Achieving Antimicrobial Stewardship on the Global Scale: Challenges and Opportunities.

Antimicrobial resistance (AMR) has been clearly identified as a major global health challenge. It is a leading cause of human deaths and also has a toll on animals, plants, and the environment. Despite the considerable socio-economic impacts, the level of awareness of the problem remains woefully inadequate, and antimicrobials are not generally recognized as a global common good, one that everyone has a role and responsibility to conserve. It is imperative for antimicrobial stewardship to be more widely implemented to achieve better control of the AMR phenomenon. The Food and Agriculture Organization (FAO) of the United Nations plays an important role in promoting and facilitating antimicrobial stewardship. The specific needs to be addressed and barriers to be overcome, in particular, in low- and middle-income countries in order to implement antimicrobial stewardship practices in agrifood systems are being identified. As a global community, it is essential that we now move beyond discussing the AMR problem and focus on implementing solutions. Thus, FAO provides multi-pronged support for nations to improve antimicrobial stewardship through programs to strengthen governance, increase awareness, develop and enhance AMR surveillance, and implement best practices related to antimicrobial resistance in agrifood systems. For example, FAO is developing a platform to collect data on AMR in animals and antimicrobial use (AMU) in plants (InFARM), working on a campaign to reduce the need to use antimicrobials, studying the use of alternatives to the use of antimicrobials (especially those used for growth promotion) and actively promoting the implementation of the Codex Alimentarius AMR standards. Together, these will contribute to the control of AMR and also bring us closer to the achievement of multiple sustainable development goals.

From OIE standards to responsible and prudent use of antimicrobials: supporting stewardship for the use of antimicrobial agents in animals.

The global action plan (GAP) on antimicrobial resistance (AMR) advocated the development of national action plans on AMR and the implementation of plans aimed at preventing, combating and monitoring AMR. The World Organisation for Animal Health (OIE)'s strategy on AMR and the prudent use of antimicrobials is aligned with the GAP and recognizes the importance of a One Health approach. This paper reviews the goals, tools and strategies that the OIE has in place to support its Members, envisioning an increased awareness of them and ultimately an increased implementation of the OIE standards. The OIE standards are endorsed by vote of all the 182 Members and are recognized by the World Trade Organization (WTO). The OIE List of Antimicrobial Agents of Veterinary Importance, which includes specific recommendations on the use of antimicrobial agents, is also of particular importance for antimicrobial stewardship. OIE's antimicrobial use (AMU) data collection started in 2015 and has been developed in particular to measure trends in AMU. An annual report is published as an output of this data collection. An AMU IT database system is being developed. The OIE provides assistance to its 182 Members to strengthen the implementation of OIE standards via its support of good governance, the Performance of Veterinary Services (PVS) Pathway, PVS Veterinary Legislation Support Program and training of veterinarians and veterinary paraprofessionals. In parallel, the OIE Observatory is a recent initiative, specifically targeting the monitoring of the implementation of the OIE standards. Cooperation agreements between the OIE and intergovernmental organizations and non-governmental organizations are instrumental for the increase of the dissemination and implementation of the OIE standards and guidelines.

Monitoring of Farm-Level Antimicrobial Use to Guide Stewardship: Overview of Existing Systems and Analysis of Key Components and Processes.

The acknowledgment of antimicrobial resistance (AMR) as a major health challenge in humans, animals and plants, has led to increased efforts to reduce antimicrobial use (AMU). To better understand factors influencing AMR and implement and evaluate stewardship measures for reducing AMU, it is important to have sufficiently detailed information on the quantity of AMU, preferably at the level of the user (farmer, veterinarian) and/or prescriber or provider (veterinarian, feed mill). Recently, several countries have established or are developing systems for monitoring AMU in animals. The aim of this publication is to provide an overview of known systems for monitoring AMU at farm-level, with a descriptive analysis of their key components and processes. As of March 2020, 38 active farm-level AMU monitoring systems from 16 countries were identified. These systems differ in many ways, including which data are collected, the type of analyses conducted and their respective output. At the same time, they share key components (data collection, analysis, benchmarking, and reporting), resulting in similar challenges to be faced with similar decisions to be made. Suggestions are provided with respect to the different components and important aspects of various data types and methods are discussed. This overview should provide support for establishing or working with such a system and could lead to a better implementation of stewardship actions and a more uniform communication about and understanding of AMU data at farm-level. Harmonization of methods and processes could lead to an improved comparability of outcomes and less confusion when interpreting results across systems. However, it is important to note that the development of systems also depends on specific local needs, resources and aims.

OIE Annual Report on Antimicrobial Agents Intended for Use in Animals: Methods Used.

For over two decades, the World Organisation for Animal Health (OIE) has engaged in combatting antimicrobial resistance (AMR) through a One Health approach. Monitoring of antimicrobial use (AMU) is an important source of information that together with surveillance of AMR can be used for the assessment and management of risks related to AMR. In the framework of the Global Action Plan on AMR, the OIE has built a global database on antimicrobial agents intended for use in animals, supported by the Tripartite (World Health Organization (WHO), Food and Agriculture Organization of the United Nations (FAO) and OIE) collaboration. The OIE launched its first annual data collection in 2015 and published the Report in 2016. The second Report, published in 2017, introduced a new methodology to report quantitative data in the context of relevant animal populations, and included for the first time an annual analysis of antimicrobial quantities adjusted for animal biomass on a global and regional level. A continuing annual increase of countries participating in the data collection demonstrates the countries engagement for the global development of monitoring and surveillance systems in line with OIE international standards. Where countries are not yet able to contribute their quantitative data, their reports also highlight the barriers that impede them in data collection, analysis and/or reporting. The OIE Reports show annual global and regional estimates of antimicrobial agents intended for use in animals adjusted for animal biomass, as represented by the quantitative data reported by countries to the OIE. The OIE advises caution in interpretation of estimates made in the first few years of reporting recognizing some important limitations faced by countries as they develop their monitoring systems. The OIE remains strongly committed to supporting its Members in developing robust and transparent measurement and reporting mechanisms for AMU.

Quantitative Outcomes of a One Health approach to Study Global Health Challenges.

Having gained momentum in the last decade, the One Health initiative promotes a holistic approach to address complex global health issues. Before recommending its adoption to stakeholders, however, it is paramount to first compile quantitative evidence of the benefit of such an approach. The aim of this scoping review was to identify and summarize primary research that describes monetary and non-monetary outcomes following adoption of a One Health approach. An extensive literature search yielded a total of 42,167 references, of which 85 were included in the final analysis. The top two biotic health issues addressed in these studies were rabies and malaria; the top abiotic health issue was air pollution. Most studies described collaborations between human and animal (n = 42), or human and environmental disciplines (n = 41); commonly reported interventions included vector control and animal vaccination. Monetary outcomes were commonly expressed as cost-benefit or cost-utility ratios; non-monetary outcomes were described using disease frequency or disease burden measurements. The majority of the studies reported positive or partially positive outcomes. This paper illustrates the variety of health challenges that can be addressed using a One Health approach, and provides tangible quantitative measures that can be used to evaluate future implementations of the One Health approach.

Why Antibiotic Use Data in Animals Needs to Be Collected and How This Can Be Facilitated.

Antimicrobial resistance (AMR) is currently recognized as one of the most significant threats to public health worldwide. It is a phenomenon that highlights the interconnectivity between human and animal health since any use of antibiotics in humans can eventually lead to resistance in the microbial populations colonizing animals and vice versa. In recent years, our understanding of the relationship between the use of antibiotics and the consequent development of resistance in microbial populations to these (or similar) antibiotics has increased. Having accurate data, ideally in a digital format, on the use of antibiotics are therefore of paramount importance. Current obstacles to having such data include, among others, the lack of consensual and harmonized technical methods and units that represent antimicrobial use (AMU), the insufficient incentives to motivate primary producers to report their use of antibiotics, and the inexistence of user-friendly technologies for the collection of such data, despite the generalized use of Internet and electronic devices. Further development and adoption of the units proposed by the European Surveillance of Veterinary Antimicrobial Consumption will contribute to the long-desired harmonization. Rewarding the animal producers (via tax incentives, for example) that use less antibiotics and the development of an app, to which producers could orally report the used antibiotics are among the solutions that could help to overcome the current challenges. I here also argue that having mandatory electronic veterinary prescriptions and awareness campaings, funded via public-private partnerships, should also be considered as methods that could help for the control of societal problems like AMR.