Antimicrobial Resistance Through a One Health Lens

One of our primary focuses at American Veterinarian^® involves One Health and the myriad ways in which human, animal, and environmental health overlap. Collaborative efforts are advancing diagnostics and treatments for all species (simply search for “One Health” on AmericanVeterinarian.com for a plethora of examples), but perhaps the initiative’s chief concern throughout the world is antimicrobial resistance.

A 2016 report from the United Kingdom estimated that at least 700,000 people worldwide die each year as a result of antibiotic-resistant infections.¹ Moreover, the report predicted that by 2050, drug-re­sistant infections will claim an estimated 10 million lives per year, with a global economic toll reaching $200 trillion.1

There is little debate that, when used shrewdly, antimicrobials can be effective against bacterial infections. It is their overuse and mismanagement that lead to the development of resistant bacteria. Last month, the FDA unveiled a 5-year plan to address antimicrobial stewardship in veterinary settings. That same week, the European Parliament passed a nonbinding resolution advocating prudent use of antibiotics and increased public education about the problem.

The FDA’s plan builds on steps the Center for Veterinary Medicine (CVM) has taken to eliminate production uses of medically important antimicrobials—such as those that treat human disease—and to bring all other therapeutic uses of antimicrobials under the oversight of licensed veterinarians.

We can’t count on outracing drug resistance,” FDA Commissioner Scott Gottlieb, MD, said in a speech at The Pew Charitable Trusts, “but we can use stewardship and science to slow its pace and reduce its impact on human and animal health. To do so, we need an all-hands-on-deck approach to combating antimicrobial resistance in both human and veterinary settings.”

As part of the plan, the CVM released Supporting Antimicrobial Stewardship in Veterinary Settings: Goals for Fiscal Years 2019-2023, which pinpoints 3 key areas:

• Applying a risk-based approach to evaluate new and currently approved antimicrobial products for animals

• Collaborating with key stakeholders to support stewardship of these products
• Collecting data on resistance and antimicrobial use to monitor the effectiveness of these actions

The CVM divides its program into 2 phases: The first phase will be initiated between fiscal years 2019 and 2021; the second, between 2022 and 2023. The agency is optimistic that this long-term approach will allow for adjustments based on analysis, public health impact, and stakeholder feedback. According to the FDA, the CVM’s plan is just 1 aspect of an agency-wide strategy to combat antimicrobial resistance in both veterinary and human health care settings. This includes efforts to facilitate product develop­ment to ensure a robust pipeline of safe and effective treatments that can combat resistant organisms.

“We are confronting a global public health threat,” Dr. Gottlieb concluded. “I’m confident that the efforts we’re launching, and the ones that we’ll continue in the months and years to come, will help us achieve our goal of facilitating stewardship and advancing innovation across human and animal health, within our borders and across them.”

As the World Health Organization notes, “antimicrobial resistance does not recognize geographic or human—animal borders.”² Therefore, addressing this increasing global concern requires a holistic and multidomain approach. American Veterinarian^® will continue to report on progress made in this vital effort, including conceptual frameworks, policy decisions, public awareness, advances in regulatory science, and current surveillance measures.

Mike Hennessy, Sr

Chairman and CEO

References

1. O’Neill J. Tackling drug-resistant infections globally: final report and recommendations—the review on antimicrobial resistance. Review on Antimicrobial Resistance website. www.amr-review.org/sites/default/files/160518_Final%20paper_ with%20cover.pdf. Published May 2016. Accessed September 18, 2018. 2. One Health. World Health Organization website. www.euro.who.int/en/health-topics/disease-prevention/antimicrobial- resistance/about-amr/one-health. Accessed September 18, 2018.