Antibiotics: “Antimicrobial resistance is a silent pandemic”

Since their discovery in the early 20th century, antibiotics have transformed medicine—both human and veterinary—by helping to curb many bacterial diseases. But their use has been accompanied by the emergence of resistant strains that threaten their effectiveness. To curb the serious risk that antimicrobial resistance poses to global public health, some countries have taken drastic measures, particularly with regard to livestock farming practices. Others, on the contrary, have been slow to act. Jean-Yves Madec, Scientific Director for Antimicrobial Resistance at the French Agency for Food, Environmental and Occupational Health & Safety (ANSES), and Florent Parmentier, Secretary General of the Center for Political Research at Sciences Po (CEVIPOF), take stock of the situation and explain why it is so difficult to implement measures commensurate with the threat.  

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The Conversation: Why are antibiotics used in livestock farming? Jean-Yves Madec: Antibiotics are given to animals for the same reasons they are given to humans: to treat bacterial diseases. Among the major diseases in livestock farming are udder infections in cattle. A cow develops mastitis almost every year. It is also very common for young animals to suffer from diarrhea when they transition from a milk-based diet to a varied diet. These dietary transition periods are very problematic; the animals suffer from infections and must be treated with antibiotics. Beyond major livestock diseases, the use of antibiotics in veterinary medicine also applies to pets, which are treated for certain conditions, following surgery, or because they develop age-related illnesses; unlike farm animals, which are slaughtered well before reaching their maximum lifespan, dogs and cats are cared for until the end of their lives.   TC: But in some countries, antibiotics are also used as “growth promoters.” Why? JYM: In many countries, antibiotics are indeed administered even when the animal is not sick. This is a kind of crutch intended to prop up substandard farming practices, particularly those resulting from poor hygiene. It turns out that when antibiotics are given to chickens living in poor farming conditions, they have a sanitizing effect. Whether antibiotics have a real effect on growth remains highly debated; there isn’t really any scientific evidence for that at this point. But it’s certain that they help the animals survive despite poor farming conditions.   TC: This off-label use is particularly problematic because the vast majority of antibiotic compounds used in humans and animals are the same… JYM: Yes. It is generally estimated that about 80% of antibiotics are common to both veterinary medicine and human medicine. Among these common antibiotics, however, are broad-spectrum antibiotics that are of importance to humans. The remaining 20% includes antibiotics restricted to human use—whose effectiveness in hospitals is thus preserved—such as carbapenems, powerful broad-spectrum antibiotics, or antibiotics that are no longer used in human medicine because better alternatives have been found, but which continue to be used in veterinary medicine. TC: So the risk is that resistant bacteria will emerge in animals and be transmitted to humans? JYM: Yes. A few cases have been documented. In the early 2000s, for example, it was found in the Netherlands and Denmark that strains of Staphylococcus aureus with antibiotic resistance, isolated in hospitals, actually originated from pig farms. Examples of Salmonella strains with antibiotic resistance—which cause foodborne infections and also originate from livestock farms—have also been documented. The number of known cases is limited, however, likely because not all of them can be traced. This is, in fact, a problem: many countries, including the United States, which still use antibiotics as growth promoters, are demanding—as a condition for changing their practices—proof that reducing antibiotic use in veterinary medicine can lower antimicrobial resistance in hospitals. However, this link is not easy to establish. It has not been demonstrated in France, for example. In our country, animal exposure to critically important antibiotics has been reduced by 90% in recent years. Although there has been a sharp decline in antibiotic resistance in animals, this has not translated into a decrease in antibiotic resistance in hospitals. However, this does not mean that the impact is zero. Above all, it indicates that many factors contribute to the emergence of resistance. These few well-known examples do, however, demonstrate that when antibiotics are used, antibiotic resistance is inevitably selected for. To take action, it is not necessary to wait until we have absolute and definitive proof for every antibiotic…   TC: The possibility that resistance could emerge in livestock farms and spread is all the more concerning given that the World Health Organization (WHO) considers antimicrobial resistance a major threat to public health. JYM: Yes. According to a British report cited by the WHO, by 2050, antimicrobial resistance will cause 10 million deaths per year worldwide—five times more than at present. This is truly a silent pandemic , with consequences that will extend far beyond the treatment of infectious diseases. Performing surgery could become more difficult, for example, since the risk of postoperative complications from infections could increase. The problem is that developing new antibiotics is a difficult, very costly, and long-term endeavor, for which the potential return on investment takes a very long time. It is therefore better to preserve the ones we already have. With this in mind, the WHO has reclassified antibiotics into three categories (“access,” “watched,” and “reserved” ). The latter category includes antibiotics that should be used only in human medicine. However, depending on the country and continent, the use of antibiotics is regulated to varying degrees. While European regulations are very clear on which antibiotics should be used and for what conditions, some countries, such as Brazil, impose fewer restrictions on their use. As a result, the latest-generation antibiotics can sometimes be found in chicken feed…   TC: Scientists have been sounding the alarm for quite some time now about the consequences of antimicrobial resistance. Why do policymakers seem so slow to respond? Florent Parmentier: One might indeed wonder why a public health crisis of this magnitude isn’t on the political agenda. To answer this question, we need to understand how any given issue becomes a concern for public policy makers. An analysis of public policy shows that an important first step is the process of “raising awareness.” Clearly, in the case of antimicrobial resistance, this is difficult to achieve, as it is a phenomenon that develops quietly. Admittedly, the threat is already present, but it will only become visible as the arsenal of effective antibiotics dwindles… However, for this process of raising awareness to work, a certain number of stakeholders must become aware of the issues at stake. Speculative fiction (or “speculative fiction,” as political scientist Virginie Tournay calls it) reveals just how much we underestimate this threat: while a vast body of literature addresses the risk to humanity posed by the emergence of a highly pathogenic virus, antimicrobial resistance appears in only a single work, *Résistants* , by Thierry Crouzet…   TC: Another problem is that the issues surrounding antimicrobial resistance are also geopolitical… FP: Indeed. Antimicrobial resistance is a critical domestic policy issue that weighs on our social contract—in other words, our ability to address collective risks, or individual risks collectively. But it is also an issue of how major powers position themselves relative to one another. The COVID-19 pandemic has served as a reminder that health issues and geopolitics are closely linked: the availability of masks, vaccines, and even the substances used in their production. A vaccine consists of 200 different substances. Depending on who controls them, geopolitics plays a role. Geopolitical issues also influence the fight against antimicrobial resistance. It is important to remember, for example, that the misuse of antibiotics in livestock farming began in industrialized countries. It’s hard today to criticize countries in the Global South for using them in the same way, especially as they seek to increase their meat production to meet the demands of their populations. JYM: The problem is that the use of antibiotics in one country can lead to resistance in another if animals carrying resistant bacteria are subsequently exported. This happened in Sweden, for example. In that country, there was no antibiotic resistance in the cephalosporin family, which are critically important for human health. That is, until the authorities detected it in 20 to 40 percent of the chickens raised in the country. The reason: an import of chicks from England, where this type of antibiotic was routinely administered…   TC: What measures do you think should be implemented to limit the risks and achieve the “visibility” mentioned earlier? JYM: There are two main approaches. The first is obviously to use fewer antibiotics. Interestingly, the drastic reduction in the use of certain antibiotics in France has not been associated with an increase in mortality on farms, which means that much of this use was likely unnecessary. The second lever is to focus on non-pharmaceutical alternatives. Significant progress has been made in zootechnics and biosecurity: preventing microbes from entering livestock operations, building isolated, clean, and healthy systems… In low-income countries, where the burden of antimicrobial resistance is very high—such as in Southeast Asia, India, or China—we will not be able to solve the problem unless we simultaneously address issues related to livestock farming itself. In other words, we cannot ask farmers to stop using antibiotics without resolving the issues surrounding livestock management. On the contrary, it is only once livestock management practices have been transformed that antibiotic use will decrease. Politically, we are at a crossroads: the reality is that antibiotics should be defined as a common good, and as such, a strategy should be put in place to preserve them. However, this strategy should not focus solely on medical needs. We need to have a cross-sectoral discussion based on the recognition that antibiotics are important for everyone: not only to treat people, but also to ensure food safety, and to maintain the veterinary medicinal product industry, thereby ensuring that these medications continue to be produced. FP: If we want to make antibiotics a global public good, the corollary is that we must establish an international coalition on the issue. In this context, the European Union can become a normative power, according to the concept popularized in France by Zaki Laïdi . This would require European leaders to reach an agreement, as they did on climate issues in the 1990s: at that time, they were able to put climate change issues on the global agenda, even though the United States was not on board. Europe has very recently included in its veterinary regulations a ban on importing food products derived from animals from countries that still use antibiotics as growth promoters . By imposing such standards on its internal market—and on those seeking access to it—Europe can still exert influence. However, its share of global wealth is declining relative to the rest of the world, which means its ability to influence is also diminishing. It must therefore find other partners to work with, particularly in its immediate vicinity. Treating antibiotics as a global public good also means providing substantial funding to support research and encourage industry to take an interest in this field, where returns on investment are long-term. JYM: To conclude, one interesting point to highlight is that consumers also have an important role to play. In the United States, it is consumers who have driven the most significant changes. By seeking to change their diets, they put pressure on fast-food chains and manufacturers, who altered their practices before any political pressure was felt. Jean-Yves Madec , Scientific Director for Antimicrobial Resistance at ANSES, the French Agency for Food, Environmental and Occupational Health & Safety (ANSES), and Florent Parmentier , Secretary General of CEVIPOF. Professor at Sciences Po. Research Associate at the HEC Paris Center for Geopolitics, Sciences Po This article is republished from The Conversation under a Creative Commons license. Read the original article.