In this series we ask some of the leading experts in the field of antimicrobial resistance (AMR) and One Health for their take on progress, leadership and challenges.
Here, we are delighted to be sharing an opinion piece by Amit Khurana and Rajeshwari Sinha, Centre for Science and Environment, India. Amit Khurana is the Director of the Sustainable Food Systems Programme and Rajeshwari Sinha is the Programme Manager, Sustainable Food Systems Programme.
The Sustainable food Systems Programme team at CSE leads the Antimicrobial Resistance Programme and has been focusing on the animal and environmental aspects of AMR for more than a decade now.
Towards food-animal systems which are not dependent on antibiotics
The global understanding on the Antimicrobial Resistance (AMR) crisis is evolving rapidly. Compared to a few years ago, we know more on inter-sectoral linkages, scale of impact and enormity of the challenge. There is more evidence, consensus and convergence, and better understanding on what needs to be done. In terms of food-animal systems, it is clear that we need to transform our food production systems as incremental changes would be inadequate and perhaps too late. Local context based and cost-effective solutions would be more useful, particularly, in the low-and-middle income countries. Approaches rooted in ‘prevention’ will likely serve better in the long run. Large-scale adoption of sustainable food production practices can happen, if there is a clear driver for farmers.
Countries are now revising their action plans and their strategies on how they are going to implement it based on past successes and failures, as well as future ambition in the post-Covid world. Here lies an opportunity to work towards food-animal systems which are not dependent on chemicals including antibiotics.
This is also a time when global governance is keen to be ambitious to contain AMR through a One-Health lens in addition to transformation of food systems.
The Global Leaders Group on AMR in its statement to promote the responsible and sustainable use of antimicrobials in food systems, called upon countries to work towards infection prevention and control, reducing antimicrobial use and professional oversight and effective governance.
Over 45 countries endorsed the Muscat Ministerial Manifesto on AMR in November 2022, which includes targets for reducing antibiotic use in agri-food systems. These targets are also expected to inform the upcoming High-Level Meeting on Antimicrobial Resistance at the United Nations General Assembly 2024, that is being approached with a view to set some bold and specific commitments. The targets include reducing the total amount of antimicrobials used in the agri-food systems by at least 30-50 per cent from the current level by 2030. It also includes zero use of medically important antimicrobials for human medicine, in animals for non-veterinary medical purposes or in crop production and agri-food systems for non-phytosanitary purposes. India also came forward and endorsed the Manifesto despite the scale of task and challenges.
India’s AMR action plan is comprehensive and it took several initiatives over the last few years but like several countries, implementation of the plan posed a big challenge and called for prioritisation, which is ongoing at present. Importantly, the national plan emphasised on the importance of state-level action plans as states are responsible for animal husbandry, fisheries, dairying, agriculture and pollution control. There are few states like Kerala and Madhya Pradesh who took the lead and are actively working to combat AMR. Andhra Pradesh and Delhi also have action plans.
Considering the need for prioritization, a set of action points are outlined below in the context of India. These are also applicable to most countries of the global south.
First and foremost, there is a need to better understand antibiotic use in terms of how much and in what kind of situations. This information can be a baseline for setting the targets and tracking the progress. It can be done at three levels. First, to understand the consumption trends at the farm level, second across supply chain through online tracking systems, and third, through mandatory disclosure by antibiotic producers. Policies and systems that can enable this should be a priority.
It is also important to know the status of antibiotic resistance in food animal sector and residues in food from animals. The Food Safety Standards Authority of India had set tolerance limits for antibiotic residues in food from animals such as meat, milk, egg and fish, several years ago. In addition, to the National Milk Safety and Quality Survey report released by FSSAI in 2019, periodic information on results of residue testing in meat, eggs and fish will help all stakeholders including consumers and farmers.
Then there are specific measures to regulate antibiotic use to minimise their misuse. To address antibiotic use as growth promoters in feed, there have been awareness initiatives and advisories by the concerned departments of animal husbandry, fisheries and drug control at the central and state-level discouraging such use. There is a poultry feed voluntary standard, which is being worked upon to phase out antibiotics in feed. There are requirements of registering feed and inputs used in the aquaculture sector, which mandates declaration of all contents including antibiotics. But a law which regulates antibiotics in feed particularly in the poultry feed – would be useful to address this in a more effective way.
With regard to antibiotics critical for human health, India had timely banned the animal-use of colistin in food-animals. It also has prohibitions on the use of select antibiotics for export-oriented aquaculture including few which are critically important. In the case of cropping systems, a draft regulation that proposes to ban streptomycin use in crops w.e.f. January 2024 is a welcome step. Considering the global momentum to conserve critically important antibiotics, it would be useful to identify those other than colistin, which can be restricted without much impact on food production; develop sector-specific standard treatment guidelines; ensure that all treatment is under veterinary supervision and supported by diagnostics to the extent possible; set systems for effective control on over-the-counter availability of animal antibiotics; and ensure feed with antibiotics is regulated.
On the issue of antibiotic use for so-called ‘prevention’ and ‘control’, such use is not really recognized as misuse by agencies like Codex Alimentarius, which are often referred to by national-level regulators of low-and middle-income countries. This is in contrast to the European Union, which has taken initiatives to regulate routine group preventative use of antibiotics. India too can recognise that such use should be avoided and minimised. It has big programmes on vaccines for animals (particularly the dairy sector) and has huge capacity for vaccine research and development and implementation programmes, which can be leveraged to reduce the occurrence and transmission of bacterial infection and thereby antibiotic use in animals. There is a large-scale ongoing and successful project on the use of ethnoveterinary medicine practices in the dairy sector by the National Dairy Development Board. The project has shown reduction in antibiotic use, decreased cost to farmers, and safe milk for the consumer, through effective treatment with herbal preparations for mastitis, fever, indigestion and diarrhoea in about 0.8 million dairy cattle. India can consider taking a lead globally in promoting use of traditional herbal alternatives. Some of this is already happening through the scientific team responsible for the project. If alternatives can be cheaper for farmers than antibiotics or proven to lead better return on investments, in addition to being effective, their large-scale adoption is a good possibility.
But regulating antibiotic use should be accompanied by efforts focused on avoiding the occurrence of disease at farms. This includes building capacity of extension officials, supporting farmers, enabling clean water and better waste management.
On waste from farms, the Central Pollution Control Board came out with environmental guidelines for poultry and dairy farms. These are comprehensive though not AMR specific. If implemented well at the state level, these will likely help limit the environmental spread of AMR determinants. An important aspect is to make sure that animal waste is made AMR safe through appropriate treatment before it is applied to crops. In view of the growing organic and natural farming movement in the country, AMR-safe animal dung and manure while substituting chemical fertilisers in the farms will not add to the AMR problem.
India has a federal structure and therefore States have a significant role in public health and agriculture. More states should come forward with their AMR action plans and actively implement them on the ground. Institutionalising a One-Health approach will be critical at the state level.
Clearly, there are challenges as well as possibilities in the much-needed coordinated response to AMR. The good part is that most of the food-animal production in India, is still far from being intensive, which means less stocking density, less conditions for disease and less input-dependence. It is largely decentralised, wherein small farmers at the village level owns limited livestock – few dairy cattle, chickens – or fish.
The challenge is how to continue doing so and yet meet nutritional requirements of a large and growing population, through dairy, eggs and meat. The per capita consumption of meat is anyways much lower than many countries of the global north and west. On one hand, several economic and market-related reasons are leading to a greater thrust towards industrial food systems, but on the other there is a growing realisation that India’s solutions need not be same as elsewhere and should be best aligned with the structure of food systems. The success would depend upon striking the right balance. What is required is a mindful approach to growth for it to be sustainable for health and nutrition of the people, for the livelihood of farmers and health of environment.
Amit Khurana and Rajeshwari Sinha, Centre for Science and Environment, India
Amit Khurana, Director, Sustainable food systems programme, Centre for Science and Environment
Rajeshwari Sinha, Programme Manager, Sustainable food systems programme, Centre for Science and Environment
The Centre for Science and Environment (CSE) is a public interest research and advocacy organisation based in New Delhi. CSE researches into, lobbies for and communicates the urgency of development that is both sustainable and equitable.
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Interview with Experts: "Towards food-animal systems which are not dependent on antibiotics" - an opinion piece by Amit Khurana and Rajeshwari Sinha, Centre for Science and Environment, India31st July 2023