The CVMA (Canadian Veterinary Medical Association) has embarked on an exercise to script another chapter into the debate on prudent use of antibiotics in animals. Its plan: participation in an antimicrobial use (AMU) workshop of Canadian veterinarians, veterinary researchers and educators, government officials and species-group stakeholders working in the areas of swine, poultry, beef, dairy, small ruminants and companion animals; the intention: to identify AMU stewardship issues of concern, anticipate needs for veterinary practitioners, address information gaps and discuss ways to communicate and engage new “tools” in using antimicrobials in food production.
Veterinarians in general grow frustrated and disappointed with the seesaw battle over antimicrobial stewardship. Producers on one hand want access to drugs, including antimicrobials, at a reasonable cost and without rigorous veterinary oversight, which often comes with an awkward regulatory burden. Most understand the implications of antimicrobial resistance (AMR) and its impact on human health. Most understand the importance of using antimicrobials prudently to preserve them as important production tools in agriculture. The big question that exists today, as it has for two generations, is how do we get there?
Veterinarians often shoulder the blame for how antimicrobials get used or misused by producers, and certainly are looked upon as logical stewards to fix the problem. There are few veterinarians who don’t cringe when thinking about yet another expert advisory committee; another round of presentations — many reiterations of basic information we have known for at least 20 years; probably another white paper outlining a raft of position statements, guidance documents, proposed regulatory changes, animal health strategies, and sets of prudent use recommendations. The CVMA’s attempt, once again, to move the AMR issue forward is laudable; success will depend on finding key partners capable of sustaining the effort and unafraid of finding answers to the hard questions.
As recently as September 2016, the CVMA urged Health Canada to make regulatory changes to close loopholes in force since 2002, identified at the time as high priorities by the Health Canada Advisory Committee on Animal Uses of Antimicrobials and Impact on Resistance and Human Health. The CVMA remained part of the Ad Hoc Committee for Antimicrobial Stewardship that grew out of the 2011 National Conference on Antimicrobial Stewardship in Canadian Agriculture and Veterinary Medicine. For a second time, the committee identified Canada’s vulnerability around existing regulations related to active pharmaceutical ingredients (API) and rules granted under own use permit (OUI) provisions. Regulatory agencies were told both required urgent attention and change. Fifteen years later, the problems remain on the table and part of every discussion on antimicrobial use.
About 450 million years ago, animals made one of the most important decisions in Earth’s history: they crawled from nourishing seas and started living on dry, desolate land. At that moment, humanity’s problems with superbugs probably began. The evolutionary history of antimicrobials made them unique for unlike any other drug, use of an antimicrobial in one patient can compromise its efficacy in another. Taking it one step further, we now know that antimicrobial use in one species compromises the use of that antimicrobial in other species. Veterinarians understand, many producers understand, but the average consumer standing at the meat counter at a supermarket has difficulty fathoming how and why antimicrobials get used in food production. We have to get better at telling our story about our individual roles in food production and generate the courage to make necessary changes to back claims of sensible and rational antimicrobial use.
The Food and Agriculture Organization of the United Nations (FAO) estimates that there are approximately 700,000 human deaths each year from antimicrobial-resistant (AMR) infections. The toll on human health results in a vicious circle with hard economics attached. FAO estimates that antimicrobial resistance could cause low-income countries to lose more than five per cent of their GDP and push up to 28 million people, mostly in developing countries, into poverty by 2050.
Though evolution progresses in microscopic steps, it is unrelenting. Everyone in agriculture also knows that answers are seldom found in repeating what’s been tried before. For starters, let us reach decision points on:
- Eliminating extra-label drug use when unnecessary.
- How to streamline the drug approval process for new animal drugs and the concurrent use clearance of combinations used in animal feeds.
- Following the U.S. example of legislating exclusion of antibiotics for growth promotion in feed and water and increasing veterinary oversight of antimicrobial use, while escalating both the regulatory desire and ability to enforce regulations.
- How to prevent the unscrupulous importation of active pharmaceutical ingredients (APIs) from foreign, second-rate manufacturing sources that ultimately get used in on-farm mixing operations.
- Tightening or eliminating the import of drugs under existing Own Use Import (OUI) provisions, some of which are not approved for use in Canada.
If Canada is not careful, responsible drug use could potentially become entangled in the debate on trade. The real or imagined differences that exist between Canada and the U.S., plus misreading the interplay of antimicrobial use in animals and food safety easily becomes skewed, presenting the opportunity for non-tariff barriers to trade by competing nations.
AMR is presently a flashpoint in human health and fingers get pointed toward animal production. From a production perspective, antibiotics are often implicated as a “negative” and from it spring mistaken impressions about food safety in the eyes of consumers. We must preserve the balance between responsible use, sound production practices and the necessity of maintaining acceptable standards of care. I implore the guardians of animal health to establish, once and for all, workable guidelines on prudent use and for the agencies responsible for laws of the land to declare, “We’ll make it happen.”
Both are achievable.