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AMR is a shared global problem
  1. Adele Waters

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This week we publish a special investigation in tandem with the Bureau of Investigative Journalism (see pages 432-433).

The research, carried out by the bureau, reveals the fundamental challenge of antimicrobial resistance in that it is very much a shared global problem but there are unequal efforts in tackling it.

Here, as in the rest of Europe, it is illegal to use antibiotics for growth promotion in food producing animals – this has been the case since 2006. The USA also banned the practice last year. But this is not the case elsewhere, for example in India.

In Hyderabad, a bureau reporter found antibiotics used for growth promotion were sold to farmers directly without prescription. The products were sold by Zoetis, the largest global animal pharmaceutical company.

As the story makes clear, Zoetis is not acting illegally here because the Indian government has not set any legislation around this. In response, Zoetis rightly argues that it works within the regulatory environment for each country where it operates.

But the company is behaving differently in different territories – in the USA, for example, Zoetis publicly supported government moves to ban antibiotic use for growth promotion. This, then, lays the company open to the charge of hypocrisy.

It is not as if all pharmaceutical companies are behaving in the same way – Elanco, for example, has taken a different approach. It has stopped advertising medically important antibiotics as growth promoters, and back in 2016, it removed any such claims from all its product labels worldwide, even where antibiotic growth promotion is legal.

If there is not international operational effort to cut the over- or inappropriate use of antibiotics, there is certainly international consensus on the need to do so. There is a recognition that if we use more antibiotics we will drive up resistance.

Antibiotic use in farming and veterinary prescribing practice is under ever greater scrutiny and there are fairly powerful lobby groups arguing for antibiotic-free production, particularly in the USA where the marketing slogan of ‘no antibiotics ever’ is seen as increasingly attractive to consumers.

All antibiotics have come to be regarded as critically important

Here in the UK, the mindset of vets and farmers has changed. It has become accepted that antibiotics are not an automatic firstline approach. In this sense, all antibiotics have come to be regarded as critically important. If there is a call to continually prescribe antibiotics prophylactically, then the first thought is likely to be ‘there is something wrong with the system of production’ and, instead of the antibiotic route, it would make sense to first review environmental factors and address biosecurity measures.

Although there is an argument to preserve antibiotics for solely therapeutic use, vets have rightly made the argument that they need to use them prophylactically sometimes but this should stay as a judgement call best left to them. They recognise that the highest priority critically important antibiotics must be used minimally.

But that is not to say there is any appetite among veterinary experts for outright bans of any antibiotics, even those now considered highest priority, such as colistin. We just don’t know what is around the corner, they argue, so we need to keep these medicines available if required to safeguard health and animal welfare.

Without question, vets are the key gatekeepers here but, with that, comes the need to prescribe responsibly – after all that is the difference between having continued veterinary access to these important drugs and outright bans.

But there is a sense that ‘we are all in this together’ – and that means that farmers and human healthcare doctors need to do their bit. It also means continued global pressure to raise antibiotic usage standards – and, here, pharmaceutical companies must also play their part.

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