between countries and the use of antimicrobials in food animal production. They looked at three scenarios that might decrease the use of antimicrobials, which would also therefore help reduce the growing global AMR problem. These scenarios are: globally increasing fees to use antimicro- bials, a global ban of meat imports from Brazil, and a de- crease in China’s meat consumption. In the first scenario, it was found that a user fee that increases the price of antimicrobials by 50% globally would lead to a 33% reduction in global antimicrobial use. “However, partici- pation of developing and emerging countries in the coordi- nation scheme is jeopardised,” the scientists explain in their paper, “since they become less competitive for meat sales compared to developed countries.” Secondly, a global ban on meat imports from Brazil would only lead former importers to turn to other countries for meat, such as the US. “Lastly, meeting China’s medium-term lower meat consumption target would not affect global antimicrobial use, but could increase China’s antimicrobial use by 11%,” the scientists conclude. They also believe trade to be an important factor in the reaching of policy goals related to antibiotic use, and that global cooperation is required to align the incentives of all countries toward tackling AMR.


Stewardship efforts In terms of how antibiotic stewardship policies should be shaped in livestock production, another analysis published in 2020 outlines the limits of existing regulation of antibiotics


Figure 1 - Antimicrobial consumption per country in 2017 and 2030. The size of the circles corresponds to the amounts of antimicrobials used. Dark red circles correspond to the amounts used in 2017, and the outer blue ring corresponds to the projected increase in consumption in 2030.


use, but also opportunities for improved surveillance, stewardship and advocacy. The authors, based in the US at Lurie Children’s Hospital, Northwestern University, the US Public Interest Research Group and the US Department of State, recognise that there has been some successful implementation of stewardship strategies in some countries, including banning uses for disease prevention, benchmarking antibiotic use and setting national reduction targets. However, “significant challenges in surveillance and regulatory oversight remain to prevent the overuse of antibiotics in food production.” Among other solutions, they believe “consumers remain a potent force via market pressure on grocery stores, restaurants, suppliers and farmers,” and that “improved, verified labelling is important for informing consumer choices.” Van Boeckel only slightly agrees with this conclusion. “It would be good to check with someone who works on consumer behaviour,” he says, “but my impression is that it will only work for the small fraction of people concerned and who aware about the problems that AMR can cause in food. To encourage a broader reduction of AMU we need to reach the larger fraction of people, this could potentially be done through [higher animal food product] prices. In a paper in the journal Science in 2017, I and my colleagues suggested introducing a tax on veterinary antimicrobials that could help do that, and fund improvements in farm hygiene.”


50,000 Tonnes 10,000 Tonnes


500 Tonnes 2 000 Tonnes


2030 2017


Global Trends in Antimicrobial Use in Food Animals from 2017 to 2030’ in the journal Antibiotic, December 2020


8 ▶ ANTIBIOTIC REDUCTION | DECEMBER 2021


Multi-faceted approach Better farm hygiene is certainly important in reducing the need for antibiotics in livestock production, but there are many other stewardship approaches. They include preventative-medicine programmes that reduce disease incidence, improving the environmental conditions for livestock animal to prevent/reduce stress and the eradication of specific livestock diseases. There are also the ideas of optimising feed nutrition to enhance animals’ natural immunity and breeding for more disease-resistant lines and the development of alternatives to using antibiotics for growth promotion and to prevent disease. Van Boeckel thinks more research is needed to discriminate between the efficacy and public health impact of different alternatives. “Antibiotics ought to be replaced, but to me it is still unclear what the best alternative will be, or more likely, what combi- nations,” he says. “One example of research ongoing on this topic is the ‘Horizon 2020 project AVANT’ of which I am a part.” AVANT is aimed at developing alternatives to antimicrobials for the management of bacterial infections in pigs, especially diarrhoea during the weaning period, as this represents the major use of antimicrobials in European livestock production.


References are available on request.


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