Global concern continues to grow over the relentless rise of antibiotic resistant infections. However, while there is general agreement that the use of antibiotics in humans needs to be reduced, there has been a longstanding debate between campaigners and advocates of intensive livestock production about the quantities of antibiotics used on intensive livestock farms and how much this impacts on human health.
Latest in these exchanges is a letter from SFT policy director Richard Young and Cóilín Nunan from the Alliance to Save Our Antibiotics (ASOA), which has recently been published in the Veterinary Record (31st October, 2015). This was a response to an earlier letter (19th September, 2015) written by David Burch, a leading veterinarian with over 40 years experience working in the industry. Burch’s letter was, in turn, a response to an editorial (15th August, 2015) written by Dr J. Scannell and Dr A. Bruce, antimicrobial resistance researchers based at the Innogen Institute at the University of Edinburgh.
Anticipating the preliminary recommendations of the independent Review on Antimicrobial Resistance (known as the O’Neill Review), Scannell and Bruce’s editorial, Antibiotics: expect to use less, more responsibly, outlines a scenario for antibiotic drug use in the future which would require going beyond current ‘responsible use’ guidelines[i], which in fact go little further than recommending compliance with current legislation.
With an estimated 10 million people worldwide predicted to die every year from antimicrobial resistance by 2050 (more than most other causes of death)[ii], Scannell and Bruce suggest that in the future, international consortia could be offering payments in the region of $3.5 billion to pharmaceutical companies to develop new classes of antibiotics. Along with further programmes being implemented in the NHS to improve antibiotic prescription protocols, and improved screening and diagnostic testing, it is unthinkable, they suggest, that the farming community shouldn’t also be made to jump through new and higher hoops to help protect this precious resource. This political argument, the authors believe, overrides the technical argument over the extent to which antibiotic drug use in animals is impacting the effectiveness of antibiotic use in humans.
David Burch responded to this editorial by questioning why the hoops need to be set so high, arguing that restrictions and legislation on antibiotic use on animals should be based on scientific facts, rather than on what he calls the ‘perception principle’.[iii] He supports his scepticism by pointing out that the UK has one of the lowest uses of antibiotics in livestock in the EU, at 51 mg/population correction unit (PCU)/year in 2011 (in relation to the quantity of meat produced), only slightly above Denmark, but well below Italy and Holland. Additionally, while accepting that the lack of strong evidence linking resistance to antibiotic use in animals may be due to lack of research, he considers that “the contribution to human resistance from animal resistance by the indirect contamination of food is surprisingly small.”[iv]
Richard Young and Cóilín Nunan disagree with both of Burch’s main points.[v] Firstly on antibiotic use in the EU, they point out that the PCU units (a way of adjusting for the different numbers of farm animals in different countries) which Burch relies on to support his claim of low levels of UK farm antibiotic use, are hugely misleading because they do not take into account the significant variation of use depending on animal species and production system – for example, pigs and poultry generally use far more antibiotics than sheep and goats, where use is generally low. This is important when comparing countries like Denmark, where pigs account for around 75% of total PCU, with the UK, where they make up only 11%. Goats and sheep, on the other hand, make up 40% of total PCU usage in the UK, but only 0.1% in Denmark. This is significant because when looking specifically at antibiotic use for pig and poultry production, the data shows that far from using less as David Burch claims, the UK actually uses over three times more antibiotics per total PCU than countries like Denmark and the Netherlands.
On Burch’s second point (the lack of evidence), Young and Nunan provide ample evidence of the transmission of antibiotic resistance between farm animals and humans, as well as offering a troubling picture of the increased spread of resistant strains/genes in a number of widely recognised bacteria including MRSA, enterococci, salmonella, campylobacter and Klebsiella pneumonia.
The European Commission has proposed ending the preventative use of feed additives for groups of animals showing no sign of disease. Some EU countries (including the Scandinavian countries) strongly support this, others such as the UK and Italy oppose it. None of this will stop the use of antibiotics in feed, water, by injection or other means for animals that are ill.
The SFT and the ASOA (to which the SFT belongs) want the EU proposal extended to include a ban on the routine use of water-based antibiotics in healthy animals as well. Countries like Sweden and Denmark have been arguing for an end to all routine preventative use of antibiotics and have themselves ended such use, but there is strong opposition to this within the industry.
Despite the mounting scientific evidence in support of increased controls over antibiotic usage in both human and animal populations, progress to date is lamentably slow. What is needed is the political will to stand up to those who are dragging their feet, in order to bring about the necessary shift in attitudes, so that antibiotics are held in reserve for treating serious or life-threatening conditions in humans and animals, but otherwise used as sparingly as possible. This needs to be supported by changes in livestock production to make animals less prone to infection, with improved education in relation to the use of antibiotics in both people and animals and substantial investment in the research needed to develop new classes of antibiotics for the future.
[i] J. W. Scannell & A. Bruce (2015) Antibiotics: Expect to Use Less, More Responsibly, Veterinary Record, 177(7), pp. 168–170.
[ii] Review on Antimicrobial Resistance (2014) Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations (Review on Antimicrobial Resistance). Available at http://tinyurl.com/pqh4jwb, accessed November 12, 2015.
[iii] D. Burch (2015) Use of Antibiotics in Animals and People, Veterinary Record, 177(11), pp. 292–293.
[v] C. Nunan & R. Young (2015) Use of Antibiotics in Animals and People, Veterinary Record, 177(18), pp. 468–470.
Photograph: Petra B. Fritz
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