21. The Committee recalled that the issue of antimicrobial resistance had been considered at the last session as one of the matters arising from the activities of international organizations (WHO). The Committee had agreed that this question would require further consideration, taking into account the work of international organizations, which would be presented at its 12th session. The Committee was informed of the activities of OIE and WHO in this area and discussed the relevance of antimicrobial resistance to its work and the need for further action.
OIE Activities
22. The Representative of OIE, referring to its submissions[9], recalled that activities on antimicrobial resistance should be considered in the perspective of the general objectives of OIE as regards animal health, and pointed out that OIE is one of the three international organizations specifically referred to in the SPS Agreement.
23. As regards antimicrobial resistance, a study undertaken in 1997 at the request of the OIE Regional Commission for Europe revealed that few countries had established official resistance monitoring programmes, that risk analysis was not commonly applied, and that there were very different approaches and methodologies in the European Region. As a consequence, the 18th Conference of the OIE Regional Conference for Europe (Prague, September 1998) had recommended to European member countries to strengthen their activities in this field and to OIE to establish an expert group to address all relevant aspects of antimicrobial resistance. The creation of this Expert Group was approved by the OIE International Committee (Paris, May 1999).
24. The Representative informed the Committee that the OIE and FAO Collaborating Centre for Veterinary Medical Products (ANMV-AFSSA, France), in collaboration with OIE and FAO, organized an European Scientific Conference in March 1999 to consider strategies to control and reduce resistance originating from the use of antimicrobials in animals. The Conference made a number of recommendations on the use of risk analysis, the prudent use of antimicrobials in animals and on resistance monitoring programmes.
25. A tripartite meeting between OIE, FAO and WHO was held in September 1999 to coordinate activities and to consider the respective responsibilities of the organizations, and regular contacts are currently maintained between the three organizations.
26. OIE set up an International Expert Group on Antimicrobial Resistance to take a systematic and comprehensive approach to this subject. The mandate assigned covers the development of an appropriate risk analysis methodology, technical guidelines on prudent use of antimicrobials and on monitoring of quantifies of antimicrobials used in animal husbandry, standardization and harmonization of laboratory methodologies for the detection and quantification of antimicrobial resistance and the harmonization of national resistance monitoring programmes.
27. The Expert Group met for the first time in Paris (March 2000) to work on all five topics. Significant progress was made on these topics, in particular on a code of prudent use of antimicrobials in animal husbandry and it agreed on the major principles for this document.
28. OIE established an objective for this Expert Group to finalize the work assigned by its mandate by the end of 2000. Consensus document should be available by the end of May, which OIE then will submit to a global public consultation for three months and which will be made available on the OIE web site.
29. The Representative indicated that the Committee would be consulted on these documents and be kept informed of the progress of the work of the OIE Expert Group. The Representative also expressed the readiness of OIE to cooperate with the Committee in its work on antimicrobial resistance, in view of its specific expertise in this area.
WHO Activities
30. The Representative of WHO noted that WHO continued to view the growing resistance of microbes to antimicrobial agents with great concern. In recognizing that applications in human medicine are the major sources of such resistance, WHO also considers the assessment and containment of the public health implications of non-human use of antimicrobials to be a priority concern. For antimicrobial growth promoters, WHO expert consultations have generally recommended to discontinue their use in food-producing animals if similar products are also licensed for use in human medicine. The major challenge for therapeutic antimicrobials remains the development and implementation of guidelines and methods for their prudent use, including assessment of risks arising from their use in food animals.
31. Over the next two years, WHO will focus its efforts mainly in strengthening capacities of Member States for the surveillance of antimicrobial resistance in foodborne bacteria by conducting external quality assurance programmes and training courses related to Salmonella. In this regard, WHO will expand its existing Global Salm-Surv database and electronically link participating national salmonellosis reference laboratories. To assist in this effort, an international centre of excellence for surveillance and containment of antimicrobial resistance from antimicrobial use in agriculture has been established in Bangkok, Thailand and others are in the process of designation. To develop and implement global recommendations for the containment of antimicrobial resistance due to agricultural use, WHO with participation of FAO and OIE will convene a consultation in June 2000 to develop draft guidelines. Another consultation to assess the public health risks from antimicrobial use in aquaculture is also being considered for 2000. Planned for 2001 are two expert consultations to develop recommendations on the procedures for the surveillance of antimicrobial use in agriculture and the assessment of national non-human antimicrobial use patterns and a WHO scientific meeting on the consequences of reducing the use of antimicrobials in agriculture, tentatively scheduled for October 2000.
32. The WHO Representative further informed the Committee that at the request of the Codex Committee on Food Hygiene, WHO in collaboration with FAO will convene a series of meetings during 2000 to prepare risk assessments for Listeria monocytogenes in ready-to-eat foods, Salmonella in poultry and Salmonella enteritidis in eggs. Associated with these risk assessments will be consideration of the public health implications of possible antimicrobial resistance in these bacteria.
CCRVDF Discussions Concerning Antimicrobial Resistance
33. The Delegation of Portugal, speaking on behalf of the member countries of the European Union, supported a multidisciplinary approach to address this complex issue, which was also relevant to the work of the Committee on Food Hygiene and the Task Force on Animal Feeding. The Committee had an important role to play to ensure the prudent use of antimicrobials and should consider the revision of the existing code of practice to integrate concerns about antimicrobial resistance.
34. The Delegation of the United States proposed that the Committee should bear the main responsibility for considering all relevant aspects related to the use of veterinary drugs and offered to prepare a discussion paper to identify the priority areas for new work, such as the development of a code of practice.
35. Several delegations stressed the importance of this issue and the need to take into account the ongoing work of the international organizations on antimicrobial resistance, especially OIE and WHO, in order to coordinate activities and avoid duplication. It was also proposed to establish a specific risk assessment policy for hazards associated with antimicrobial resistance.
36. The Observer from Consumers International stressed the importance of this issue for consumer protection and proposed that the Committee should endorse the recommendation of WHO to discontinue the use of antimicrobials in livestock as growth promoters and take into account the work of WHO to develop guidelines for the containment of antimicrobial resistance.
37. The Observer from COMISA expressed the view that some clarification would be needed on the exact responsibility of the Committee in this area since other international organizations were already working on this subject.
38. The Committee agreed that the Delegation of the United States, with the assistance of a drafting group (Australia, Brazil, Canada, Costa Rica, Denmark, Finland, Germany, Thailand, United Kingdom, United States, OIE, WHO, European Community, COMISA, Consumers International) would prepare a discussion paper for consideration by the next session taking into account work of other international organizations and Codex Committees in this area. The paper would consider all aspects of antimicrobial resistance relevant to the work of the Committee and identify specific areas for further action, as required. The Committee also agreed that the drafting group would consider development of a code of practice for the containment of antimicrobial resistance in the discussion paper.
