“A study published in the journal PLOS Global Public Health by researchers from Europe and India used data from 42 countries to estimate global antimicrobial use at 99,502 metric tons (109,682 tons) in 2020. Nearly 60% of that occurred in just five countries: China, Brazil, India, the United States and Australia. Factoring in trends in food animal production and antimicrobial use, the researchers projected that antimicrobial use could rise to 107,472 metric tons (118,468 tons) by 2030 — an 8% increase.”
“Penicillin and other antimicrobial agents have long been used to beat back infections in livestock. But in recent decades farmers have increasingly been using such drugs to bump up healthy animals’ ability to grow bigger and produce milk by preventing infections and altering digestive tract bacteria in a way that makes more nutrients available to the animal. As a result, the use of antimicrobials has skyrocketed — and with it, the risk of microbes’ evolving resistance to them.”
“Demand for animal protein has been rising globally over the past decade. [1]. Meeting this growing demand has been facilitated by the expansion of intensive animal production systems where antimicrobials are used routinely to maintain health and productivity [2]. In 2017, antimicrobial use (AMU) in animals represented 73% of all antimicrobials used worldwide [3], and its use contributes to the rise of antimicrobial resistance (AMR) [4]. In animals, AMR can result in treatment failure [5], and thus represents a threat to the long-term sustainability of the animal industry. In humans, drug-resistant infections resulting from veterinary antimicrobial use remains challenging to quantify [6, 7] but may, for certain drug-pathogens combinations, pose a serious threat to human health [8, 9].”
“Monitoring global AMU is essential for tracking progress in addressing the causes of AMR. However, current initiatives are heterogenous across regions. In Europe, the harmonized Surveillance of Veterinary Consumption (ESVAC) report has been in place since 2005, and currently reports data from 31 countries in the European Union (EU) [10]. Outside of the EU, only 9 countries routinely publish national reports on AMU.
Since 2016, the World Organization for Animal Health (WOAH, formerly the Office International des Epizooties) annually gathers data, on a voluntary basis, from up to 157 countries on their use of antimicrobial agents in animals [11]. However, prior to public release, the country-level data collected as part of these annual surveys is aggregated in five regions (Europe, Africa, Americas, Middle East, and Asia/Far East/Oceania).
Furthermore, the list of countries that contribute data on AMU within each region is not publicly available. As such, this unidentifiability of countries which report to WOAH, and the regional aggregation of national AMU reports, precludes establishing a truly global AMU monitoring system. Firstly, it prevents evaluating the effect of national policies and stewardship efforts on AMU levels. Secondly, the acknowledgment of countries that have successfully reduced AMU might be diluted at regional level if neighboring countries compensate with an increase in AMU. Thirdly, it prevents further epidemiological analyses, such as evaluating a country’s antibiotic footprint using national trade data, which would also benefit from AMU at a national level.
In the absence of national-level data, previous studies have utilised modelling approaches to extrapolate for non-reporting countries using usage data reported by countries for 2010, 2015 and 2017 [2, 3, 12]. However, AMU regulation and policy is a dynamic landscape. In 2021, for the first time, the population-weighted mean antimicrobial use (AMU) in food-producing animals was lower than in humans in the EU/EEA [13]. This reduction of AMU in food-producing animals could be explained by policies and stewardship efforts [14, 15].
For example, in Nordic countries antimicrobials can only be obtained by veterinarian’s prescription, who should follow guidelines on antimicrobial treatments of animals (when to treat, dosage, administration route etc.), and who are not allowed to make a profit from their sales [16], decentivising (over)use of antimicrobials. However, policies governing AMU in animal production in other continents still vary widely between countries [17]. Brazil—the largest meat exporter in the world—still largely lacks a legal framework on the use of antimicrobials [18]. In contrast, other major meat producers such as China have recently implemented strategies for reducing AMU and in 2017 banned colistin as a feed additive [19]. Therefore, global estimates of antimicrobial use in animals need to be regularly revised, and new trends must be interpreted in light of this ever-changing regulatory landscape.”
In this study, “Data on usage of antimicrobials in food animals were collected from 42 countries. Multivariate regression models were used in combination with projections of animal counts for cattle, sheep, chicken, and pigs from the Food and Agriculture Organization to estimate global antimicrobial usage of veterinary antimicrobials in 2020 and 2030. Maps of animal densities were used to identify geographic hotspots of antimicrobial use. In each country, estimates of antimicrobial use (tonnes) were calibrated to match continental-level reports of antimicrobial use intensity (milligrams per kilogram of animal) from the World Organization for Animal Health, as well as country-level reports of antimicrobial use from countries that made this information publicly available.
“Globally, antimicrobial usage was estimated at 99,502 tonnes (95% CI 68,535–198,052) in 2020 and is projected, based on current trends, to increase by 8.0% to 107,472 tonnes (95% CI: 75,927–202,661) by 2030. Hotspots of antimicrobial use were overwhelmingly in Asia (67%), while <1% were in Africa. Findings indicate higher global antimicrobial usage in 2030 compared to prior projections that used data from 2017; this is likely associated with an upward revision of antimicrobial use in Asia/Oceania (~6,000 tonnes) and the Americas (~4,000 tonnes). “
See the Figure below for a map of antimicrobial consumption per country in 2020 and 2030.
Figure. Antimicrobial consumption per country in 2020 and 2030. Circles are proportional to quantity of antimicrobials used. Red circles correspond to the quantity used in 2020, and the outer dark red ring corresponds to the projected increase in consumption in consumption in 2030.
The authors concluded that: “National-level reporting of antimicrobial use should be encouraged to better evaluate the impact of national policies on antimicrobial use levels.”
One Health Approach to Tackle Antimicrobial Resistance
Prime Minister Mottley of Barbados recently hosted the seventh Meeting of the Global Leaders Group on Antimicrobial Resistance, or AMR.
At this international meeting, it was articulated that, “To protect human, animal, planetary and economic health, we must address AMR head on through a One Health approach.”
One Health is an approach to designing and implementing programs, policies, legislation and research in which multiple sectors communicate and work together to achieve better public health outcomes. The One Health approach is critical to addressing health threats in the animal-human-environment interface (WHO, 2023).
The areas of work in which a One Health approach is particularly relevant include:
- food safety
- control of zoonotic diseases
- laboratory services
- neglected tropical diseases
- environmental health
- antimicrobial resistance.
As reported in a recent review article by Dr. Matthew Hayek, Assistant Professor of Environmental Studies at New York University (Hayek, 2022), “Infectious diseases originating from animals (zoonotic diseases) have emerged following deforestation from agriculture. Agriculture can reduce its land use through intensification, i.e., improving resource use efficiency. However, intensive management often confines animals and their wastes, which also fosters disease emergence. Therefore, rising demand for animal-sourced foods creates a “trap” of zoonotic disease risks: extensive land use on one hand or intensive animal management on the other.”
“Not all intensification poses disease risks; some methods avoid confinement and improve animal health. However, these “win-win” improvements alone cannot satisfy rising meat demand, particularly for chicken and pork. Intensive poultry and pig production entails greater antibiotic use, confinement, and animal populations than beef production. Shifting from beef to chicken consumption mitigates climate emissions, but this common strategy neglects zoonotic disease risks.” Preventing zoonotic diseases requires 1) international coordination to reduce the high demand for animal-sourced foods, 2) improvement of forest conservation governance, and 3) selectively intensifying the lowest-producing ruminant animal systems without confinement.” (Hayek, 2022)
“Now, as we look down the road to the UN General Assembly 2024 High-level meeting on AMR, there are three key areas in which we can accelerate action.” The three areas include:
One, making the economic case for fighting AMR.
The many impacts of AMR damage the global economy. The Global South is hit hardest. If decision makers understand the costs, they can be motivated to act.
Two, pushing R&D on prevention.
While R&D is needed to advance the antibiotics pipeline, prevention is key. Stronger engagement with industry and specific regulatory changes can boost R&D on keeping antimicrobials effective, rather than just racing to stay ahead of resistance with new drugs.
Three, increasing funding.
More coordinated action needs increased and predictable funding. The Bridgetown Initiative to reform the international development financial architecture can make a positive difference to developing nations. Opportunities are being explored through the GEF and the Pandemic Fund. Other ways to mobilize funding include realigning incentives, public-private collaboration and eliminating harmful subsidies in agriculture. (WHO, 2023)
References
Mulchandani R, Wang Y, Gilbert M, Van Boeckel TP. Global trends in antimicrobial use in food-producing animals: 2020 to 2030. PLOS Global Public Health 2023;3(2): e0001305. https://lnkd.in/g-wWCAyi
Hoff M. Use of Antimicrobial Drugs in Food Animals is Accelerating. Here are suggestions for correcting that trend. Ensia. July 6, 2023. Available at: https://ensia.com/notable/antimicrobial-drugs-food-animals-farming-human-health/
United Nations Environment Program (UNEP). One Health approach to tackle antimicrobial resistance. July 3, 2023. Available at: https://www.unep.org/news-and-stories/speech/one-health-approach-tackle-antimicrobial-resistance
World Health Organization (WHO). One Health. Accessed July 6, 2023. Available at: https://www.who.int/europe/initiatives/one-health#:~:text=One%20Health%20is%20an%20approach,animal%2Dhuman%2Denvironment%20interface.
Hayek, M. The infectious disease trap of animal agriculture (review). Science Advances. 2022;8(44): DOI:10.1126/sciadv.add6681
World Health Organization (WHO). Global antimicrobial resistance and use surveillance system (GLASS) report: 2022. December 9, 2022. Available at: https://www.who.int/publications/i/item/9789240062702
Sustainable RDN 