Ensuring responsible use of antimicrobials in your supply chain

The World Health Organisation (WHO) has warned that irresponsible antibiotic practices are leading the world towards a post-antibiotic era where routine operations will no longer be possible and many infections no longer treatable. This has not escaped the attentions of stakeholders and consumers alike. The growing concern about antibiotic resistance is likely to increase the demand for meat produced without routine antibiotics. This article explores the steps food businesses should take to incorporate the responsible use of antibiotics within their supply chains into their animal health and welfare strategy.

Authors: Alice Willett & Mair Morgan

A coalition of 54 investors addressed an open letter to 10 of the largest UK and US food companies asking them to stop sourcing their meat and poultry from suppliers that use non-therapeutic antibiotics [i] (i.e. where a diagnosis of disease has not been made).

The investors stated “While we agree that antibiotics should be used for the treatment of sick animals, they should not be used to support irresponsible practices such as growth promotion or routine [prophylactic] disease prevention of animals kept in closely confined and unsanitary conditions.” i

What is the issue?

The global burden of Antimicrobial Resistant (AMR) infections is growing at an alarming pace, with drug-resistant infections responsible for over half a million human deaths globally each year. In 2013, the UK’s Chief Medical Officer said “antibiotic resistance is one of the greatest threats to modern health and we face a future without cures for infection if antibiotics are not used responsibly.” [ii]

Research predicts that if actions are not taken to control AMR the human deaths related to AMR will exceed 10 million per year by 2050 and cost the world over $100 trillion USD in lost output [iii].

What do we mean by antimicrobial resistance?

Antimicrobial resistance (AMR) is a natural process in which microbes evolve to resist the action of antimicrobial drugs (including antibiotics). This results in antibiotics becoming less effective over time and eventually useless [iv].

There is a debate about the contribution of antibiotic use in livestock to human antimicrobial resistance. Some academic research suggests that the use of antibiotics in livestock is causing the development of antimicrobial-resistant bacteria which can spread to humans, and that the transfer between humans and animals occurs more frequently than initially thought. Other research suggests that in humans, resistance is largely attributed to human medical use.

A review carried out by Jim O’Neill, commissioned by the UK Prime Minister, discovered that out of 139 academic studies, 72% gave evidence of a link between antibiotic consumption in animals and resistance in humans. This provided credible evidence of antibiotic use in animals being a factor in promoting resistance in humans and provides sufficient justification for policy makers to aim to reduce global use in food production to a more optimal level iii.

Limiting the use of antibiotics in agriculture

Around half of all antibiotics produced in the UK are given to livestock, with the figure rising to 70% in the US[v]. Given that the balance of scientific evidence supports limiting the use of antibiotics in agriculture, it is essential to understand why and how antibiotics are used on a species by species basis, as working towards a blanket reduction target could be detrimental to animal health and welfare.

Antibiotics are being used in livestock for three key reasons:

  • The treatment and cure of disease (Therapeutic use) | this refers to their use on a sick animal or group of animals when the diagnosis of disease or infection has already been made. In the UK and EU, treatment is strictly under veterinary direction to ensure effective disease control. This may not be the case outside the EU.
  • The prevention of disease (Prophylactic or Preventative use) | antibiotics can be used to prevent sickness or disease developing, where a vet has diagnosed the animals to be at high risk of infectio Preventative treatment should only be applied to animals diagnosed at high risk of bacterial disease and should only occur under prescription by a veterinarian on the basis of epidemiological and clinical knowledge.
  • Growth promotion | antimicrobial growth promoters (AGPs) are sometimes used on livestock to increase the feed-to-gain efficiency. Although the use of antibiotics for growth promotion has been banned in the EU since 1st Jan 2006, this is not the case in many major meat producing countries such as China, Brazil, Russia Federation and Argentina.

The key areas for reducing antibiotic usage are on the prophylactic use and use for growth promotion. AMR is a global issue, so while use of AGPs is not allowed in EU it can be an issue for livestock products sourced from other territories.

Within the EU, the focus is firmly on reducing the prophylactic (particularly the routine) use of antibiotics on livestock. Prophylactic use is most common in intensive livestock systems such as pigs and poultry. Such treatments should not be administered on a routine basis or used to compensate for poor hygiene or for inadequate husbandry conditions, but this is not always the case. That said, intensive producers are working hard with their veterinary advisers on initiatives to prevent disease and reduce reliance on prophylactic medication such as improved housing design/replacement housing and alternative health management systems, including vaccination, coupled with enhanced biosecurity practices and should be supported in this process.

What is already being done to limit use of antimicrobials?

AMR is a global issue in need of immediate action. To this end the World Health Organisation (WHO) have set up the global action plan on antimicrobial resistance. Working closely with the United Nations (UN) and other collaborators such as the Food and Agriculture Organisation (FAO), its objective is to have multisectoral national action plans in place by the 2017 World Health Assembly.

Europe has also responded. Action on antimicrobial use has been identified as a priority within the Council of the European Commission, with draft legislation proposed by MEP’s that would:

  • Ban the preventative use of antibiotics,
  • Restrict collective treatment to very specific cases,
  • Monitor actual use of antibiotics in member states;
  • Prohibit the veterinary use of antibiotics important in human medicine; and,
  • End the online sales of antibiotics, vaccines and psychotropic substances

The proposal will be going before the European Council for consideration, however;

  • A risk of arbitrary reduction targets is that reducing dosages or the duration of antibiotic treatments or using a lesser quantity of antibiotics to meet arbitrary reduction targets is not responsible use. It could encourage the development of antibiotic resistance and compromise animal health and welfare.
  • Under UK and EU animal welfare legislation, farmers are legally required to ensure that animals receive appropriate treatment if they become sick. Removing their ability to do this by appropriate prescription of antibiotics could have a negative effect on animal health and welfare.

In response to stricter regulation, sales of antibiotics to Dutch livestock farmers reduced by 56% (between 2007 and 2009) without any impact in production or profits. Dutch farmers shifted their focus from using antibiotics, to optimising the living conditions of livestock [vi]. A similar framework will be adopted by more national governments in the coming years.

Closer to home, the UK Government commissioned the Review on Antimicrobial Resistance, the final recommendations reported in May 2016. Frequently referred to as the O’ Neill report, key recommendations propose country by country ten-year targets to reduce unnecessary antibiotic use in agriculture and their dissemination into the environment, to be introduced in 2018, with milestones to support progress consistent with each country’s economic development. One specific recommendation is that the food industry should “improve transparency for consumers regarding the use of antibiotics in the meat that we eat, to enable better informed decision-making by customers.” iv

Regardless of the origin, it is clear that regulatory pressure on reduction of antibiotic use will continue. But government action alone will not be enough. Business, civil society and consumers all have a role to play.

Voluntary steps are being taken by livestock industries towards more responsible antibiotic use such as promoting veterinary prescribing principles to strictly limit the use of antibiotics of critical importance to human health and collating antibiotic use data and benchmarking that use between farms of similar type.

One example of a successful voluntary initiative is the British Poultry Councils (BPC) Antibiotic Stewardship Scheme which was set up in 2011 to develop a strategy for the responsible use of antibiotics in the UK poultry meat sector. This initiative set out to achieve a reduction of unnecessary use of antibiotics, restricted use of highly-critical antibiotics, open reporting, and exploration of alternatives. The BPC were the first UK livestock sector to launch a data collection system to record antibiotic usage and were the first to share its data with government’s Veterinary Medicines Directorate (VMD) - demonstrating their commitment to openness and transparency. Since 2011 BPC member companies have reportedly reduced their antibiotic use by 44% [vii]. This concept has been extended by AHDB who have developed an online medicine book (https://emb-pigs.ahdb.org.uk/) for the pig sector, which enables producers to provide total antibiotic usage data, the aim of the scheme is to develop an accurate picture of pig specific antibiotic use in the UK.

The main tool in the fight against AMR is a thorough, practical farm-animal health and welfare strategy. Improving animal health and welfare through enhanced biosecurity allied with alternative management systems incorporating latest developments on housing, nutrition and the selection of breeds that are less susceptible to disease are just a few of the many means available to producers to enable them to meaningfully reduce the need for antibiotics [viii]. Table 1 outlines the four golden rules of disease control being applied to the poultry industry, although the principles hold good for other livestock such as pigs.

Table 1: Disease Control: Four Golden Rules – Poultry Guidelines

(Source: Responsible Use of Medicines in Agriculture Alliance (RUMA))

What is expected from food companies?

Food businesses, particularly multinationals with global supply chains, are in a position to drive necessary changes in how antibiotics are used on livestock faster than legislation alone. Through their sustainable sourcing commitments, food companies have an opportunity to influence their supply chains to sustainably reduce the need for antibiotics in a controlled manner. And there are growing pressures on them to do so:

  • The key message coming from the investment community is one urging companies to end non-therapeutic use of antibiotics important to human health in their global meat and poultry supply chains i.
  • Consumers and consumer groups have also voiced their concerns demanding increased transparency to enable better informed decision-making.
  • Based on the recommendations in the O’Neill report, and the stance taken by national governments, pressure will also build on the public sector for their food supply chains to be active in supporting the responsible use of antibiotics through public procurement policy.

In response to these growing pressures, McDonald’s have stated that they are “monitoring, controlling and reducing the use of antibiotics among chickens in our supply chain” and that they “have a policy that will ban the use of the highest-priority critically important antibiotics for human medicine, as designated by [the] WHO, in our chicken supply chain by 2018.” i

Examples of practical steps that can be taken by your food company include:

  • Make your position clear and communicate with consumers, category buyers and suppliers;
  • Understand where and why antimicrobials are entering your supply chain;
  • Support your suppliers in their aims to reduce usage or improve existing production systems through supplier groups or providing targeted expertise and,
  • Get involved in collaborative (pre-competitive) research projects which aim to promote sector / industry wide improvements.

How can ADAS help?

We recognise that food companies will be at different stages in relation to their understanding of the issue of antimicrobial resistance and in developing and implementing Animal Health and Welfare policies that specifically relate to antimicrobial resistance. Our experts, within ADAS, can help you navigate each stage of the process, whether it be starting at providing thorough, independent information on the issue, raising awareness internally with buyers and externally with suppliers or in developing a long-term collaborative approach with your suppliers and their veterinary advisers. The overall aim will be to promote best practice production systems which enable a sustainable reduction in the need for prophylactic use of antibiotics, particularly those considered critically important for human medicine, whilst also ensuring that animal welfare is protected and product quality and food safety is maintained.

ADAS has a long track record working with farmers, the farming industry, Government and food supply chain to develop and implement practical solutions to problems, based on good evidence and business needs. We work with our clients to deliver robust research and research reviews, policy/strategy development, impact assessments, monitoring and evaluation, market intelligence and insights and project management and facilitation.

  • Link with other sustainability objectives

If you would like to know more about how the growing concern around antibiotic resistance might impact your business or on steps you could take please contact Alice Willett on Alice.Willett@adas.co.uk

[i] http://www.fairr.org/news-item/1-trillion-investor-coalition-demands-corporate-action-on-systemic-overuse-of-antibiotics-press-release/ Accessed 3rd May 2016

World Health Organisation (2014) Antimicrobial Resistance: Global Report and Surveillance. http://apps.who.int/iris/bitstream/10665/112642/1/9789241564748_eng.pdf

[ii] http://www.ruma.org.uk/wp-content/uploads/2014/04/RUMA-ANTIBIOTIC-RESISTANCE-INFORMATION-NOTE.pdf

[iii] O’Neill, J. (2015) Antimicrobials in Agriculture and the Environment: Reducing Unnecessary Use and Waste - http://amr-review.org/sites/default/files/Antimicrobials%20in%20agriculture%20and%20the%20environment%20-%20Reducing%20unnecessary%20use%20and%20waste.pdf

[iv] Review on Antimicrobial Resistance - http://amr-review.org/background Accessed 2nd June 2016

[v] The Grocer - Can the livestock sector prevent an antibiotic apocalypse? Published 22 Apr 2016.

[vi] McKenna, M, ‘The Abstinence Method: Dutch farmers just say no to antibiotics for livestock,’ Article in Modern Farmer June 17, 2014, Available at: http://modernfarmer.com/2014/06/abstinence-method/

[vii] The British Poultry Council - The O’Neill Report: BPC Response - http://www.britishpoultry.org.uk/the-oneill-report-bpc-response/

[viii] Alliance to Save Our Antibiotics - https://www.ciwf.org.uk/media/7247793/antibiotics-alliance-40pp-report-2015.pdf

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