The Responsible Use of Medicines in Agriculture Alliance (RUMA) online conference 2021 presented information from the UK and drew on expertise from overseas to provide a balanced view of expectations. There was a certain amount of backslapping concerning the reductions in antibiotic use, but as performance data from the field is lacking, information from veterinary practices will now be essential if momentum is to be maintained, particularly in the cattle and sheep sectors.
Although the carefully compiled sector targets are national, it is the success on individual farms that will ensure that more and more herds and flocks replace antibiotics with targeted management and prevention of disease. What needs to be done over the coming months and years is not likely to be easy, and the early indications are that success is not guaranteed.
Initiatives
Enthusiastic veterinary surgeons and practices have set up meetings and information sources to encourage clients to tackle the problems detected from product sales, assessments and call-outs.
Spectinomycin initiative
Jonathan Hobbs of the North Park Veterinary Group Ltd, North Tawton, Devon, displayed a poster presentation at BCVA Congress on one such initiative, and gave a recorded presentation during the RUMA Conference.
Working initially with members of a flock health club, the initiative targeted the use of spectinomycin in neonatal lambs. Success with this group expanded to a general veterinary practice standard and recommendations were sent to flock keepers. Across the whole practice the outcome in year one was modest, with a fall of 14 percent in sales of the antibiotic, but as clients became aware that no negative consequences were recorded the second year yielded a drop of 54 percent.
The next set of annual data is being assessed, but the early indications are that the farmers who were likely to embrace a major change have now engaged and that the challenge will be to influence the remainder. Jonathan discussed that disease occurrences on-farm do not remain static year-on-year, so comparing units of antibiotic sales is useful but infrequent outbreaks of disease requiring treatment can upset the downward trend.
In order to understand the successes and problems encountered in encouraging a change in use of antibiotics by veterinary surgeons, more hard information is asked for by RUMA. There will be formal trials and assessments taking place, but it is the day-to-day experiences that are also sought
In order to understand the successes and problems encountered in encouraging a change in use of antibiotics by veterinary surgeons, more hard information is asked for by RUMA. There will be formal trials and assessments taking place, but it is the day-to-day experiences that are also sought. A major pointer appears to be that a whole practice role is required, involving all staff and an agreed practice standard. How that is achieved is worthy of comment.
Few people will underestimate the challenge with beef herds and sheep flocks. Involvement of dairy herds with a veterinary practice is now well established, but going beyond, say, 25 percent of beef and sheep clients is another level of challenge.
Farm Vet Champions
Fiona Lovatt explained that the Farm Vet Champions initiative has implemented its CPD stage, involving veterinary surgeons and the vet-led practice team. The intention is not to tell vets when and how to use antibiotics, but to plan not to use antibiotics at all through an attention to quality colostrum and other areas of management. This will be done using the overarching theme of “Plan, Prevent and Protect”.
Smart goals for achievement are to be targeted, and it is recognised that different practices and individuals are at different stages of awareness and implementation. An early ambition is already happening with knowledge sharing, case histories and the whole idea of responsible stewardship.
Online presentations
There were around 20 people presenting online during the conference and recordings are available through the RUMA website.
Farm animals
Catherine McLaughlin oversaw the programme, while Grace Webster indicated the value of data capture with pigs, benchmarking and application of the electronic medicines book. Herds with persistently high usage were first targeted to have a plan for reducing antibiotics as part of their routine management. This successfully lowered product volumes. A further 30 percent reduction is targeted across the sector.
Herds with persistently high usage were first targeted to have a plan for reducing antibiotics as part of their routine management. This successfully lowered product volumes. A further 30 percent reduction is targeted across the sector
Mark Jeffrey highlighted that with cattle, the data is fragmented and a national data set is needed. Engaging with the Medicines Hub is an important way forward, but it should be noted that past data cannot be utilised so involvement needs to start now to enable enough data to be accumulated for the guidance of reduction initiatives. It is recognised that many drugs that are indicated for cattle are also used across multiple species.
Equine and companion animals
It was interesting to hear about the companion animal and equine involvement with RUMA. Gwyn Jones pointed out that a family and their pets share the same house and share the same bugs, and Steve Howard stated that 51 percent of UK adults own a pet. A culture of antibiotic stewardship is being promoted for stable yards and veterinary consulting rooms, but it is recognised that there is pressure from clients to have antibiotics administered and prescribed. A reduction in post-operative antibiotic use has been shown by audit not to lead to an increase in infections. Daniella Dos Santos emphasised that it is difficult to set targets with a lack of data from the companion animal group, and benchmarking between veterinary practices is a way forward. The RUMA hub is a source of information, research findings and guidance.
A culture of antibiotic stewardship is being promoted for stable yards and veterinary consulting rooms, but it is recognised that there is pressure from clients to have antibiotics administered and prescribed
Issues facing veterinary surgeons
James Russell had a conversation with Kitty Healey of the Veterinary Medicines Directorate (VMD) to tease out some of the issues facing veterinary surgeons at present. UK legislation is distinct from EU legislation, and the VMD is setting up workshops and consultations with the aim of creating legislation that suits the needs of the UK. Veterinary surgeons are asked to engage with this process as the opportunity arises. Views on improving use of the cascade, likely restrictions on new medicines for animal use, protection of consumers and trade issues with imports are expected to be included. The salmon and trout sectors were also being addressed by RUMA.
The VMD is setting up workshops and consultations with the aim of creating legislation that suits the needs of the UK. Veterinary surgeons are asked to engage with this process as the opportunity arises
A panel also responded to questions from delegates. During this it was highlighted that:
- Small animal vets are worried about the control of infections and the development of resistance, especially with pet owners said to be unaware of antimicrobial resistance (AMR) issues
- There was not a drive to zero use, but instead to reach a point of acceptable use of antibiotics
- An increased use of vaccines needed suitable direction for storage and use on-farm
One Health
A global perspective on antimicrobial resistance was presented by Dame Sally Davies, the UK envoy on AMR, and Dr Jeffrey Scott Weese (Canada), with reference to the United Nations global leaders group and the One Health approach. It is recognised that antibiotics are misused across the world, which has both an environmental component and an implication in the contamination of water courses. There are no simple solutions to antimicrobial resistance, but the more effectively we treat animals the less need there will be for antibiotics. Governments should not dictate but instead provide support for “doing things right”.
There are no simple solutions to antimicrobial resistance, but the more effectively we treat animals the less need there will be for antibiotics
Carel du Marchie Sarvaas of the Global Association of Animal Health Companies indicated that diagnostics is the fastest growth area and that vaccine sales have increased. Worldwide, there has been a 34 percent reduction in the use of antibiotics for animals, with a 50 percent reduction in the UK.
Christine Middlemiss stated that 75 percent of infectious diseases are of animal origin and that 60 percent of existing human diseases are zoonotic. AMR infections are estimated to cause 700,000 deaths each year. Intelligence sharing is ongoing between countries, and a non-regulatory approach to reducing antibiotic use is being taken in the UK, with critically important antibiotics comprising 0.5 percent of total antibiotic sales for animals. The science base is strong in the UK with a multi-collaborative approach within this country and globally.
RUMA and the food industry
Various aspects related to food were discussed by a panel, with emphasis on quality, supply chains and industry collaboration. Key ideas were that the UK industry needs to adapt to a changing world, point to where things are successful and be confident that UK standards can be developed and maintained.
Key ideas were that the UK industry needs to adapt to a changing world, point to where things are successful and be confident that UK standards can be developed and maintained
Peter Boriello considered the challenges in ensuring the responsible use of medicines and did not hold back in recognising the difficulties in assessing the depth and breadth of the data. The early signs are that the UK is successful in reducing antibiotic usage, but more needs to be published on these achievements. A lack of endemic disease data and the economic and biosecurity implications is seen as an issue requiring attention. More information is required to understand what is meant by the use of a proficiency scheme rather than benchmarking, but this is perhaps only one of the many indications arising from the conference. There was a warning that the industry can expect to become increasingly regulated, but what is needed is a regulator, not more regulations.
The animal health industry also needs to be prepared that animal vaccination is seen as similar to child vaccination and that anti-vax attitudes can be expected to increase.
Summary
It is clear that the input of veterinary practices will be increasingly important to emphasise the practical aspects of controlling antimicrobial resistance in the UK.
