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Guest Article by Erik Ruis, Healthcare without Harm

Our recommended targets for the UNGA High Level Meeting on AMR  

According to current data AMR causes 1.27 million deaths every year. If no further action is taken in the right direction, by 2050 it could cause as many as 10 million deaths annually, which is more deaths than cancer and diabetes combined and triples the death toll of the COVID-19 pandemic.  

In Europe this would mean an estimate of 390,000 deaths per year, which is the equivalent of the entire population of cities like Florence or Zurich. 

Food production is a huge contributor to this health crisis. Evidence shows that increasing animal welfare standards can decrease the need for antibiotics, which can in turn reduce the prevalence of multi-drug resistant bacteria. Through urine and faeces antibiotic residues and resistant bacteria reach the environment, which can act as a reservoir for resistant bacteria and accelerate the process of resistance through the horizontal gene transfer mechanism.  

The September 2024 UNGA High-Level meeting on AMR will be a major milestone in the global efforts to reduce the acceleration of antibiotic resistance from food production. For that, we need to incorporate ambitious targets and help countries in the global south to transform their production of food of animal origin. 

The targets presented below constitute essential steps in minimising the contribution of the agri-food sector to the spread and development of antibiotic resistance.  

Reduce overall use of antibiotics in farming 

A staggering 70% of antibiotics sold globally are used in food production. Growth promotion and routine antibiotic use are the main sources of antibiotic misuse and overuse, as explained in the next sections. Increasing animal welfare standards together with other specific measures such as increasing biosecurity in farms and improving vaccination can significantly reduce this number. 

In the EU between 2011 and 2022 the overall sales of antimicrobials for animals fell by 53% between 2011 and 2022 following the implementation of stricter regulations on antibiotic use in agri-food systems. The ban of preventative use of antibiotics in farming is expected to make this reduction even bigger in the years to come.  

Countries in the Global North should be able to follow the EU’s example and reduce their antibiotic use in farms and aquaculture by 50% by 2034. Similarly, LMICs should aim at reducing at least by 30% the antimicrobial consumption in food production.  

Phase out antibiotics as growth promoters  

The discovery of antibiotics’ growth-promoting effects in the 1940s marked a significant advancement in agri-food systems, as studies showed notable improvements in the production efficiency of poultry and swine. Since then, subtherapeutic doses of antibiotics have been commonly included in animal feed to boost growth rates, enhance feed conversion efficiency, and prevent infections.  

Although this practice is banned in the EU, in many countries antibiotics and antimicrobial agents are used in low or sub-therapeutic doses to increase the yield of the farm. This problem has been accelerated with the intensification of farming worldwide.  The UNGA declaration is a great opportunity to phase out the use of antibiotics as growth promoters in food production. The timeline should prioritise the phase out of WHO Medically Important antimicrobials for human health as growth promoters before 2028, specially in LMICs.  

End routine prophylactic use of antibiotics  

Preventive use of antibiotics has been a common practice to promote healthy livestock. This means that the antimicrobial product is administered to an individual or a group of animals before clinical signs of disease to prevent the occurrence of a disease or infection. Overuse and misuse of antibiotics in healthy animals can contribute to the emergence and acceleration of antibiotic resistance. 

The EU has paved the way for the ban of routine prophylactic use, with a legislation that entered into force in February 2022. However, its implementation is proving to be challenging. According to the ESVAC report data, the proportion of antibiotics sold for group treatment has remained unchanged compared to the sales before the ban was in place.

UNGA targets should push for a phase out of routine prophylactic use of antibiotics in farming use no later than 2028, with a potential extension until 2030 for some vulnerable LMICs. Policies on farm antibiotic use need to be delivered in conjunction with new policies on animal husbandry and animal health to ensure an effective reduction of antibiotic consumption without an impact in local communities of the health of animals.  

Increase ‘One Health’ Education 

All the above recommendations need to be supported by incorporating the One Health approach in national education schemes for professionals in the following fields: veterinary medicine, agricultural sciences, human medicine and environmental sciences. Mainstreaming the One Health approach in education is a crucial step towards reaching ambitious targets in the reduction of antibiotic use in farming.