Antibiotic resistance needs more work

A recent survey found 67 countries have information on antibiotic use in animals, but only 41 collect systematic data

An international survey has found that most countries have good intentions when it comes to tracking antimicrobial resistance and antibiotic use among humans, animals and plants, but more work is needed.

All World Health Organization member states agreed on a global action plan in 2015, saying they would have antimicrobial resistance plans in place within two years. While progress has been made, many have not reached the full commitment.

WHO adopted five objectives to reduce antimicrobial resistance:

  • More awareness and understanding of antimicrobial resistance is needed.
  • Strengthen knowledge and evidence with more surveillance and research.
  • Reduce the risk of infection through better sanitation, hygiene and infection prevention.
  • Optimize the use of antimicrobial medicines in human and animal health.
  • Develop the economic case for sustainable investment that addresses the needs of all countries and increase investment in new medicines, diagnostic tools, vaccines and other interventions to prevent infections.

A joint project of the United Nations’ WHO, World Organization for Animal Health and Food and Agriculture Organization asked member countries to submit information on their progress in reducing the use of antimicrobials, tracking use and monitoring resistance. The first survey was done in 2014 and the second report in 2017 covered 154 countries and was released July 18.

In this most recent survey, more than 100 countries said they have a national surveillance system for humans, and 67 said they have some information on animal use. However, only 41 percent reported a systematic data collection. Only 11 countries survey antimicrobial resistance in plants or the environment.

Upper middle income countries tended to do more information gathering. The G20 members agreed in 2017 to develop and implement national action plans by the end of 2018. About half the members have national action plans, while the rest are in development.

Most of the top 10 chicken, pork and beef producing countries, including Canada, have developed a national action plan on antibiotic use, but responses show most of the work is done in the human health sector. More action in the animal and food sectors is needed, said the report.

Ninety countries report that they have a national infection prevention and control program and national guidelines. About half those countries have a national plan for good production practices in the animal health sector.

Preventing infection plays a major role in curbing antibiotic use.

Vaccination for people and animals is still low.

Access to basic water supplies, basic hand hygiene and functional sanitation facilities are also lacking in health care centres around the world. This is particularly pronounced in Africa and some parts of South Asia.

Progress is being made to introduce immunization, enhanced biosecurity in health care facilities and farms and environmental sanitation in communities.

Prescriptions for antibiotics in humans are required in 123 countries, 64 countries have limited the use of antibiotics for growth promotion in livestock and 10 countries have regulations to limit environmental contamination with antibiotics. Seventy-eight countries have general regulations on this.

The Global Strategy Laboratory at Toronto’s York University analyzed the results and ranked the countries from one to five. Level one is minimal progress, level two is in development, level three is satisfactory and indicates they have national plans while levels four and five are in advanced stages.

“There has been progress across all the sectors. Progress is a little more advanced in the human sector. Many countries have been working on their AMR strategies. There is also scope for improvement in all the countries,” Susan Rogers Van Katwyk of the Global Strategy laboratory said during a webinar last month.

“Many countries have awareness campaigns for human health, but few countries have campaigns in the animal sector.”

Henk Jan Ormel, senior veterinary policy adviser with the FAO, agreed with the survey results.

“We think progress is too slow. It needs to go faster,” he said.

More countries need to understand the importance of all sectors working together for a one-health approach in which human, animal and environmental factors are co-ordinated.

“The survey is also showing very clearly there is chronic under-investment of the animal, plant and environment sector. Countries need to invest more in how our daily food is produced. This is not only investing in antimicrobial resistance laboratories or legislation; we need to offer alternatives to farmers,” he said.

“More investment is needed in good agriculture practices in hygiene, better infection prevention, biosecurity and quality and affordable vaccination because all those things are reducing the need for antimicrobials.…

“We have to acknowledge that 50 to 70 percent of the new emerging infectious diseases come from animals. To cope with these diseases, we need to fight the diseases at the source where the animals are.”

The elimination of infectious diseases such as rinderpest improved the health of cattle and lessened the need for antimicrobials.

Antibiotics should not be taken away, but excess use needs to be discouraged, said Elizabeth Tayler of WHO.

“Antibiotics allowed us to get away with poor quality care in many places. To have health facilities without a clean toilet, without clean water or somewhere to wash your hands is a real problem. We have a lot of work to do there.”

Investment in basic systems is needed, especially in low income countries where there is a high burden of infections.

Antibiotics are needed because of the growing demand for animal based protein, but many countries need to step up best practices to improve the health of their livestock. Farmers need more education.

“You need to wash your hands in hospitals. It is the same in farms. You need to wash your hands,” Ormel said.

“You need to clean your boots. You need to see animals coming into your farm are at risk for bringing in microbes, creating diseases, and then you need to use antimicrobials.”

While international groups consider antimicrobial resistance to be a growing threat as more drugs become less effective against bacterial infections, governments need to understand the urgency.

A strong national action plan on antimicrobial use has to fit in with a country’s national development plan, said Ben Davies of the World Organization for Animal Health.

“It has to be presented in a way that will support national development and economic growth,” he said.

“You have to have a convincing economic argument.”

The pharmaceutical industry also needs to be encouraged to develop new products that will last a long time.

“This is a real example of market failure because the incentives to develop new drugs are much weaker, and when countries do develop new drugs, we need to ensure they are looked after with tight stewardship, tight controls on utilization so that resistance does not develop quickly,” said Tayler.

What to know about antibiotic resistance:

  • Antimicrobial resistance occurs when micro-organisms — bacteria, fungi, viruses and parasites — evolve resistance to antimicrobial substances such as antibiotics, antifungals and others.
  • This occurs naturally through adaptation to the environment or through selective pressure when micro-organisms come into contact with antimicrobials.
  • The process is accelerated when there is inappropriate or excessive use of antimicrobials.
  • As a result, medicines that were once effective treatments for disease in people and animals become less effective or not effective at all, leading to a reduced ability to successfully treat infections.
  • This in turn leads to more severe or prolonged illnesses, increased mortality, production losses in agriculture and reduced livelihoods and food security.
  • There is no standardized data on the global use of antimicrobials in livestock, and less than half of the countries in the world have a system to collect data on use in farm animals.
  • The risk appears particularly high in countries where legislation, regulatory surveillance and monitoring systems on the use of antimicrobials and the prevention and control of antimicrobial resistance are weak or inadequate.

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