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Marking progress on resistance

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THE UK Five-Year Antimicrobial Resistance Strategy, published in September 2013, was notable for the way in which it highlighted the threat posed by antimicrobial resistance (AMR), and also in advocating a One Health approach to that threat. In a joint foreword to the document, the Chief Medical Officer (CMO), Dame Sally Davies, and the UK's Chief Veterinary Officer (CVO), Nigel Gibbens, wrote that there were few public health issues of greater importance than AMR in terms of their impact on society, both in the UK and across the world, and that concerted action was needed to deal with it. AMR, they pointed out, is a global problem that cannot be eliminated; but, they argued, ‘a multidisciplinary approach involving a wide range of partners will limit the risk of AMR and minimise its impact for health, now and in the future’ (VR, September 21, 2013, vol 173, p 254).

In a foreword to the first annual report on progress in implementing the strategy, which was published by the Government last month,1 the CMO and the CVO point out that that position has not changed. However, one year on, they report that good progress has been made with the strategy in the UK, as well as in putting AMR firmly on the international agenda. The report gives details of what has been achieved during the first year of the strategy, along with what is planned for the next four years.

The strategy identified seven key areas for action, three of which were considered likely to have the most impact on resistance. These were: improving infection prevention and control practices in human and animal health; optimising prescribing practice; and developing new drugs, treatments and diagnostics. The other areas identified were: improving professional education, training and public engagement; better access to and use of surveillance data in human and animal sectors; better identification and prioritisation of AMR research needs; and strengthened international collaboration.

Discussing progress, and what has still to be achieved, the annual report, like the strategy itself, adopts a One Health approach, identifying areas where human and animal activities overlap, while also referring to activities and developments relating solely to human or animal health. Like the original strategy, it also makes clear that government cannot deliver the action necessary to minimise the spread of AMR on its own, and that human and veterinary care professionals, along with researchers and academia, industry and the public, will all have to be involved.

Commenting on what has been achieved so far, the CMO and CVO remark that developments marking a ‘step change’ include: collection and analysis of baseline data from which prescribing and trends in resistance can be monitored; publication of outcome measures against which the UK will assess progress; and development of a strong research infrastructure to address knowledge gaps and promote collaboration. They also note that the 2014 Longitude Prize, worth £10 million, was awarded to further work on AMR, by popular vote. Regarding the development of new products, the report draws attention to the fact that the Prime Minister has established an independent review, chaired by economist Jim O'Neill, to see what can be done to stimulate the development of new drugs. On the international front, it reports that the UK and Sweden led the development and adoption of a new World Health Organization (WHO) resolution on AMR, providing a mandate for the development of a WHO-led global action plan by May this year.

In the animal health field, the report draws attention to, among other things, the efforts being made to strengthen surveillance for AMR and the guidance available to vets and farmers. It notes that ‘Clinical resistance is rare in animal health in the UK and resistance in key veterinary zoonotic microorganisms [is] generally among the lowest in the EU.’ Nevertheless, it makes the point that ‘With animals, good farm management, effective biosecurity and animal husbandry systems reduce susceptibility to bacterial disease, minimising the need for antibiotic use in animals’ and highlights the importance of best practice. It notes that the total weight of antibiotic sold compared to the farm animal population has remained relatively stable in the UK over the past five years and aspires to ‘reduce antimicrobial use in livestock production in real terms over the next four years, measured in sales of antibiotics against national livestock population’. It also aims to ensure that sales of fluoroquinolone and modern cephalosporin classes of antibiotics remain low and reduce further as a proportion of total antibiotic sales.

Regarding research, it notes that ‘we still have gaps in our knowledge of the development and transmission of AMR in and between humans, animals, food and the wider environment’ and discusses steps being taken to address this. It also discusses work being undertaken to obtain a better understanding of how human behaviours contribute to the spread of AMR.

As Veterinary Record has commented previously, interest in doing something about the threat posed by AMR has gained momentum in recent years (VR, November 15, 2014, vol 175, p 466), and this report on progress with the UK strategy provides another illustration of how that momentum continues to grow. While it highlights the progress being made in some areas, it also makes clear that there is still much to do. The veterinary profession has a key role in helping to tackle resistance and a recent position paper from the Federation of Veterinarians of Europe discusses the particular part that vets can play.2

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