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Report warning of looming global health crisis to prompt action on antimicrobial resistance

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The Government has signalled its intention to take ’strong action’ after a major report on antimicrobial resistance called for further moves to reduce antibiotic usage in farm animals.
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The UK pig sector recently launched a new antibiotic stewardship programme
The UK pig sector recently launched a new antibiotic stewardship programme

UK animal health, farming and food chain organisations are joining forces to develop ‘meaningful targets’ to cut antibiotic use in UK agriculture, after the Government signalled ‘strong action’ on the issue.

 

This followed the publication on Thursday (May 19) of the final report of the O’Neill Review on Antimicrobial Resistance (AMR), which warned ‘superbugs’ could kill 10 million people a year by 2050 - one person every three seconds, and more than cancer kills today - unless something is done now.

 

The extensive report, commissioned by Prime Minister David Cameron in 2014, sets out 10 areas where action is needed to address the ‘worsening’ global problem of drug-resistant infections, including reducing the ‘unnecessary use of antibiotics in agriculture’.

 

It highlights how antimicrobial drugs are becoming less effective and warns the world is not developing enough new ones to keep up. On top of the human health cost, failure to address the problem will result in a cumulative economic cost of around $100 trillion, it adds.

Agriculture targets

 

Use of antibiotics in agriculture cited as a contributing factor in the report, which highlights the US, in particular, where, of the antibiotics defined as medically important for humans, over 70 percent (by weight) are sold for use in animals.

 

The report calls for improved surveillance to establish the extent of antibiotic use in agriculture in different parts of the world.

 

It also recommends the establishment of targets to be set by individual countries, giving governments flexibility over how they cut usage.

 

“Alongside this, we need to make much quicker progress on banning or restricting antibiotics that are vital for human health from being used in animals,” the report adds.

 

Other recommendations include:

 

  • A global public awareness campaign
  • Encouraging more selective use of drugs in human medicine
  • Improving the supply of new antibiotics and
  • Promoting the development of vaccines and alternatives.

Call for action

 

Review chair Lord Jim O’Neill called on the governments across the world to ’take real action’ on his proposals ’to avoid the terrible human and economic costs of resistance that the world with otherwise face’.

 

He said: “My Review not only makes it clear how big a threat AMR is to the world, with a potential 10 million people dying each year by 2050, but also now sets out a workable blueprint for bold, global action to tackle this challenge."

 

The UK Government has signalled its clear intent to act, with Chancellor George Osborne describing the report as a ‘stark warning’ that ’unless we take global action, antimicrobial resistance will become a greater threat to mankind than cancer currently is’

 

“It is not just a threat to health, but also to the world economy," he said.

 

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Defra’s Chief Veterinary Officer Nigel Gibbens said: “There is no question we have more than enough evidence to take strong action now on use in animal production as well as in human health.”

 

He called for action in all areas identified in the report, including minimising antibiotic use to where it is ’unavoidable, necessary and effective’.

 

He also welcomed the 'framing of targets in terms of a progressive, monitored process' .

 

He added: "However, it is clear that within this we must minimise the threats to human health as rapidly as we are able to, and this includes assessing what risk is posed to people by use in animals of certain antibiotics which are ‘critically important’ for human health – and restricting or even prohibiting their use in animals when this is necessary to protect public health.”

Task force

 

The Responsible Use of Medicines in Agriculture (RUMA), an alliance of 24 organisations from across the supply chain, immediately announced it was setting up a ‘task force to look at how meaningful targets can be developed to replace, reduce and refine antibiotic use in UK agriculture’.

 

RUMA backed the O'Neill report’s main findings, agreeing maintaining the efficacy of antibiotics required ‘global focus combined with local action across both human and animal medicine’.

 

RUMA secretary general John FitzGerald said: “We also understand the report’s ambition to develop long-term targets.

 

"The industry has long recognised the beneficial role targets can play, but is acutely aware that inappropriate targets can also be counterproductive and even lead to increased risk of resistance.

 

“So we are delighted to announce the setting up of this task force which will harness the expertise of specialists across different sectors and work proactively with the authorities to look at identifying effective, evidence-based goals that work for our UK livestock sectors and protect animal welfare.”

 

Recognition

 

Mr FitzGerald said that RUMA was also pleased to see recognition of the importance of surveillance in the UK livestock sectors.

 

The UK poultry meat sector set up detailed surveillance of antibiotic use five years ago and through this has been able to replace, reduce and refine antibiotic use and pass on its learnings to other sectors, he said.


The pig sector has just launched an online medicine book and stewardship programme to improve on pig usage data already collected through the Red Tractor scheme, while the cattle sector announced last year it would be working with vets to collect usage.

 

Summary of O'Neill recommendations

  • A massive global public awareness campaign
  • Improve hygiene and prevent the spread of infection
  • Reduce unnecessary use of antimicrobials in agriculture and their dissemination into the environment
  • Improve global surveillance of drug resistance and antimicrobial consumption in humans and animals
  • Promote new, rapid diagnostics to cut unnecessary use
  • Promote development and use of vaccines and alternatives
  • Improve the numbers, pay and recognition of people working in infectious disease
  • Establish a Global Innovation Fund for early-stage and non-commercial research
  • Better incentives to promote investment for new drugs and improving existing ones
  • Build a global coalition for real action – via the G20 and the UN

More reaction

British Veterinary Association President Sean Wensley said: "Antimicrobial resistance is a global issue, which the veterinary profession is deeply concerned about as it threatens our ability to treat animals and protect human health.

 

We welcome Lord O’Neill’s report, which recognises the importance of using a whole range of measures in both human and animal health to tackle AMR, and the fact that action must be taken globally.

 

“BVA has opposed the introduction of arbitrary, non-evidence based target setting; such targets, to reduce antibiotic use, risk restricting vets’ ability to treat animal diseases, which could have serious public health and animal welfare implications.

 

However, we accept that evidence-based targets to reduce usage in animal agriculture are likely to form part of the solution to address AMR on a global scale. Therefore we are pleased that the report recognises the need for targets to be evidence-based and country-specific, acknowledging that the UK and Europe have already taken action such as banning the use of antibiotics as growth promoters."

 

National Pig Association chief executive Zoe Davies said: “We support the report’s view that unnecessary use of antimicrobials in agriculture can cause a threat to human health and we agree with its key findings concerning agriculture.

 

“Its recommendations regarding improved animal health education, the need for accurate data on antibiotic usage, and restricting the use of last-resort antibiotics are already included in our new stewardship programme.

 

"Our goal now will be to ensure our aspirations are aligned with the O’Neill report in key areas and to make sure our stewardship programme moves forward as quickly as possible.

 

Georgina Crayford, NPA senior adviser, said: "We can’t do much ourselves about countries where antibiotics are used indiscrimi-nately, but we can take the necessary actions to make sure our own standards are be-yond reproach."

 

 

Patrick Holden, Sustainable Food Trust chief executive said: “David Cameron was far-sighted in asking Lord O’Neill to undertake this review, but he needs to understand that the commercial realities of farming at the moment are increasing the pressure on farmers to use more, not less, antibiotics.

 

"The question for the Prime Minister is, therefore, how can the government incentivise farmers to improve their systems so they use less antibiotics?

 

“Introducing a tax on antibiotics could be part of the solution, but only if the funds raised were recycled to help cover the costs farmers will incur in adapting their systems to reduce illness in their animals and the need for antibiotics”.

 

Professor Dame Sally Davies, Chief Medical Officer for England, said: "In every international forum, including the G7, G20 and the UN, we must work with our international partners to ensure global action.

 

"At present around 7 per cent of deaths are due to infections. If we do not act, this could rise to 40 per cent - as it was before we had antibiotics.”

 

Sir Venki Ramakrishnan, President of the Royal Society, and Nobel Prize-winning biologist, said: “The emerging global problem of antimicrobial resistance is one of the most serious health concerns we face today.

 

"The problem can only be tackled by combining a variety of measures, including appropriate use of existing antibiotics, public awareness and public health measures.

 

"It is equally important to solve the problem of the current lack of market incentives for the development of new antibiotics."

 

Dr Monique Eloit, Director General of the World Organisation for Animal Health (OIE), said: “To make progress in the fight against antimicrobial resistance in various countries throughout the world a realistic assessment of the local situations and variety of production systems is required.

 

"Strengthening national capabilities, in particular regarding legislation and control of antimicrobial use through the oversight by veterinarians will be the cornerstone to success in our fight against antimicrobial resistance.”

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