Many of our common medical treatments and surgical procedures - from urinary tract infections to cancer treatments and hip replacements - may require antibiotic treatment. But for many decades, antibiotics have been both misused and overused, leading to a rapid rise in antibiotic resistance.

National initiative to help communities and regions become 'antibiotic smart

"Antibiotic resistance is a very complex problem where people, organisations and sectors of society are part of the problem, but also part of the solution. We cannot rely on the development of new antibiotics fast enough to meet existing needs. We must also work to prevent infections and the spread of infections," says Ulla Elofsson, researcher and project manager at RISE in the field of formulation with focus on biopharmaceuticals, food and innovation for reduced antibiotic resistance.

Antibiotic-Smart Sweden is a national initiative led by the Swedish National Board of Health and RISE together with the national working group Strama and ReAct - Action on Antibiotic Resistance, as well as a number of municipalities and regions.

"In order to help municipalities, regions and their organisations understand their role and provide them with tools to ensure that antibiotics continue to work, we have developed several criteria to become 'antibiotic smart'," explains Ula Elofsson.  

The criteria have been developed together with policy-makers and professionals in the target organisations. These currently include local government, schools, pre-schools, care for the elderly and disabled, water and sewage services, regional government, health centres and hospitals.  

For schools, the criteria include, for example, teaching students about antibiotics and antibiotic resistance. For nursing homes, the criteria include measuring healthcare-associated infections. Both pre-schools and nursing homes emphasise the importance of working systematically to prevent the spread and occurrence of infections. For water and wastewater operations, the focus is on reducing the release of antibiotics and bacteria from treatment plants.

Tanum takes action after citizens' initiative 

Tanum Municipality has been a partner in Antibiotic-Smart Sweden from the start. They have chosen to tackle the antibiotic problem at the municipal level. Public Health Strategist Lillan Fahlstedt explains:  

"At the end of 2017, a citizen's proposal was received that included the introduction of a theme day on antibiotic resistance and the annual reporting of antibiotic prescriptions. Shortly after the proposal was received, Antibiotic Smart Sweden was launched and it was decided that Tanum would participate."  

Tanum has been involved in the development of the municipal management criteria, which can now be used by municipalities throughout Sweden. These criteria include deciding on the municipality's commitment to the issue and spreading knowledge about the wise use of antibiotics among the population. It also includes creating the conditions for the municipality's activities to prevent infections and the spread of infections.  

"In addition to reporting on the use of antibiotics in the Sustainability Report, we have carried out communication activities on our website and social media in connection with the European Antibiotic Awareness Day. We have also publicised our involvement in Antibiotic-Smart Sweden in the municipality's information magazine, which is distributed free of charge. This shows that we are taking a stand on the issue," says Lillan Fahlstedt.  

Committed work in Köping 

About 35 kilometres to the east is the municipality of Köping, which has also decided to get involved in Antibiotic-Smart Sweden. After the pandemic subsided, the municipality wanted to find new ways of working with hygiene issues. Two specialist homes became the focus of the work.  

"As we had already appointed hygiene officers and carried out monthly infection registries, two things that were included in the criteria for Antibiotic-Smart Nursing Homes, we decided to test the criteria related to participation in Swedish HALT. This is a measure of healthcare-associated infections and antibiotic use in specialised housing. The municipality had worked with HALT before, but not in recent years," says Malin Svakko, a nurse in Köping, and continues:  

"We also chose to work with hygiene self-monitoring and decided that we would put an online hygiene training programme into an annual cycle so that the staff would do it every year. On the same topic, we organised a presentation for staff in cooperation with the region on the prevention of urinary tract infections, which are very common in elderly care."

Evaluated criteria predicted to be of great benefit 

In early 2024, Antibiotic Smart Sweden rolled out a final set of pilot-tested and evaluated criteria for municipal operations. Malin Svakko believes that these criteria will be of great use:

"The municipality is an important part of the chain to prevent the spread of infections and reduce unnecessary antibiotic prescriptions. It is important that all municipalities and regions look at what they can contribute. The criteria can be helpful to ensure that they do what they can."  

Ula Elofsson agrees:  

"Being certified as antibiotic-smart is proof that you meet the criteria and are striving to improve in these areas. "We believe that being an antibiotic-smart organisation can be a source of pride for your own organisation, while at the same time inspiring other organisations and municipalities to get involved," she says:  

"We hope that the work in communities and regions will lead to important changes in the long term, including increased knowledge and awareness among children and adults about antibiotics and antibiotic resistance, a reduction in the spread of infections in healthcare and society, and the judicious use of antibiotics. In short, sustainable development where antibiotics continue to work and save lives."

By working with established criteria, organisations in a number of areas can be certified as antibiotic-smart. The criteria aim to create commitment, provide inspiration and, among other things, stimulate efforts to reduce the occurrence of infections. In the long run, this will contribute to a healthy use of antibiotics. By March 2025, ten preschools, one school, four elderly and disability care organisations, and two water and sanitation organisations will have been certified. 

More information on how your organisation can work with the criteria and how you can apply to become certified →

Test and demonstration environments, also known as technology infrastructures, are important for the development of new products, services and innovations. In the more than 130 test and demonstration environments that RISE operates across the country, countless hypotheses have been tested, small-scale experiments have been scaled up and new products have been verified under realistic conditions.  

These environments also serve as meeting places for collaboration between business, industry, academia and RISE. It is not uncommon for regulators to be involved. Entire industries can also collaborate here, building new knowledge that speeds up technology development and system implementation.

"When we talk about collaboration, we mean when different actors come together and work together to solve common challenges. A good example of this is the green transition. For the transition to gain momentum, several actors from different disciplines, even those without a technology focus, need to work together," says Per Lindquist, acting CTO at RISE.  

Two ways to collaborate 

There are two main routes to test and demonstration environments. The first, and most common, is when a company comes to RISE with the ambition of putting its new software or product into a context that is relevant to multiple actors.  

"One example is AstaZero, a full-scale test environment for autonomous vehicles. Here, car manufacturers can work with sensor manufacturers and also include telecom-based technology to see how it all works," says Per Lindquist.  

"The other way is to come together around a common challenge. In this case, there is a concrete problem that requires the involvement of companies, authorities and lawyers when it comes to labelling new solutions. This is where RISE acts as an enabler," says Per Lindquist:

"RISE is independent and has no vested interest in what is being developed, nor is it incentivised to make things better for any particular actor. We also have a very broad thematic focus, which means we can go a long way in-house when we need to involve more experts."

Networked test environments 

The 130 test and demonstration environments are not isolated islands, but can be linked together. For example, AstaZero, the test environment for autonomous vehicles, can be connected to the Cyber Range cybersecurity centre.  

"From there, we can subject software systems to simulated, controlled cyber-attacks. Each of the test environments is unique, and when we connect the infrastructure in this way, we become world leaders," says Per Lindquist.  

In order for AstaZero, Cyber Range and the other test environments to continue to function as collaborative arenas and enablers for the development of new solutions in the future, it is important that they are kept up to date. If RISE falls behind in terms of equipment and technology, the environments are not worth much, says Per Lindquist.  

"The ability to apply for grants nationally and in the European innovation system is crucial for the institute. "I would say that the test and demo environments give a good return on every krona invested in the form of technological advances and increased Swedish competitiveness. "

“I'm very impressed by the conference. Having been engaged in industrial research and development for a considerable time, I can attest that gathering such a diverse range of international stakeholders – from companies and research arenas across Europe – is no small feat. I must tip my hat; I was genuinely impressed.”

Do you consider it important to organize events of this nature within additive manufacturing?

“I believe it is. While additive manufacturing is not a new concept – having been on the Gartner curve since around the Second World War – it's only now that we're witnessing its industrialization on a large scale. Additionally, additive manufacturing has demonstrated numerous benefits, including significant environmental and logistical advantages. However, challenges persist in areas such as post-processing, the value chain, IT infrastructure, quality, and energy, as well as health risks associated with various powders. Given the complexity and potential of additive manufacturing, collaboration and knowledge-sharing among stakeholders are paramount. Events like this conference provide a platform for participants, many of whom are in an early stage of understanding, to openly exchange insights and findings. Such collaboration propels the technology forward for everyone present, ensuring that all depart with valuable insights to apply within their respective organizations and countries.”

What advantages do you see in fostering strong partnerships between industry, academia, and research institutes within additive manufacturing? 

"There are no disadvantages to collaborating! When industrializing complex technologies, such as AM or AI, many different thought models are needed. Companies tend prioritize factors such as cost-effectiveness, performance, quality, and efficiency – with the customer in focus. Researchers often bring entirely different perspectives to the table. As with any new technology, additive manufacturing presents its fair share of challenges, necessitating collaborative efforts to overcome them. In my view, companies often lack the patience or resources required to tackle these problems on their own. Hence, partnerships with institutes like RISE are important. At RISE, you can test new equipment and different materials, and explore various solutions in a controlled environment. This collaborative approach also allows for risk-sharing."

How do you perceive the Application Center for Additive Manufacturing (AM Center) as a player in the innovation system? 

"The successful gathering of 200 participants from across Europe at a conference of this calibre, with representatives from both industry, academia, and research institutes, speaks volumes. This conference would not have been possible without the AM Center. I know that the centre is highly sought after across Europe, by civil society, the defence sector, researchers, and businesses. It is a clear sign that the right technologies, expertise, machinery, and questions have been prioritized."

What do you think is needed to accelerate the transition to a sustainable and competitive manufacturing industry in Sweden?

"It's a big question, but I would underscore the importance of adept leadership. This aspect has been brought up in various discussions at the fair, linked to both AM and maintenance. The Swedish manufacturing industry frequently targets highly tailored solutions and systems for customers. However, customization and scalability are complex entities to unite. It necessitates a considerable level of flexibility, which takes time to cultivate and requires perseverance."

"At the same time, significant investments are currently being made in Swedish production, especially in battery technology and battery factories. Automation technology and robotics are also booming. Moreover, Sweden's favourable energy mix, boasting a significant proportion of fossil-free electricity, meets the demands of many enterprises. I believe this favorable combination of factors will keep us going for a while. Now it's just a matter of educating more engineers, the ever-present scarcity!"

If current trends continue, the extraction of the world's natural resources will increase by 60 per cent by 2060 compared to 2020 levels, according to the latest report by the UN's International Resource Panel (IRP).  

How should companies go about reversing this trend and finding a place in a truly sustainable future world?

Shift the focus from making the current organisation better

 According to Dennis Pamlin, we need a systemic shift, essentially a reboot of our economic system, which has served us well in terms of material prosperity in the rich world, but is at the end of the road in terms of equity and ecological sustainability. He elaborates on his thinking by targeting traditional businesses:  

"Shift the focus from how you make the current organisation better, to how you best deliver solutions to human needs. That kind of drive is not inherent in our economic system today, where we have reduced everything to profit.  

The systemic shift that Dennis Pamlin hopes for would mean that companies would move away from aiming to sell as many products as possible, to looking at how their products or services can provide the best possible conditions for people to live meaningful lives.

From wear and tear to circular solutions 

Part of the systemic shift is the transition to a globally sustainable circular economy, characterised by business models that focus on optimal resource consumption in relation to human needs. Instead of wear and tear, it is about creating quality from the start, designing for longevity, with repair and upgrading, and remanufacturing, reusing and recycling. Ann-Charlotte Mellquist, a researcher and head of unit at RISE, sees a future in which companies need to make better use of existing resources.

"As an entrepreneur, I would like to earn money on the same product over and over again. The business model should always be based on the highest possible revenue per unit produced.  

Examples of this are product-as-a-service based models. This means that ownership and control of the product remains with the selling/manufacturing company.

"In this way, the same product can generate multiple revenue streams over time, rather than just once as in a linear model. At the same time, ownership of the product and the raw materials it consists of increases resilience to raw material shortages, inflation and geopolitical disruptions."  

Shoe companies can contribute to healthy lives 

And this is where the mindset of contributing to meaningful lives for people comes in. Dennis Pamlin and RISE are working with a range of companies to support them in their journeys of change towards true sustainability. One example is a shoe company that makes outdoor shoes.

"Such a company could aim to contribute to healthy lives, where people get value from being in nature with friends and family."

In the current system, sustainability efforts are often limited to making a more sustainable version of the product, says Mr Pamlin.

"This is not bad, but only a small part of delivering sustainability," he says, giving an example:  

"The company that sells shoes, for example, could start to complement that business by being involved in a subscription service that supports getting out into nature. It could include everything from an app that measures health to nutrition."

He believes that the path to a global societal transition rarely goes through the current sustainability department in companies. Instead, it is important to find people in the organisation who have the ability to think disruptively and creatively, outside the current framework.

"Today, sustainability work is often owned by people who do not know much about innovation or developing solutions. Such people are more likely to work as business developers, and they usually don't think about sustainability but about new technologies, business models, markets and opportunities."

"Difficult to make the transition in-house" 

In the circular transition required to reduce the consumption of the Earth's resources, Ann-Charlotte Mellquist believes that most of today's companies will not exist in 30 years. That's how disruptive she sees the future.

"I think it is difficult to make the transition in-house. Either companies will go under and others will grow, or the companies that exist today will buy up the new innovative companies or corporatise their own innovation projects," she says.

Ann-Charlotte Mellquist believes, despite the difficulties, that this type of social change is necessary and that legislation is the way to go.  

"I believe that humans are innovative and that sooner or later we will find ways to tackle the challenges, but it is urgent and to accelerate the transition from a linear to a circular economy, I believe in mandatory legislation combined with government financial support for research and new innovative solutions."

"Natural resources are too cheap and labour is too expensive. This has to happen at least at EU level, and I realise it is difficult, but I believe it is necessary."