In January 2026, Bulgaria’s Council of Ministers adopted the National Programme for Acting Against Antimicrobial Resistance 2026–2029. This is the country’s first comprehensive national action plan on antimicrobial resistance (AMR), and aligns with the WHO Global Action Plan on AMR and the European One Health Action Plan.
The programme addresses a persistent public health challenge. Antibiotic consumption in Bulgaria is among the highest in the EU, reaching 26.3 defined daily doses (DDDs) per 1,000 population per day in 2023, around 30% above the EU average. Only 42% of this use comes from the WHO AWaRe Access group antibiotics, compared with over 60% EU-wide, and an estimated 50%–80% of outpatient antibiotic prescriptions are unnecessary or inappropriate.
Built around five strategic objectives within a One Health framework, the programme aims to:
- increase public and professional awareness of AMR;
- strengthen AMR surveillance and research;
- reduce infections through improved hygiene and prevention;
- optimize antimicrobial use in humans and animals; and
- enhance effective governance, coordination, monitoring and evaluation.
Further, the programme corresponds to the June 2023 EU Council Recommendation on strengthening action against AMR under a One Health approach, whose 2030 objectives include a 20% reduction in overall antimicrobial consumption and at least 65% of use from the WHO “Access” group. Effective implementation depends on intersectoral coordination and sufficient human and financial resources, long-standing limitations to Bulgaria’s AMR response.