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AMR – UK is leading the rest of the world
  1. Adele Waters

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Six out of 10. That’s how the government’s chief medical officer rates the level of progress made by the UK in tackling antimicrobial resistance (AMR).

Her verdict: ‘We’re doing really well, we’ve just got to do more.’

Speaking at a seminar on AMR last month, Dame Sally Davies hardly paused before rating progress in the human and animal health sectors as equal.

Some vets might say she has not always been as balanced, given that the biggest cause of AMR is the overuse and misuse of antibiotics in human medicine.

But 2019 has brought a shift in tone. Speaking at a Westminster Health Forum seminar, she was fulsome in her praise for the farm animal sector.

‘I can’t tell you how proud I am of our farmers … since 2014 they’ve reduced by 40 per cent their antibiotic use from 62 mg/kg in 2014 to 37 mg/kg in 2017 … they set their own targets and just got on with it – fantastic!’

Earlier this year the government announced a 20-year vision for AMR to be effectively contained, controlled and mitigated across the globe by 2040 (VR, 2 February 2019, vol 184, p 140-141).

The ambition is threefold: to reduce the need for, and unintentional exposure to, antimicrobials; to drive the launch of new therapies and interventions to treat infections; and to use the antimicrobials we have optimally.

There are several five-year targets – to reduce UK antimicrobial use in people by 15 per cent and in food-producing animals by 25 per cent among them.

The UK has shown international leadership on this issue while making notable progress itself. Quite right, then, for Dame Sally to turn her attention to the rest of the world. ‘Look at where other countries are,’ she said. ‘Are they really making the progress we are?’

Referring to farm antibiotic sales in Europe (2016) – she showed the highest levels were recorded for Italy, Spain and Cyprus, while the lowest were in the Nordic countries. The European Food Safety Authority and European Centre for Disease Prevention and Control recently warned that AMR ‘shows no signs of slowing down’.

If this is the case in Europe, with its regulations and restrictions around antimicrobials, what about the rest of the world? In many African countries there remains a great deal of ignorance – Nigeria and Zambia, for example, have very few antibiotic stewardship programmes in their tertiary hospitals and as many as 70 per cent of antibiotics are purchased over the counter. While UK pharmacists receive training in AMR, this is not the case in every country.

Recently, the World Organisation for Animal Health (OIE) released its third annual report on antimicrobial use in animals. Despite hopeful signs – more countries than ever before contributed data to the report, and the number of countries permitting the use of antimicrobials for growth promotion purposes fell – it is clear that many challenges remain.

Many countries lack regulatory frameworks to govern the manufacture, registration, use and pharmacovigilance of veterinary products, or struggle to enforce their frameworks. Some do not have the required infrastructure or technology to collect data on antimicrobial use, while others do not have the human resources to do so. Still others report a lack of coordination or cooperation between national authorities and the private sector.

Time is of the essence, if AMR is to be controlled

As a result, the global picture of antimicrobial use in animals remains patchy. Time is of the essence, however, if AMR is to be controlled. Countries that already have systems in place to govern antibiotic use cannot rest on their laurels, while countries that do not must be encouraged and supported to institute them as soon as possible.

So while it is certainly right for the UK to get recognition for its leadership on this issue, as this journal has argued many times, AMR is a global problem, and, as such, requires a global One Health response.

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