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Resistance and one health

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INTEREST in antimicrobial resistance shows no sign of abating, with the latest manifestation of this being publication by the World Health Organization this month of a document called ‘The evolving threat of antimicrobial resistance – options for change’.1 Like most publications on this subject, and as one might expect from the WHO, it is primarily concerned with preserving the efficacy of antimicrobials for use in human medicine, and includes a chapter on reducing antimicrobial use in animal husbandry with this aim firmly in mind.

This is by no means the first time the WHO has focused on antimicrobial resistance, which a press release about the document describes as ‘a crisis [that] has been building up for decades’. In 2001, for example, it published a strategy for tacking the problem and, in 2011, it chose antimicrobial resistance as the subject for World Health Day. Using the slogan ‘No action today, no cure tomorrow’, the WHO used the day to highlight the threat posed by resistance and also published a six-point policy package to tackle the problem.2 Its latest publication aims to assess progress since the original strategy was published in 2001, highlight areas where action is still needed and stimulate more coordinated action globally.

An introductory paragraph to the chapter on animal husbandry leaves little doubt as to its thrust: ‘Antibiotics are used widely and in vast quantities to ensure the health and promote the growth of livestock, poultry and fish reared for food production. The fact that greater quantities are used in healthy animals than in unhealthy humans is a cause for serious concern, particularly as some of the same antibiotics are involved and food animals have been shown to carry resistant human pathogens. Some countries have banned the use of antibiotics as growth promoters, but the practice remains widespread. Legislation and regulation with enforcement are needed to control the use of antibiotics for these purposes in many countries.’

Other chapters consider the use of antibiotics in people, both in healthcare institutions and more widely, as well as rightly highlighting the need for more information on antibiotic usage and better surveillance for resistance worldwide. However, the chapter on animals, along with various other comments in the document, tends to reinforce the impression – evident when the European Parliament unveiled its 12-point action plan to tackle antimicrobial resistance last November – that political efforts to deal with the problem are focusing particularly on use of antimicrobials in animals at present. This is unfortunate, because antimicrobial resistance is a problem for animals as well as people and effort is needed across the board (VR, November 26, 2011, vol 169, pp 564, 565–566).

Tackling resistance requires a ‘one health approach’ and, in this respect, a symposium to be held in London on October 2 should prove helpful. Organised by the RCVS, the Royal College of Physicians and the Royal College of Pathologists, in association with the Health Protection Agency (HPA), it will bring together medical and veterinary scientists and practitioners to discuss antimicrobial resistance in the spirit of one medicine. Speakers will review the scientific evidence base to help inform a rational debate; as well as discussing the origins and spread of resistance between humans, animals and the environment, they will consider the importance of antimicrobial use and misuse globally, the impact of travel and the outcomes of previous interventions. Details are available at www.rcvs.org.uk/amrsymposium

Antimicrobial resistance will be discussed, too, at this year's BVA Congress, in a debate that will consider the issues from both a veterinary and public health perspective. It is also likely to feature in the plenary Wooldridge memorial lecture, in which David Heymann, chairman of the HPA, who contributed to the recent WHO report, will discuss the veterinary contribution to public health. The congress will be held in Liverpool from September 28 to 29 and details are available at www.bva.co.uk/events/BVA_Congress.aspx

As these meetings and other developments make clear, attention seems set to continue to focus on resistance for some time yet. There are good reasons for ensuring that effective antimicrobials remain available for use in veterinary as well as human medicine and therefore for ensuring that products are used responsibly. Meanwhile, given the current level of political interest, and with the EU in the process of reviewing veterinary medicines legislation and animal health law, it remains important not only to ensure responsible use, but to demonstrate that this is happening.

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