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IT is a measure of the head of steam building up around tackling antimicrobial resistance that, just a few weeks after all the publicity generated by European Antibiotic Awareness Day and World Antibiotic Awareness Week (VR, November 14, 2015, vol 177, p 476; November 21, 2015, vol 177, p 510), the subject is again in the news, this time courtesy of a report from the O'Neill Commission on reducing unnecessary use and waste of antimicrobials in agriculture and the environment.1
The commission, chaired by economist Jim O'Neill, was established by the UK's Prime Minister, David Cameron, in 2014, to examine the economic issues surrounding antimicrobial resistance and the development of new drugs, after the Prime Minister had warned of the threat posed by resistance and of the world being ‘cast back into the dark ages of medicine where treatable infections and injuries will kill once again’ (VR, July 12, 2014, vol 175, p 30). Its report discussing agriculture and the environment,1 which was published this week, forms part of a series on antimicrobials it has published in recent months as it prepares to publish its final report and recommendations in spring 2016. Topics discussed in other reports have included improving the ‘pipeline’ for the development of new products, managing the supply of antibiotics, and improved diagnostics. Recommendations in this latest report include:
Setting a global target to reduce antibiotic use in food production to an agreed level per kilogram of livestock and fish, along with restrictions on the use of antibiotics considered important for use in human medicine;
Rapid development of minimum standards to reduce antimicrobial manufacturing waste released into the environment; and
Improved surveillance to monitor these problems and progress against global targets.
It is the first of these recommendations that has attracted most attention.
Calls for reduced use of antimicrobials in food production have been made before, but not, perhaps, in such blunt and specific terms. On the basis of a literature review undertaken using the search terms ‘drug resistance, microbial’ and ‘agriculture’, the report argues that the case for reducing antibiotic use in agriculture is ‘compelling’ and that there is a need to take action now. It also notes that, in many countries, consumption of antimicrobials by animals exceeds consumption by humans. In proposing global targets, it suggests that the best way to reduce overall antibiotic use will be to establish targets for antibiotic use in agriculture and aquaculture to an agreed limit for each country, while allowing individual countries to decide the best way to achieve this goal. It argues that ‘an ambitious but achievable target’ is needed to reduce antibiotic use over the next 10 years. Although it doesn't specify what that target should be, it draws attention to the progress made by Denmark in reducing the amount of antibiotics used in pig production and suggests that the levels achieved there (50 mg/year/kg of livestock) might be a good starting point.
Broad-brush proposals for global limits are likely to be controversial and could be difficult to implement, even within Europe where the use of antimicrobial growth promoters is already banned and where the use of antimicrobials and other medicines is, for the most part, well regulated. They could be even more problematic in other parts of the world where the animal production challenges are greater and where a regulatory infrastructure is lacking. The extent of the problem is illustrated in a recent article by Bernard Vallat, director of the World Organisation for Animal Health (OIE), discussing the risks associated with the use of antimicrobials in animals worldwide. In the editorial on the OIE's website, he draws attention to an OIE evaluation of the quality of national animal health systems in over 130 countries. More than 110 of the countries evaluated (mainly developing and emerging countries) did not have relevant legislation concerning appropriate conditions for the importation, manufacture, distribution and use of veterinary products, including antimicrobials, and in some cases there was no legislation at all. Worse still, he says, ‘thousands of tonnes of adulterated antimicrobials destined for use in animals are in circulation worldwide (and the same is true of antimicrobials for human use).’ He draws attention to the need to develop and strengthen legislation in these countries, and to ensure that sufficient veterinary coverage is available for animal health surveillance and to help ensure that antimicrobials are used appropriately.2
Commenting on the O'Neill commission's report this week, Sean Wensley, the president of the British Veterinary Association, noted that BVA was opposed to the introduction of arbitrary, non-evidence-based target setting; such targets, he pointed out, risked restricting vets' ability to treat disease outbreaks in livestock, which could have serious public health and animal welfare implications. He added: ‘The current EU legislation on vets’ prescribing of antibiotics for all animals, including those intended for production, is robust and we would like to see equivalent legislation rolled out globally.'
Overall, the report takes a tough line on the use of antimicrobials in animals. To an extent, this might reflect the Commission's sequential approach to publication and the report's particular focus, and it will be interesting to see how its recommendations on the use of antimicrobials in agriculture compare with the rest of its recommendations when it publishes its final report in the spring. That said, it adds to the pressure to be seen to be doing something about the use of antimicrobials in agriculture, and that pressure shows no signs of going away.