A less dramatic example surfaced in an op-ed that ran in the Los Angeles Times and Palm Springs Desert Sun in January. The opinion piece was written by Jeff Sebo, a clinical associate professor of environmental studies, affiliate professor of bioethics, medical ethics, philosophy and law, and director of the animal studies master of arts program at New York University. I give Sebo’s credentials, as printed, wondering who this gentleman is. I also wonder how many California residents understand the significance and background to Sebo’s diatribe other than that the price of a dozen eggs peaked at US$7 (up US$5 through last year) at the time of writing in January, with many retailers facing empty shelves in their egg section.

Sebo’s claims include:

• The high prices might be temporary, but problems causing them won’t go away as long as large-scale animal farming continues.
• The reality is large-scale animal farming is unsustainable.
• Ninety-eight per cent of animals are raised on factory farms, which are very bad for animals.
• Animal farming is incredibly inefficient consuming about 83 per cent of farmland and 56 per cent of fresh water, while producing only 18 per cent of our calories and being responsible for an estimated 14.5 per cent of all human-caused greenhouse gas emissions.
• Animal farming is an incredibly inefficient method of food production and a major contributor to climate change.

He briefly mentioned avian influenza as one cause of depressed egg production. This year’s strain of highly pathogenic avian influenza turned out to be one of the deadliest strains ever to affect the industry. National bird loss exceeded 50 million.

Proposition 12, fully implemented on Jan. 1, 2022, banned layers in cages, and the import of eggs from states not following suit. Sebo concludes, “The California egg shortage is a reminder that as long as animal farming remains at the center of our food system, the system will remain at the center of our global welfare, health and climate problems.” It’s too bad people of this ilk even get space in papers.

Animal agriculture continues to get a bad rap over its role in antimicrobial resistance. I do not deny antimicrobial resistance is a critically important issue and that the agriculture industry should continue to decrease its demand for antimicrobials and always use them judiciously. While much has been accomplished in the North American animal agriculture scene, we must continue to help tackle problems in human medicine as part of the One Health discussion.

COVID affected the medical community in many ways. For one, response to the pandemic reversed progress made in the fight against antimicrobial resistance in the U.S. (as reported by the Centers for Disease Control). The pandemic pushed back years of progress made combatting antimicrobial resistance. Resistant hospital-onset infections and deaths increased by 15 per cent during the first year of the pandemic and more than 29,400 patients died from antimicrobial resistance pathogens.

Dealing with an all-new pandemic of zoonotic origin creates a sense of defenselessness. The temptation to repurpose antimicrobials in our arsenal, and resort to innovation, is understandable. The consequence of doing so has long-term implications.

The pandemic produced diminished effectiveness of medication used to treat illness, something we failed to recognize as a consequence in the beginning. In North America, progress has been made ascertaining farmers’ and veterinarians’ behaviours and needs surrounding antimicrobial resistance. When we look at the global consumption of various antibiotics, we see approximately half of all antibiotics used in animal husbandry are consumed in China, followed by India. This takes antimicrobial resistance onto a global stage.

Currently, antibiotic resistance is linked to:

• Over-prescription of antibiotics.
• Patients not finishing the entire anti-biotic course.
• Overuse of antibiotics in livestock and fish farming.
• Poor infection control in health care settings.
• Poor hygiene and sanitation.
• Absence of new antibiotics being discovered.

Priorities changed. Human health care assumed a greater role in the battle against antimicrobial resistance.

Producers who take underfed cows onto the calving grounds face issues of poor-quality colostrum for newborn calves. The risk is immune incompetence and the threat of scours and respiratory infections. The unintended consequences associated with lactating females in poor condition are delays in the return to heat and poorer conception rates when cows and calves enter the breeding pasture. Over time, poor conception rates spread the calving interval and lengthen the calving season.

Advice from an old rancher: As you think about animal health management in your operation in the coming year, focus on why you have fires and not how you put them out.

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Until recently, the best Canadian feedlot antibiotic use information came from a small 2006 project (Antimicrobial Resistance in Escherichia coli Recovered from Feedlot Cattle and Associations with Antimicrobial Use, PLoS ONE 10: e0143995). Antibiotic use practices change over time, so a Beef Science Cluster 2 project updated and expanded this knowledge.

What they did: A team of veterinarians with Feedlot Health Management Services in Okotoks, Alta., gathered, summarized and analyzed injectable and in-feed antibiotic use records from more than 2.6 million cattle placed in 36 feedlots between November 2008 and October 2012.

What they learned: Nearly all feedlot cattle received antibiotics. Over 85 per cent of the antibiotic doses given to feedlot cattle were ionophores, like Rumensin or Bovatec, that are not used to treat bacterial infections in humans. The rest of this column focuses on the roughly 15 per cent of antibiotic doses that were related to antibiotics used in human medicine (medically important antibiotics, or MIA).

Injectable antibiotics (including the antibiotics that some growth implants contain to prevent abscessed ears) were given to 73 per cent of cattle. But because most cattle only received antibiotic injections on a few occasions, injectable antibiotics accounted for only 17 per cent of all MIA doses used in feedlot cattle. The vast majority of injectable antibiotic doses were given to prevent, control or treat respiratory disease. Cattle deemed high risk for bovine respiratory disease (BRD) were given antibiotics 95 per cent of the time, while 59 per cent of low risk cattle were given antibiotics. Average injectable MIA use per animal declined by nine per cent over the four-year study.

In-feed antibiotics were given to 97 per cent of cattle. Because these antibiotics are given every day over a longer period of time, in-feed antibiotics accounted for 83 per cent of MIA use in feedlot cattle. Almost half were used to prevent liver abscesses, 29 per cent were used to control histophilosis, and the remaining five per cent were used to treat outbreaks of footrot, pinkeye, etc. Unlike injectable antibiotic use, in-feed antibiotic use was similar between cattle of high versus low BRD risk. Average in-feed antibiotic use per animal declined by 14 per cent over the four-year study.

MIA can be further categorized as very high, high or medium importance in human medicine. In this feedlot study, 87 per cent of the MIA used were of medium importance. In contrast, data reported to the Public Health Agency of Canada indicate that medium importance antibiotics only account for three per cent of the antibiotics sold for use in people.

What it means: Nearly all feedlot cattle were exposed to antibiotics through feed, injection, or implants, but the vast majority of antibiotics used in feedlot production were ionophores (generally not used in human medicine) and when MIA were used in feedlot production, the majority were medium importance antibiotics that are seldom used in human medicine. Adding feedlot antibiotic use data to the Canadian Integrated Program for Antibiotic Resistance Surveillance (as is already done for poultry and swine) would allow us to monitor these antibiotic use patterns on an ongoing basis.

Antibiotic use in livestock has come under greater regulatory and media scrutiny in recent years. Upcoming changes to antibiotic access (described below) are intended to minimize the development of antibiotic resistance by reducing antibiotic use. The pressure to demonstrate responsible use will likely intensify in the coming years. For the reductions in feedlot antibiotic use reported in this study to continue, more effective non-antibiotic approaches to address liver abscess, histophilosis and bovine respiratory disease challenges will need to be developed and adopted.

As of December 1, all livestock producers will need to have a prescription from a veterinarian with whom they have a valid veterinary-client-patient relationship before they will be able to access any MIA. The key change for feedlot producers, most of whom already work closely with a veterinarian, will affect in-feed antibiotics. You will require a veterinary prescription before a feed mill will sell you complete feeds or pre-mixes containing antibiotics. If this is news to you, or if you don’t already have regular contact with a veterinarian, start planning now! More information about these Health Canada changes are available at www.beefresearch.ca/amr.

The Canadian Beef Cattle Check-Off has increased from $1 to $2.50 per head in most provinces, with approximately 75 cents allocated to the Beef Cattle Research Council. Canada’s National Beef Strategy outlined why the check-off increase was needed, and how it would be invested. One of the target outcomes under the strategy’s Beef Demand pillar is to communicate the role of responsible antibiotic stewardship in maintaining the effectiveness of human health products. This project generated important baseline antibiotic use data that our industry can use to reassure regulators, human health professionals and consumers that Canada’s feedlot sector is continuing to use antibiotics responsibly.

The Beef Research Cluster is funded by the Canadian Beef Cattle Check-Off and Agriculture and Agri-Food Canada with additional contributions from provincial beef industry groups and governments to advance research and technology transfer supporting the Canadian beef industry’s vision to be recognized as a preferred supplier of healthy, high-quality beef, cattle and genetics.

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CBS Biosystems’ blog, Antibiotic Crackdown: The Elephant in the Room states it succinctly: “What’s been brewing and bubbling has boiled over — with major implications for everyone in the feed business, from feed suppliers to individual operations. In the broad food industry, the big brands have felt the pressure and responded by dictating tough new terms for the supply chain. Large dominoes are falling.” From many perspectives, the statement also applies to general management of animal health on the production side of our industry.

Many beef producers feel their freewheeling and independent way of life is about to be compromised. Producers wanting to use antimicrobials will have to work with a veterinarian. Starting by the end of 2018, veterinary practitioners will be expected to show they have a appropriate client patient relationships established with a livestock producer before prescribing antimicrobials. To some farmers and ranchers, changes that have already taken place and those forthcoming in the near future are perceived as an annoyance, especially to those who have traditionally stood at the periphery of technology adoption and offer a dissident voice to any proposition for change.

Six major changes to the availability and use of antimicrobials in livestock include:

• Increased federal government control on the importation of veterinary drugs for own-use on farm (OUI). Concessions surrounding the purchase of products in the U.S. for import by individual producers were initially given for parasite control products prompted by substantial price differentials between Canada and the U.S. The shopping list expanded to include vaccines not available in Canada and found to be effective in controlling new and highly destructive diseases — primary in the swine industry. The range of drugs that could be purchased in the U.S. by producers and imported into Canada if shown to be for a rancher’s “own use” continued to expand until the list started to infringe on prescription drugs considered medically important in humans. OUI will be prohibited with the exception of certain products.
• More oversight on the importation of active pharmaceutical ingredients (API), chemicals with antimicrobial activity imported in bulk forms, then mixed on farm into feed or water to control disease. APIs imported as chemicals — different from a drug in a finished form — and all too often originated from second-rate and unapproved manufacturing facilities in foreign countries. Steps have now been taken to ensure these products are of the highest quality and produced in accordance with good manufacturing practices. Persons who import, fabricate, package, label or test veterinary APIs must do so under an establishment license.
• Mandatory reporting of sales and imports will start because there is poor understanding of what is sold in Canada. Manufacturers will report annually on the total quantity sold and for which species. This covers imports of drugs and APIs by bona fide manufacturers.
• Access to low-risk veterinary products will be allowed.
• The interim notification pilot program has been in place since 2012 to allow sales of products like vitamins, minerals or Chinese medicines. It has allowed about 600 oral and topical products to enter Canada for pets and horses. It will be expanded to food-producing animals and allows products like calcium boluses to prevent milk fever.
• Growth promotion claims from medically important antimicrobials will be removed. Health Canada has not approved one of these since 2004 and there is no modern data that says they work. About 64 products are implicated. The existing concern is how to replace the additional role some antimicrobials have played in supporting important production needs such as growth promotion and feed efficiency. In many ways this issue is the “elephant in the room” regarding antimicrobial resistance and the fine line between “production enhancement” and “the prevention and control of disease.” In Canada, growth promotion claims are gone. Using mass medication for control of disease will come under strict scrutiny carrying veterinarians and producers into a band of accountability not previously experienced. Use of all medically important antimicrobials in animals is clearly set on a downward spiral; alternative options are on the rise with continued advancement of new tools to supporting efficient and profitable production. Leading examples are feed enzyme technology and innovative synthetics such as nucleotides.
• Increased veterinary oversight and prescriptions for all antimicrobials sold. This includes over-the-counter and medicated feed products. Medically important antimicrobials (MIAs) listed in the Compendium of Medicating Ingredient Brochures (CMIB) will also be listed on the prescription drug list (PDL).
• Provinces and territories may make additional rules about who can sell veterinary drugs.

New thinking is taking hold. There will be a need to become more sophisticated in looking at options and updating antimicrobial use protocols. For those accepting change, the upside is a more stable and sustainable future that fits what the marketplace is asking for. Big players in the animal protein business like Purdue Farms have upped the ante even further by adopting the position: “For consumers who want chickens raised with no antibiotics of any kind, and want that choice now, we are committed to offering consumers the clarity, transparency and assurance that only comes from ‘No Antibiotics Ever.’”

There is no shortage of myth, misconception and controversy in the mix of argument and rhetoric surrounding changes in antimicrobial use. While there is virtually no dispute anymore that antimicrobial resistance is real and agricultural use is a factor, the extent of its contribution is hard to pinpoint and many feel has been overblown.

Dr. Jeroen Dewulf, University of Ghent researcher, in an article that appeared in Feed Navigator.com, debunks common myths on antibiotic resistance that could reduce reliance on antibiotics in a smart, economical and viable way. He emphasizes there is no need for pessimism. Antimicrobial resistance should not be looked at as a threat, rather an opportunity to reach the next level of quality and sustainable production.

Myth #1: The issue is not about antibiotic residues in animal production, but rather the presence of antibiotic-resistant bacteria in the environment that are transmitted from animals to humans.

Myth #2: Antibiotic resistance is a new issue. It has always been here. New levels of antibiotic resistance are the result of antibiotic use; the more you use, the more resistance you have. Antibiotic use enhances the spread resistance.

Myth #3: Reducing antibiotic use will automatically cost money. You can make things better by improving management, biosecurity and animal husbandry.

Myth #4: AMR is not worth losing sleep over. WRONG. Common bugs become superbugs and people die. Costs measure in the billions of dollars.

Myth #5: Change happens quickly. People need time. Coaching, herd management, biosecurity and prudent antibiotic use are factors. Change happens more quickly if everyone is on the same page.

Myth #6: Check management. Improve things like animal husbandry and biosecurity then reduce antibiotic use (in order).

Myth #7: Antibiotics need to be replaced with other medicines. Look at things like better vaccines and vaccination protocols, and improved nutrition. Management mistakes become more obvious after taking away the umbrella of antibiotics.

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• Read more: Do you have a veterinary-client-patient relationship?

If the industry is going to be seen as doing the right thing, a common language is needed. There should be no question why antimicrobial resistance (AMR) is an issue and why agriculture needs to be part of answering questions when they use 80 per cent of the antimicrobials produced. It’s frightening when people die following surgery or after injury because bacterial infections resist any and all treatment. Questions do remain about the degree agriculture plays versus the role played by humans and the medical community. There are burning questions about environmental interaction when antimicrobials are used indiscriminately.

There is no point in thinking that change will come slowly because significant change is around the corner even though new regulations address issues that have been on federal government dockets for nearly two decades. The learning curve will be steep. Situations and circumstances exist for which answers are still missing — things like prevention of disease in feedlots and swine operations based on proper management of the immune system, and use of vaccines versus treatment using broad-spectrum antimicrobials. These and other important questions beg resolution. Almost assuredly, quick answers to important questions err on the side of safety and may need to be rethought.

2018 will be a grace period of sorts. Veterinarians and their clients must figure out how these new regulations fit with individual operations. There is no reason not to believe that revamping how we buy, sell and use antimicrobials will involve an additional financial burden, and be construed as an operational inconvenience based on old habits. Bitterness will work its way into the system as the freedom to use drugs in treating and preventing disease becomes more restrictive than we have come to know. Veterinarians, on one hand, will be targeted with petitioning control yet remain under the gun to issue prescriptions appropriately and maintain accurate records showing that clients have been properly instructed on antibiotic use and withdrawal times. In the event mistakes are made, veterinarians will be obligated to be front and centre in engineering solutions and developing protocols to prevent potential problems in the future. The legality of how business is conducted on a day-to-day basis is about to become more acute.

Understanding all aspects of change requires consideration of individual pieces first, then fitting them together. A critical aspect of compliance with new regulations is understanding the concept of a veterinarian-client-patient-relationship. A valid veterinarian-client-patient-relationship (VCPR) must exist before a veterinarian can prescribe or dispense medication. Two additional issues in Canada need to be discussed with a veterinarian: the import and use of active pharmaceutical ingredients (AIP) and the import of drugs for use by individual producers (OUI).

The following are excerpts from documents published by the Canadian Veterinary Medical Association and several provincial veterinary associations.

A legitimate VCPR is considered to exist only if medical records of the practice contain sufficient evidence of relevant and timely interaction between the veterinarian, animal owner and animal patients.

Interactions include, but are not limited to: farm or home visits, clinic appointments, consultations, direct animal examinations (individual or herd/flock), laboratory reports, production record reviews, etc.

The VCPR is supported by documented evidence that the veterinarian has undertaken steps necessary to establish medical needs, and consequently prescribes and subsequently dispenses pharmaceuticals.

The VCPR is not a signed contractual agreement but rather a working connection and interaction between veterinarian, client and specific animal patient or group of animals. The VCPR is not in and of itself an entitlement to prescribe and subsequently dispense.

Each provincial and territorial veterinary statutory body has its own definition of VCPR in provincial legislation. Veterinarians with clients in more than one province need to be aware of the differences and ensure clients are aware of them.

The CVMA’s Antimicrobial Prudent Use Guidelines (2008) states that a VCPR exists when the following conditions have been met:

1. The veterinarian has assumed the responsibility for making clinical judgments regarding the health of the animal(s) and the need for medical treatment, and the client has agreed to follow the veterinarian’s instructions.

2. The veterinarian has sufficient knowledge of the animal(s) to initiate at least a general or preliminary diagnosis of the medical condition of the animal(s). This means that the veterinarian has recently seen and is personally acquainted with the keeping and care of the animal(s) by virtue of an examination of the animal(s) or by medically appropriate and timely visits to the premises where the animal(s) are kept.

3. The veterinarian is readily available for followup evaluation, or has arranged for emergency coverage, in the event of adverse reactions or failure of the treatment regimen.

Changes to federal policies and regulations in 2016 resulted in the removal of all production claims for antimicrobials in animal feed and water. The shift led to mandatory veterinary oversight of antimicrobial use in food-producing animals.

The website on Veterinary Oversight of Antimicrobial Use produced by the CVMA and provincial associations is mandatory reading for veterinarians and their clients.

The document outlines standards of antimicrobial use covering: active pharmaceutical ingredients (AIP), own use imports (OUI), veterinary stewardship, classification of medically important antimicrobials, prescription preparation and documentation, extra-label use of antimicrobials, information related to labelling and dispensing of antimicrobials, compounding, medical records, surveillance.

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World Antibiotic Awareness Week began Monday, November 13. The United Nations, through its Food and Agriculture Organization (FAO), the World Health Organization (WHO) and the World Organization for Animal Health (OIE), summoned all those responsible to take steps toward prudent use of antibiotics. The emergence of bacterial resistance is a troubling issue tied to the use of antimicrobials in both animals and humans. The issue is complex and global in nature. Answers are hard to find.

No subject touches modern livestock production more fully than antimicrobial use in animal-based food production and the relationship it has to AMR (antimicrobial-resistance) in humans. The assignment of cause for the growing dilemma of highly resistant, life-threatening bacterial infections on hospital wards stimulates arduous debate and finger pointing over the judicious use of antimicrobials. Agriculture must approach the future with the responsibility to be actively engaged in finding answers or stand suspect and untrustworthy. Regulatory changes, now underway in both the U.S. and Canada, will affect producers, veterinarians, and businesses in the business of selling antimicrobials.

“Antibiotic resistance is a global crisis that we cannot ignore,” said Tedros Adhanom Ghebreyesus, director-general of WHO. “If we don’t tackle this threat with strong, co-ordinated action, antimicrobial resistance will take us back to a time when people feared common infections and risked their lives from minor surgery.” Animal diseases are becoming harder, and sometimes impossible, to treat as antibiotics become less effective. The WHO has gone as far as recommending the elimination of antibiotic use in animal agriculture. As implausible as this might seem, we must remember that WHO called for the reduction of feed-grade antibiotics for growth promotion, which the animal health industry readily adopted. Also on the table: the elimination of antibiotics for disease prevention, unless a veterinarian has diagnosed a disease condition within a herd or flock. With WHO’s recommendations comes rising pressure for food companies to develop “antibiotic-free” policies. In Europe, companies like Domino’s Pizza Group U.K. have committed to phasing out the routine use of antibiotics in beef, pork and poultry.

The federal government has proposed new rules for veterinary drugs used in livestock. In that agriculture uses an estimated 80 per cent of antimicrobials produced, Health Canada has clearly taken the stand that overuse and misuse of antimicrobials in animals is a contributing factor to the development and spread of AMR in humans. Health Canada says the decreasing effectiveness of antimicrobials is having a significant impact on the government’s ability to protect Canadians from infectious diseases. In their view, current regulations do not provide the necessary regulatory oversight to mitigate risk.

Both Canada and the U.S. have been criticized for lagging behind Europe in regulations governing prudent use of antimicrobials. North American agriculture is under pressure to enact major changes. Significant trade sanctions lie at the crux of inattention.

Health Canada updated the framework for veterinary-use antimicrobials by publishing regulatory changes to the Food and Drug Regulations in the Canada Gazette, Part II on May 17, 2017. These changes aim to increase oversight of antimicrobials available for use in animals. In particular, Health Canada addressed gaps in the regulations identified as issues multiple times over the last decade:

• Active pharmaceutical ingredients (API) for veterinary use.
• Personal importation of certain drugs for food-producing animals (Own Use Imports).
• Reporting antimicrobial sales information (surveillance).
• Use of veterinary health products (VHP) — low-risk drugs used to maintain or promote the health and welfare of companion and food-producing animals. VHPs contain ingredients like vitamins, minerals and traditional medicines.

In addition, Health Canada has implemented microbiological safety requirements for assessing new veterinary antimicrobial drug submissions for use in food-producing animals. They have also categorized antimicrobials into four categories based on their importance in human medicine to help prioritize risk management options, and added warnings on certain medically important antimicrobials in Categories I, II, and III. Steps have been taken to increase surveillance activity and enhance communication on prudent use of antimicrobials with a wide network of stakeholders including: provincial and territorial authorities, international counterparts, veterinarians, industry, food animal producers, associations, other animal health stakeholders, other federal departments and agencies.

Many producers do not understand the implication of changes coming forward in 2018 in the form of regulations. By default, everyone handling antimicrobials will assume ownership of a major international crisis. There will be a need to understand the issues and a need to correct any deficiencies in your health practices.

Practices associated with how antimicrobials are purchased and used will change, and there will be costs tied to these changes. Key among them will be the need to develop a veterinary client-patient relationship with a veterinary practitioner who will facilitate the maintenance of appropriate animal care practices and issue prescriptions for the purchase of antimicrobials. Registered pharmacists may be a part of the equation. The loss of API and own use permit privileges (as they existed) will affect some production units.

If industry and government don’t carry out this transition cleanly and smoothly, the outcome could range from trade sanctions to erosion of consumer confidence. Whether we like it or not, animal agriculture must play a part in tackling antibiotic resistance. It is essential that the public and consumers understand we are there and doing the right thing.

— Dr. Ron Clarke prepares this column on behalf of the Western Canadian Association of Bovine Practitioners. Suggestions for future articles can be sent to Canadian Cattlemen or to the WCABP.

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Describing a lack of effective antibiotics for humans as “a security threat” on a par with “a sudden and deadly disease outbreak”, WHO Director-General Tedros Adhanom Ghebreyesus said “strong and sustained action across all sectors” was vital to turn back the tide of resistance and “keep the world safe”.

The WHO “strongly recommends an overall reduction in the use of all classes of medically important antibiotics in food-producing animals, including complete restriction of these antibiotics for growth promotion and disease prevention without diagnosis,” the United Nations agency said in a statement.

Any use of antibiotics promotes the development and spread of so-called superbugs — multi-drug-resistant infections that can evade the medicines designed to kill them.

According to the WHO’s statement, in some countries, around 80 percent of total consumption of medically important antibiotics is in the animal sector. They are largely used in healthy animals to stop them getting sick and to speed up their growth.

The WHO said such use should be halted completely. In sick animals, it added, wherever possible, tests should first be conducted to determine the most effective and prudent antibiotic to treat their specific infection.

Some countries have already taken action to reduce the use of antibiotics in food-producing animals. The European Union has since 2006 banned the use of the drugs for growth promotion.

Consumers are also driving a demand for meat raised without routine use of antibiotics, with some major food chains adopting ‘antibiotic-free’ policies for meat supplies.

The WHO said alternatives to using antibiotics for disease prevention in animals include improving hygiene and farming practices, and making better use of vaccines.

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For those of you craving more detailed information, there have been several very good brochures published and websites established providing factual and current information on the subject. This knowledge is important anytime we try to explain to the average urbanite what we know and how the entire industry is really following the guidelines about prudent usage of antimicrobials.

We hear the public and some industry sectors use terms like “raised without antibiotics.” The fact is, reducing antibiotic use can have severe ramifications from an animal welfare perspective. They are effective and safe. We have established withdrawal periods by law so there are no antibiotic or other drug residues from products such as NSAIDs or vaccines in our meat or milk. The established withdrawal times are set for each product.

The best printed brochure I have seen is the “Worried about Antibiotic Use and Resistance in Cattle” put out by the Alberta Beef Producers and available for anyone across Canada. It explains the four main categories of antimicrobials including Category One products, which also have very high importance in human medicine. They give examples of products we use in cattle like Excede or Baytril. This category makes up less than one to two per cent of the antimicrobials used in cattle production. But we must still think twice before we use them and only use the Category One drugs for treatment of severe medical conditions like a bad pneumonia.

Veterinarians continually advise on the least-critical product category that is still likely to be effective on the condition at hand.

I believe veterinarians, when they are doing autopsies, are doing more culture and sensitivities tests, especially when dealing with cases that have been unresponsive to drugs that previously worked.

This means the lab grows the bacteria causing the illness and uses little discs impregnated with antibiotics to actually see which ones work. This gives us a much better scientific approach to treatment and should provide a higher success rate. The issue is it can take a couple of days to test and get results, so in the meantime we as veterinarians must prescribe a treatment often based on previous protocols and success rates.

Very low risk

The possibility of getting resistant bacteria from cattle to humans is very remote because first very few Category One drugs are used. Plus the resistant bacteria would need to get through the packing plant and all the sanitary precautions used such as steam sterilization, UV light and a very clean environment through the cooking process. The bacteria have to survive all that, then get into a human who has been prescribed the same antibiotic by the doctor. This is a very, very unlikely chain of events.

There is now a research cluster led by researcher Dr. Tim McCallister at Agriculture Canada’s Lethbridge Research Centre, together with researchers from the cattle industry and veterinary colleges, looking at all these potential pathways. The teams is looking at all possibilities and finding very positive evidence the industry is doing its due diligence to protect both livestock production and humans. A great quote from veterinarian Dr. Craig Dorin of Airdrie: “It is our privilege and not our right to be able to use antibiotics in the animals we take care of.”

In all the surveillance being done in the industry, drug resistance levels are very low in beef. That doesn’t mean, however, they can’t increase. If resistance is found, the bacteria are resistant to most antibiotics in the same family of drugs. Veterinarians know this and will prescribe a different family of antibiotics as needed.

Today veterinarians are much more involved with antimicrobials that are used in production animal medicine, especially non-prescription products commonly administered in the feed or water. More than 75 per cent of the drugs are used in feed, so enhanced oversight at this level is where you as producer will see the most changes.

These are all positive steps in reducing overall antibiotic usage where possible and using the most effective ones for the condition at hand.

Good management practices important

Among the first steps — growth-promotant indications are being removed from antibiotic labeling this year. Most growth-promotant products contain antibiotics and often it is the reduced disease incidence that results in increased growth as a secondary benefit. But going forward this will require your veterinarian having a medical reason to prescribe the products.

More good information is available on the Beef Cattle Research Council (BCRC) website at www.beefresearch.ca/amr. Along with reading material the site also offers a seven minute video that is worth watching by everyone in the cattle industry.

Producers (and veterinarians) need to get back to management practices that we have known will minimize sickness and hence reduce antibiotic usage. For example, calves receiving adequate quality and quantity of colostrum (colostrum is the best “drug” one can use), low-stress weaning and preimmunization of calves up to two weeks before weaning are practices which reduce the need for treatment.

More direct movement of cattle through satellite and Internet sales is another measure that eliminates lots of commingling and risk of disease spread. These practices can definitely reduce the cost and usage of antimicrobials. In some ways I know it is easier said then done, but the potential for reduction in antimicrobial usage is great.

The pharmaceutical companies are focusing more on vaccinology so you will see broader coverage vaccines for viruses and bacteria. Intranasal vaccines can provide quicker coverage and technology has and will improve the degree of immunity and length of coverage over time. The future will most likely see more vaccines replacing the antimicrobials. It is far better to prevent by management and vaccination than treat with antibiotics.

Also pay attention to parasite treatments. Reducing parasite pressure in your herd will also stimulate the cattle’s own natural immune system. That, along with proper nutrition helps to minimize sickness.

With increased usage of antibiotics there is increased risk of selecting for resistance in that species. The oversight of veterinary communities will focus on four things — prevention, production, control and therapy. Another website has been built by the Alberta Veterinary Medical Association (ABVMA) found at: www.raisedwithcare.ca.

This very interactive website offers some quizzes to test your knowledge. The questions you get wrong become an educating experience.

I encourage everyone to check out these reference sources and inform the public. As we all work together in the cattle industry to do the right thing we can be leaders and educators in helping with the global battle against AMR.

Generally speaking we are already doing a good job but there is always room for improvement. Question your veterinarian and yourself if there is a better way the next time antimicrobial usage seems too frequent on your operation.

Responsible antibiotic usage is not about residues. We already do a fantastic job at that. It is about using the right drug for the right bug and for the right length of time. Take pride in the fact the cattle industry, in many ways, is taking the lead. The medical profession can learn a lot from what you do. Tell your story.

Many times painkillers, supplements, vitamins or minerals rather than antimicrobials may be the therapy of choice. Prevention of the disease through vaccination, low-stress weaning and reduced commingling of cattle can also greatly reduce the usage of antimicrobials. In specific instances we may be able to actually lower drug costs and have better outcomes while at the same time not contributing to any resistance. There will be lots more ahead on this topic in the future, so stay tuned.

This article was originally published on the Alberta Farmer Express.

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Despite rigorous public relations and lobbying by the medical community in North America for over 20 years, enactment of meaningful and robust legislation is just starting to emerge. In the meantime, microbial resistance grows, the antibiotic pipeline continues to diminish, and the majority of the public remains unaware of the crisis. The movement to control antimicrobial resistance is underfunded and resources are often applied in an unco-ordinated, often ineffectual manner. The misguided regulation of antibiotics in agriculture has undergone strict scrutiny and needed reform is just underway. Self-regulated control of antimicrobials in human medicine is also evolving. Prudent-use guidelines sprung from the recognition by veterinarians and physicians that solutions to AMR required more. Missing at the grassroots level is a common understanding of why change is needed in the first place and how individual responsibility will effect change.

Antimicrobial resistance has been under critical scrutiny by the scientific community for over two decades. In 2001, for instance, the Federal Interagency Task Force on Antimicrobial Resistance (U.S.) released the Action Plan to Combat Antimicrobial Resistance. The Infectious Diseases Society of America (IDSA) followed in 2004 with its own report, Bad Bugs, No Drugs: As Antibiotic Discovery Stagnates, A Public Health Crisis Brews, which proposed incentives to reinvigorate pharmaceutical investment in antibiotic research and development. Promising legislation addressing antimicrobial resistance was introduced in the 109th U.S. Congress (2006) and failed. In 2007 a group of distinguished scientists representing the Infectious Diseases Society of America published a report, The Epidemic of Antibiotic-Resistant Infections: A Call to Action for the Medical Community, but little became of it.

With few exceptions, professional organizations, producer groups and governments at all levels in North America and Europe took a cut at antimicrobial resistance/antimicrobial use (AMR/AMU). They respectfully filed their accusations and offered solutions. Most died on the table. Though some still question the significance of the issues involved, the pool of naysayers slowly withers. Unfortunately, today’s solutions become faint-hearted echoes tendered by prognosticators of the past, things like common sense practices that reduce antimicrobial demand, enhancing immunity and decreasing stress. More often than not, the wise and judicious retreat from the pressure to resolve problems and initiate action, glad they have miraculously supplied the grand solution, expecting different results though doing the same things.

Several watermarks of more recent vintage should pull the medical and veterinary medical communities out of the stall they experience in the search for answers, and spur both along with an accompanying host of regulatory agencies to take meaningful action. For one, the animal food industry must move beyond its fixation that resistance is a function of food residues: no residues, no significant involvement in the antimicrobial issue problem. What often gets missed when promoting food quality is how far the bounds of antimicrobial use and resistance extend beyond basic meat and milk production. Often overlooked is the interaction between minute amounts of antimicrobials in soil, water, air, manure and waste that result in the genetic exchange between microorganisms that ultimately creates resistance. The theatre of plasmid transfer between micro-organisms leading to the emergence of resistance is global in nature.

An alarming new superbug gene that makes bacteria resistant to a last-resort antibiotic has been detected in Canada and the U.S. The gene, called MCR-1, produces an enzyme that makes bacteria invincible to colistin, a highly toxic antibiotic reserved for use when all other drugs have failed. Scientists in China first reported MCR-1 in November (2015) in common E. coli from meat, farm animals and a human patient. But the news that really sent a shudder through the scientific community was that MCR-1 is located on a plasmid, a free-floating snippet of DNA that bacteria easily share. The simple transfer spreads resistance to other organisms. The nightmare scenario is that MCR-1 can potentially spread to more virulent bacterial strains that carry resistance genes against other antimicrobials, thus creating a “pan-resistant” superbug capable of defeating every antibiotic in the medicine cabinet.

According to the Center for Disease Control and Prevention in the U.S., at least two million people are infected with antibiotic-resistant infections each year, 23,000 of whom die as a result.

Seagulls, birds with enormous “migratory reach,” heighten the risk of transferring genes like MCR-1 internationally. The authors of a new study published in the Journal of Antimicrobial Chemotherapy found highly drug-resistant E. coli in gull droppings.

A linkage between copper supplementation and colistin resistance has also been identified, implying that use of copper in animal husbandry may select for colistin resistance, even in the absence of colistin usage.

In October 2014, the Government of Canada released its report Antimicrobial Resistance and Use in Canada: A Federal Framework for Action. The framework outlines a co-ordinated, collaborative federal approach to responding to the threat of antimicrobial resistance. For the most part it mimics what was said in 2001 and now, as then, proactive steps languish in a world of missed target dates, underfunding and political somnolence. The World Economic Forum concluded in 2013 that the greatest risk to human health comes in the form of antibiotic-resistant bacteria. They recognized that humans live in a bacterial world where they will never stay ahead of the mutation curve. A test of human resilience is how far behind the curve we allow ourselves to fall.

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The Public Health Agency announced last year that Health Canada’s Veterinary Drugs Directorate would introduce new regulations requiring veterinary oversight of antibiotics used in food animals, such as those administered in water and feed.

Health Canada is now asking for industry input on the proposed changes, including tougher rules around the quality of active ingredients, increased monitoring of drug sales and restrictions on the importation of some veterinary drugs.

“I think this is a historic process, it is dramatic,” said Prescott, co-chair of the Ad Hoc Committee for Antimicrobial Stewardship in Canadian Agriculture and Veterinary Medicine. “It will reduce the use of antibiotics to when the benefits are really clear and substantial.”

In a summary of the proposed changes, the federal department states that “the overuse and misuse of antimicrobials in animals is a contributing factor to the development and spread of AMR (anti-microbial resistance).”

Prescott agrees. He was one of the many experts gathered in Niagara Falls last week for a Canadian Veterinary Medical Association summit where antimicrobial resistance was a key concern. But while 80 per cent of all antimicrobials used are used in animal agriculture, the professor emeritus of veterinary bacteriology cautioned that the situation should be keep in perspective.

“That sounds like a huge number, but you have to realize there are a lot more animals than humans in Canada,” he said, adding that the Canadian Integrated Program for Antimicrobial Resistance Surveillance has done an excellent job of tracking resistance in Canada, often being the first to identify newly resistant bacterial strains.

More monitoring

Prescott would still like to see more done in terms of data collection and monitoring.

“What we’d really like to see is use data on a farm basis and on a veterinarian basis… how well does farm X compare to farm Y, and if farm X or one particularly veterinarian seems way out of line… it would be very valuable to then tap them on the shoulder and say ‘look, you are out of line here, what’s going on?’” he said.

“If we can track use, we can track resistance because the two are so linked together, if you use more antibiotics you will get more resistance. If you use less you will get less.”

No one at the summit was surprised by the new regulations proposed by Health Canada, which have been in development for several years.

“There is 100 per cent support for the regulatory changes, there is definitely concern with how are these changes going to be implemented and kind of the details around that, but in general the CVMA has been consulting with Health Canada for the last number of years and we do support these regulatory changes,” said the association’s president-elect, Troy Bourque.

Prescott noted the details of the proposed changes must still be finalized and that things feel “a bit chaotic” as industry and government come together to reduce antimicrobial resistance. But he stressed that even if benchmarking and antimicrobial use data still need to be worked on, changes to importation and oversight of ingredients marks a monumental change.

“The whole area is sort of in a ferment at the moment,” he said.

CCA support

Rob McNabb, general manager of the Canadian Cattlemen’s Association said, “it is very clear that food animal producers and veterinarians must work together to ensure the prudent use of antimicrobials.”

The association will respond to the Health Canada proposal in the coming weeks, but McNabb said, as they stand, the impact on production practices will be minimal.

“The most direct impact to our industry would be the changes or new restriction on own-use import, and we’ve been recommending that they they create a list of products, which they are now proposing to do,” he said. “They aren’t eliminating it all together, but they do need to have some controls in place.”

He expects that consultations with Health Canada will continue as regulatory changes move forward. The updated regulations are expected to come into effect in late 2017.

This article originally appeared in the July 14, 2016 issue of the Manitoba Co-operator

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Bacteria are everywhere — in drinking water, food, soil, plants, animals, and humans. Although most bacteria do not harm us, and some are even useful, many are capable of causing severe infections. The ability of antibacterials to stop infection depends on killing or halting the growth of harmful bacteria, but some resist the effects of drugs, multiply and spread. Although resistant bacteria have been around a long time, the scenario today is different from even just 10 years ago. The number of bacteria resistant to many different antibiotics has increased, in many cases, tenfold or more. Many new drugs that have been approved are confronting resistance soon after introduction.

In North America, approximately 250,000 people require hospital care for Clostridium difficile (C. difficile) infections every year. Antibiotic use is a major contributing factor leading to C. difficile infection. Between 15,000 and 20,000 people die each year from acquired C. difficile infections, many of which are preventable. Common, resistant infections contracted while in hospital threaten the ability to implement advanced medical procedures.

It’s estimated antibiotic resistance costs the U.S. economy $20 billion to $35 billion a year, including as many as eight million extra patient days spent in the hospital and another $35 billion in indirect costs including lost productivity. Bacterial diseases, now resistant to all antimicrobials and considered untreatable, cause two million illnesses and 23,000 deaths annually. Unfortunately, the investment to combat AMR isn’t commensurate with the threat. In the U.S., for instance, 2014 federal spending on antibiotic resistance was approximately $450 million in direct funding ($1.40 per American per year). Very little has been published about current overall medical costs of antibiotic resistance to the Canadian health-care system. Rough estimates put it at around $200 million per year. New investment, private and public, are necessary to create change.

Antibiotics are among the most commonly prescribed drugs in human medicine. The use of antibiotics is the single most important factor leading to antibiotic resistance around the world. It’s estimated, up to 50 per cent of all the antibiotics prescribed for people are not needed, or are not optimally effective as prescribed.

• Read more: The AMR dilemma: Part 1

Antibiotics are also commonly used in food animals to prevent, control, and treat disease, and promote growth. Regulatory and industry groups have wrestled with the fact that the use of antibiotics for promoting growth is not necessary, and the practice should be phased out, especially for classes of antibiotics deemed important in humans.

Direct comparison of drug volumes used in people and animals is difficult. Evidence suggests approximately 70 per cent of the total volume (in tonnes) of antimicrobials produced are used in food-producing animals (including poultry). Many of the antibacterial drugs used in animals have no application in humans, an example being the ionophores used extensively in poultry and cattle for prevention of disease.

Another concern to some health experts is the escalating use of antibacterial soaps, detergents, lotions, and other household items. Some health authorities feel antibacterial products should be reserved for the hospital setting, for sick people coming home from the hospital, and for those with compromised immune systems.

Missing pieces of the puzzle

The ability to measure success is often missing. The scientific community must address difficulties faced tracing the origins and spread of resistant microbes — more fundamentally, the transmission and spread of specific resistance genes in microbial communities.

Millions of dollars continue to pour into research on antimicrobial resistance without a clear way of integrating research priorities between teams of scientists. Meaningful surveillance systems are frequently missing and there seems to be no clear way of evaluating research findings and applying the knowledge in a way we collectively understand what’s happening. Perhaps it reflects a gap in our understanding of AMR’s complexity, but more often than not it’s the reluctance of research institutions to egress from academic and bureaucratic silos and work together in becoming problem solvers.

In searching for missing pieces, the importance antibiotics continue to play in livestock production and the supply of safe and wholesome food cannot be omitted. Diversity of the livestock industry is vast. Today, prudent antimicrobial use is a significant part of producing food more efficiently and safely. The maxim being: safe and wholesome food comes from healthy animals.

Antimicrobials become important tools in assisting the veterinary profession and agriculture industry deliver appropriate standards of care for livestock and poultry. The industry is slowly coming to grips with antimicrobial applications that take precedence over improvement in production practices that would lessen the need for antimicrobials. A prime example being less stressful ways of introducing weaned calves to the marketplace, including better vaccination and preconditioning programs. Finding better ways of weaning calves and use of quality vaccines in preconditioning programs as an alternate to broad-spectrum antimicrobials to treat and prevent bovine respiratory disease will become part of the industry’s commitment to responsible stewardship. If the effort is not genuine, or not visible and understood by consumers, and if not properly communicated the default is agriculture’s misrepresentation of prudent antibiotic use. The full extent to which antibiotic resistance in animal agriculture contributes to human infection is not known. While risks to human health posed by agricultural use of antibiotics are a matter of serious concern, supposition and fortune-telling are unproductive — from all perspectives. Clear, concise, scientifically accurate debate must prevail.

Progress, I believe, will require careful consideration regarding an appropriate home to manage and provide direction on the entire subject of antimicrobial resistance. It may not be a government agency. Governments at all levels appear unable to fund AMR research without the continuous and unpredictable burps of fiscal restraint. The nature of government makes it difficult to set priorities across tiers of jurisdictions — then, the inability to effectively communicate within the sphere of political fatuity. Is it time to establish a virtual, for profit, community run by a board of directors with administrative, financial, scientific and communication skills armed with the ability to establish laboratories, set research priorities, hire and manage people and manage surveillance programs? Government, livestock industries, veterinary and human medical institutions, the pharmaceutical industries and public organizations become paying clients. Accurate yet clearly understood scientific information and sound communication capabilities would be products offered for sale. The virtual community could be located within an academic setting or spread across existing facilities and managed centrally.

A number of organizations in the haphazard pursuit of answers related to AMR has identified a number of valid key outcomes. They encompass: international co-operation, long-term investment and leadership, surveillance and response capacity, stewardship in human health care and animal agriculture, commercial development, new antibiotics and fundamental research. A number of groups has identified the limitations of estimating the burden of disease associated with AMR a critical gap.

Other missing pieces in the pursuit of understanding AMR include:

• Limited national, state, and federal capacity to detect and respond to urgent and emerging antibiotic-resistance threats.
• Lack of systematic international surveillance related to antibiotic resistance.
• Systematic collection of data on antibiotic use in human health care and in agriculture.
• Universally applied programs to improve antibiotic prescribing practices.
• Lack of access to advanced molecular detection technologies to identify genetic causes of AMR.

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