Superbug risks fail to dent attitudes to antibiotics

Antimicrobial-resistant infections could be killing more than 33,000 people a year in Europe.

Warnings about drug-resistant superbugs aren’t enough to change most people’s behavior on using antibiotics, according to a Europe-wide poll out Thursday.

The Eurobarometer survey reported seven in 10 people who received information telling them not to take antibiotics unnecessarily said it didn’t change their views on using them.

Excess use of the drugs is contributing to a growing threat of antimicrobial resistance and related infections. As germs multiple they can develop the ability to defeat the medicines designed to kill them — and those infections could be killing more than 33,000 people a year in Europe, according to recent estimates.

“It is ridiculous,” European Health Commissioner Vytenis Andriukaitis said in response to the fact that people aren’t responding to warnings, at an event in Brussels Thursday. “We have science on one hand and lack of trust on the other.”

“Unless we act decisively, immediately and together, we could face a public health and financial disaster,” he added.

The EU is failing to gain traction with its effort to get member countries to combat the rise of resistance.

The Eurobarometer survey showed the number of people who had taken antibiotics in the last 12 months fell from 40 percent in 2009 to 32 percent in 2017. But less than half of people said they were aware that antibiotics don’t work to treat viruses, and 20 percent said they take antibiotics to treat flu or colds.

Seven percent of people said they took antibiotics without having seen a doctor or getting a prescription.

Andriukaitis said the survey, which polled around 27,400 people in 28 countries, shows Europeans “are still not sufficiently aware of the dangers of AMR.”

A report from the European Centre for Disease Prevention and Control (ECDC) on Thursday raised particular concern about the rise of superbugs in hospitals and care centers — estimating there are around 8.9 million cases of health care-associated infections in European facilities each year, many of them caused by multidrug-resistant bacteria.

Brussels is largely forced to take a backseat to national capitals | George Frey/Getty Images

The ECDC said these infections are being fueled in part by overprescribing of so-called broad-spectrum antibiotics, which wipe out multiple forms of bacteria and are stronger than traditional, more targeted antibiotics such as penicillin. Prophylactic antibiotics, meaning those prescribed before a surgery in anticipation of potential infection, are also being prescribed for too many days, it said.

Meanwhile the EU is failing to gain traction with its effort to get member countries to combat the rise of resistance.

The Commission released a One Health Action Plan in 2017 that included guidelines on how to ensure prudent use of antimicrobials in people, and promised to promote global standards in areas such as trade. It also set aside funding for research to monitor and control potentially fatal infections, and develop new antibiotics or vaccines to combat transmission.

But the EU’s limited competence in health means Brussels is largely forced to take a backseat to national capitals. While governments such as the U.K., Sweden and Finland have made fighting antimicrobial resistance a priority, Andriukaitis said Thursday he’s frustrated the EU can’t be more effective.

“Our main goal is to show that the EU is a best practice region fighting against AMR. But it will be empty words if you do not have concrete instruments at member states level,” he said.

Last line of defense

One area the Commission has been able to push new rules in on the use of antimicrobials in farm animals.

Andriukaitis said he is expecting a “major breakthrough in a few days” when the Council of the European Union will greenlight new rules on veterinary medicines and medicated feeds. These are designed to phase out the prophylactic use of antimicrobials as well as preventing their use to promote growth in cattle.

The EU will also under the new rules ringfence a protected list of antibiotics for human-use only — part of an attempt to keep drugs that still work in humans from becoming obsolete.

Malta and Croatia were named for their poor performances | Joe Raedle/Getty Images

The proposed list, a joint effort between the ECDC, the European Medicines Agency and the European Food Safety Authority, is expected to be put out for consultation next month, according to the ECDC.

ECDC Director Andrea Ammon said at the event Thursday that getting patients, health care providers and national governments to cut down on unnecessary prescribing will take time but there is still a chance to limit the threat from AMR.

The ECDC’s efforts to monitor antimicrobial resistance country-by-country in Europe have been “quite powerful because no one wants to be at the bottom” of the list, Ammon said. The agency also visits European countries at their request to assess their national antimicrobial resistance plans and recommend improvements.

Eight European countries saw a statistically significant drop in public consumption of antibiotics between 2013 and 2017, according to ECDC data released Thursday: Finland, Germany, Italy, Luxembourg, the Netherlands, Norway, Sweden and the U.K.

One area the Commission has been able to push new rules in on the use of antimicrobials in farm animals | AFP via Getty Images

Malta and Croatia were named for their poor performances, recording increases in antimicrobial consumption in hospitals.

A report on antibiotic use in humans by the World Health Organization published Monday concluded Greeks consume the most antibiotics on average in Europe, with Italy, France and Belgium also named as having high use.

Improvements are “not something that will happen very quickly because this epidemic has built up over years and it will take some years until it goes down. It needs sustained efforts,” Ammon said.

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Businesses call for state bailouts if UK crashes out of EU

Firms argue Brexit is a political crisis and no fault of theirs.

LONDON — A no-deal Brexit could require U.K. government bailouts like those following the financial crisis to prevent businesses from going bankrupt.

That’s the view of some in industry who see Brexit as a problem created by politicians that threatens to destroy British businesses and bring about an economic crisis.

Even if negotiators in Brussels craft a Brexit divorce deal in the coming days, it is far from certain that any agreement will be ratified by MPs in Westminster, and the U.K. could still leave with no deal at all, even though many among the country’s traders, manufacturers and in town halls say it is probably already too late to prepare adequately for it.

If the U.K. does fall over the Brexit cliff edge, ministers must leverage the government’s “financial muscle … in rather the way they did for the banks during the [2008] crash,” said Ian Wright, director general of the Food and Drink Federation, which represents 7,000 firms.

“If the government was to say no [to that] now there would be a very big question from British industry: ‘You were prepared to fund the banks who brought the crisis on themselves … but you’re not prepared to support British business which is completely innocent of any fault in the current circumstances?’”

Local councils have also expressed dismay at gaps in no-deal planning.

“Very few businesses in the U.K. asked for this to happen,” he added. “This is a crisis entirely created by politicians.”

While discussion of no-deal preparations has focused on what the government is doing — from re-engineering motorways to serve as lorry parks, to hiring more customs officers — industry and local government has also had a role to play.

They are closer to the day-to-day reality of U.K.-EU trade and their message is simple: At this late stage, there’s not much more that can be done to prevent major disruption.

In such a scenario some firms won’t survive, many predict.

Anti-Brexit demonstrators form a chain along Whitehall in London | Tolga Akmen/AFP via Getty Images

“If you’re an exporter and a significant proportion, say 30 percent or above, of your business is with the EU, or if you’re an importer and you have critical ingredients or products that you bring in from the EU — maybe you import feta cheese or salami — I think there’s probably relatively little you can do to be prepared for a no-deal Brexit. And for those businesses it’s perfectly possible that the disruption could be terminal,” said Wright.

A U.K. government spokesperson said in response: “It is in the interests of both the EU and the U.K. to strike a good deal and we are confident this will be achieved. But as a responsible government we are making plans for all possible outcomes, including the unlikely event that we reach March 2019 without an agreement.”

“This comprehensive no-deal preparation includes informing businesses through a series of technical notices what practical steps they need to take,” the spokesperson said.

Too late

When Whitehall published more than 100 “technical notices” over the summer giving advice to businesses, public authorities and citizens on what to do in the event of no-deal, the U.K.’s business lobby was unimpressed.

“We still don’t know exactly what no-deal would look like on the day it takes effect, whether the government would relax import controls or cut tariffs as a mitigating response,” said Allie Renison, head of Europe and trade policy at the Institute for Directors, which represents business leaders. “Even its own technical notices don’t suggest this, and much of the advice on import and export with EU has been fairly general.”

Only a third of the IoD’s more than 30,000 members have done contingency planning for a no-deal Brexit, Renison said.

Businesses using the ports could turn up the day after Brexit without the right paperwork or licenses.

Those that have not are often smaller firms that have struggled to afford the investment in staff, IT systems or outsourcing needed to ensure they are prepared for an EU third-country customs regime. With continuing uncertainty about whether there will or won’t be a deal, many have gambled on there being a deal rather than make an investment they can ill-afford.

“They can only prepare when they know the exact direction of travel,” said Renison. The IoD is also calling for financial support for business, in this case to assist with the cost of professional advice on no-deal planning. The Irish and Dutch governments have offered such schemes to businesses in their countries.

“As long as it remains government policy to potentially walk away, it is incumbent on them to make further provision to help firms be fully ready for the consequences of that outcome,” Renison said.

Local councils have also expressed dismay at gaps in no-deal planning. A report prepared for a meeting of the Local Government Association’s leadership board on October 17 said the government’s technical notices do not deliver essential practical guidance — or cash — for council-run port authorities that might be required to dramatically step up operations.

A lorry arrives at Dover Ferry Terminal on April 26, 2018 in Dover, England | Dan Kitwood/Getty Images

Pauline Bastidon, head of European policy at the Freight Transport Association, one of the U.K.’s biggest business groups, representing transporters, retailers and manufacturers, tells a similar story.

“Maybe three-quarters of the things that could have been done, if companies are waking up and deciding to do it now, it’s probably too late for March 2019,” she said.

At the moment U.K. government officials are considering waiving additional customs checks for all but security purposes in the event of no-deal. To alleviate snarl-ups at the ports of Dover and Holyhead, freight that needs thorough inspection will be sent inland to one of two clearing centers in southeast England at Milton Keynes or Heathrow. But there remains uncertainty at the very top of government about the stance French authorities on the other side of the Channel will take.

The problem is not just what the port authorities will do, but that businesses using the ports could turn up the day after Brexit without the right paperwork or licenses.

Concerns about food and medicine availability are well-documented.

“That’s quite probable,” said Bastidon, “certainly in the first few weeks. But should we really blame these companies? All these things come at a cost. When it comes to expenditure, companies have to ask: ‘Is it needed now?’ … The uncertainty around whether there is going to be a deal or not, all of this means that for industry it is a gamble [to spend on no-deal contingencies.]”

The government is aware of the risks.

Appearing before the House of Commons public accounts committee on November 5, Jon Thompson, chief executive of Her Majesty’s Revenue and Customs, listed “customer readiness” as one of the greatest no-deal risks.

“We are not going to be naïve about whether businesses will be ready for day 1, no deal,” he said. “That is currently rated red. To some degree, customers will not be ready for what would happen in the event of day 1, no deal.”

The consequences

In other words, the risk of no-deal disruption is real, and so therefore is the risk of goods shortages.

Concerns about food and medicine availability are well-documented, but even in these vital areas there remains uncertainty that enough has been done.

Representatives of pharmaceutical firms and the NHS warned Health Secretary Matt Hancock on October 31 that if a damning National Audit Office report on the state of government planning was correct, then “we will have widespread shortages if we do not respond urgently.”

British Prime Minister Theresa May leaves 10 Downing Street | Jack Taylor/Getty Images

As for food, the shelves will not be bare, Wright said, but added he is aware of firms already stocking ingredients from Europe that might become temporarily inaccessible in the event of no deal.

If the disruption lasts longer than a month or so, he said, there are “very, very few businesses which could stockpile enough of their ingredients or products this side or the other side of the Channel to be able to bulletproof themselves.”

“I think there will be businesses who through no fault of their own will be put at very serious risk,” he said.

Brexiteers fear price rises, not return of Irish border

Poll for POLITICO finds nearly half of voters believe that Brexit’s economic legacy will be positive a decade hence.

LONDON — Few things are likely to change the minds of the British public on Brexit — and the Irish border almost certainly isn’t one of them.

While the debate in Westminster, Brussels and Dublin is now almost solely focused on efforts to avoid a hard border between Northern Ireland and the Republic of Ireland, most U.K. citizens appear largely apathetic. According to an exclusive poll for POLITICO by the consultancy Hanbury Strategy, they are far more concerned about the possible effect Brexit will have on prices in the shops.

The data suggests that some potential negative outcomes of Brexit are more likely than others to make voters change their minds. And the responses of Leave supporters to the poll indicate they are particularly resistant to having a change of heart if things get rough — whatever the outcomes.

Presented with a list of possible consequences of Brexit, 35 percent of Leave voters said prices going up in shops would be likely to change their opinion — the highest of any potential negative outcome. In second place, 32 percent of Leavers said staff shortages in the NHS could make them think again.

But less than 22 percent of these voters said that the creation of a hard border between Northern Ireland and the Republic of Ireland would shift their stance on Brexit, while 42 percent said that it was unlikely to.

The figures are based on a poll of more than 3,000 people, including 1,236 Leave voters, carried out between October 29 and November 2, which was weighted to be representative of the U.K. population.

Notably, no single negative scenario — not a major recession (27.5 percent), millions of job losses (29 percent), food shortages (28 percent) or medicine shortages (30 percent) — is likely to prompt a majority of Leavers to change their mind.

Economic impact

Overall, respondents were much more positive about the long-term outlook for the U.K. economy after Brexit, but with some significant concerns — even among Leave voters — about the short-term impact.

Asked whether Brexit would have a positive or negative impact on the economy, 45 percent said that the weeks immediately after Brexit would be negative and only 26 percent thought the opposite (the rest expect a neutral impact). Even among Leave voters, 26 percent expect the impact weeks after Brexit to be negative for the economy.

However, 38 percent of people believe that a year after Brexit the U.K. will doing better economically. The exact same number believe things will have gotten worse.

Ten years down the line, 48 percent of people believe that Brexit’s economic legacy will look positive, compared to just 26.5 percent who think the effect will still be negative.

All that though depends on the U.K. government getting a divorce deal in the short term. Amid continuing uncertainty that Theresa May will be able to secure a Withdrawal Agreement that will satisfy the U.K. parliament, respondents were asked to choose from a range of options for next steps should MPs reject May’s plan.

Reflecting the continuing Leave/Remain split in U.K. opinion, the most popular options were to leave without a deal (34 percent) and stay in the EU (26 percent). Eighteen percent back the opposition Labour Party’s preferred option of a general election.

Given this range of options, only 9 percent said they want a second referendum on EU membership and only 8 percent back a referendum where the options would be May’s deal or no deal. Six and a half percent went for none of the above.

However, when asked the second referendum question in a different way — “When the negotiations with the EU are over, would you support or oppose a public vote on the outcome of the negotiation?” — 43 percent support the idea, 35 percent oppose and 22 percent don’t know.

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Dutch plant-growers don’t dig Brexit

The UK’s departure will mean orders take ‘substantially longer’ and cost more, horticulturalists predict.

DEURNE, The Netherlands — In the village of Deurne in the south of the Netherlands, Henk Raaijmakers is not looking forward to Brexit day.

“I am expecting complete chaos at the border,” said the 60-year-old owner of a large plant and tree nursery, “Brexit will be disruptive for my business and the Dutch horticultural sector as a whole.”

At his nursery, big wooden boxes filled to the brim with small blueberry plants in black plastic pots are being made ready for transport. This particular batch will go to Poland but inside the greenhouses tiny shoots of a wide variety of plants are growing until they are big enough to be shipped to the U.K.

Sweet berry honeysuckle, white beam berries, blueberries, blackberries, raspberries, goji berries: Raaijmakers’ superfood collection is enough to make any tabloid lifestyle editors’ eyes light up. His nursery is also packed with fig trees, azaleas, camelias and much more besides.

Raaijmakers’ company, which he started from scratch in 1982, consists of 2 hectares of greenhouses and 4 hectares of outdoor growing space. He exports nearly three-quarters of his total production to other countries. A quarter goes to the U.K., largely from online sales.

What all this means for gardening-mad Brits is not clear.

Normally a British customer waits three to four days for the plants to arrive. “Right now, fast delivery combined with good quality products is why the British import from the Netherlands,” said Raaijmakers, who is also vice president of the European Nurserystock Association, which represents growers across Europe.

He fears Brexit will change all that — meaning “substantially longer” waits and a significant price hike. “Forms, import fees and a longer list of phytosanitary obligations — which I think will also be used as a political tool after Brexit — will cost a lot,” said Raaijmakers. “Combined with the exchange rate of the British pound, this could mean that our products will cost up to 50 percent more.”

The business is typical of the Dutch horticultural sector as a whole, with Germany the biggest export destination and U.K. second. Growers have since October begun the production and planning process for next year. Not an easy task in the face of uncertainty, said Raaijmakers. As far as possible he will try to export plants and trees to the U.K. before Brexit day so local companies he works with can stock up. “But it is impossible to do this for online sales which is a substantial part of our business,” he added.

What all this means for gardening-mad Brits is not clear. Raaijmakers does not think the U.K. will be able to increase its domestic horticulture production. “Historically the U.K. is a garden-loving country, it is part of their culture. But production-wise it has never been able to match the demand,” he said. “About 90 percent of their shoots come from overseas. In addition, creating stricter rules for labor immigrants from Eastern Europe won’t help in scaling up the domestic production.” That will inevitably mean higher prices, he expects.

Raaijmakers intends to compensate for lost U.K. sales by branching out into new markets, but he sees wider consequences of Brexit for the sector.

“It is still sad this is happening. With Brexit, the Netherlands has lost a strong partner within the EU on innovation. Other countries, like France, are much more conservative when it comes to approving selection techniques. This could seriously put the quality of plants and trees all around Europe in danger in the long term,” he predicts.

Parliament endorses Brussels’ plan to split quotas after Brexit

The European Parliament’s trade committee today backed a draft law to grant the European Commission special powers to reduce EU food import quotas after Brexit. The law would allow Brussels to unilaterally carve out Britain’s share from EU food import quotas, if it fails to reach an agreement with World Trade Organization countries in time […]

The European Parliament’s trade committee today backed a draft law to grant the European Commission special powers to reduce EU food import quotas after Brexit.

The law would allow Brussels to unilaterally carve out Britain’s share from EU food import quotas, if it fails to reach an agreement with World Trade Organization countries in time for Britain’s exit from the EU customs union.

Parliamentarians only slightly amended the Commission’s original proposal and will now enter into negotiations with the Commission and EU countries on the final text of the law.

In the amendments, Parliament tried to ensure that the Commission would cut the EU’s tariff-free food import quotas by an amount equal to Britain’s average share, and would not go for a smaller reduction — which farmers fear would result in lower food prices, as the imported beef, milk, sugar and other foodstuffs are spread among a smaller market after Brexit.

The new amendments call for “ensuring that the market access into the Union as composed after the withdrawal of the United Kingdom does not exceed that which is reflected in the share of trade flows during a representative period.”

Another amendment automatically extends the Commission’s powers to do these adjustments from the original four years to perpetuity, should Britain remain in the EU customs union for longer than expected.

Madrid tells businesses to get ready for (any) Brexit

Only one-third of Spanish companies have made Brexit contingency plans.

MADRID — Spain is stepping up calls on businesses to get ready for any potential Brexit outcome.

Industry and Commerce Minister Reyes Maroto this week announced a series of actions aimed at “helping companies prepare contingency plans” for Brexit, including informational meetings with business leaders and a public website.

“We have to inform companies that any scenario can occur,” she told reporters. “Some [companies] still convey to us hopes that nothing will happen, and the reality is that something is going to happen.”

Only 31 percent of Spanish companies have made contingency plans for Brexit, and just 19 percent have started implementing those plans, according to a survey of 2,000 executives conducted by KPMG in coordination with the CEOE, Spain’s biggest business lobby.

A CEOE official said the government has told businesses to prepare for three potential scenarios: A no-deal Brexit (with the U.K. falling under the trade rules of the World Trade Organization), a so-called Canada-plus agreement — which would go beyond the EU’s deal with the North American country — and a deal whereby the U.K. remains in the EU customs union.

Spanish Prime Minister Pedro Sanchez has told civil and business leaders to prepare for any kind of Brexit | Raul Arboleda/AFP via Getty Images

Madrid has consistently advocated for the softest possible Brexit, under both the current Socialist and previous conservative governments. But there are growing concerns among officials that this may not be the outcome, leading some to fear Spain could be one of the biggest economic losers from Brexit.

The U.K. is the biggest recipient of Spanish foreign investment, the second largest foreign investor in Spain and the fifth biggest destination for Spanish exports. The U.K. also sends the largest number of tourists to Spain, and Brits buy more real estate in the country than any other foreign nationals, according to KPMG.

On top of that, more than 300,000 British nationals live in Spain — the highest number from any EU country — and around 150,000 Spaniards live in the U.K.

Maroto’s comments follow a series of warnings in recent weeks by Socialist Prime Minister Pedro Sánchez and his Foreign Minister Josep Borrell, asking both public administrations and business leaders to get ready for any kind of Brexit.

“The agreement on air transport is the most important thing” — Josep Borrell, Spanish foreign minister

Speaking in Parliament last week, Sánchez called on all economic, social and institutional stakeholders to elaborate “their own contingency plans” to face “any kind of scenario that can occur after March 29, 2019.”

Last month, Borrell warned the Congress of Deputies that many companies still don’t have contingency plans, when they should. “It’s important for people to understand that we must be ready for any eventuality,” he said.

A Spanish diplomat working on the Brexit negotiations said the likelihood of a cliff-edge, no-deal scenario had increased slightly after the EU and the U.K. failed to reach an agreement in October, leading Madrid to accelerate preparations.

The diplomat said Deputy Prime Minister Carmen Calvo is coordinating plans across all government departments, which, he said, includes getting ready to hire extra customs officers, as well laying out urgent regulations on trade protocols or phytosanitary standards.

He said Madrid was stepping up calls for everyone to get ready for Brexit after seeing that Spanish companies lagged their German and French counterparts in their preparations.

Top among Madrid’s economic concerns is the fate of the aviation sector.

“The agreement on air transport is the most important thing,” Borrel said in Congress. Spain’s flagship airline Iberia is part of the IAG conglomerate that also owns British Airways, Aer Lingus and Vueling.

Spanish officials have also expressed concerns about the fishing industry — Spanish shipowners partly rely on British waters — tourism and expected cuts to agricultural subsidies and structural funds.

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