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Joint approach to resistance

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THIS year's annual report from the Chief Medical Officer (CMO), Sally Davies, was notable for the way in which it drew attention to the extent of the threat posed by antimicrobial resistance (AMR), warning that ‘Global action is needed to tackle the catastrophic effects of AMR, which in 20 years time could see any one of us dying following minor surgery’ (VR, March 16, 2013, vol 172, p 276). It was notable, too, for the way in which it advocated a coordinated, ‘one health’ approach to the problem, calling for concerted action from everyone involved. This was a refreshing contribution to a debate which, too often in the past, has degenerated into an interprofessional blame game, and it is good to see this one health approach being incorporated into the UK Antimicrobial Resistance Strategy, which was published by the Government last week and which should drive UK policies in this area for the next five years.1

In a joint foreword to the document, the CMO and the UK's Chief Veterinary Officer (CVO), Nigel Gibbens, make the point that antimicrobial resistance is a global problem that cannot be eliminated, but argue that ‘a multidisciplinary approach involving a wide range of partners will limit the risk of AMR and minimise its impact for health, now and for the future’. The strategy is focused around three main aims: improving knowledge and understanding of AMR; conserving and ‘stewarding’ the effectiveness of existing treatments; and stimulating the development of new antibiotics, diagnostics and therapies. The aims, in turn, will be ‘underpinned by actions’ in seven areas. These include improving infection prevention and control practices in human and animal health; optimising prescribing practices; and improving professional education, training and public engagement to improve clinical practice and promote wider understanding of the need to use antibiotics sustainably. They also include developing new drugs, treatments and diagnostics; and improving access to and use of surveillance data in both the human and animal sectors. Action will also be taken to identify and prioritise research needs more effectively, and to strengthen international cooperation.

Like so many government documents these days, and no doubt rightly in this instance, the AMR strategy notes that the government ‘cannot deliver the action necessary to minimise the spread of AMR on its own’, and it calls on a wide range of public and private sector bodies, including pharmaceutical companies, to take coordinated action to deliver an integrated programme to safeguard human and animal health. It sees the government's role as being ‘to lead and coordinate the work of various partners in the public and private sectors, acting as steward of the system’. A new ‘high level’ steering group is to be established within government to help coordinate activities and report progress to the CMO and the CVO.

Discussing the contribution of antimicrobial use in animals to the development of resistance, the strategy notes that ‘Increasing scientific evidence suggests that clinical issues with antimicrobial resistance that we face in human medicine are primarily the result of antibiotic use in people, rather than the use of antibiotics in animals.’ Nevertheless, it points out, ‘use of antibiotics in animals (which includes fish, birds, bees and reptiles) is an important factor contributing to the wider pool of resistance, which may have long-term consequences.’ It acknowledges the efforts already being made with regard to resistance in the animal health sector but sets out a fairly long list of areas where ‘veterinary surgeons and nurses and their professional bodies, including the RCVS and the BVA, animal keepers and their representative bodies together with trade associations and food retailers need to take action.’ These range, for example, from embedding an appreciation of AMR issues and strategies for containing it in the undergraduate courses to increasing the level of CPD provision for veterinary professionals, and from improving practices' adherence to responsible prescribing policies to using farm assurance schemes to increase adherence to best husbandry.

It would be difficult to argue with the principles of the strategy but, as always, implementation will be key. The document sets out what it describes as ‘an ambitious programme of work’ involving many different parties and there will be a need to establish ways of measuring outcomes so that progress can be assessed. In areas such as surveillance in particular, it will be important to ensure that sufficient resources are available to help make the whole thing work. Resistance is a problem for people and animals and, in their foreword, the CMO and the CVO issue a call for action to all the different sectors involved. Success will depend on a coordinated effort and it must be hoped that the response is positive.

1. www.gov.uk/government/publications/uk-5-year-antimicrobial-resistance-strategy-2013-to-2018. Accessed September 14, 2013

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