For many years now the animal sector, much like the human sector, has been involved in measuring the sales of antibiotics with a view to reducing their use to fight the now-called ‘silent pandemic’. But to truly understand how we can address antimicrobial resistance, it is clear that we first need to pay close attention to the data and ensure enhanced surveillance, not only of sales and use of antibiotics in animals and people, but also of development of resistance.
Data from 2020 collected by the European Medicines Agency shows that animal antibiotic sales have fallen across Europe since 2011. The decrease can be as much as over 50% in some major livestock producing countries and 43% on average across the EU, UK and EEA. And the World Organisation for Animal Health 2022 summary report on global antimicrobial use - which is collected from 120+ countries worldwide – shows a 27% decline in three years.
It is not about ‘zero use’ of veterinary medicines and antibiotics. It is about reducing our need for them but acknowledging that if we do have to use them, we use them in the right way
Yet data from the European Commission reports 33,000 deaths per year due to AMR - a figure that is reported to be rising. The same reports also show that AMR costs €1.5 billion per year in healthcare spending. At a time of rising costs and insecurities, a stringent focus on where best to invest efforts is critical.
Although sales data from animal and human health sectors can offer an indicator of trends in antimicrobial use, it cannot measure whether AMR itself is rising or falling, and that’s what we really need to address. Only testing for resistance itself can help shed light here. It is imperative that sales reporting from all sectors is also accompanied by AMR surveillance.
Better access to accurate data should allow for greater analysis of where our attention and actions should focus. Potential actions for tackling AMR are endless, but funding, time and manpower are not. Better understanding of where AMR transfer occurs and what actions can be most effective is essential. As EPRUMA, we support such efforts so that future strategies can focus on actions that provide the greatest potential impact.
For example, a study from the European Centre for Disease Prevention and Control found that “75% of disease linked to resistant bacteria is due to healthcare-associated infections”. And an OECD analysis of antimicrobial resistance found that “three out of four deaths could be averted by spending just USD 2 per person a year on measures as simple as handwashing and more prudent prescription of antibiotics”
Research indicates that animals can play a role in AMR development, which is why the progress for responsible use in the animal sector remains important, but complementary action in human health is required to make a significant dent in the development of resistance in the years ahead. As a study from the University of Edinburgh indicates, reducing antibiotic use only in animals but not in people has “little impact on the level of resistance in humans.”
Efforts to ensure responsible use should of course continue in all sectors, but solely focusing on continued declines in sales of antibiotics in the animal sector will not adequately address the challenge. In fact, some countries in Europe are starting to show a levelling out of sales after steep declines. This could be a sign that those countries have reached an optimal level of use where prevention is optimised, but antibiotics remain necessary for treatment of disease. Animals - pets, fish and livestock - can still get sick, no matter the care provided, and they will require treatment with antibiotics in the case of a bacterial infection.
There are many actions we can take in common. We need to think about how we look after and feed our animals, just like people need to take care of their health, through diet and wellbeing. We need to be mindful of disease risks and mitigate against those risks through surveillance and preventative health care, just like people need to be aware of disease spread and take preventive measures such as vaccination.
It is not about ‘zero use’ of veterinary medicines and antibiotics. It is about reducing our need for them but acknowledging that if we do have to use them, we use them in the right way, at the right moment, at the right dosage and adhering to veterinary prescriptions and instructions. The same applies in human healthcare.
The concept of One Health is about recognising that responsible use of antibiotics is of equal importance in both humans and animals. Antibiotics are a cornerstone of modern medicine and will remain essential tools to treat bacterial diseases. Using antibiotics as little as possible, but as much as necessary, will continue to be EPRUMA’s guiding principle for now and into the future.
Cat McLaughlin is chair of EPRUMA a multi-stakeholder platform linking best practice with animal health and public health.