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Head of Epidemiology & Risk, National Food Institute, 
Technical University of Denmark

Johanne Ellis-Iversen PhD MSc DVM is Head of Epidemiology and Risk Assessment Group at The Danish National Food Institute that integrates and interpret the data from the national surveillance data on AMR and AMU (DANMAP). The group also supports EFSA in their surveillance data management and harmonization of data collation on zoonoses and AMR in the EU, and represent Denmark in international networks on surveillance of zoonoses and AMR and on risk assessment. Johanne is also a veterinary epidemiologist and senior advisor for the Danish Government on microbiological food safety and a Steering Committee member of DANMAP. She is Head of Scientific Committee for International Conference for Animal Health Surveillance (ICAHS2020), a member of EFSA’s Risk Assessment Network and VET-MED-NET Scientific Committee. Previously, she was a veterinary advisor for the UK government department, Defra, providing advice mainly on design of surveillance programmes, data interpretation and risk assessments. Her international experience also expands to Bangkok, working with a joint US-Thai laboratory (AFRIMS) doing research and surveillance of foodborne pathogens and antimicrobial resistance in South East Asia and conducting research for policy in the UK and Denmark.

Session 5: From action plan to actions (2)

[5.2] Integrated surveillance – a success story

DANMAP integrated surveillance – a success story

DANMAP is the Danish integrated surveillance system for antimicrobial use and antimicrobial resistance in animals, food and people. It was founded in 1995 and reports are available on Teach year, the report is downloaded around 9000 times from all over the world. DANMAP’s main objective is surveillance of all antibiotic consumption and antibiotic resistance in Denmark. The surveillance is supported by a substantial research programme to develop new surveillance methods and investigate associations between use of antimicrobial agents and occurrence of resistance in both animals and humans among bacteria from animals, food, and humans. DANMAP is a multisector initiative, because AMR is a cross-sector problem that needs addressing in collaboration between all relevant actors. AMR is also a global problem and today, DANMAP is intertwined with reference laboratories and collaboration centers for EU, WHO and FAO, actively supports development of EU AMR surveillance and offer training and workshops for agencies around the world.

For 23 years, Denmark has actively intervened to reduce antimicrobial use in both humans and animals, using DANMAP as the evidence base for policy action. Many different interventions have been implemented years leading to a reduction in antimicrobial use in Denmark. When antimicrobial growth promoters were faced out in 1997, DANMAP demonstrated a dramatic reduction in macrolide resistance in enterococci. DANMAP also illustrates how campaigns for GPs to reduce prescription for specific diseases have measurable effects on the amount of antimicrobials used in the primary health sector. Many other interventions have been applied in Denmark during the 23 years including differential tax on veterinary products, removing financial incentives from veterinarians for selling antimicrobials, restrictive license policies for selling antimicrobials and electronic systems to capture all drugs sold. One of the most important interventions is the continued public awareness on AMR. This influences not only consumers, but also ensures that AMR stays high on the political agenda, proving sufficient support for surveillance and research to continue to work to solve the problem of AMR worldwide