Antimicrobial Resistance A One Health Challenge for Joint Action
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by Juan Lubroth, DVM PhD, Chief Veterinary Officer, FAO
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Antimicrobial Resistance A One Health Challenge for Joint Action
- 1. Antimicrobial Resistance A One Health Challenge for Joint Action Juan Lubroth, DVM PhD Chief Veterinary Officer Stockholm, 29 August 2016
- 2. PHAC – Canada - Canadian Meat Council Technical Symposium Toronto 2011
- 3. Antimicrobial usage in humans, animals and agriculture, and resulting dispersion of antimicrobial residues into aquatic and terrestrial environments () (Berkner et al., 2014)
- 4. Global Action Plan on AMR AMR: a Tripartite priority • Major global public health threat • Theme of the WHD 2011 • Global Action Plan on AMR • FAO and OIE contributions • Endorsed by WHA May 2015 • WHO, OIE and FAO Resolutions 2015 • FAO Action Plan on AMR (2015, 2016) • Presented to Governing Bodies
- 5. 5 FAO/OIE/WHO work on AMR since 1997 • International collaboration established • Codex Alimentarius, (1963) • FAO, WHO and OIE • > 20 expert meetings and consultations • Roles • Codex and OIE: normative work • FAO and OIE: practical guidance and capacity building • WHO: raise public awareness, monitoring, leading the debate • Publications
- 7. Key areas in GAP and NAP (2015-2016) 1. Improve awareness and understanding of AMR Risk communicatio n Education 2. Strengthen knowledge through surveillance and research National AMR surveillance Laboratory capacities Research and development 3. Reduce the incidence of infection through effective hygiene & IPC IPC in health care Community level prevention Animal health: prevention and control 4. Optimize the use of antimicrobial medicines in human & animal health Access to qualified antimicrobial medicines, regulation, AMS Use in veterinary and agriculture 5. Ensure sustainable investment through research & development Measuring the burden of AMR Assessing investment needs Establishing procedures for participation
- 8. 1. Improve systems awareness and advocacy on AMR and related threats 2. Develop capacity for surveillance and monitoring of AMR and AMU in food and agriculture 3. Strengthen governance related to AMU in food and agriculture 4. Promote good practices in food and agricultural d the prudent use of antimicrobials FAO Action Plan on AMR – addressing the FAO AMR Resolution and the Global Action Plan
- 9. FAO Action Plan Animal Health Feed Safety Food Safety Codex Alimentarius Plant healthFisheries and aquaculture Legal Framework Communication Livestock Production AMR and One Health at FAO Regional / Sub- regional level National level FAO AMR Working Group AGAH AGAS AGAL AGE AGFF AGFC AGL AGPM FIAA FIAM LEGN OCC
- 10. • Main texts: • Code of Practice to Minimize and Contain Antimicrobial Resistance (CAC/RCP 61-2005) • Guidelines for Risk Analysis of Foodborne Antimicrobial Resistance (CAC/GL 77-2011) • Other Codex texts relevant to AMR includes: • Code of Practice on Good Animal Feeding (CAC/RCP 54- 2004) • General Principles of Food Hygiene (CAC/RCP 1-1969) • Several Codes of hygienic practices for different commodities (e.g. milk and milk products, fish and fishery products) • The 39th session of the Codex Alimentarius Commission (June 2016) Codex
- 11. Identification of legal elements and areas relevant for AMR and AMU Recommendations to mainstream AMU- related obligations and responsibilities in the relevant legislation Support to participatory processes for legal reform Legislation – Coherence - working at country level on animal, plant health and food safety legislation. The work of the Development Law Service (LEGN) www.fao.org/legal LEGAL INFORMATION – FAOLEX (faolextfao.org/faolex)
- 12. AMR and Food Safety: Key Messages for Countries 1. Improve overall coordination 2. Improve regulatory framework 3. Reduce the need for and promote prudent use of antibiotics 4. Improve surveillance 5. Advocate and communicate 6. Build capacity and provide training 7. Address knowledge gaps and research needs
- 13. • National interdisciplinary cooperation • National intersectoral collaboration • holistic strategy • action plan • intergovernmental steering committee or task force • Formal mechanism between health and food/feed safety/veterinary authorities. • Environment • Private sector (pharmaceutical, food production) © iStockphoto 1. Intersectoral Coordination / Collaboration
- 14. • Reducing and eliminating antimicrobials /antibiotics for growth promoters • Requiring that antibiotics be administered to animals only when prescribed by a veterinarian • Requiring that antibiotics identified as critically important in human medicine only be used in food animals when justified (i.e., fluoroquinolones and third/ fourth generation cephalosporins) - © Gettyimages 2. Improved Regulatory Framework
- 15. • Establishing a surveillance system for the use of antimicrobials food animals, in feed, and environment • Establishing an integrated (among public health, food and veterinary sectors) surveillance system to monitor antimicrobial resistance in selected food-borne bacteria 4. Integrated Surveillance
- 16. European Surveillance of Veterinary Antimicrobial Consumption (ESVAC) • Project run by European Medicines Agency since 2010 • Harmonised approach for the collection and reporting of data on the use of antimicrobial agents in animals in Europe (EU/EEA).
- 17. ESVAC Data
- 18. • Raise awareness of antibiotic resistance from a food safety / One Health perspective • Prompt action that prevents the development and spread of antimicrobial resistance in the food chain 5. Advocacy and Communication
- 19. • Develop guidelines on the prudent use of antibiotics in food animals • Provide the training needed to implement them 6. Training and Capacity Building © Thehindu.comjifsan.umd.edu
- 20. • Evidence vs. confounding results • Precautionary Principle / precautionary approach • Science based • Food and Agriculture – contribution to the problem? • “Finger Pointing” – not helpful • 20% of the problem: 80% of the knowledge gap • Studies to provide comparable data on antibiotic resistance and usage for risk assessment and risk management • Strengthen research on the epidemiology of resistance • Development of new antibiotics • Alternative approaches to antibiotic therapy • Vaccine development. improved vaccines, strengthened vaccinations regimes • Point-of-care diagnostics - affordable 7. Opinion, Knowledge gaps and research needs
- 21. WHO Advisory Group on Integrated Surveillance of Antimicrobial Resistance (AGISAR) • 2008 • Minimize the public health impact of AMR associated with the use of antimicrobials in food animals • Comprised of 36 internationally specialists in AMR in a broad range of disciplines (microbiologists, veterinarians, physicians, epidemiologists) • Support implementation of the Global Action Plan
- 22. Progressive Management Pathway to support countries with their National Action Plans on AMR 22
- 24. Action for WWW and Environment ? We need you 20 % of the problem?? 80 % of the knowledge gap?? www.fao.org/antimicrobial-resistance
Notas del editor
- Antimicrobial resistance is a priority in WHO due to the wealth of evidence showing that this represents a major global public health threat. In 2011, the Regional Committee for WHO/Europe endorsed the European Strategic Action Plan of Antibiotic Resistance, which includes the following action area;“Prevent and control the development and spread of antibiotic resistance in the veterinary and agricultural sectors”. WHO is working closely with countries to implement this.
- To support the implementation of Conference Resolution 4/2015, an inter-departmental Working Group on AMR (AMR-WG) drafted an FAO 5-year Action Plan on AMR through an inclusive cross-sectoral and multi-dimensional consultative process. The proposed FAO Action Plan on AMR addresses four major focus areas that are important for public health, livestock, crops and aquatic resources, with impact on food security, nutrition, the environments and sustainable development. The FAO Action Plan advocates for a programme cutting across the Organization involving headquarters, decentralized and country offices. The implementation of country and global oversight activities listed in the FAO Action Plan on AMR, including the required level of collaboration with international partners, will require voluntary contributions estimated at USD 10 million, which translates to USD 2 million per year for five years (not including in-country depth implementation for which additional voluntary contributions and/or extra-budgetary funds shall be raised).
- In the Rome Declaration on Nutrition (ICN2) (Rome, 19-21 November 2014) Members recognized that “food systems need to contribute to preventing and addressing infectious diseases, including zoonotic diseases, and tackling antimicrobial resistance” (http://www.fao.org/3/a-ml542e.pdf) FAO Resolution on AMR (June 2015) (http://www.fao.org/antimicrobial-resistance/en/) AMR recognized as an increasingly serious threat to public health and sustainable food production that requires a response spanning all sectors of government and society. Status report on AMR (http://www.fao.org/3/a-mm736rev1e.pdf) An AMR inter-departmental working group This inter-departmental FAO Working Group meets on a regular basis, chaired by Chief Veterinary Officer Dr Juan Lubroth and brings together FAO officers from Animal Health, Animal Production, Codex Alimentarius, Fisheries, Food Safety and Plant FAO brings multidisciplinary expertise (from animal health, livestock and production, food and feed safety, plant health and production, fisheries and aquaculture, legislative contexts, etc.) that is needed to address a cross-sectoral issue such as AMR. FAO already contribute to many aspects of ONE HEALTH through its multi-disciplinarity. Each of these aspects were considered in developing the FAO Action Plan (in support of Global Action Plan on AMR) and implementing at national and regional levels
- Codex interest in AMR (why?): Concern on the relationship between use of antimicrobial agents and the emergence of resistant microorganisms in the food chain – Extent to which use of antimicrobial agents in food animals/horticulture/humans contributes to antimicrobial resistance varies. Codex texts: (i) CAC/RCP 61-2005 - Recognizes importance of veterinary antimicrobials for controlling infectious diseases. Stresses that appropriate systems be established to ensure that veterinary antimicrobials are manufactured, marketed, distributed, prescribed and used responsibly. (ii) CAC/GL 71-2011 - Risk managers need to know how to deal with the AMR risk and take decisions that are proportionate to the level of risk. To achieve this is necessary to follow science-based risk analysis approach. Risk analysis of foodborne antimicrobial is still new and before it can be applied countries would need to identify any problems associated with foodborne antimicrobial resistance by setting up surveillance programmes. Future work: Information on the recent FAO and WHO resolutions on AMR was presented at the 2015 Session of the Codex Alimentarius Commission, which agreed to request countries information on use and application of the Codex texts and the need for reviewing the texts and requesting FAO, WHO and OIE to convene expert meetings. An analysis of the replies and proposals, prepared by the Codex Secretariat in collaboration with FAO and WHO, will be presented at the 39th Session of the Codex Alimentarius Commission (June 2016) for consideration.
- The Development Law Service (LEGN) of the Legal Office provides assistance to countries and regional organization to modify or update their national legal frameworks for all areas under FAO Mandate, including good legal practices to prevent AMRs and for good AMUs. The first stage of this assistance is the identification of legal elements and areas relevant for AMR and AMUs. AMR and AMUs might be addressed by legislation on a broad gamut of areas, from the authorization, production, sale and use of veterinary pharmaceuticals, to food safety-related maximum residue limits (MRLs) or the use of antimicrobials as phytosanitary products. The baseline for the identification of these legal elements is provided by the relevant international reference standards, particularly the standards of the Codex Alimentarius Commission and the OIE. Some of the good practices and recommendations provided in these standards will require legal underpinning to become legally binding. Once the relevant elements have been identified, the legal support at the national level involves the analysis of national legislation, including the identification, collection and analysis of national legislation in the abovementioned areas. Countries may cover these areas under different legal instruments: veterinary pharmaceuticals, for example, can be regulated in standing alone legislation, in broader general pharmaceuticals legislation or in broad veterinary legislation. To facilitate this analysis, FAO usually works with national lawyers in the analysis of national law. The analysis of national legislation by a national jurist may reveal a number of gaps, overlaps and areas that need regulatory reform. Based on this analysis, the second stage of the legal support results in recommendations to mainstream AMU-related obligations in national legislation. This second stage should be followed by a participatory process where the different stakeholders, including public and private stakeholders, support the formulation of recommendations for legal reform. The final stage will be to, in close collaboration with the government and other national stakeholders, support the drafting of new or updated legislation. FAO has a team of international lawyers specialized in the different legal traditions and technical areas who work with national lawyers and regulators in the formulation of new draft legislation. All this process is supported by the legal information collected in FAOLEX, the world widest database of food and agriculture legislation. FAOLEX is composed of more than twenty lawyers who analyze national legislation in fifteen languages and that support legal research activities in different domains.
- Publication issued on occasion of the World health Day 2011 suggests actions for tackling antibiotic resistance from a food safety perspective WHO encourages national authorities in developing and carrying out policies to contain antibiotic resistance and protect public health
- Sales for food-producing species, including horses, in mg/PCU, of the various veterinary antimicrobial classes, for 26 countries in 2012 Source: http://www.ema.europa.eu/docs/en_GB/document_library/Report/2014/10/WC500175671.pdf
- FAO is developing a Progressive Management Pathway to support countries in the process of their auto-assessments, development, implementation and evolution of national action plans on AMR, with emphasis on the factors addressing antimicrobial use and resistance in food and agriculture. FAO and EU-FMD have successful experience with the development, implementation and use of such pathways and stepwise approaches (Foot and mouth disease, Rabies…). Countries are encouraged to integrate multi-sectorial and multi-disciplinary stakeholders to ensure all are onboard and have a sense of ownership in the process of development and implementation.