ongoing work on development of the new National Action Plan on countering human trafficking with the support of IOM in Turkmenistan. ……………………….. The International Organization for Migration has been working in Turkmenistan since 1997. IOM is one of the key partners of Turkmenistan in combatting trafficking in persons. Two previous National Action Plans of Turkmenistan on Combatting Trafficking in Persons (2016-2018, 2020- 2022) were developed and implemented with the support of IOM in Turkmenistan.

The visit aimed at providing technical advisory support in the implementation of the mhGAP-IG (Mental Health Action Gap) program in Turkmenistan. Additionally, the visit included piloting of the mhGAP-IG program at the International Traumatology Center, introducing the EQUIP program (ensuring quality provision of psychological support) and conducting a 6-day training on mhGAP-IG during the period of November 13-18, 2023.  The comprehensive training led by Dr. Peter Hughes aimed at enhancing the capacity of the family doctors, neurologists, and psychiatrists in the area of mental health providing psychological support to the patients. At the beginning of the training the participants took a pre-test to check their level of knowledge in mhGAP prior to the training. The participants of the training included representatives from the Ministry of Health and Medical Industry of Turkmenistan, International Center for Traumatology, Center for the Prevention of Alcoholism, Drug Addiction and Mental Illnesses, Turkmen State Medical University named after M. Garryyev as well as family doctors and neurologists from the health houses responsible for the implementation of mhGAP-IG in the country. Following the training, cascade trainings and supportive supervision will be implemented to ensure the effective dissemination of the knowledge gained at mhGAP training program. Over the course of the 6-day training various topics, including introduction to the mhGAP manual and pedagogical skills for addressing borderline disorders such as depression, neuroses, stress, child and adolescent mental health, epilepsy, depression, suicide prevention, dementia was covered. Following the training, the participants took part in Q&A session and took post-training test to assess their skills after the training. At the end of the training the participants were awarded with the attendance certificates of recognition for successful completion of the training from WHO CO in Turkmenistan and the Ministry of Health and Medical Industry of Turkmenistan.