Article
Reference
Global resistance to antimicrobials and their sustainable use in agriculture
LHERMIE, Guillaume, et al.
LHERMIE, Guillaume, et al . Global resistance to antimicrobials and their sustainable use in agriculture. The Lancet. Planetary health , 2019, vol. 3, no. 3, p. e109-e110
DOI : 10.1016/S2542-5196(18)30251-1 PMID : 30904103
Available at:
http://archive-ouverte.unige.ch/unige:125964
Disclaimer: layout of this document may differ from the published version.
1 / 1
Comment
www.thelancet.com/planetary-health Vol 3 March 2019 e109
Global resistance to antimicrobials and their sustainable use in agriculture
Decision-making on antimicrobial use relies on an interdependent mix of economic, behavioural, ethical, and cultural factors. In animal agriculture, antimicrobials are used to achieve: economic objectives, via optimisation of farm benefits related to sale of animal derived foodstuffs; animal welfare objectives, by ensuring good health at individual and herd levels;
and public health objectives, via limiting risk of zoonotic diseases. There is evidence showing the effect of antimicrobial use in animal agriculture on antimicrobial resistance in humans.1 The growing magnitude of this public health issue is encouraging the development and implementation of policies such as voluntary agreements, taxes, or permits, to decrease antimicrobial use in food-producing animals.2 The growing scientific literature spanning from microbiology, agricultural and environmental sciences, medicine and public health, pharmaceutical development, and ethics and law, to behaviour and economics, provides evidence for the public commitment dedicated to tackle antimicrobial resistance. Additionally, other research stresses the importance of understanding anthropological and socioeconomic factors contributing to antimicrobial resistance,3 and pinpoints that there are gaps in the global governance of this issue.4 An appropriate and functional scientific framework can help to integrate different strategies to curb antimicrobial resistance.
As with many unsustainable production and consumption practices, the responses to address the challenge caused by the rise of antimicrobial resistance have been formulated after the event, and scarcely consider the complexity of social- ecological systems (SES), overlooking unexpected consequences of potential policies.5 We advocate that evaluating antimicrobial use in animal agriculture as a sustainability issue under an SES perspective, in which human and nature are deeply entangled,6 can help to decompartmentalise national and international traditionally sector-based decision making, which affects stakeholders with opposing interests.
We propose to determine optimal antimicrobial use in animal agriculture using a SES framework and multi-criteria decision analysis, beyond the classic
cost–benefit or risk analysis perspectives. This scheme requires determining which indicators at the frontier of biological and social domains would be able to capture the social, environmental, and economic implications of a specific SES scaled to time and space.
The Public Health-Economic-Environmental-Social- Political model shows a set of public health, economic, environmental, social, and policy response indicators (appendix). Public health indicators commonly used in health economics, such as value of a statistical life or quality-adjusted life year, allow all for the presentation of different outcomes of the sustainability assessment in the common metric of monetary units. A challenge is to determine the extent of these metrics as a function of antimicrobial use in agriculture. Economic indicators consist of a set of indicators capturing the viability of the farming system.7 One ideal environmental indicator consists of measuring the evolution of bacterial susceptibility over space, time, and among animal and human communities and in the environment. Given the technical feasibility and availability of such data, a set of indicators of susceptibility to be included in our model should be identified per animal production category.
However, the complexity of collecting harmonised data for bacterial susceptibility trends among countries requires the addition of complementary indicators, such as antimicrobial consumption, as the most simple and easy way to monitor and compare across the food systems of countries. Social indicators are related to the wellbeing of farm communities, consumers, and animals. They integrate the dimensions of food safety, food security, and animal welfare. Policy response indicators measure qualitatively and quantitatively the implementation of national policies. They encompass the feasibility of the response, depending on the time horizon of the policy planning and on available resources.
These indicators also consider the progression of the policies from the framing to implementation, and the deadlines specified (if any) to observe an improvement in the SES, because of the expected delays between enactment and the effects on the other indicators.8
To achieve a sustainability assessment on anti- microbial use, combining methods developed for
Comment
e110 www.thelancet.com/planetary-health Vol 3 March 2019
environmental systems analysis with tools used in public health and economics is of particular relevance.
A simultaneous assessment of the associations and indicators presented here should be completed by the use of a system dynamics modelling approach. A multi- criteria objective function with trade-offs between animal and human welfare would produce a single index social welfare function to be assessed by simulation, or optimised with specified controls, such as antimicrobial use by an animal group over time. Functional relations would be estimated with data collected or generated by various techniques, including expert judgements and experiments, as well as primary and secondary data collection.
*Guillaume Lhermie, Didier Wernlii, Peter Søgaard Jørgensen, Donald Kenkel, Loren William Tauer, Yrjo Tapio Gröhn
Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine (GL, YTG), Department of Policy Analysis and Management, College of Human Ecology (DK), and Dyson School of Applied Economics and Management, Cornell SC Johnson College of Business (LWT), Cornell University, Ithaca, NY 14853, USA (GL, YTG); Global Studies Institute, University of Geneva, Geneva, Switzerland (DW); School of Public
Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China (DW); Global Economic Dynamics and the Biosphere, The Royal Swedish Academy of Sciences, Stockholm, Sweden (PSJ); and Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden (PSJ) gl467@cornell.edu
We declare no competing interests.
Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC-BY-NC-ND 4.0 license.
1 Tang KL, Caffrey NP, Nóbrega DB, et al. Restricting the use of antibiotics in food-producing animals and its associations with antibiotic resistance in food-producing animals and human beings: a systematic review and meta-analysis. Lancet Planet Health 2017; 1: 316–27.
2 Van Boeckel TP, Glennon EE, Chen D, et al. Reducing antimicrobial use in food animals. Science 2017; 357: 1350–52.
3 Collignon P, Beggs JJ, Walsh TR, Gandra S, Laxminarayan R. Anthropological and socioeconomic factors contributing to global antimicrobial resistance:
a univariate and multivariable analysis. Lancet Planet Health 2018;
2: e398–405.
4 Wernli D, Jørgensen PS, Harbarth S, et al. Antimicrobial resistance:
The complex challenge of measurement to inform policy and the public.
PLoS Med 2017; 14: 1–9.
5 Merrett GLB, Bloom G, Wilkinson A, MacGregor H. Towards the just and sustainable use of antibiotics. J Pharm Policy Pract 2016; 9: 31.
6 McGinnis MD, Ostrom E. Social-ecological system framework:
initial changes and continuing challenges. Ecol Soc 2014; 19: 30.
7 Food and Agriculture Organization. Sustainability assessment of food and agriculture systems. Guidelines version 3.0. 2013. http://www.fao.org/nr/
sustainability/sustainability-assessments-safa/en/ (accessed Feb 14, 2019).
8 Hoffman SJ, Outterson K. What will it take to address the global threat of antibiotic resistance? J Law Med Ethics 2015; 43: 363–68.
