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Politics and resistance

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IT may not be binding, but a resolution on antimicrobial resistance adopted by the European Parliament last week gives a further example of the growing political interest in this subject and a worrying indication of where this debate might be heading. While rightly highlighting the importance of preserving the efficacy of the antimicrobials that are available, and making some useful suggestions for helping to ensure that products are used responsibly in people and animals, it also calls on the European Commission to make legislative proposals to phase out the prophylactic use of antimicrobials in livestock farming. As Carl Padgett, the BVA President, pointed out this week, this could have a detrimental effect on animal health and welfare by reducing the ability of vets to treat animals in a timely and appropriate fashion. While blanket prophylaxis is clearly inappropriate, there are many situations where it might be necessary to treat an injured animal to prevent infection or to treat the penmates of sick animals which are also likely to be infected. Vets should be able to apply their clinical and professional judgement in such circumstances and it would be wrong to force them to wait until the animal becomes sick before starting treatment. Not only would such a restriction affect animal health and welfare; it could ultimately result in more antimicrobials having to be used.

This is not the first time that veterinary use of antimicrobials has been the subject of attention from members of the European Parliament in recent months. In April, the Parliament's agricultural and rural affairs committee considered a proposal suggesting that vets should be prevented from selling medicines directly to farmers and other animal owners in non-acute cases, ‘thus reducing the incentive to prescribe more antimicrobials than needed’. In the event, the proposal was rejected (see VR, April 16, 2011, vol 168, p 392), but there does seem to be a head of steam building up around this issue, which lends weight to the view, expressed in a Viewpoint article by Neil Craven on pp 498–499 of this issue, that vets should be fully engaged in the debate, to ensure that an appropriate balance is maintained.

This is all the more pressing because the European Commission is currently in the process of reviewing veterinary medicines legislation while also developing its strategy on resistance. Although the aim of the legislative exercise is to try to improve the availability of veterinary medicines, one of the ideas being considered is whether the legal framework should be changed to restrict the veterinary use of antimicrobials that are considered critical for use in human medicine. Preserving the efficacy of antimicrobials for use in people is vital, but the fact remains that they are also needed to treat animals.

Whether legislation should be used to specifically prevent veterinary use of certain antimicrobials is questionable. As the Federation of Veterinarians of Europe (FVE) pointed out last week, many, if not all, of the active substances used in veterinary medicine are derived from or are the same as those used in human medicine, and work by the same mechanisms. Separating those used in the human field from those used in the veterinary field would lead to fewer products being available for veterinary use and increased use of this smaller product pool would increase the chances of resistance developing to these substances.

Antibiotic resistance is a problem for both humans and animals and, as the presidents of the BVA and the British Medical Association have pointed out, tackling it effectively requires a joint approach from both professions (VR, July 2, 2011, vol 169, p 25). In a position paper published earlier this year, the FVE drew attention to the contribution that the veterinary profession can make to preventing resistance, both through responsible prescribing and by helping to optimise health surveillance and management on farms. It believes that antimicrobials with special importance in human medicine must continue to be available for use in the veterinary field, but that these should be subject to stricter conditions regarding best practice, ensuring responsible use.

At a global level, the World Health Organization chose antimicrobial resistance as the subject of World Health Day in April this year, and it was also one of the main topics of discussion at the recent World Veterinary Association congress in South Africa. Looking ahead, the FVE will be holding a half-day conference on the subject later this month and, in March next year, the RCVS, together with the Royal College of Physicians and the Royal College of Pathologists, will be holding a one-day symposium on antimicrobial resistance in association with the Health Protection Agency. Both of these meetings aim to address the issues in the spirit of ‘one medicine’. There is certainly no lack of interest in antimicrobial resistance at present. At a political level, the continuing challenge is to ensure that the subject is approached rationally, and that any decisions are evidence based.

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