In this series we ask some of the leading experts in the field of AMR and One Health for their take on progress, leadership and challenges.
Our fourth interviewee is Lisa Morgans BVSc PhD MRCVS, livestock vet and Head of Precision Livestock at Innovation for Agriculture (IfA) – a Knowledge Exchange charity set up by the Royal Agricultural Society of England. Lisa leads a team that aims to bridge the gap between science and practice through participatory and farmer-led approaches to change. IfA have interests in animal health and welfare, particularly in calves, as well as precision livestock farming and responsible medicine use.
Hi Lisa, what have you been doing on AMR (antimicrobial resistance) in the last few years?
Besides being a vet and practicing judicious use since qualification, the first big project on AMR was my PhD, which I completed at the University of Bristol in 2019. I established the Farmer Action Group project, funded by AHDB Dairy (the Agricultural and Horticultural Development Board) and the Langford Trust. I explored how a bottom-up, participatory approach helped to change practices around antimicrobial use on UK dairy farms. Thirty dairy farms from across South West England participated over two years in this farmer-led project. They shifted away from using Critically Important Antibiotics within a year and made multiple changes to their systems, their management and treatment protocols; which resulted in less reliance on antibiotics. The farmers were awarded joint 1st in the Antibiotic Guardian Awards in 2019 for their efforts.
I have also worked on a research project looking at the role diagnostics plays in helping farmers and vets make better decisions to improve animal health and reduce reliance on antibiotics. I have provided a variety of online training courses for vets, academics, clinicians and feed advisors on AMR (antimicrobial resistance) - particularly on responsible antibiotic usage - and am currently working on an international project called DISARM (Disseminating Innovative Solutions for Antibiotic Resistance Management). DISARM aims to bring together researchers, farmers, vets and other advisors to share best practice and improve livestock health across Europe.
How has the global AMR community responded to the Covid-19 pandemic?
Impressively! Many academics I know working on AMR have pivoted to applying their skills and expertise to the COVID pandemic. For instance, mathematical modellers that work on AMR have applied their skills to new datasets and systems to help with the effort to control the pandemic. Epidemiologists, data scientists, microbiologists and clinicians have all contributed hours and hours into helping their medical colleagues. On a local scale, vet practices have been donating ventilator equipment to hospitals.
Will the pandemic affect the global response to AMR over the next few years?
Certainly, in positive and in negative ways. In human medicine both remote prescribing, due to lockdown restrictions, and cautionary prescribing of antibiotics to COVID patients may have increased during the pandemic. As we know, COVID is a virus and does not respond to antibiotics but the risk of secondary bacterial infection may well lead to cautionary prescribing, particularly in the elderly and vulnerable. This will have had an effect on AMR development. The same could be said in veterinary practice where there have been changes to how we treat animals under our care (i.e. remote prescribing and telemedicine) but the evidence isn’t there yet and we still need to compile the data to see how prescribing has changed, and the impact this will have on AMR.
The lockdown restrictions may have had beneficial outcomes as people are interacting and travelling less, so the spread of bacteria and the transmission of resistant genes is potentially minimised. More data is needed to fully see what the effect has been. In terms of the global response specifically, I think it may well have been heightened, as there is more funding and focus on health, medical care and biosecurity. The focus on hand washing for instance, is sure to have a beneficial impact on bacterial disease occurrence and spread. I hope we continue to see such focus on disease control and global health.
Do you think the public’s perception of the AMR risk has changed because of the pandemic?
I think more people will have come across the science behind AMR and the benefits of easy interventions, such as handwashing, largely due to an increase in science and medical journalism. The public’s understanding of pandemics, vaccination and disease spread during COVID is transferable to AMR, so I imagine many people will now be able to better appreciate interventions to reduce AMR. I think the pandemic has also highlighted health inequalities and the importance of healthy diets for many across the world.
What lessons have you learned from this pandemic?
In an academic sense; the importance of collaboration, inter-disciplinary working and applying a One Health approach. In a veterinary and farming sense I’ve learnt the importance of local short supply chains, which can withstand the shocks of something like a pandemic. Due to the climate crisis, and subsequent extreme weather events, I fear major global shocks are more not less likely in the future.
In a personal sense, I have learnt that a slower pace of life is quite a nice thing and to enjoy the small things whilst you can.
Over 70% of global antibiotic use is in livestock. But to what extent do you think the overuse of antibiotics in farming contributes to the global AMR crisis?
This is a tricky question and one that we simply do not know the answer to, yet. From the research I have seen, the role that environmental reservoirs play in the development and transmission of resistance is an emerging picture. What we do with human sewage, how we dispose of animal waste, what antimicrobials are used - and how - in hospital and community settings and where the waste from these hospitals goes in all parts of the world, are still key questions we need to fully understand in order to develop interventions with maximum impact on slowing AMR.
Clearly, there is a risk that any antibiotic use can select for resistant bacteria, in humans and animals. However, a blanket ban on antibiotics in farming does not necessarily lead to a reduction in AMR infections. There have been significant reductions in antibiotic usage in the UK poultry sector (76% reduction between 2012-2019), as an example. Yet, around 50% of C. jejuni isolates from UK retail chicken are resistant to ciprofloxacin, a level that has not changed substantially over the past 7 years, despite minimal use of these antibiotics in poultry. Resistant bacteria are a fickle bunch and can persist in the environment, despite interventions.
Saying that, here in the UK, we have seen decreasing trends in antibiotic usage across all food-producing species over the last 5 years and this has been associated with decreasing AMR in indicator strains of bacteria during routine monitoring and surveillance. So, I would argue that farming is a lot less to blame for driving AMR in the UK than first assumed.
What changes would you like to see in the UK or in Europe regarding the use of antibiotics in farming?
In the UK, I would love to see greater use of approaches that help farmers and vets change their behaviour when it comes to improving animal health. Less sick animals means less need for antibiotics and generally better animal welfare. Obviously, I am biased, but the use of facilitated farmer-led approaches that allow peer-to-peer learning can have a massive impact on changing ingrained practices and habits when it comes to animal management. In Europe, AMU (antimicrobial use) is hugely variable between countries and livestock sectors. However learning from other countries and sectors can be helpful by adding a different perspective. We also need more harmonisation of data monitoring and surveillance systems, not just in Europe but globally. The data science and technology exists to combine, share and analyse the data produced on farms, from prescribers and laboratories but there are commercial barriers to collaborative working, not to mention data ethics! Nevertheless, Europe does have some of the best data monitoring and surveillance systems in the world (I particularly like VetStat in Denmark and MediRund in Netherlands!).
A final thought is that I would like to see more funding and resources put into improving animal health and welfare in farmed systems. As we have seen with AMR and now COVID, it is not just an animal health issue but a public health issue. Hand in hand with improving animal health and welfare should be a focus on reducing inefficiency and inequalities right along the supply chain from farm to fork; this includes paying farmers fairly, so they can afford to invest and improve their systems, as well as reducing the over consumption of (cheap) animal protein in our diets. These will all play a part in transforming our food production systems.
Do you think the global increase in intensive livestock farming is likely to lead to higher levels of farm antibiotic use? Would you recommend any systemic changes to the way we raise livestock in order to preserve the efficacy of antibiotics - In the UK, Europe and globally?
I always get stuck on the term of intensive livestock farming so before I can answer, I’d like to explore what is meant by the term. Many ‘intensive’ systems are very low users of antibiotics, and some more traditional, extensive systems (if by extensive we mean low inputs and outputs, and generally outdoor rearing/access) have very high usage. In terms of biosecurity, outdoor systems can leave animals unprotected from infectious disease, which as a vet, is something I must carefully consider. Quite surprisingly, a good 15 conventional dairy farms participating in my PhD had lower antibiotic use than 2 organic farms in the cohort! In terms of dairy farming, is an intensively grazed low yielding dairy herd on a strict rotational grazing pattern with high fertiliser application for maximal grass growth and nutrition for their herd, an intensive system? Do we mean an indoor reared, high-yielding dairy herd is ‘intensive’, but is able to house some of the most chilled-out, comfortable cows (particularly during a wet winter) that are fed tailored diets and rarely get ill or require antibiotics? In my experience, it is not a clear dichotomy of intensive = more disease and antibiotic use. What does matter is the individual running the farm system. A farm system is only as good as the farmer running it. And farmers are under a whole host of pressures that affect what they do. They far too often get blamed for things outside of their control, rather than being helped and supported to change.
I would like to see more support mechanisms for farmers (be that financial, social or institutional structures) to help them reflect on what they do on farm, how they could or should change and practical steps to achieve that. Too often, we hear those in the food and farming industry say, farmers needs to cut pesticide use, cut artificial fertiliser use, reduce water pollution, control emissions, increase biodiversity and go further in looking after animal welfare, and all the while producing wholesome, safe food. All the required investment and risk is piled onto the producers at the end of the supply chain with little practical assistance as to how best to go about achieving these commendable but complicated goals. In a food system, those producing the food, safeguarding our land, waterways and animals involved in the production of food, should be central to major changes.
What do you think about the UK government’s position on the issue of antibiotic misuse in farming?
The UK has been very strong in its position to reduce unnecessary antibiotic use and has produced detailed Action Plans for all sectors to follow. This has given guidance and leadership and has resulted in the UK being the 5th lowest consumer of antibiotics in food-producing species in the EU. The VMD (Veterinary medicines Directorate) has done a fantastic job at collating data and producing reports on antibiotic usage and resistance levels in food-producing species, with clear to read updates on the industry’s progress. Of course, more can still be done; data coverage for many species when it comes to usage is inadequate and only based on sales of antibiotics, not usage at the individual animal level. There is a real need for centralised databases and detailed medicine recording in the ruminant sector in the UK.
How important do you think the environmental spread of AMR is and should farming industries where the spread could be significant take action to counter it?
Very important, and yes! The role of the environment and our impact on it is going to be a key theme in farming over the next few years. Where antibiotic residues end up and how they are dealt with, where animal and human waste goes and what happens to it, are key areas that need specific action plans to address. I argue farmers should be central to developing these action plans in collaboration with researchers and policy makers so that they are multi-stakeholder, participatory and therefore, valuable and subsequently implemented.
What do you think the most important thing is for the next year in fighting AMR?
Collaboration! Working with multiple stakeholders and spending time finding out who these are, listening to them and working together to find solutions and adopting a One Health approach. Also, reduce animal disease, reduce antibiotics!
If you had $1bn to fight AMR, how would you spend it?
Ahhh, I wish! I would spend it in two key areas; firstly, coordinating a data harmonisation and governance structure that brings together commercial entities and public bodies to share and collect the right data to monitor AMR and usage and then feed that data back to those on the ground who can use it to drive change, like clinicians and farmers. Secondly, I would like to see funding for more social support networks between farmers and advisors, as well as bringing in members of the public, medical colleagues and policy makers in a large scale, participatory network with its roots in local action. It’s important to think global and act local.
What advice would you give to world leaders about their response to AMR?
Excellent progress so far. It really is commendable how well many countries have responded to this, and there has been very good leadership from the likes of the UN and WHO. But the bacteria are still winning and many countries are taking a worse hit or are contributing unevenly to the problem. So a more linked up approach will be needed.
What can we do to help bring down the amount of antibiotics used on farms?
As consumers, buying habits are an obvious way to help. However, this is tricky as like I said before, it is difficult to choose a product based on a single farm and that is what ultimately decides whether there is high or low antibiotic use (labelling is based on systems). If you can buy from farm shops and direct from farmers, then do! Reach out to farmers, attend open farm days, like/add farmers on social media and start the conversation about their use of medicines (and all manner of things). Nearly all farmers I speak with want to connect with consumers more, we are all food citizens after all.
Thank you for your time Lisa, and for giving us an insight into your work.