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In Belgium the Federal Public Service (FPS) Health, Food Chain Safety and Environment is responsible for antibiotics policy and sanitary risks. 3 scientific institutions fall under FPS:
• The Superior Health Council provides independent evidence-based advice and guidelines on infection control and on the containment of antimicrobial resistance in Belgian healthcare facilities.
• The Scientific Institute of Public Health (WIV-ISP) supports public health policy through research, expert advice and service. WIV-ISP is in charge of the national surveillance and surveys of healthcare-associated infections, antimicrobial use and antimicrobial resistance in hospitals and nursing homes. WIV-ISP coordinates the European point-prevalence survey of HAI and antimicrobial use in in long-term care facilities (European-wide: HALT II study). The institute also surveys antimicrobial resistance in food pathogens.
WIV-ISP also studies in vitro activity of antibiotics in clinical isolates, antibiotic resistance mechanisms and markers, as well as clinical management of drug resistant tuberculosis. The institute hosts the Belgian national reference centre for aminoglycosides and the national reference lab for antimicrobial resistance (in food pathogens).
• The CODA-CERVA (Veterinary and Agrochemical Research Centre) core activities are research, expert advice, services. Focus is on epidemic, endemic and emerging transmittable diseases in animals, zoonotic and emerging infectious diseases threatening public health; surveillance, risk analysis, and molecular epidemiology; contaminants and quality of the environment for safe food production.
The Belgian Antibiotic Policy Coordination Committee (BAPCOC) promotes responsible use of antibiotics and fights antibiotic resistance in Belgium. Therefore it focuses on surveillance, prevention and awareness (awareness campaigns on appropriate use of antibiotics and on hand hygiene). www.health.belgium.be/antibiotics
Research and Innovation policy is mainly under the responsibility of the regional governments and there are no thematic research programs. In Flanders the Department of Economy, Science and Innovation is responsible for research policy.
• Basic research is funded by the Research Foundation – Flanders (FWO). At the moment, there are two ongoing research projects funded relevant for the topic ‘antibiotic resistance’ for a total amount of € 484.500 over a total of 7 years, corresponding to € 69.214,3/year on average. The total amount for projects funded in the entire domain of medical sciences in 2010 was € 24,8 Million.
• Strategic basic research and applied research in Flanders is funded by the governmental agency for Innovation by Science and Technology (IWT). IWT is also involved in three ERA-net projects with relevance to the life science sector, including microbial resistance: EuroTransBio (ETB), Industrial Biotechnology (ERA-IB) and ERA-Infect.
In Wallonia it is the Service Public de Wallonie – Direction générale opérationnelle de l’Economie, de l’Emploi et de la Recherche”(DGO 6) that is responsible for research policies.
• The Fund for Scientific Research (FRS- FNRS) is funding basic research in the Walloon region universities.
• The Walloon health cluster BioWin supports the emergence of innovative R&D projects run collaboratively by industries, universities and research centres. Three projects have been funded by the Walloon Government relevant for the topic “antibiotic resistance” for a total amount of 9.7 M€ over a total of 11 years.
Antimicrobial research in Belgium is spread over 5 universities in Flanders and 3 universities in Wallonia and can be divided into four broad areas with the following aims:
1. To develop integrated point-of-care platforms for critical infections to rapidly detect bacteria, mycobacteria, and related antibiotic resistances that would allow a timely institution of adequate therapy that by itself would limit subsequent morbidity and mortality;
2. To identify biomarkers that might serve as potential targets for new antimicrobial therapies or as diagnostic/prognostic markers and development of sustainable phage therapy in human medicine;
3. To obtain in-depth knowledge of bacterial resistance mechanisms that are not related to the presence of resistance gene markers, such as biofilm and persistent cell formation, which would facilitate development of therapeutic options for recalcitrant infections;
4. To study the impact of antibiotic usage on the development of drug resistance in the human host at the gene, genome and microbiome levels to allow important insights on the selection potential of commonly used antibiotics and the impact on human infectious disease of the human commensal flora as well as of pathogen burden in the environment. This also includes epidemiology and monitoring in animals and environment.
Belgium is participating as well as co-ordinating several EU projects funded by DG Research (FP6 and FP7; GRACE, MOSAR, SATURN, RGNOSIS, APRES, IntopSens, TheraEDGE, TB PAN-NET etc.), IMI-JU (RAPP-ID, in collaboration with EFPIA partners), DG Sanco (ARPEC) and ECDC (EARS-Net, ESAC-Net, HALT-I and HALT-II). Furthermore, several international research and capacity building programs involving antimicrobial resistance issues specifically related to developing countries in Africa and Asia are also being funded by Belgian directorate general for development through the Flemish and French Interuniversity Council (VLIR-UOS, CUD) and the Institute of Tropical Medicine at Antwerp.