7 April 2018

Africa: There's a Time and a Place for Antibiotics Even While We Address Drug Resistance

Tackling antibiotic resistance is a delicate balancing act - stopping a raging illness while using only as much antibiotics as absolutely necessary.

Tackling antibiotic resistance can be like trying to control a fire while conserving water. It is a delicate balancing act - stopping a raging illness while using only as much antibiotics as absolutely necessary.

It can be tempting to look for an easy explanation that helps to solve the challenge, and one of the often-cited factors behind growing levels of drug resistance is the use of antibiotics in animal agriculture.

But the truth is, while animals have a role in the problem of antimicrobial resistance, we simply do not know enough yet about how or to what extent.

However, that doesn't mean there aren't steps we can - and must - take if we are to bring this threat under control.

The first thing we urgently need, and what the animal health sector is working hard to fund, is greater research. We can't begin to tackle antibiotic resistance until we understand better how and to what degree it interacts between people, animals and the environment.

The need for such research was clear when the World Health Organization (WHO) recently released its guidelines for animal antibiotic use, and stated that its recommendations were made on the basis of "low" and "very low-quality evidence".

The WHO group behind the guidelines even stated that one of "several research gaps" was the actual "effects of restricting antimicrobial use in animals... on antimicrobial resistance."

This was a weak foundation on which to build a set of global guidelines that could stop veterinarians from treating animals in danger of disease and hurt the billion people around the world who rely on livestock for their incomes.

What's more, it does not address the research findings that tackling antibiotic resistance in animals alone does little to tackle the problem in people, perhaps because, as experts within the European Medicines Agency say, the "biggest driver of anti-microbial resistance (AMR) in people is the use of antimicrobials in human medicine."

The second step is to invest in better preventative healthcare that reduces the need for antibiotics in the first place.

This is true both of human pharma, an industry worth $1.13 trillion, and the animal health sector, which is 40 times smaller.

Among some of the innovations being pioneered by animal medicine manufacturers are custom vaccines, which are tailored to specific herds and illnesses so they do not compromise "standard" treatments.

Another method that improves the overall health of animals is the use of improved feed to boost antibodies that fight off common diseases, which can then be passed to offspring. This enhanced immunity is especially valuable in poultry as it offers greater protection for unborn chicks that might otherwise be left vulnerable.

And then, despite best efforts and conditions, there are those circumstances in which antibiotics themselves can be used preventatively to help reduce the need for more or stronger medicines later. When an animal shows sign of disease, the responsible approach would be to treat the sick animal while preventing the illness from spreading to the rest of the herd or flock, and this may mean the anticipatory use of antibiotics.

Finally, we also need greater collaboration between the human and animal medicine sectors.

The animal health industry shares the same goal as the World Health Organization, the World Animal Health Organization (OIE) and public health authorities to manage antibiotic resistance.

But we depend on each other to find ways to do this effectively. Veterinarians and animal health workers have valuable expertise that can help inform the global action plan for the management of drug resistance.

This approach, known as a One Health approach, could offer rigorous, realistic recommendations for farmers, veterinarians, pet owners, doctors and patients based on the best supported evidence from across the medical spectrum.

Such an approach is critical to tackling AMR because it is not simply a human health problem caused by animal health abuses.

As has been said before, we need more international and inclusive research into the ways in which we can improve both animal and human health services to counteract the challenge of drug-resistant disease.

The post-antibiotic apocalypse is a One Health problem facing us all, and averting it requires all of our combined efforts.

Any views expressed in this article are those of the author and not of Thomson Reuters Foundation.

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