News and Opinions  –  2023

Sweden: Towards an antibiotic smart society

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Imagine a society where everyone plays their part to safeguard antibiotics. And not just where they are directly being used - such as in health care settings - but also in schools, wastewater treatment facilities and child care centers across the country. This is the goal of the nation-wide initiative Antibiotic Smart Sweden. ReAct Europe is one of the collaborating organizations. 


People on Drottningatan in Stockholm city centre, Sweden. Photo: Shutterstock.

Antibiotic Smart Sweden is an initiative that promotes the understanding of antibiotic resistance not just a medical issue, but a public health issue that is relevant to the whole of society. Through setting up and encouraging the use of criteria in different sectors, the project demonstrates, in practical ways, how different parts of society can be antibiotic smart.

“It can be in the way we teach about the issue in schools, how we monitor and report antibiotic residues in wastewater, how we work strategically to reduce infections in pre-schools or long-term care facilities, or in municipalities’ guidelines for food procurement. We want to strengthen existing work, and foster better collaboration and management but also be a catalyst and engage new actors in society ”

explains Gunilla Skoog Ståhlgren, the Swedish Public Health Agency, one of two leaders of Antibiotic Smart Sweden.

Led by 4 stakeholders – with engagement beyond

A map of Sweden showing where the initiative Antibiotic Smart Sweden is piloted. At this point, in 40 places.
The map shows where there are ongoing pilots in Sweden. Currently around 40 of them in schools, pre-schools, primary care centers, hospitals, long-term care facilities and water treatment facilities. Click to enlarge map.

Antibiotic Smart Sweden started in 2019 and is led by the Swedish Public Health Agency and Research Institutes of Sweden (RISE) in collaboration with ReAct Europe and Swedish Strategic Program against Antimicrobial Resistance (Strama). This with funding from Sweden’s Innovation Agency – Vinnova.

Several municipalities and administrative hospital regions are also part of the mission. Numerous professionals and pilot sites are engaged.

Pilots across the country

Criteria are being piloted in several schools, pre-schools, primary care centers, hospitals, long-term care facilities and water treatment facilities across the country.

Several additional pilots are in the pipeline and discussions are held for possible expansion into the animal health sector.

Dr. Camilla Björn, RISE, the other leader of the initiative says:

“Antibiotic Smart Sweden gives us concrete tools for systematic work with antibiotic resistance. We have formulated criteria and activities to reach them in close collaboration with the respective sectors to ensure that the criteria are realistic and meaningful to them. We find that working with criteria helps us put spotlight on important areas to address within each respective context while also creating a commitment and an opportunity to inspire each other”.

Water and wastewater sector – work progressed the furthest

Photo: Shutterstock

One of the areas where work has progressed furthest is in water and wastewater sector. The criteria cover:

  • collaboration
  • measurements
  • sludge management
  • prevention of sewer overflow
  • understanding more through participating in research projects and
  • dialogue with industries upstream the wastewater treatment plant.

The piloting phase has just been finalized in February 2023 and the criteria are now being evaluated.

The water and wastewater organizations are keen to continue working and learn more about how they can contribute to an antibiotic smart society.

Towards an antibiotic-smart generation

To come closer to the vision of an Antibiotic Smart Sweden, young people need to be in the centre of the efforts. Schools have an important role to play. Criteria for antibiotic smart schools have been developed through dialogue with principals, teachers, researchers in pedagogy and other key actors. The criteria cover education and activities for students, training for staff, and sharing of experiences with a focus on making the topic engaging and inspire action.

Maria Pränting, Scientific Officer, ReAct Europe. Photo: Thomas Goecke

Dr. Maria Pränting, ReAct Europe says:

“While we have many dedicated teachers who are interested in working on this topic, it’s challenging of course to fit yet another topic into the already cramped curriculum. But the advantage with antibiotic resistance is that it can be a clear entryway to other important topics such as sustainable development, equity and ethics for example”

With more partners piloting and developing the criteria – and as citizens in their professional roles learn how to be antibiotic smart – the project is coming closer to its 2030 vision:

  • to have one million antibiotic-smart citizens
  • to have 100 antibiotic smart municipalities
  • to have all 21 Swedish administrative regions on board

There is also ongoing work to connect with international partners and organizations to share the experiences as well as taking inspiration from innovative practices around the world.

Gunilla Skoog Ståhlgren, the Swedish Public Health Agency, concludes:

“Of course there isn’t a one size fits all…primary care centers in different parts of the country or even in the same town, may choose to prioritize things differently depending on their capacity. This is not so important though.

What matters is the commitment, that we are working towards the same vision of a society where antibiotics continue working and save lives.”

Exchange experiences with other settings

While the process, including mapping, dialogues, piloting and evaluation would have to be developed locally – the Antibiotic Smart Sweden project are interested in sharing its experiences and are also looking for inspiration from innovative practices around the world that are already ongoing, or starting up.

Antibiotic Smart Sweden also want to raise awareness among the public. Using behavioral insights the project aims to reach different target groups in the population for knowledge and behavioral change. There is also ongoing activities to build a long term network for stakeholders working with the antibiotic resistance issue. All these parts together will lead us closer to the vision of an antibiotic-smart society.

Community engagement initiatives such as Antibiotic Smart Sweden or ReAct Asia Pacific initiative Antibiotic Smart Communities  are two examples to help implement aspects of National Action Plans on Antimicrobial Resistance.

For more information about Antibiotic Smart Sweden contact ReAct’s:

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