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Maintaining momentum on AMR

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Last month, in his most recent update for Veterinary Record, Nigel Gibbens, the UK’s Chief Veterinary Officer, described 2016 as ‘a breakthrough year’ in international efforts to tackle antimicrobial resistance (AMR) (VR, August 5, 2017, vol 181, pp 133-134).

There was a definite sense of a momentum change last year, with a number of significant developments both nationally and internationally.

In the UK, in May 2016, the Review on Antimicrobial Resistance published its final conclusions. The review had been commissioned in 2014 by the then UK prime minister, David Cameron, and was chaired by the economist Jim O’Neill. It drew attention to the scale and global nature of AMR, estimating that, if AMR was not addressed, it could cost the global economy US $100 trillion by 2050 and result in 50 million human deaths worldwide each year. The review said it was ‘time to turn ideas into effective action’ and outlined a 10-point programme and 29 recommendations for tackling AMR. These included setting country-level reduction targets for antibiotic use in livestock, with an initial target of 50 mg/kg being proposed for the UK.

Defra subsequently committed to this target, with the aim of it being met by 2018.

More widely, publication of the O’Neill report was followed later in May 2016 by a pledge from the leaders of the G7 nations to commit to ‘concrete actions’ for advancing global health. Central to these was promoting a One Health approach to tackling cross-cutting issues of AMR in human and animal health, agriculture, food and the environment. The leaders also agreed to strengthen collaboration and support other countries to develop their surveillance capacity for AMR and antibiotic use across all sectors.

In September 2016, in a further significant recognition of the global challenge of AMR, leaders of the G20 group of countries agreed to take action on AMR. Later the same month, the 193 member states belonging to the United Nations endorsed a concerted One Health approach to addressing the issue.

There can be a risk of complacency after making what appears to be good progress in a fairly short space of time. However, there is already evidence of further progress in 2017.

In January, the Food and Drug Administration (FDA) in the USA announced it had completed work to prevent antimicrobials deemed to be important in human medicine from being used for growth promotion purposes in animals. The same process also saw the use of these antimicrobials in animals being brought under veterinary oversight. The FDA described this ‘a significant milestone’ in efforts to address the use of medically important antimicrobials in food-producing animals.

At a global level, the Food and Agriculture Organization (FAO), the World Health Organization (WHO) and the World Organisation for Animal Health (OIE) are currently inviting comments on a draft ‘monitoring and evaluation’ plan to help track global progress in tackling AMR. The monitoring and evaluation plan links to the WHO-led Global Action Plan (GAP) on AMR, which was adopted by the World Health Assembly in 2015. The GAP sets out responsibilities for national governments, the WHO, the FAO, the OIE and other national and international partners in responding to AMR and the proposed monitoring and evaluation plan suggests a framework and a range of indicators against which progress can be measured.

In the EU in June, the European Commission adopted a new five-year action plan to tackle AMR. Again, the focus has been placed on a One Health approach, with the plan providing a framework for action to reduce the emergence and spread of AMR.

A key objective is to make the EU a ‘best practice region’ that can contribute to shaping the global agenda on AMR. Central to this is supporting member states to develop and implement their own national action plans on AMR and reducing the differences between member states in antimicrobial use and the occurrence of resistance.

The scale of this challenge has been illustrated recently in a report from the European Centre for Disease Control, the European Food Safety Authority and the European Medicines Agency, which analysed the consumption of antimicrobials and the occurrence of resistance in bacteria isolated from people and food-producing animals across the EU in 2014. This showed that, while the EU-wide average consumption of antimicrobials in human medicine was 123.7 mg/kg, use in individual countries ranged from 49.9 mg/kg to 181.7 mg/kg. Average consumption in animals across the EU stood at 151.5 mg/kg, but it ranged from a low of 3.1 mg/kg to a high of 418.8 mg/kg.

In the UK, too, developments continue. Figures published in November 2016 showed that the livestock industry as a whole was on track to meet the 50 mg/kg target by 2018, with sales by weight of antibiotics for use in food-producing animals falling by 10 per cent between 2014 and 2015, reaching an average of 56 mg/kg. Recent significant reductions in antibiotic use in the UK’s pig and poultry sectors are expected to have changed the situation again and it will be interesting to see the most up-to-date figures when they are published later this year.

A further significant step will be the announcement of sector-specific usage targets for the livestock industry. These have been drawn up by a Targets Taskforce established by the Responsible Use of Medicines in Agriculture Alliance, and are due to be made public at RUMA’s conference next month.

Veterinary surgeons will have a central role in helping producers in each sector work towards meeting the targets set, through advising on improving housing and husbandry and strengthening biosecurity on farms, and by encouraging the use of vaccination or other means to prevent disease.

Not every year can be a breakthrough year, but with AMR firmly on the international agenda, and with the One Health nature of the challenge recognised and accepted, the emphasis seems to be starting to shift from talking about the threat AMR poses, to taking action to tackle it.

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