Government adopts new national strategy against antibiotic resistance

“We are facing one of the greatest and most underestimated threats of our time, with enormous repercussions for health and medical care if we do not act forcefully and collectively. Sweden generally has a low level of antibiotic resistance but we cannot take a back seat on this issue. In addition, resistant bacteria do not care about national borders. With this new strategy, we are setting clear and time-bound targets to protect human and animal health,” says Minister for Social Affairs and Public Health Jakob Forssmed.

“This work is long-term, but it is work that needs to be done for our future health and that of our children. Antibiotic resistance affects everyone in society. It’s about preventing an ever increasing threat to global health,” says Minister for Social Services Camilla Waltersson Grönvall.

“We enjoy a uniquely low use of antibiotics in Swedish animal husbandry. This is made possible by Swedish farmers’ day-to-day work with animal welfare and health. So, buying Swedish food, in particular animal products, is a way to reduce the risk of antibiotic-resistant bacteria,” says Minister for Rural Affairs Peter Kullgren.

“So far, we’ve been able to fight off infections, safeguard transplants and provide cancer patients with care that is safe. This needs to continue, and it requires society to act forcefully and collectively to combat AMR. We must protect both current and future patients,” says Lina Nordquist, group leader for the Liberal Party. 

The new strategy comprises AMR and is based on society as a whole helping to reduce the spread of resistant microorganisms and ensuring access to effective pharmaceutical products, such as antibiotics.

The strategy is evidence- and knowledge-based and has been produced in dialogue with experts, government agencies, organisations and international actors. It contains 17 overarching quantifiable and time-bound goals under five headings, with a focus on preventive work, responsible use of antibiotics, and access to pharmaceutical products and diagnostics.

The strategy puts particular focus on ensuring that efforts are implemented in several sectors – human and animal health, food production and the environment – as resistance is spread between people, animals and where nature can act as a reservoir.

Concurrently, the Government has decided on a five-year assignment for the Public Health Agency of Sweden and the Swedish Board of Agriculture to lead the work with a national action plan and to follow up on the implementation of the strategy. The Government has previously also decided on permanent funding for working group Strama, which supports the Swedish regions in the responsible use of antibiotics.

With its low antibiotic use and good access to data, Sweden already has a strong position in this area. The new strategy enhances conditions for long-term and coordinated work throughout society.

Overarching targets during the strategy period

Sweden’s targets for the level of AMR are as follows:

• The rate of increase in incidences of Methicillin-Resistant Staphylococcus aureus (MRSA) in blood for the period 2026–2030 does not exceed the rate of increase in 2009–2018.
• The rate of increase in incidences of ESBL-producing Escherichia coli in blood for the period 2026–2030 does not exceed the rate of increase in 2009–2018.
• In 2030, the incidence rate of Carbapenem-Resistant Klebsiella pneumoniae in blood does not surpass the level measured in 2019.
• The proportion of random Escherichia coli results from healthy slaughter pigs and poultry that are sensitive to all tested substances in the EU-harmonised resistance surveillance programme is not less than 70 per cent on two consecutive measurement occasions.
• Reliable data on resistance among animal pathogens is available to ensure effective resistance monitoring.

Sweden’s targets for the use of antibiotics are as follows:

• By 2030, the total use of antibiotics in outpatient and inpatient care has decreased by three per cent compared to 2019, measured in DDD per 1 000 inhabitants/day. 
• A maximum of 250 prescriptions per 1 000 inhabitants and year (outpatient care) in all regions until 2035.
• Prescriptions to humans of a certain category of narrower-spectrum antibiotics (as per the international standard AWaRe) remain above 75 per cent in 2035.
• The consumption of antibiotics in Sweden’s livestock production in relation to total consumption should be on a par with consumption during the period 2016–2025.
• The proportion of antibiotics for group treatment in food-producing animals does not exceed the proportion in the period 2016–2025.
• The proportion of penicillin in total consumption used in animals is not less than that of the period 2016–2025.

Sweden’s targets for preventive measures:

• Childhood vaccination coverage should not fall below the current level of 95 per cent, and in accordance with WHO recommendations, good vaccination coverage is desired among risk groups against influenza and COVID-19, amongst other illnesses.
• The ability to maintain the good health of livestock has been maintained.
• The hygiene and infection prevention efforts in the health and medical services of animals and in [humans’] health and medical care, social services and the Support and Service for Persons with Certain Functional Impairment (LSS) has reduced the risk of spreading infection and of healthcare-associated infection (HCAIs).

Sweden’s targets for healthcare-associated infections:

• The average rate of healthcare-associated infections in humans – as per the European Centre for Disease Prevention and Control (ECDC) definition – between 2026–2035 has decreased by a third compared to 2023 data from the ECDC point prevalence measurement conducted in Sweden.

Sweden’s targets for access to antibiotics:

• Shortages of antibiotics and other antimicrobial agents will be reduced by 2035 compared to 2025 levels.
• The best possible treatment for WHO Bacterial Priority Pathogens will be available on the Swedish market. 

As a whole, the environment remains a crucial part of the work against AMR, with aligned and binding EU legislation. By maintaining low levels of resistance and prescribing antimicrobials as well as minimising residues in the environment, Sweden is contributing to the overarching goals and to realising the strategy’s vision. For this reason, there is currently no need for measurable objectives in the environmental area.

The overarching objectives are to be achieved through work within 10 target areas. Several of the target areas apply to all of society and to multiple sectors.