Antibiotic resistance: A silent tsunami

Written by The Parliament Magazine on 7 July 2017 in News
News

A conference in the European Parliament has heard calls for a 'name and shame' approach for countries that fail to properly tackle antibiotic overuse.

A conference in the European Parliament has heard calls for a 'name and shame' approach for countries that fail to properly tackle antibiotic overuse | Photo credit: PA Foundation


In a packed meeting room of the European Parliament Ms Susan Fallon took the floor. Moments later the employee of a university in England managed to refocus the attention of Commissioner Vytenis Andriukaitis and the entire audience to the bare essential of Antimicrobial

Resistance: it indiscriminately kills hundreds of thousands of people every year, including her daughter. She called on the Parliament and on the European Commission to ensure that this threat will stop. 

The mere size of the problem - 300 million AMR deaths by 2050 - inspired Commissioner Andriukaitis to deliver deeply emotional statements: "AMR is a silent tsunami. Decisive collective actions are needed to avoid slipping backwards towards a pre-antibiotic age where even minor infections and injuries resulted in death."


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Highlighting the rapid spread of AMR, Professor Ramanan Laxminarayan, director of the US Centre for Disease Dynamics, Economics and Policy, said the problem was particularly acute in developing countries.

"What has happened in the last 10 or 15 years is that resistance has gone up from being under one per cent or under 0.5 per cent; that was observed in many instances to being as high as 50, 60, 70, 80 per cent in many countries. We always expected this, anticipated it, did nothing to prepare for it and now we are faced with it". 

Discussing the MCR-1 plasmid, Dr Laxminarayan stated that "we just found it two years ago in China in animals and today you can see that MCR-1 is a global phenomenon."

Sarah Cahill, of the Food and Agriculture Organisation of the United Nations, warned: "As all of you here are aware, antimicrobial resistance now threatens to undo decades of improvements and gains in human health care outcomes, in managing animal health issues and has a direct impact on the ability of people to live full and productive lives."

Developing methods aimed at reducing antibiotic use in animals was a key discussion point at the event. Diederik Standaert, from the Belgian health ministry's animal, plant and nutrition directorate, outlined a new EU functional group of feed additives.

"Antimicrobial resistance now threatens to undo decades of improvements and gains in human health care outcomes, in managing animal health issues and has a direct impact on the ability of people to live full and productive lives"

By amending Regulation EC 1831/2003, feed additives could be recognized as supporting animal welfare and help drive investment in the "development of feed additives that may reduce the need for antibiotics, the so-called alternatives". These are products that bolster the immune system and natural defence abilities of animals. 

Looking further into the core of the AMR problem, Standaert commented that the current proposal lacked "an explicit reference to animal growth and performance which is a well-known secondary effect of antibiotics; offering farmers officially regulated and registered substances as an alternative may further reduce their demand for antibiotics."

Dr Thomas Van Boeckel of the Swiss Institute of Integrative Biology, presented global trends in antimicrobial use in the animal world. He suggested ways society could potentially try to limit the "alarming" rise of antimicrobial resistance from the animal side.

Van Boeckel also looked at the economic impact of phasing out antimicrobials used as growth promoters. He said, "Using the limited data available on this we evaluated that the financial loss on the value of meat production would be around 1.3-3 per cent. So, the message is that loss is minimal and it's probably not worth it to use antibiotics as growth promoters."

EFPIA Director General Nathalie Moll signalled that the antibiotics producers' business model is ready for adaptation. Weeks earlier CEOs of the animal husbandry industry indicated the same. Competitive positions disallow individual companies to reduce production, market share or profitability; only regulatory action and enforcement applied to all, can do so. 

This point was driven home by both COMECE expert Michael Kuhn and Oxford University Deputy Director Uehiro Chair in Practical Ethics Dr Hannah Maslen: "Governments are under clear moral obligation to regulate antibiotics use in farming."

Dr Van Boeckel also referred to the taxing of products produced with antibiotics as one of the best ways to immediately reduce the attractiveness of antibiotics as low-priced animal growth promoters. According to Dr Maslen this idea could be combined with the consumer labelling of such products if only to promote consumer choice. 

According to ENVI Vice Chair Pavel Poc (CZ, S&D) such labelling may also be considered to inform pregnant women and other more vulnerable consumers.

Knut Nesse, the CEO of Dutch animal feed giant Nutreco, said there was little awareness of the role that an animal nutrition approach could have on AMR reduction. "If we don't start changing and looking at alternatives to antibiotics, then we will end up using more, not less," he argued. 

This was corroborated both by Laxminarayan and Van Boeckel: by 2030 global agricultural antibiotics use is expected to increase by 67 per cent and 99 per cent in the BRICS. 

"If we don't start changing and looking at alternatives to antibiotics, then we will end up using more, not less"

Nutrition, animal health and good farm hygiene should be the "first line of defence", Nesse said, adding, "We should only use antibiotics as the last line of defence, and only when animals are sick." 

He told participants that Nutreco was working alongside other companies on preventative health actions, on ways to strengthen immune systems areas through the development of "integrated feed farm health management systems". 

He added that it was through measures such as nutrition-based strategies, that his home country had delivered a 58 per cent reduction in arm antibiotic use in five years.

The day after the conference EU health Commissioner Vytenis Andriukaitis presented the new EU Action Plan on AMR. He said the plan is based on three main 'pillars': making the EU a best practice region; boosting research; and shaping the global agenda on AMR.

Oddly, during the conference Andriukaitis conceded that despite "many initiatives" over recent decades "we have collectively failed to keep pace" with the rise of antibiotic-resistant infections. 

He said, "Certain superbugs are now in the ascendency. We have now reached a critical point where AMR is jeopardising both human and animal health. We are witnessing concentration of antimicrobials in the vicinity of big farms, hospitals, production facilities, waste water treatment plants, big cities in general."

Somewhat divergent of the approach of the new Plan, he said: "The golden days of miracle cures for many infectious diseases may be drawing to a close." 

The World Bank, the event was told, warns that by 2050, drug-resistant infections could cause global economic damage on a par with the 2008 financial crisis. 

"No single country or region can hope to defeat AMR working individually. People, animals, foods and goods move around the world every day, every hour, every minute. Bacteria move together with them, freely crossing borders," added the Commissioner. 

But despite such efforts he criticised member states who, he said, had been slow to adopt existing EU laws designed to combat AMR both in humans and on veterinary medicines and medicated feed.

While the European Parliament had adopted its position, and is ready to start negotiations, member states "are still lagging behind," he claimed. He went on, "We encourage the Council to speed up its work to be ready to start trilogue discussions still this year."

The former health minister said, "We can be proud of the fact that the EU banned the use of antimicrobials as growth promoters in feed for animal livestock production as long ago as 2006. We would like to see its further adoption beyond the EU, in the wider world. 

"Citizens are also becoming more and more aware and indeed worried about the rise of AMR. Their demands and pressure on producers and regulators to ensure that the food we eat comes from animals not unnecessarily treated with antibiotics will only increase in future."

It was vital, he noted, to halt resistant infections and to "keep our antimicrobials effective: for now, and for future generations."

Three MEPs also spoke at the event, including ENVI chair Adina-Ioana Valean, who said the main reason behind the "very worrying" growth in AMR had been the "inappropriate use" of antibiotics over a period of time, both in human medicine and animal husbandry. 

Along with more public awareness of the problem, more "prudent" use of antibiotics was among the urgent measures necessary to stem the increase, said the MEP who co-hosted the conference.

Further comment came from Swedish ALDE deputy Fredrick Federley who believes AMR is the "one of the biggest challenges" facing society.

There was a risk, he warned, that meat production would fall "dramatically" in the coming years because of an inability to effectively treat sick animals with non-resistant drugs. 

"There is also a risk that this will throw us back 100 years in human medicine if, for example, we are unable to provide effective cancer treatments because of the risk of infection. That will mean there will be more needless deaths," he said.

"We need shifts to less intensive, less traumatising, less brutal husbandry to ensure less need for antibiotic use and less use of those pesticides which could have a role in antimicrobial resistance development"

Czech MEP Pavel Poc, describing AMR as a man-made disaster, summarised the proceedings saying, "We need an AMR crisis mechanism, we need a legislation or horizontal reflection in existing legislation on both EU and member state level to limit any possible misuse of antibiotics to possibly zero. 

"But as usual, what we need most is accountability and strict enforcement, what here in EU means much more responsible approach from the side of member states who are responsible and only able to enforce and implement European legislation. 

"We need to invest heavily both in new molecules for antibiotics and in alternatives, particularly for antibiotics currently used to promote animal health and growth. We need shifts to less intensive, less traumatising, less brutal husbandry to ensure less need for antibiotic use and less use of those pesticides which could have a role in antimicrobial resistance development. 

"We need to enforce these new rules certainly in Europe but also within the context of the UN, using a name and shame approach when UN member states do not perform properly. We need a truly global and effective public information plan to ensure that every single mother really does understand the risks of consuming food containing antibiotics for the unborn or newly born child. We need new forms of labelling so that consumers can be made aware of what they eat."

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