WOAH takes a leadership role in tackling antimicrobial resistance

Dame Sally Davies is the UK Special Envoy on antimicrobial resistance (AMR). After a career as a hematologist and as Chief Medical Officer for England, she is now a leading advocate on AMR on the global stage.  

Professor Scott Weese is a veterinarian and professor in pathobiology at the Ontario Veterinary College, Canada, and Director of the Centre for Public Health and Zoonoses. He is also a co-author of “Worms and Germs”, a popular science blog on animal health.

When was antimicrobial resistance first acknowledged?

Dame Sally Davies: Alexander Fleming, the discoverer of penicillin himself, recognised it as early as 1945. We were always aware it could happen. In the past decade, the data shows that AMR has been steadily on the rise. I was asked to chair the first Technical Advisory Group on AMR in 2014 and the first Global Action Plan was passed in 2015 at the World Health Organization (WHO) with the support of WOAH and the Food and Agriculture Organization of the United Nations (FAO).  

Professor Scott Weese: Issues in animals emerged similarly but it took longer for us to recognise them as resistance because there is less testing and research in animal health compared with human health. Still WOAH did warn against improper use of antibiotics as early as 1952, in a resolution.  

“Practitioner must not use antibiotics at the discretion of his fantasy, but following rules that have been set by experience. Use of antibiotics against insensitive germs or specifically resistant, utilisation of too weak doses or through a too short time frame, can reveal resistant germs, delaying the onset of an efficient therapy and lead to treatment failures, harming a method that, when judiciously and correctly applied, has saved numerous human and animal lives.”

Abstract from WOAH’s 1952 resolution based on scientific evidence reported in 1948.  

Why do human and animal health stakeholders need to work together to fight AMR?  

Prof. S.W. We are not sure how much AMR in humans is attributable to animals: probably between 4% and 96%! What we do know is that we need everyone to act. Doctors, veterinarians, humans and animal carers alike. In the past, a “blame game” was going on: veterinarians blaming physicians for giving children antibiotics against viral infections [reminder: it doesn’t work], physicians blaming the overuse of antibiotics on livestock… The truth is, we all need to do a better job. 

D.S.D. Calculations by WHO have shown that antibiotics give an extra 20 years of life to humans. We don’t want to misuse them so that resistance develops. We also know that animals, including humans, pee and poo more than 70% of the antibiotics they absorb. Without extraordinarily modern sewage, high-use farms, hospitals, and other facilities can contaminate the environment.  

What can an international organisation such as WOAH do?  

Prof. S.W. WOAH has been a strong voice on issues such as growth promotion. Telling farmers what to do can be unpopular, so it makes it easier for countries if they get international support. There is also an advocacy component, to get Nations to bring in robust funded action plans to improve more than just antibiotic use, but whole health systems.  

D.S.D. WOAH plays a leadership role. It shows that AMR matters, and that it is not only a concern of human health.  

What were the key achievements in the past years? 

D.S.D. In 2016, at the United Nations High-level meeting, the Secretary General established the Inter-Agency coordination group (IACG) which brought in WOAH, WHO and FAO as equals, working together. In 2019, the Global Leaders Group was created, with a Joint Secretariat including WOAH, WHO, FAO, and recently the United Nations Environment Programme (UNEP). The inclusion of UNEP shows that resistance is no longer just a human health, or animal health issue, but truly “One Health”. Most countries are now ready to have a national action plan against AMR, although funding is still an issue. The recently launched Multi-Stakeholder Platform brings in the private sector and civil society, as responsible use is not only a matter of regulation, but of awareness, understanding and collective engagement from everyone.  

What can be done today against antimicrobial resistance?

D.S.D. Let’s start with preventing infections. The first thing is to have clean water, use of soap, sanitation, good air flow: in health care facilities, in animal rearing, and in people’s homes. We need more use of vaccines: routine campaigns, as well as new vaccines for animal farming. We also need to improve diagnostics, so that antibiotics are used only when appropriate, not because of an erratic diagnosis or for growth promotion. Action on antimicrobial resistance requires support and training for veterinary and medical expertise. 

Prof. S.W. AMR is a tricky issue, because it is an end result of our health care challenges. There is no miracle cure: let’s start with better barns, with good ventilation. We need better education, empowerment of women who are often decision-makers for health issues and equitable access to appropriate treatments and preventives. We also need to change mindsets in farming, because we get a lot of resistance to change from people who have always done things a certain way and don’t necessarily understand why we can’t go on the way we used to.  

What will you propose at the High-Level Meeting of the United Nations on AMR ?

D.S.D. We would like to come out of the High-Level Meeting in September 2024 with an independent scientific panel, owned by low- and middle-income countries, which could set targets for the world. UNEP could play a key role in making sure of that, with its experience with the Intergovernmental Panel on Climate Change (IPCC).  

Prof. S.W. We need to focus on actionable things for prescribers and farmers. Reducing use of antibiotics by kilograms is not an effective target, because the outcomes vary from drug to drug. We need more funding for research, to understand exactly which components drive resistance. For example, we are preparing an app-based guideline for Veterinary Services in low- and middle-income countries, with content adapted to what’s available in each country. We also proposed an AWaRe-type classification for antibiotics for animal use.  

D.S.D. We need standards to implement the good practices that we already know are working, as well as innovation on growth promotion, disinfection, diagnosis, affordable new treatments and vaccines. For the 2024 High-Level Meeting, I suggested a focus on access to medication because you can’t worry about resistance when people are not getting access to standard and essential antibiotics, basic hygiene, vaccines. 

Prof. S.W. People are not marching on the streets for antimicrobial resistance like they do for climate change: we need to motivate people, groups and Nations to act. Rather than deflecting blame, we need all organisations to work together. A One-Health approach, as we are building it right now, is much more effective.

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