In 2014, David Cameron commissioned the Independent Review on Antimicrobial Resistance (AMR). This is in response to the rising levels of AMR and the enormous threat it poses to global human health. They have published 8 papers and the final review was published in May this year. The review was chaired by economist – Jim O’Neil – and covered the use of antimicrobials in humans and agriculture and the consequences of AMR if not controlled. The term antimicrobials covers antibiotics but also antivirals, antifungals and parasiticides. Antibiotics are the main concern.
The main aim of the review was to establish a way forward to protect antimicrobials and their effective future use in human health. The use of antimicrobials in agriculture is included as the report concluded there is a link between use in agriculture and the increasing AMR issue in humans…
“The issue of antibiotic use in agriculture and its impact on drug resistance has been recognised by the World Health Organisation (WHO) as part of its Global Action Plan, requiring its member countries to develop National Action Plans to tackle AMR which incorporate considerations of animal usage. It has also been recognised by both the UN’s Food and Agriculture Organization (FAO) and the World Organisation for Animal Health (OIE).”
The current estimate of deaths globally from AMR is 700,000/year. If AMR increases as it is doing for certain pathogens then the projected deaths in 2050 are 10 million/year – the biggest cause of death ahead of cancer and any infectious
disease. This may be a “worse case” scenario but it is possible, hence the review and the need for urgent action.
The review delivers 10 interventions that each detail specific areas. These areas cover public awareness, sanitation, vaccine use, research, diagnostics and combined global action. One intervention is focused purely on agriculture.
Intervention 3: Reduce unnecessary use of antimicrobials in agriculture and their dissemination into the environment
The 3 action points within this intervention are…
1. 10 year targets to reduce unnecessary antibiotic use in agriculture.
2. Restrictions and/or bans on certain types of highly critical antibiotics.
3. Improved transparency from food producers on their use of antibiotics.
Antibiotic use targets will be set with the aim of reducing the amounts used. This will be measured by mg product/kg live weight. There are no targets set yet but Denmark and Holland already use this within their pig industries. In 10 years they halved their use of antibiotics – within an increasingly productive industry – with no negative health or production effects.
The main target will be the use of antimicrobials as growth promoters – where they are included at lower doses within feed/water to improve performance. Prophylactic use – where they are used to prevent disease – will also be targeted. A current example in the dairy industry is the use of dry cow therapy – this is now coming under review and selective dry cow therapy is advocated. The principle is that we can only use antibiotics where clinically justified.
“There are circumstances where antibiotics are required in agriculture and aquaculture – to maintain animal welfare and food security. However, much of their global use is not for treating sick animals, but rather to prevent infections or simply to promote growth.”
The review recognises that the health and welfare of animals is important and we must continue to treat sick animals, but we should be looking to reduce the therapeutic use of antibiotics to treat sick animals by improving the environment and management of our livestock. The second action point is relevant to this as it is possible we will lose some of our current antibiotics or certainly have their use restricted. These antibiotics are considered critical for human use and thus will have their use in agriculture restricted. The critical groups that are relevant to us are 3rd and 4th Generation Cephalosporins and Fluoroquinolones. We will have to prove a need before prescribing these and at some point they may be withdrawn. The report discusses the current dispensing of medicines without an accurate diagnosis and calls for advances in rapid diagnosis technology.
“I call on the governments of the richest countries to mandate now that by 2020, all antibiotic prescriptions will need to be informed by up-to-date surveillance information and a rapid diagnostic test wherever one exists.”
The third action point calls for improved transparency – this will mean open records. If we are to measure use and assess responsible use then this is a consequence. This may be a contentious point but as responsible food producers, we will have to embrace this.
What does it mean for the UK farming industry?
The fundamental challenge will be to manage our antimicrobial use sensibly and to work to reduce it. As vets committed to the future of our livestock industry, we work with our clients to actively reduce antibiotic usage. Simple measures like effective vaccine programmes can make big improvements in health. Management and environmental investment do reduce disease and improve health and production leading to reduced antibiotic use.
We will not have a choice. Vets will be required to prescribe correctly and farms will be required to use as prescribed and to keep accurate records. There will be change and some systems that are too reliant on antibiotics will have to adapt. We are facing enormous pressure on our use of medicines and we must work to preserve this use. The positive side is that we have proven we can work positively to reduce disease on farm and thus reduce medicine use. This does take investment but will improve animal performance.
The agricultural interventions are one area of the review. Within the human area there are many interventions across multiple areas – improved sanitation, more awareness and surveillance, research into vaccines and many other areas.
We have our part to play to use our current antimicrobials sensibly.