The tug of war between government’s discounted ability to mount a meaningful defence against antimicrobial resistance (AMR), recent accusations that pull the ethical and professional conduct of food animal veterinarians offside, and the reality that we may be losing the battle against antibacterial resistance hinders the progress toward resolution.
Three recent events highlight the tug of war. First is the long-awaited treatise by the federal minister of health titled Antimicrobial Resistance and Use in Canada: A Federal Framework for Action. The document is a rhetorical review of material documented and addressed prior to 2004 and several times since. While recognizing that antimicrobial resistance is a serious and growing global public health threat, it does little to instil confidence that fresh initiatives will arise from the depth of concern, enough to stimulate investment and commitment to solving problems.
The document identifies four key goals:
- To establish and strengthen surveillance systems to identify new threats or changing patterns in antimicrobial resistance and use, in human and animal settings.
- To strengthen the promotion of the appropriate use of antimicrobials in human and veterinary medicine.
- To work with the animal agriculture sector partners to strengthen the regulatory framework on veterinary medicines and medicated feeds, including facilitating access to alternatives and encourage the adoption of practices in order to reduce the use of antimicrobials.
- To promote innovation through funding collaborative research and development efforts on antimicrobial resistance both domestically and internationally.
All listed goals have been identified in one form or another at every major scientific gathering on antimicrobial resistance for at least 10 years. What is always missing is the financial incentives and resolve to make them happen. The goal of AMR surveillance, while being actively pursued for much of the last decade, is always orphaned by the fact that an overall surveillance plan for monitoring endemic disease levels and emerging diseases is missing. Multiple strategic plans have identified surveillance as a critical component of moving forward in both animal and human health, and offer recommendations that simply gather dust.
- More with Dr. Ron Clarke on the Canadian Cattlemen: Vectors and emerging disease: a growing dilemma
Organizational dysfunction has certainly played a role. At the federal level, no less than five agencies toss the ball back and forth: The Public Health Agency of Canada; Health Canada; Canadian Food Inspection Agency; Canadian Institutes of Health Research; and Agriculture and Agri-Food Canada. Add to this mix all the provincial departments of Health and Agriculture, a myriad of municipal agencies, and a broad network of international bureaus. Dysfunction becomes inevitable.
The next and more recent event hindering progress on the issue of antimicrobial resistance is media pressure launched by U.S. news agencies that challenges the ethics and professionalism of veterinarians, especially food animal practitioners. The media has tried to link relationships with pharmaceutical companies that develop, research and market animal drugs with the routine use of antibiotics by veterinarians.
The article, “Veterinarians face conflicting allegiances to animals, farmers, and drug companies,” was part of a series of articles under the heading Farmaceuticals that ran in the U.S. This particular article states a “Reuters examination found the FDA will be empowering a profession that not only has allegiances to animals, farmers and public health, but also has pervasive and undisclosed financial ties to the makers of the drugs.” The relationships between medical doctors and the pharmaceutical industry are subject to strict rules that require the public disclosure of payments for meals, trips, consulting, speaking and research. Similar rules on the veterinary side are missing.
Professional groups, like the American Association of Bovine Practitioners and American Veterinary Medical Association challenged the accuracy of a number of statements made in these articles, and welcomed a wider debate on the responsible use of antibiotics in cattle.
The Indianapolis Star carried a similar series (Pets at Risk), attacking the integrity of veterinarians in small-animal practices and calling their motives into question.
This coverage had a ripple effect in Canada, as well.
While largely sensationalist and laced with inaccuracies, this media barrage has pronounced veterinarians guilty in the court of public opinion and unfortunately has detracted from any meaningful progress on solving the antimicrobial-resistant dilemma.
Although many unanswered questions remain about the degree to which antimicrobial use in food animals promotes AMR, the realities are:
- AMR is an issue, and an often misunderstood one;
- Antibiotics are an important tool for treatment of bacterial infections in food animals and humans;
- Antimicrobial use for growth promotion, disease prevention, and treatment contributes to improved health and productivity of food animals, which benefits human health;
- The use of antimicrobial compounds creates selective pressure on bacterial populations and contributes to antimicrobial resistance, which negatively impacts human health;
- Antimicrobial use in food animal production is under increased scrutiny;
- Consumers are concerned about unwarranted use of antimicrobials;
- The extent to which antimicrobial use in food animals contributes to human health problems because of antimicrobial resistance is likely small, but perhaps not inconsequential;
- The issue is complex and controversial, and while a science-based approach is frequently advocated, emotional arguments are frequently presented;
- Continued use of antimicrobials in veterinary medicine depends upon the profession’s ability to use them wisely.
Veterinarians and animal owners share a responsibility for minimizing the risk. We have not effectively communicated the value of antibiotic use in food animals to the consuming public and the risks of doing without them.
In order to progress to a sensible resolution around AMR this tug of war for public opinion has to cease.