Dr Javier Yugueros-Marcos, Head of the Antimicrobial Resistance and Veterinary Products Department

The report shows a decrease in the use of antimicrobials in the animal health sector, but is this enough to curb the development of antimicrobial resistance (AMR)?

JYM: We are pleased to see steady progress in the way antimicrobials are used in animals. From 2016 to 2018, the global amounts used in animals have declined by 27%, according to the data1 reported to our Organisation. These are encouraging results as they show the commitment of the animal health sector, from farmers to veterinarians, to address this global health challenge. These efforts also contribute to protect everyone’s health, as drug-resistant bacteria can spread between and within animals, humans, plants and through the environment.

Yet, much more still needs to be done to fight antimicrobial resistance and preserve the efficacy of these critical medicines. It is important to rely on practices in animal production systems that reduce the need for antibiotics, by preventing diseases in the first place. Biosecurity measures and good animal husbandry can have an enormous impact in reducing the risk of introduction, establishment and spread of infections in animals. Concurrently, appropriate funding needs to be provided to support the research for alternatives to antimicrobial use, including vaccination, for instance.

Core to making more progress is to increase our knowledge and understanding around how, when and why antimicrobials are used worldwide. The database created by the World Organisation for Animal Health in 2015 contributes to this knowledge, as it enables countries to gain a good understanding of their situation and measure progress and efficiency of actions over time.  

Tetracyclines are the most used antibiotics in animal health globally. Why is this happening? Does it pose a risk for the development of resistance?

JYM: Tetracyclines are one of the earliest discovered family of antibiotics. They were found in 1944, not long after penicillin was discovered by Alexandre Fleming. Tetracyclines have a very broad spectrum of activity, meaning that they can act against a wide range of disease-causing bacteria. They are easily available worldwide and much cheaper compared to other broad-spectrum antibiotics (e.g., fluoroquinolones). In terrestrial food-producing animals they can be used as first line treatment to numerous diseases in various species, including large ruminants (listeriosis, mycoplasmosis, etc.), swine (respiratory and gastrointestinal diseases, neonatal septicemia, etc.), poultry (respiratory diseases, coccidiosis, arthritis, etc.), among others.

As with every antimicrobial, when tetracyclines are misused or overused, there is a risk to select resistant pathogens. While some studies show a relationship between use in animals and resistance observed in humans, more research is needed to fully understand the implications. AMR is a complex phenomenon that can originate in animal, human or plant populations, and which can then pose a threat to all the other species.

Integrated surveillance, which allows to gather data from across sectors, is essential to monitor and take preventive actions before it is too late. This is why we are working with our Quadripartite partners – the Food and Agriculture Organization of the United Nations (FAO), the United Nations Environment Programme (UNEP) and the World Health Organization (WHO) – to reinforce surveillance at national level, integration of regional and global data, and cross-sectoral analyses.

The report also highlights a decrease in the use of “critical” antimicrobials in animals. What else could be done to preserve the efficacy of these specific antimicrobials that are essential to human medicine?

It is worth emphasising that antimicrobials are important for both human and animal health. In 2006, we developed a list of antimicrobial agents of veterinary importance. Within this list, we provide recommendations to our Members for those antimicrobials that are considered as highest priority and critically important for human health by WHO. The aim of our recommendations is to discourage their use in animals. This means that these critical antimicrobials should not be used as first line treatment unless justified by evidence (e.g., findings of antimicrobial susceptibility testing), or to boost growth in healthy animals, for instance. Yet, in some specific situations, their use may still be necessary to ensure animal health and welfare.

Such list serves as a reference for countries to develop their own guidelines to ensure responsible use of antimicrobials in food-producing animals.

Antibiotics are still used in healthy animals to boost growth in at least 40 countries. What is the position of the World Organisation for Animal Health on this kind of practice?

JYM: Any use of antimicrobials in animals should be in line with our international Standards, which encourage responsible and prudent practices. These evidence-based Standards are published in our Terrestrial and Aquatic Codes. According to these recommendations, the use of antimicrobial agents for growth promotion in the absence of a risk analysis is not deemed to be responsible use. Noteworthy, for those antimicrobials considered as highest priority and critically important by WHO, we do urge Members to phase out their use as growth promoters and explore alternatives to enhance productivity.  

In addition to this, we work closely with veterinary authorities to make sure that these guidelines are adapted and deployed at national level. Equally relevant, we support the development of awareness campaigns to promote the prudent use of antimicrobials and the implementation of good husbandry and biosecurity practices to prevent diseases in animals. 

Why can the data presented in the report not be accessed by country?

JYM: The report provides global and regional overviews of the use of antimicrobials in animals. The data is not broken down by country as the aim of our database is to foster the participation of the greatest number of countries, without pointing out potential gaps in national capacities.

Nevertheless, we do encourage countries to use their available data to better understand their national situation and measure the progress and efficiency of their actions over time. The information collected can be published on national platforms and countries that are already doing this are referenced in the report (Section 11). In the near future, our new interactive and customised online system (ANIMUSE) to collect and report antimicrobial use data will allow countries to explore and analyse their data through an interactive dashboard. 

Can we compare the data on the use of antimicrobials between animals and humans?

JYM: One of the major advances achieved in our data collection and analysis process over the past years, was to be able to adjust the quantities of antimicrobials used in animals to their biomass. This parameter is key to draw relevant comparisons of the amounts of drugs used across different animal species, regions and over time and hopefully soon with humans. Animal biomass is calculated as the total weight of live domestic animals in a given country and year. Since antibiotics are used differently depending on animal species and types of animal production systems, variation in the species composition of regional biomass may explain some of the differences noted in antimicrobial consumption across countries and regions.

However, to date, it is not possible to compare our global data on animals to the quantities of antimicrobials used in the human health sector. While some countries are able to do so (e.g., Canada and countries from the European Union), achieving this at global level is more challenging. To address this gap and have a better picture of antimicrobial use and antimicrobial resistance across sectors, we are collaborating with the World Health Organization and the Food and Agriculture Organization of the United Nations on the development of a joint platform. The latter will have an important role in supporting policy makers in the development of relevant strategies against antimicrobial resistance under the One Health approach.

Could the use of antimicrobials in animals be banned and replaced with vaccines and good animal husbandry practices?

JTM: Vaccines and good animal husbandry are both core measures to prevent disease and are central components of the fight against AMR, but sometimes animals still fall ill and need treatment.

Unfortunately, we do not have vaccines available for all diseases, thus, an outright ban on antimicrobials would be damaging for animal health and welfare, as well as the livelihoods of farming communities. This would consequently have a negative impact on national economies and food security.

Antimicrobials are needed to fight infectious diseases in animal health too. But they must be used in a  responsible manner, only when necessary, when biosecurity and husbandry fail, and when there are no other alternatives available. That’s what we advocate for at the World Organisation for Animal Health.

1 Based on the data reported by 72 countries to the World Organisation for Animal Health for all years between 2016 to 2018.

Specialists:  

  • Sean Shadomy, DVM, MPH, DACVPM, Veterinary Epidemiologist, Food and Agriculture Organization of the United Nations (FAO)
  • Tianna Brand, Foresight Advisor, International Standards and Science Directorate, World Organisation for Animal Health (OIE)
  • Dr Mariana Marrana, DVM, Programme Manager, Preparedness and Resilience Department, World Organisation for Animal Health (OIE)
  • Dr Stephane de La Rocque, DMV, MSc PhS, Team lead for the Animal-Human Interface Health Security Preparedness Department, World Health Organization (WHO) Emergency Program
1. What factors can increase the emergence and spread of zoonoses?

Tianna Brand, OIE: The literature and scientific studies reveal numerous factors – environmental, pathogen, host or vector adaptation, to name a few. The central and recurring theme in emergence and spread are the interactions between humans and animals.

The opportunities for zoonotic pathogens to emerge are increasing. The growth of the human population and its consumption habits are the underlying factors – or root causes – for the emergence and spread of diseases. Ultimately a larger human population drives higher levels of intensive animal production, and furthermore drives the expansion of crop lands, human settlements and cities. All these factors contribute to the disruption of natural ecosystems and increased encroachment of humans into previously wild areas. Historically, the emergence of new human diseases from animal sources, such as the plague or Ebola, has been associated with major societal change.

Mariana Marrana, OIE: New pathogenic agents appear all the time at the human-animal-environment interface. While, most often, the newly emerged diseases often only result in local transmission before fading away, human activities provide the pathway for local disease events to become regional or global. Therefore, a disease outbreak that could be inconsequential from a global perspective can take pandemic proportions in a matter of weeks, as we saw at the start of the COVID-19 pandemic.

2. Why is preventing zoonotic diseases important for food security?

Sean Shadomy, FAO: It is critical to control and prevent zoonotic diseases, and to protect livestock in order to ensure food security and safeguard the livelihoods of families and communities. Food production and distribution systems are highly complex and multisectoral, and the full impact of zoonotic diseases on food production and food security, as well as the human health and societal costs and economic impact on producers, is difficult to determine.

The direct impact of some zoonotic diseases can include high rates of illness and death among food-producing animals, causing mass die-offs among livestock and poultry herds and flocks. They can also cause decreased production, such as by causing poultry to lay fewer eggs, or by causing stillbirths and abortions in meat producing or dairy animals, which mean both less meat and less milk production. In those countries where livestock are used as draught animals, the illness or death in these animals from zoonotic diseases can mean a loss of power and transport for agricultural production.

Some zoonotic diseases such as brucellosis can be spread in abattoirs and meat-packing facilities, causing debilitating illness and preventing their work, thereby impacting production. However, as witnessed with the COVID-19 pandemic, some zoonotic diseases are even more highly transmissible in these settings. The introduction of zoonotic pathogens into the food production and transport system, either through infected workers or on contaminated products, has led to widespread production and processing facility shutdowns, severely impacting market chains and distribution networks, leading to food shortages. The disruptive effects can be seen up and down the production chain, even causing some livestock producers to cull their animals as they cannot go to market. In addition, the economic impact and complete cessation of use of certain food commodities due to pandemic control measures has negatively affected or even forced closure of producers and processors throughout the production and distribution pathways.
The responses required to control certain zoonotic diseases can exacerbate the direct losses in animal production. Control measures including culling affected flocks and herds can cause the elimination of whole farms. In addition, national campaigns can cull hundreds of thousands of animals or more. When countries restrict or ban exports from other countries affected by zoonotic diseases of concern for animal trade, this can have tremendous negative economic impact on the producers in the affected countries, potentially driving them out of business. In turn, other exporting countries may move to fill the export trade gap, and this disruption in food trade to countries importing meat (often higher income countries) means that prices for meat will go up in the exporting countries; this in turn can put meat protein out of the reach of less affluent consumers, and impact the food security in those exporting countries.

3. What lessons have we learned from the COVID-19 outbreak and how will that change the approach to zoonotic disease preparedness?

Stephane de La Rocque, WHO: COVID-19 demonstrated the impacts that zoonotic diseases can have on all aspects of society. We all know that pathogens are shared between animals and humans, but this is often a neglected aspect of public health, especially in advanced countries where biosecurity, prevention and curative options keep us safe from many of these diseases. It appeared that some of the capacities we thought were robust in fact still needed to be further consolidated. This includes capacities for coordination between sectors, through a One Health approach.

The Tripartite has worked through expert consultations to develop tools and guidance for countries. But with COVID-19, we realized now more than ever, that countries needed to be able to access and implement key principles and best practices for the management of zoonotic diseases in the midst of active outbreak response. The Tripartite accelerated the deployment of its tools, and developed online trainings and methods for virtual facilitation to adapt and iteratively improve existing tools and approaches for diseases arising at the human-animal-interface.

4. How can capacity building needs be identified at the human-animal interface?

Stephane de La Rocque, WHO: The IHR-PVS National Bridging workshops (NBWs) create an opportunity for the human health and veterinary sectors to jointly discuss their respective capacities for health security and to agree on concrete activities to improve their multi-sectoral coordination, through a One Health approach.
The jointly developed operational roadmaps resulting from this exercise helps countries to prioritize their investments in building capacities, whether technical, institutional or workforce related. The NBWs provide a first step in One Health operational planning in countries and the implementation of these roadmaps is ensured through operational tools developed by WHO and its partners.

5. Why did FAO, OIE and WHO come together to write the Tripartite Zoonoses Guide (TZG)?

Mariana Marrana, OIE: For many decades the Tripartite Organisations have been collaborating on programmes to support their respective memberships in addressing zoonotic diseases, such as rabies or zoonotic influenzas, and health risks such as antimicrobial resistance. As part of this collaboration, the organizations advocate for an approach which is inclusive of a variety of disciplines in an effort to bridge knowledge and practices to respond or address zoonotic diseases and other health risks at the human-animal-environment interface. In the simplest of terms, we refer to this as the One Health approach.
The Tripartite Zoonoses Guide is a reflection of this approach and ways to make it operational at national level. It brings together principles for One Health, along with best practices in play in countries and information on how to set up efficient coordination mechanisms across sectors to address health threats, notably in regard to strategic planning and emergency preparedness or surveillance and information sharing to name a few.

6. What makes the Tripartite Zoonoses Guide unique?

Sean Shadomy, FAO: The TZG was developed under the leadership of FAO, OIE and WHO with the technical contributions of hundreds of experts representing UN and other international organizations, national ministries and agencies, and organizations representing civil society. This global team of experts developed detailed guidance to support countries in taking a multisectoral, One Health approach to address zoonotic diseases, and included recommendations for best practices for implementation as well as country examples.

The TZG was developed to be applicable to all countries and regions, and to address zoonotic disease threats, be they endemic or newly identified in a country or region. To go further, operational tools are now being developed and pilot tested to provide step-by-step guidance on implementing specific technical sections of the TZG – this detailed advice has been requested by countries. The Tripartite Zoonoses Guide and the operational tools are broadly applicable and not disease-specific. The entire toolkit is also flexible enough to support multisectoral collaborations to address other health threats at the human-animal-environment interface, such as food safety and antimicrobial resistance.

7. How can the Tripartite Zoonoses Guide and operational tools support country preparedness for their national context?

Stephane de La Rocque, WHO: The Tripartite Zoonoses Guide highlights over 80 country examples, ranging from the development of effective government One Health mechanisms or platforms, to zoonotic disease prioritization, joint risk assessment, planning and preparedness, investigation and response, coordinated surveillance and workforce development. Designed for decision makers and technical staff in countries, we recognized the need to create operational tools to support implementation of key principles. Three operational tools have been developed so far to support a step-by-step One Health approach in countries for joint risk assessment, multisectoral government mechanisms, and coordinated surveillance and information sharing. These tools are facilitative and adaptive to country context and allow for sustainable and iterative use as needed.

8. What will the Tripartite do to further promote the use of the Tripartite Zoonoses Guide?

Sean Shadomy, FAO: As part of a coordinated communication and dissemination strategy for the TZG, the Tripartite organizations have promoted its use through their respective communication channels, including websites, publications, social media, and throughout their respective networks. In addition, they have introduced the TZG and the operational tools through international conferences and virtual events such as the 2021 World One Health Congress.

The Tripartite provide training on the use of the TZG and the operational tools to the Tripartite regional and subregional offices as part of the pilot process for the operational tools. The goal is to increase the use of the TZG and to arrive at the point where countries and regions can use the TZG and the operational tools without Tripartite facilitation. Training on the TZG in six languages is freely available online.

9. How can we further improve our response to zoonotic diseases?

Tianna Brand, OIE: Pragmatically, working in isolation to address complex and constantly evolving parameters, really only provides one or a limited view of a much larger, dynamic and interconnected problem(s) – potentially worsening the issue.

Improving the operationalization of the One Health approach requires identifying the linkages between disciplines, organizations, data, resources and stakeholders, to bridge knowledge and actions and thereby prevent, mitigate or adapt to health risks.