Spread Awareness, Stop Resistance: Interview with FAO's Maria Helena Semedo and EU's Claire Bury on Antimicrobial Resistance

World Antimicrobial Resistance Awareness Week (WAAW), held this year between 18 and 24 November was organized around theme ‘Spread Awareness, Stop Resistance’. It called for the global engagement of all actors to step up efforts to combat antimicrobial resistance (AMR), through a One Health approach. To mark the occasion, FAO Deputy Director-General, Maria Helena Semedo, and the European Commission’s Directorate-General for Health and Food Safety Deputy Director-General, Claire Bury, shared their vision and key messages on the importance of working together across sectors, countries and continents to address this silent pandemic – an alarming global health threat.

Antimicrobial resistance represents a major global threat to human, animal, plant, food and environmental sectors. What are the key factors driving AMR?

Maria Helena Semedo: Antimicrobial resistance is one of the most important health threats we face. Decades of overuse and misuse of antimicrobial products in human and veterinary medicine, agriculture, and food production have made us reliant on antimicrobials to cure human and animal and plant infections. In some countries, antimicrobials are used at alarming rates to treat and prevent diseases in animals, fish and plants, or to make animals grow faster. Antimicrobial use is exacerbated by higher disease burdens in low- to- middle-income countries, poor hygiene and inadequate disease prevention in many stages of the food chain, and lack of access to vaccines and other ways to prevent diseases, thus triggering the emergence and spread of resistant microbes. Furthermore, inadequate access to guidance from qualified veterinarians and information on antimicrobial alternatives can lead to antimicrobials overuse or misuse.

In addition, weak regulatory systems can facilitate the sale of antimicrobials without prescriptions or even fuel counterfeit and substandard drugs. Finally, insufficient or lack of proper infrastructure can make it very challenging to establish effective sanitation and other necessary services. All these factors combined with drug-resistant microbes being exchanged among people, animals and the environment, make this silent pandemic even harder to stop.

COVID-19 pandemic has highlighted the importance of working across sectors and regions to preserve our global health. What are the key lessons we can apply to tackling AMR?

Claire Bury: AMR is a major threat with long-term consequences for global public health and the global economy. One of the clearest lessons from this Covid-19 crisis has been the need for urgent global collaboration. AMR requires a determined, systematic, harmonised response at global level, to boost our pandemic preparedness and reverse resistance levels. Only a coordinated One Health response will do as resistant microbes arising in humans, animals, plants or the environment spread from one to the other and do not stop at borders. We also need to work towards developing robust surveillance frameworks and ensuring solid supply chains of available antimicrobials to ensure access, while also doubling our efforts to strengthen prudent use. Equitable access to diagnostics, treatments and vaccines should be the key for future pandemic preparedness as pandemics could affect everyone. Covid-19 showed how fast scientific research can lead to breakthrough vaccines, supporting science through novel “pull” incentives could bring new antibiotics to the market. Finally, we need to take measures to limit the release of antimicrobials in the environment.

Does climate change affect AMR?

Maria Helena Semedo: No doubt, climate change can exacerbate AMR. Climate variability and rising global temperatures lead to thermal adaptation in microbes and an increased proliferation and spread of infectious diseases and, consequently, higher levels of AMR. Extreme weather events and natural disasters can damage infrastructure and wipe out livelihoods, and increase the population pressure in certain geographic areas. This has an impact on health services and may be associated with disease spread and increased use of antimicrobials.

The climate crisis also places unprecedented pressure on agri-food production systems, which can lead to an increased use of antimicrobials in agriculture. Climate change impacts are hitting many low- and middle-income countries particularly hard as they already grapple with socio-economic and environment challenges. Indeed, discussions at this month’s COP26 Climate Conference in Glasgow reaffirmed the need to bridge the climate and health agendas.

What are the new scientific and technological developments that could help us combatting AMR?

Claire Bury: Scientific and technological innovation will bring major contributions to the fight against AMR and this includes not only the treatment of infections caused by resistant pathogens but also the detection and prevention of these infections.

Several new scientific concepts are currently being explored, including diverse innovative approaches to treat bacterial infections without having to use antimicrobials[1]. Investigating vaccines against pathogens with resistance to antimicrobial medicines will also be a growing area of interest. Among novel vaccine technologies, the mRNA vaccine platform has revolutionised vaccine development (as witnessed during the current Covid-19 pandemic) and has the potential of broad utility for many different pathogens beyond SARS-COV2. Innovative and cost-effective new diagnostics is also crucial to curb AMR, as this would allow using antimicrobials only where necessary.

Finally, the financial support provided through the EU research and innovation programme Horizon 2020 allows researchers to tackle the global problem of AMR in its many facets by developing novel technologies for the prevention of resistant bacterial infections in high AMR prevalence settings.

Who are the key players involved in ensuring antimicrobial efficacy? How can we each act?

Maria Helena Semedo: From doctors to veterinarians, farmers and consumers, food-processing companies to chefs, policy-makers and citizens, we each have a role to play in addressing the spread of AMR. Today, more than ever, we need to mobilize the entire society, and empower all stakeholders to reduce the emergence and spread of drug-resistant micro-organisms and use antimicrobial drugs more responsibly. We all need to change our behaviour away from demanding and expecting antimicrobials as a given to recognising the needs of others and society to preserve antimicrobials as precious, essential life-saving medicines. 

With better data availability, we can compare our use of antimicrobials with others which can also help shift needed behaviour changes from farmer level to national policy. Data for everyday decisions that can building solid evidence concerning AMR to inform and evaluate policy is key. Effective agricultural practices and investments that boost profitability and reduce the burden of infections are equally crucial. Additionally, we need to support countries with a whole of government and society approach – that is a One Health approach - preserving the health of people, animals and the environment.  We need to support countries in eliminating antimicrobials as growth promoters in livestock while maintaining animal health, welfare, and productivity and increasing farmers’ access to expert advice, prescriptions, and appropriate and quality antimicrobials. Different countries have different resources.  Low-to-middle-income countries cannot be expected to have the capacities or finance to help manage this global health threat alone. Mobilizing adequate funding that can be leveraged for longer-term financing, coupled with technical advice can ensure countries’ sustainable implementation of National Action Plans tackling AMR.

Claire Bury: This fight against AMR is a shared responsibility in which everyone must be involved. Farmers, animal owners and veterinarians can help lower the need for antimicrobials by complying with good antimicrobial prescription practices and adhering to good animal husbandry practices that are conducive to better animal health and welfare and therefore less need for antimicrobial use. At the same time, all of us as patients or potential patients can contribute to the prudent use of antimicrobials by preventing getting ill in the first place – by vaccinating, adopting good hand hygiene habits – and by taking antimicrobials only in case of bacterial infection, confirmed by a physician, and following carefully the conditions of use of the antimicrobials (taking it for the full period prescribed).

The life-sciences industry can help develop new antimicrobials, alternative treatments and diagnostic tools. Hospitals and human health professionals can use preventive measures such as enhanced hygiene, improve prescription practices, education of patients and reporting of AMR cases.

Policy-makers can develop legislation around AMR adopting a One-Health approach including protecting the environment and incentivising innovations.

Good hygiene practices in the food sector can prevent dissemination of microbiological hazards.

What are FAO and the EU doing to tackle AMR? Why is partnership so important?

Maria Helena Semedo: FAO’s Director-General QU Dongyu has said that ‘safeguarding human, plant, animal and environmental health requires an interlinked and joint approach – this is a One Health Approach’. That is why FAO assists countries around the world to reduce AMR risks by leveraging FAO’s expertise in aquatic and terrestrial animal health and production, food and feed safety, genetic resources, crop production, natural resource management, risk communication and behavioural science. To guide our actions, we launched the Action Plan on AMR 2021-2025 on 19 November. This Action plan aims to enhance national capacities to minimize and contain AMR in food and agriculture sectors.

FAO also works in close partnership with the Tripartite[2] and the UN Environment Programme (UNEP), to address AMR through a One Health approach. The AMR Multi-Partner Trust Fund is a perfect example of how joint resources can successfully work to sustain efforts in combating AMR and leverage the Tripartite and UNEP’s technical support to countries’ deliver on the National Action Plans.

The Tripartite is also working to mobilize a global movement for change through establishing an AMR Multi-Stakeholder Partnership Platform that will bring together different voices across the human, animal, plant and environment interface, ensuring that AMR threats and impacts are addressed at all levels.

Last but not least, I would underline that we are pleased to be working closely with the European Union to combat AMR at all levels. The EU-FAO Strategic Dialogue is reflecting our common vision for agri-food systems and One Health that resulted in a joint work plan. Our work for joint ends dovetail through linkages between FAO’s Strategic Framework 2022–2031 and the One Health Priority Programme and the European Green Deal and its Farm-to-Fork Strategy.

Claire Bury: President Von der Leyen set AMR as one of the priorities for this EU Commission. She asked Commissioner Kyriakides to “focus on the full implementation of the European One Health Action Plan against Antimicrobial Resistance and work with our international partners to advocate for a global agreement on the use of and access to antimicrobials”. This Action Plan proposed over 70 actions, encompassing human health, animal health and the environment. These include the revision of the EU veterinary medicinal products and medicated feed regulations and the Guidelines on prudent use of antimicrobials in human health.

The European Commission and the Member States also exchange good practices over the development and implementation of national action plans on AMR. The Pharmaceutical Strategy for Europe includes important actions to combat AMR whilst the Strategic Approach to Pharmaceuticals in the Environment addresses the environmental aspects. Moreover, the EU Farm to Fork Strategy sets an aspirational target ‘to reduce overall EU sales of antimicrobials for farmed animals and in aquaculture by 50% by 2030’. Finally, I want to flag that in 2022 the Commission intends to present to the Member States and the Parliament a policy initiative on AMR.

We must all come together to tackle this common threat. The EU advocates for a revision of the Global Action Plan on AMR, established by WHO, with a view to reaching a broad agreement on the use of and access to antimicrobials. It must be stressed that the EU is also advocating for the inclusion of AMR in a possible future Global Pandemic Treaty. Both actions would enhance a synergic international efforts to reinforce global health security.

Following the UN Food Systems Summit 2021, the Tripartite (FAO, WHO and OIE) and UNEP proposed a commitment to build collective actions to reinforce a One Health approach in food systems and address AMR. The EU supports the proposal for such commitment that is going into the same direction of fostering an international response that is commensurate to this major health threat.