Antimicrobial resistance in agriculture - why we need to act now

Antimicrobial resistance (AMR) is recognised as one of the greatest global threats and vets play a key role in the fight to preserve the efficacy of these crucial medicines. It’s widely thought that vets and farmers are largely responsible for the current levels of antimicrobial use; in fact globally, two thirds of antibiotics are used in agriculture. But in the UK, less than 30% of antibiotics are used in production animals. In recent years, enormous reductions have been documented and antibiotic sales for livestock in the UK have fallen by 53% since 2014, placing the UK amongst the lowest users in Europe. But there’s still a lot to be done. AMR, amongst other social, environmental and political risks, threatens the sustainability of agriculture. It is an escalating "one health" problem that both animal and human health practitioners must tackle as a matter of great urgency.

Global health burden

Whilst the picture in the UK looks pretty positive, elsewhere a different story is emerging. With global expansion of intensive farming practices to support the demands of the booming population, a 67% increase in the use of antimicrobials in animals in low-middle income countries is predicted by 2030. The largest hot-spots of resistance are in China, India, Brazil and Kenya. Between 2000 and 2018, the proportion of antimicrobial compounds with over 50% resistance increased from 0.15 to 0.41 in chickens, 0.13 to 0.34 in pigs and cattle plateauing between 0.12 and 0.23 (Van Boekel et al., 2019). The effects are frankly frightening. AMR causes approximately 700,000 human deaths globally per year, predicted to increase to 10 million costing $100 trillion by 2050 if we do not act now. And if that isn’t enough to shock the global community into action, the effects on human healthcare are a real and growing threat. Imagine a world where simple infections are untreatable, where simple surgical procedures or chemotherapy are impossible.

"Imagine a world where lives are lost because of a generation that failed to act on the facts in front of them."

Global health, food security, the environment and socio-economic development will be impacted. The World Bank estimates an additional 28 million people may be forced into poverty due to economic shortfalls caused by AMR. The UK is well placed to set a vital and inspiring example. Some major and brave decisions must be made to propel the industry towards becoming world leaders in sustainable antibiotic use. Upscaling surveillance systems would provide an accurate picture of the situation to better guide the actions required, whilst policy makers across all nations may consider supporting a transition towards farming practices including low antimicrobial use as an objective.

Essential medicines

Antibiotics are essential to treat disease and prevent suffering whilst safeguarding food safety. We must be cautious not to compromise our privilege and clinical freedom to prescribe these vital medicines where there is a clinical need, in the move towards the goal of sustainable levels of use. Disease is a major challenge, exacerbated by climate change causing the emergence and spread of new infections. Alternative disease prevention receives greater emphasis in herd health planning since the introduction of compulsory vet-led medicines reviews by Red Tractor in 2018. Since then, new guidelines have been rapidly and regularly rolled out. Are we looking at a future where farmers lose the privilege of keeping and administering medicines on farm? For many that alone is enough to trigger a drastic shift in attitude.

"Antibiotics are essential to treat disease and prevent suffering whilst safeguarding food safety. We must be cautious not to compromise our privilege and clinical freedom to prescribe these vital medicines where there is a clinical need, in the move towards the goal of sustainable levels of use."

Vets in knowledge transfer

As a clinician it feels frustrating when producers cannot see past their farm gates, but a perceived lack of transparency from industry bodies alienates the very people who need to act. Farmers have done a remarkable job cutting their use of critically important antibiotics, but they cannot be tasked with continuing to reduce their use without incentives and evidence-based strategies for doing so without compromising animal welfare. Our producers mustn’t be kept in the dark. Urgent conversations must be had and vets are key in knowledge transfer. In practice, making regulations relatable to farmers' individual businesses really resonates with them. Community is integral to the farming fraternity and a useful tool for encouraging these conversations to take place - I have heard and had incredibly engaging and encouraging exchanges in this setting. An urgent acknowledgement and acceptance of the facts is the first step, and only once we have achieved this can we instigate true and lasting change.

References

RUMA (2019) RUMA Targets Task Force: Two Years On. (online) Available from: https://www.ruma.org.uk/wp-con... (Accessed 17 September 2020)

HM Government (2019) UK One Health Report: antibiotic use and antibiotic resistance in animals and humans. (online) Available from: https://www.gov.uk/government/... (Accessed 17 September 2020)

HM Government (2019) Contained and controlled: The UK’s 20-year vision for antimicrobial resistance, (online) Available from: https://assets.publishing.serv... (Accessed 17 September 2020)

Boeckel, Thomas & Pires, João & Silvester, Reshma & Zhao, Cheng & Song, Julia & Criscuolo, Nicola & Gilbert, Marius & Bonhoeffer, Sebastian & Laxminarayan, Ramanan. (2019). Global trends in antimicrobial resistance in animals in low- And middle-income countries. Science. 365. eaaw1944. 10.1126/science.aaw1944.