TACKLING DRUG-RESISTANT INFECTIONS GLOBALLY FINAL REPORT AND RECOMMENDATIONS

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is an issue that the G20 must take a lead on, alongside wider
international efforts through the UN, WHO, OIE and FAO.
in our paper, Antimicrobials in agriculture and the environment:
reducing unnecessary use and waste34.
“There is an increasingly robust consensus
that unnecessary use of antibiotics in animals
and agriculture is a significant concern for
human health.
”
What we need to do
We propose three broad steps to improve this situation:
1. 10-year targets to reduce unnecessary antibiotic use in
agriculture, introduced in 2018 with milestones to support
progress consistent with countries’ economic development.
In order to reduce global use of antibiotics in agriculture there
is a strong case for targets on use at the country level, taking
into account countries’ production systems.
2. Restrictions and/or bans on certain types of highly critical
antibiotics. Too many antibiotics that are last‐line drugs for
humans are being used in agriculture, sometimes without even
professional oversight. These need to be the prime focus of
efforts to reduce consumption in animals and action should
be taken on this now.
3. Improve transparency from food producers on the
antibiotics used to raise the meat that we eat, to enable
consumers to make more informed purchase decisions.
1.
TARGETS / LIMITS TO REDUCE ANTIBIOTIC USE IN
AGRICULTURE, INTRODUCED IN 2018
All antibiotic use increases the chance of resistant bacteria
developing and spreading, and a ban on the use of antibiotics
for growth promotion for example, while a significant step
forward, alone would not solve the problem. It is also difficult for
regulators to know how an antibiotic is being used. For example,
antibiotic use declared to be prophylactic may increase when use
for growth promotion is banned, as some users may try to ‘game
the system’. Providing targets allows countries to decide on a local
level how they can best reduce unnecessary use of antibiotics in
farming. We described our rationale for targets in more detail
We have made proposals on how these targets could be structured
but an expert international group is needed to guide countries
and help them develop these proposals into ones that are ready
to be implemented within the next two years. There are many
questions, which it is beyond the scope of the Review to address,
but which now need to be given urgent consideration by the
global agricultural and veterinary community. These include:
• How should the targets be calculated? Our lead proposal is
that this should be on a mg / kg basis for livestock and fish.
However, one other option might be to measure usage on
a ‘defined daily dose’ (DDD) basis. The methodology to set
such targets will need careful consideration, such as whether
antibiotic classes should be treated differently, and whether
targets should be broken down by animal type – e.g. poultry,
cattle, etc. - or broken down even further to give more
specificity by species.
• What levels should countries aim to reach? We highlighted
the success of Denmark as one of the largest pork exporters in
the world. They have a highly productive farming system with
levels of antibiotic use of less than 50 mg / kg. We therefore
see this as a broadly reasonable target for high-income
countries to aim for in the short-term. However, further
consideration needs to be given to such targets and how they
vary globally, not least since some countries are already below
this level, whilst for others it would require substantial change
and investment. There will not be a one-size-fits-all target,
but all countries need to play their part in reducing use.
• How long should be given to reach these targets? We have
proposed that targets could be set with a 10-year horizon,
with benchmarks to encourage regular progress. Since there
is a need for continuing, even indefinitely, efforts to optimise
antibiotic use in animals, we envisage that new targets
should be set, after these initial ones, to continue progress.
We recognise that low and middle-income countries are
likely to need more time to reach the same levels of use as
high-income countries, and that developing further economic
analysis on the switching costs in these countries in particular
might assist with design and implementation. We believe that
targets should be set globally within two years, beginning by
2018, but encourage countries that have good data on antibiotic
use to already begin work on what appropriate targets
would look like now.
34 Review on AMR, Antimicrobials in agriculture and the environment: reducing unnecessary
use and waste, 2015.