FAO is ready to continue the project on reducing AMR spread

On the eve of the World AMR Awareness Week, on 15 November, the hospitable UN House in Moscow held a final workshop of the ''Reducing the advance of antimicrobial resistance in food and agriculture'' FAO project.

“FAO has been implementing the project funded by the Russian donor in five countries, Armenia, Belarus, Kyrgyzstan, Kazakhstan and Tajikistan, since 2017,” said Oleg Kobiakov, Director of the Moscow FAO Liaison Office with the Russian Federation, in his welcoming remarks.

“The head agency is Rospotrebnadzor and the operator is the Central Research Institute of Epidemiology,” the head of the FAO Moscow Office continued. “The objective of this endeavour is to provide technical assistance to recipient countries in developing and implementing national action plans on AMR.

Antimicrobial resistance is one of the global health challenges of our time. It also causes significant damage to livelihoods, income of agricultural producers, the food industry and national economies overall.

The objectives of our meeting are presenting the main activities and specific outcomes of the project implementation, exchanging opinions and receiving feedback from representatives of the focal countries.

It is necessary to discuss the next steps and priorities in the field of AMR in food and agriculture beyond the timeframe of the project and outline its potential second stage, which is now being discussed with the Russian donor,” Oleg Kobiakov concluded.

“In 2018 we held the first conference in Moscow where we meet the representatives of all countries participating in the project,” reminded the audience FAO legal expert Irina Kireeva. “Back then the problem itself was new from the legal standpoint. There was no specific legislation focusing exclusively on antimicrobial resistance.

There was a need for an interdisciplinary approach and a review of various areas of legal regulation regarding food safety, environmental management, as well as current environmental, water and land legislation and regulations governing agricultural activities.

It was necessary to cover a wide range of legal problems, make sense of accumulated legislative acts and by-laws, and define the role of legislation in solving the problem of antimicrobial resistance. FAO developed a technical guidance and began working with national experts, starting with a legal analysis, through which we realized that one of the main problems was the lack of coordination of efforts.”

One of the issues raised in the report concerned legal matters related to the prescription of antimicrobials or groups of antimicrobials and non-medical use of veterinary drugs. “There is no clear legal prohibition on using antimicrobials as growth promoters in animal husbandry and on selling them over-the-counter,” Irina Kireeva noted.

“It is important to impose severe restrictions on the veterinary use of medicines that WHO included in the list of essential medicines for humans. A specific ban is also needed to prevent their use for non-therapeutic and non-medical purposes, especially as growth promoters,” the expert concluded.

Igor Manzenyuk, CRIE Assistant Director for Academic Affairs, emphasized that “even 40 years ago we conducted research on original substances and generics. It turned out that the generics had 2–4 times less activity against certain microorganisms than the original drugs. Unfortunately, in my opinion, these issues have not been sufficiently studied, because we have a wide range of the same antibiotics that are used, but they appear under different trade names.

As for prescriptions for antibiotics, the laws of many countries address these issues. Many questions remain regarding medicated feed, because if it contains antimicrobials, then where the separation line between medicated feed and a growth promoter is and how it should be drawn. I do not think that there are any regulatory documents in this area.”

“We understand that it is difficult to change the practice in such a short period, so for now we are focusing on building the capacity of regulatory authorities and specialized laboratories,” commented Daniel Beltran-Alcrudo, FAO leading animal health expert.

Maripa Kichinebatyrova, FAO AMR specialist, presented the “Evaluation of a university curriculum on learning outcomes related to antimicrobial resistance” report. The FAO expert said that the development of such a tool aims to “provide veterinary institutions with a systematic approach for a quantitative assessment of their institutions’ competency level in managing AMR and determination of the areas to be reflected in the curriculum.”

Koen Mintiens, FAO expert from the AMR team, dedicated his presentation to the topic of “Development of NAPs, observation and assessment of their implementation”. The summarized conclusions on FAO’s contribution to the development of national action plans in each of the six focal countries were valuable information.

FAO animal health expert Dora Kovacs from the AMR team arrived in Moscow to personally participate in the forum. She gave the “Establishing a baseline – antimicrobial use and antimicrobial resistance in the livestock sector” presentation.

Talking about the methodology for conducting surveys to identify AMR awareness in the livestock sector, she emphasized surveys based on the Knowledge, Attitude and Practices model and face-to-face interviews. It is recommended to include in the focus group livestock producers specialized in breeding chickens, pigs, meat and dairy cows or engaged in beekeeping, as well as field veterinarians, veterinary pharmacists and workers of feed mills where medicated feed is produced.

Francesca Latronico, FAO AMR laboratory coordinator, presented the topic of “Improving laboratory diagnostic capacities”, including with the use of AMR surveillance systems known as FAO-ATLASS. She listed the actions needed to bridge the gaps in the context of the FAO Action Plan on Antimicrobial Resistance 2021–2025:

• “developing/approving a National Action Plan on AMR in accordance with the One Health approach;
• defining the goal for monitoring AMR in food and agriculture, relevant for each specific country;
• appointing a national focal point for AMR in food and agriculture, certifying a national AMR reference laboratory;
• funding AMR surveillance activities included in the National Action Plan.”

FAO expert Alejandro Dorado Garcia introduced colleagues from six countries attending the Moscow workshop to new FAO tools and initiatives, the most important of which is the International FAO Antimicrobial Resistance Monitoring (InFARM) data platform.

Alejandro Dorado Garcia explained that the platform made it possible to “support countries in collecting, analyzing and using their AMR data from animals and food, and support countries willing to publicly share the data on combating AMR in the food and agriculture sectors for global surveillance” for advocacy and coordinating actions against AMR.

The InFARM platform built as a one-stop shop is a “repository of documents/information to contextualize country data (national surveillance plans, protocols, reports on the application of tools, FAO assessments)”. The end result of using the InFARM platform should be “improved coordination in the collection, analysis and harmonization in data generation and a contribution to the global One Health AMR monitoring efforts”.

Vasily Akimkin, Director of theCentral Research Institute of Epidemiology of Rospotrebnadzor, RAS member, spoke in detail about cooperation with FAO. “Employees of the Institute, together with FAO, took part in training specialists from the Republic of Armenia, the Republic of Tajikistan and the Kyrgyz Republic on the methods for antimicrobial susceptibility testing in accordance with international standards.”

He noted that “the theme of nutrition, food and its safety is becoming extremely important. Today we are considering the point related to safety in a rather unique format: in terms of antimicrobial resistance. We used to think that it was the purview of medicine, without thinking about the fact that food products directly account for the majority of human consumption of antibiotics. Their amount is colossal, same as the amount of antibiotics used when growing meat as one of the main products for humans, and it exceeds the scale of their use in medicine,” the expert said.

“Incorrect approaches to using antibiotics, not to treat sick animals but to increase the volume of protein mass during fattening, is a definite position which is prohibited to a certain extent in all official documents. However, we see that today about 10% of the products we analyze contain antibiotics. This means that regrettably, antibiotics are used in poultry and animal production. Fortunately, positive dynamics have been observed recently: the excess of the permissible norm is no more than 0.5%, and there is a visible trend towards its steady decline.”

In a review of the project implementation in the Republic, Arman Gevorgyan, Director of the Republican Veterinary-Sanitary and Phytosanitary Center of Laboratory Services SNCO, the Republic of Armenia, noted the strengthening of laboratory capacity to identify AMR: “Trainings were conducted for laboratory personnel, research protocols to identify AMR were introduced, 30 milk samples and 1200 manure samples were tested.”

“It is prohibited at the legislative level to add antimicrobials to feed, the content in raw materials and finished products is governed by the EAEU regulatory framework, but there is no uniform legislation yet, including on the methodology for laboratory research.”

Irina Protas, Director of the Department of Veterinary and Food Supervision of the Ministry of Agriculture and Food of the Republic of Belarus, named a completed ATLASS mission in laboratories, obtaining a national legal report identifying gaps, collecting annual data from farmers and veterinary clinics on antimicrobial use, conducting an evaluation of the curriculum on antimicrobial resistance at two universities, and continuing awareness-raising among the main achievements of the project for the country.

“Active work is underway to introduce tools to reduce the negative impact of antimicrobial resistance on the food sector, agriculture and the safety of animal products. At the same time, a lot still has to be done for more effective work in this direction, including improving the legislative framework of the Republic,” Irina Protas shared with the audience plans for the future and needs in the fight against AMR in food and agriculture.

Aygul Djumakhanova, Head of the Laboratory Testing Centre, Department of Disease Prevention and State Sanitary and Epidemiological Surveillance of the Ministry of Health of the Kyrgyz Republic, noted conducting the FAO evaluation of republican laboratories with the ATLASS tool in 2018, and training farmers and farm owners aimed at raising awareness about AMR as the main results of the project. “Public campaigns are carried out, which are timed to coincide with the World AMR Awareness Week. The project will carry out laboratory testing of 1800 manure samples and 40 milk samples in accordance with trainings and protocols provided by FAO,” concluded Aygul Djumakhanova.

Ismoil Andamov, Head of the Department of Veterinary and Breeding Control of the Food Security Committee under the Government of the Republic of Tajikistan, and Mustafo Muminzoda, Head of the National Center for Food Security, noted that since the beginning of the project implementation, the national veterinary service collects data on the movement (import and use) of antimicrobials in veterinary medicine. “The National AMR Action Plan for 2018–2022 was implemented, the plan for 2023–2028, which will cover not only human and animal health but also food, agriculture and the environment, has been developed and is under approval. It will also be necessary to ensure the collection of data on antimicrobials’ value chains using FAO tools for their mapping.”

Participants of the meeting unanimously noted that the project achieved its goal, strengthening capacity to combat AMR and enhancing coordination among focal countries. They spoke in favor of looking for opportunities to continue it.

BACKGROUND INFORMATION

Due to antimicrobial resistance (AMR), drug-resistant infections are becoming an increasingly serious problem for human, animal, plant, and environmental health.

The spread of AMR could push tens of millions of people into extreme poverty, hunger and undernourishment, with associated economic losses amounting to several percent of the gross domestic product. However, we can prevent such a situation from occurring, if we act fast.

FAO developed the Action Plan on Antimicrobial Resistance 2021–2025 that serves as a roadmap for concentrating global efforts to tackle AMR in the food and agriculture sectors. The goal of the Plan is to help accelerate the progress of member countries in developing and implementing multisectoral national action plans to tackle AMR.