Antimicrobial Policy Direction: Decades of Learnings
This post was written by Dennis L. Erpelding, science advisor, International Poultry Council (IPC); project lead, IPC Transformational Strategies for Farm Output Mitigation (TRANSFORM); chairman, Global Farm View, LLC — global policy leader.
Antimicrobial resistance is a global public health concern in both human and animal medicine, and we have decades of learnings on what can work to address this risk through establishing sound policies. The risk is a bacterial infection that cannot be appropriately treated with antibiotics as a result of antibiotic-resistant bacteria. Lack of treatment options can jeopardize human health due to illness and food security due to animal disease.
Collaboration between the private sector and governments is essential for progress globally. The USAID Global Health Security-funded TRANSFORM project is an excellent example through which key stakeholders are working collaboratively to address zoonotic diseases, transboundary diseases and antimicrobial resistance to improve global health security and access to safe, affordable animal-sourced foods. (Transformational Strategies for Farm Output Mitigation (TRANSFORM) | Agrilinks)
A science-based, risk-based approach needs to be the basis for all policies. Having personally had a seat at the table globally, whether advancing the veterinary feed directive, the phasing out of selected antibiotic growth promotion uses, the drafting of association policies or the drafting of company policies, one understands action is needed, but critically the right actions for impact are needed.
In policy development, we need to focus on best practices that negate the need to use antimicrobials. Then, when needed, provide antimicrobial use stewardship principles to ensure appropriate use.
Learnings in the past decades provide the following insights. The right policy actions include:
- Laws and regulations that incorporate full risk analysis into the antimicrobial approval process. Identify the hazard, determine appropriate controls and then ensure proper communication on use.
- A risk analysis process that differentiates medically important for humans from nonmedically important for humans, that differentiates human use only, shared class use and animal use only antimicrobials.
- Terminology that provides differentiation of antimicrobials from antibiotics from anticoccidials, definitions being:
- Antimicrobial: the broadest term used, refers to any type of product that has activity against a variety of microorganisms, which can include bacteria, viruses, fungi and parasites. This includes products such as antibiotics and antiprotozoals.
- Antibiotic: a type of antimicrobial, specifically antibiotics are compounds produced naturally by a fungus or another microorganism, or synthetic analogues of these, which kill or inhibit the growth of bacteria that cause disease in humans or animals.
- Anticoccidial: products, including ionophores, having a unique mode of action and are used to control the common protozoan parasite, which causes the disease coccidiosis in poultry. Ionophores and chemicals are used as anticoccidials. A class of compounds not used in human medicine and not considered as medically important for humans.
- Consideration of a separate regulatory approach for anticoccidials as feed additives.
- Private sector stewardship principles and use policies, that are science based, risk based and seen as a journey from current state to desired state, that understands the unique species and geographical aspects around uses.
- Definitions that provide clarity on uses, to include therapeutic uses:
- Disease treatment (curative) use: any specific procedure used for the cure or the amelioration of a disease.
- Disease control (metaphylaxis) use: practices aimed at reducing the spread of, or incidence of, a disease.
- Disease prevention (prophylaxis) use: reducing the likelihood of a disease where there is a high probability of the occurrence of a disease in a susceptible population.
- Defining growth promotion/production use: shifting the microflora in the gastrointestinal tract for better balance of beneficial and harmful bacteria, thus improving nutrient utilization to support healthy growth and improved performance. Nutritional efficiency, feed efficiency and average daily gain are indicators of response.
In summary, antimicrobial policies need to be science based and a collaborative effort between the private sector and governments in order to yield a positive impact for global health and food security.