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25 August 2016

How cramming our food with pharma can send our healthcare back to the Dark Age

Photo by Craig Sillitoe via Flickr (CC BY-NC-ND 2.0)

Photo by Craig Sillitoe via Flickr (CC BY-NC-ND 2.0)

Looking at antimicrobial resistance from the view of international policy with Cecilia Nordin Van Gansberghe

Reduced meat consumption has been shown to be good for health. However, statistics tell us that animal-based food consumption is on the rise around the globe. In fact, if the world’s general economic development gains momentum, more and more people will be able to afford a protein rich animal sourced diet. And just imagine how much more milk, cheese and meat we will need if the entire population of Asia, which has five times more people than Europe, switches to diets rich in animal sourced protein.

So, despite the fact that we have to continue to promote diets rich in fruits, vegetables and pulses, because eating meat three times a day has detrimental health and environmental consequences, we also have to seriously re-think the way our meat and dairy products get to our tables because we can’t afford to waste our water, land and energy like it has no value. At the same time, moderate consumption of animal sourced food is necessary for shifting our malnutrition statistics, so we have to figure out a way to manage our livestock systems sustainably. That is why this year’s High Level Panel of Experts Report focuses on the role of livestock for sustainable agriculture and food security.

Something that is used a lot in our livestock production systems and something that we do not hear so much about is antimicrobial pharmaceuticals or antibiotics. Animals on the industrial farms are often kept in high density, and antibiotics are used as a prophylactics measure to prevent the spread of diseases. Antibiotics are also used for growth promotion to maximize business returns. In many places around the world there is very little control over the use of antibiotics. In many countries antibiotics are available over-the-counter without a recipe. The World Health Organization (WHO) reports the use of antibiotics in food animals can sometimes outweigh the use in humans. Farmers often drench their produce in pharmaceuticals and chemicals to maximize yields, or simply out of habit, and because they know little about the consequences.

The discovery of penicillin was a milestone in the advancement of medicine, and antibiotics can be considered a backbone of the modern healthcare. However, as more and more antibiotics are used in food production and enter our water supply, we are risking undermining the progress achieved. As antibiotics are overused, the bacterial infections we fight with them are becoming resistant. And it is not like we have hundreds of antibiotics in reserve. Moreover, as we have to develop stronger and more complex antibiotics, the costs of healthcare will go up.

The movement of people and trade in the ever fast globalizing world can lead to rapid spread of resistant bacteria, making antimicrobial resistance (AMR) a global problem. To find out more about the current state of the AMR policy development, we spoke with Cecilia Nordin Van Gansberghe who is currently a Senior Advisor at Government Offices in Stockholm, but who used be a permanent representative of Sweden to the FAO.

SIANI: Why is AMR an issue of international policy?

CNG: International policy is needed because antibiotic resistance is a global risk beyond the capacity of any organization or nation to manage or mitigate alone. International initiatives for improved awareness, capacity building, antimicrobial stewardship and improved practices in food and agricultural systems are essential for a successful management of antimicrobial resistance.

SIANI: What is Sweden’s standpoint on the issue of AMR in livestock management?

CNG: The Swedish government considers AMR to be an issue of high priority, and recognizes that the overuse of antibiotics in livestock production worldwide needs to stop. Swedish animal husbandry is based on using antibiotics only when needed – which means, only to treat infectious diseases with a wise choice of antibiotics based on good diagnostics. Within the EU, Sweden has the lowest use of antibiotics in the animal production. Already in the 1980’s, we introduced a ban on the routine use of antibiotics for animal growth promotion purposes. When this ban entered into force, we had to learn how to instead improve the health status of animals to prevent diseases that had previously been masked by the routine use of antibiotics.

Today – 30 years later – we have become adept at preventing disease from occurring through improved hygiene and animal management. As a spin-off effect of improving animal health, we also saw a reduction in other diseases than bacterial infections and an increase in production effectivity. Sweden has long experience and know-how regarding preventive animal health and antimicrobial stewardship and we are happy to share this knowledge. There is no silver bullet… Today’s situation has been accomplished by long-term hard word and cooperation between stakeholders.

SIANI:  How has the discussion and action been going so far and what is the current state? And how do you see the progress in the future?

With the Swedish entry into the European Union in 1995, we had the opportunity to demonstrate our situation regarding the prudent use of antibiotics in animals. It led to more awareness and action within the EU. The understanding, that only joint action over sectors and countries will have an impact, has grown. Now it is time to bring this understanding and commitment to the highest level.

The international organizations like WHO, FAO and OIE have together formulated a Global action plan, within the tripartite cooperation. The action plan will yield good results if sufficient amount of resources is allocated for its implementation. The Swedish government is one of the initiators of the high-level meeting on fighting AMR, which will be held in conjunction with the UN General Assembly on the 21st of September. It is important that this meeting becomes the starting point for sustained global efforts to reduce the threat of antimicrobial resistance.

SIANI: What can be the steps to successful AMR policies?

CNG: Antimicrobial resistance is driven by a multitude of factors, which means that single interventions will have little impact! Sweden believes that this problem is best viewed from a One-Health perspective and managed in collaboration between many sectors, including agriculture, aquaculture, food, environment and human- and veterinary medicine. Finance and planning authorities must also have knowledge and understanding of the problem and share the vision of what must be done.

All the stakeholders need to be heard and preferably agree on where the greatest risks are, and what measures should be prioritized. Without a common vision, there is no joint action. For this reason the Swedish Government has established a national collaboration platform to ensure that various measures against antimicrobial resistance are coordinated nationally. The responsibility for this collaboration platform is shared by our competent authorities from the human and animal side – together.

SIANI: How can the guidelines from the HLPE report support development and implementation of these policies?

CNG: As the HLPE report emphasizes the importance of multi-stakeholder dialogue, consultation and collaboration as well as sustainable agriculture development in line with the Sustainable Development Goals, the report will be a useful tool to integrate livestock in overarching national plans. The overriding contribution of the report is to underline the need for coherence and collaboration between sectoral policies and programmes. The good AMR situation in Sweden has been accomplished with daily multisector cooperation at national, regional and local levels.

Would like to know more? Meet Cecilia Nordin Van Gansberghe and other experts on the topic at our event at the World Water Week 2016.

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