Antibiotics, or more broadly, antimicrobials are amazing products that have saved billions of food animals’ lives. Their discovery and use have been crucial to reducing morbidity and mortality and thus unquestionably helping farmers feed the world. World Antibiotic Awareness Week provides an opportunity to reflect on our learnings the past decades so we can preserve their effectiveness for future decades.
The World Health Organization (WHO) notes, “… World Antibiotic Awareness Week (WAAW) aims to increase global awareness of antibiotic resistance and to encourage best practices among the general public, health workers and policy makers to avoid the further emergence and spread of antibiotic resistance. ...”
The World Organization for Animal Health (OIE) states, “The goal of this week is to raise awareness of the health risks posed by antibiotic resistance and to promote good practice in this area of concern, to limit the emergence and spread of resistant bacteria throughout the world.”
Globally the antimicrobial resistance apocalypse alarms have sounded, activists have mobilized, the food chain has engaged, and farmers have acted. Amongst all the whirlwind is the need to act whereby appropriate antimicrobial use and stewardship are key to reducing resistance as we look to the future. One might postulate for antibiotics ‘proper animal care’ means to ‘handle with care’ aligning with the theme of this year’s awareness week.
A recent report published by the Food & Agriculture Organization (FAO) and the Ministry of Environment & Food of Denmark titled “Tackling Antimicrobial Use and Resistance in Pig Production: Lessons Learned in Denmark” highlights key insights from two decades of efforts to reduce antimicrobial use in swine production.
Key success instruments for Denmark included the VetStat database on use, Veterinary Advisory Service Contracts and the Yellow Card Initiative on Antibiotics. Collectively these instruments track uses in detail, ensure veterinary involvement in all use, and flag high users to investigate the cause of use and potential actions to take to reduce use.
Key actions in Denmark included strict biosecurity measures such as the Speciﬁc Pathogen Free system (SPF system), phasing out uses as growth promotion with time to adjust and joint applied research activities.
Some key lessons learned include that change takes time, infections have been treatable despite limitations on uses, the need for co-creation of incentives to encourage change in practices via a well-organized industry, and strong private and public structures to aid implementation. The report does note that the Denmark model may not be transferable due to the unique differences of the Danish production system from the various and diverse global farm animal production systems.
Some observations from the report include that antibiotic use means selection for resistance and reduced use results in reduced selection pressures. As one looks to the broader antimicrobial resistance concerns, some are “associated” with resistance traits transferred from livestock but not necessarily caused by livestock use. In Denmark, there is concern of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA). There are alternative practices, such as the increased use of zinc oxide and vaccines, but the use of zinc oxide also has environmental contamination concerns.
One of the most insightful observations is regarding a public health benefit, there are no identifiable benefits. The greatest beneficiary for responsible use is actually at the farm level through ensuring antimicrobial effectiveness for on-farm use. Decades ago, the argument for the need to change food animal antimicrobial use practices was for a public health benefit; this remains a theoretical argument, not a reality based on outcome evidence.
The Danish industry, farmers, veterinarians, universities and their stakeholder partners are to be commended on the willingness to share their learnings. There are key learnings within for all. As one extrapolates globally, it is important to understand the uniqueness of the Danish pig sector, which includes fully integrated operations, large professionally run operations, mechanized and specialized facilities; ultimately a consolidated industry with a few large farms. Biosecurity, health and nutrition management, and professionalism are characteristics that yielded success. Such systems and industry resources are not present globally so adaptation of learnings will be key to leveraging these learnings globally.
Recognizing this is antibiotic awareness week, a One Health approach is key, and to be successful and allow focus and collaboration going forward it is likely best to avoid the hype, avoid the politics and avoid the finger pointing. Rather, all need to act responsibly, leverage and share our learnings, and work together globally in a true public and private partnership.
Leveraging learnings to date, include that for the public sector, at the government level, three factors are critical: 1) having appropriate legislation and regulations in place for all antimicrobial approvals and uses, 2) implementing a rigorous science-based risk analysis as part of the approval process and then 3) having a surveillance program in place at the farm and food levels to track antimicrobial resistance. For the private sector, industry and farm level, critical factors include: 1) antimicrobial use and stewardship policies in place, 2) efforts made and actions taken for understanding best practices that avoid the need to use antibiotics and 3) when antibiotics are needed they are used appropriately.
Industry leadership and action is key. Actions at the global, national and company level can happen immediately. The poultry meat sector is a good example of how collective and individual efforts can be advanced. In 2017, global action resulted in adoption of the “International Poultry Council (IPC) Position Statement on Antimicrobial Use and Antimicrobial Stewardship Principles.” This week global action yielded the “International Poultry Council Best Practice Guidance to reduce the need for antibiotics in poultry production.” These are steps that build upon prior actions by individual companies and associations. They seek to leverage learnings to date and provide tools for all globally to develop polices and implement practices that will contribute to broader One Health initiatives. Other livestock sectors as pork, beef, dairy and egg are also acting.
Globally the tripartite group of OIE, FAO and WHO are working together to advance the One Health approach. Collectively and individually efforts are now underway for more effective public-private partnerships. History has demonstrated that both government and the private sector each have their role to play in addressing antimicrobial resistance. Let’s ensure that we each are doing our part as individuals, as farmers and as food chain stakeholders.