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‘As little as possible, as much as necessary’
  1. Josh Loeb

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News that UK sales of antibiotics for use in food-producing animals continue to fall is welcome.

As data from the Veterinary Medicines Directorate (VMD) revealed last week (VR, 2 November 2019, vol 185, p 520), antibiotic sales (a proxy for on-farm antibiotic usage) dropped by 9 per cent between 2017 and 2018.

But can sales keep on falling? In theory, yes, they could keep dropping year on year, eventually reaching zero. Would this be a desirable endpoint? No, because sometimes antibiotics are necessary.

Nevertheless, in the minds of some consumers, ‘no antibiotics’ is evidently seen as a plus. American food shoppers already pay a premium for meat and dairy products stamped with the slogan ‘No Antibiotics Ever.’ More and more brands in the USA pride themselves on being ‘antibiotic free,’ and a small number of European food producers have also started catering for this demand.

If – and it’s a big if – human health infections with multidrug-resistant bacteria can be linked to antibiotic use on farms, then surely it would seem logical that the fewer antibiotics farmers use, the better. In other words, instead of aspiring merely towards a ‘responsible’ level of usage (and who says what counts as responsible?) why not simply aim for zero usage?

Superficially, that might seem appealing, but it’s far from practical. The American slogan is itself arguably misleading – animals on farms supplying meat labelled with the ‘No Antibiotics Ever’ slogan are often treated with antibiotics if the need arises, the only difference being that those livestock are then moved to a different production line and their meat is sold without the ‘No Antibiotics Ever’ stamp.

In other words, the problem (if one considers antibiotic usage per se to be a problem) is simply displaced.

When one thinks about it, in a completely antibiotic-free system the only alternatives to that are either (a) leave sick animals to suffer and then kill them (which inflicts an animal welfare harm), or (b) euthanase such animals straight away (uneconomical and ethically unjustifiable).

So, it’s hard to see the justification for the ‘No Antibiotics Ever’ movement. Perhaps it makes more sense in the American context, where usage of antibiotics for growth promotion was banned as recently as 2017, a decade after the practice was banned across the EU, so the ‘no antibiotics’ brand may appear to have more social currency.

Instead of reducing sales/usage to zero, one might expect to see graph lines showing year-on-year falls in antibiotic sales in the UK eventually plateauing and fluctuating above the zero mark.

The latest VMD data show that appears to be happening. For example, the high priority critically important antibiotic (HP-CIA) colistin – of which on-farm sales have been brought down to miniscule levels – had a slight upturn in sales volume between 2017 and 2018.

As Kitty Healey, the VMD’s head of antimicrobial resistance, explained at the Responsible Use of Medicines in Agriculture Alliance (RUMA) conference last week: ‘There’s been a very, very fractional uplift – measured in grams rather than kilograms, let alone tonnes.’

The challenge, she said, was communicating any upward use. How can the industry justify higher usage when it’s required? When antibiotic usage arrows go up that may signal a problem but, equally, she said, it could be that ‘we have reached the level of appropriate use.’

As this journal has argued before, efforts in animal health care need to be matched by their human equivalent. As RUMA, whose maxim is ‘as little as possible, as much as necessary’, points out, UK humans use around 2.4 times more antibiotics per kg of their weight than farm animals.

According to a recent joint One Health report by the VMD, Food Standards Agency and Public Health England, between 2013 and 2017, use of HP-CIAs increased in people by eight per cent and decreased in animals by 51 per cent.

The livestock sector is pulling its weight

So while we should not aspire towards using no antibiotics ever, the livestock sector is pulling its weight, with vets a key part of progress.

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