Seal of Good Local Governance (SGLG) 2024Final.pptx
Dr Mark Schipp
1. The AMR One Health
Policy Toolkit: Animal -
Human Interface
Dr Mark Schipp
December 2014
2. One Health – One
Strategy
“To slow the development and spread of AMR and
conserve the effectiveness of antimicrobials”
•preventing infections and the spread of resistant infections
•improving surveillance, and
•improving the appropriate use of antimicrobials
Department of Agriculture
Murdoch AMR Symposium
8 December 2014 2
3. Department of Agriculture
Murdoch AMR Symposium
8December 2014 3
Specific action areas
Infection prevention and control
Surveillance
Antimicrobial stewardship
Communication and education
International engagement
Research and development
Governance
4. Infection prevention and control
Department of Agriculture
Murdoch AMR Symposium
8December 2014 4
National Biosecurity
Farm level Biosecurity
5. Department of Agriculture
Murdoch AMR Symposium
8December 2014 5
Surveillance
$ 11 million from the Commonwealth
Government
AMR surveillance and usage monitoring
Several surveys performed over the years –
low levels of AMR both human and animal
Work is ongoing to build a repeatable survey
based on existing systems in agriculture and
human health
6. Department of Agriculture
Murdoch AMR Symposium
8December 2014 6
Surveillance (cont.)
Antibiotic usage report by APVMA
587 tonnes per a year 2005 – 2010
Usage levels per animal similar to Finland and
lower than Denmark
7. Department of Agriculture
Murdoch AMR Symposium
8December 2014 7
Antimicrobial stewardship
Veterinary prescription required
Fluoroquinolones not used in food producing
animals in Australia
Only one third generation cephalosporin
injectable available for food animals
New antimicrobials assessed for human AMR
risk by APVMA - One Health approach
8. Department of Agriculture
Murdoch AMR Symposium
8December 2014 8
Communication and education
Awareness campaigns – One Health approach
Professional Education and support -
Australian Veterinary Association
9. International engagement
National AMR strategy – One Health
WHO, OIE and Global Health Security Agenda
Department of Agriculture
Murdoch AMR Symposium
8December 2014 9
10. Department of Agriculture
Murdoch AMR Symposium
8December 2014 10
Research and Development
CSIRO Biosecurity flagship
Pharmaceutical firms and vaccines
Companion animals
11. Department of Agriculture
Murdoch AMR Symposium
8December 2014 11
Governance
• Steering Group - Health and Agriculture
•Strategic and technical advisory group human
and animal health experts
12. Conclusion
Australia has stringent antimicrobial controls ,
and we are in a strong position
More data on AMR required, and we are
addressing this.
With continued positive collaboration with
agriculture, health, government and industry
We will achieve our stated One Health goal :
“To slow the development and
spread of AMR and conserve
the effectiveness of
antimicrobials”
Department of Agriculture
Murdoch AMR Symposium
8December 2014 12
Editor's Notes
Thank you
Great pleasure to be back at Murdoch , I spent 8 years here which perhaps reflects both my thick headedness and my perseverance. I still remember my student number 830593B which could often and easily be found at the bottom of the ranked results when they were posted outside the lecture theatre. Still it is good to be here today in such exalted company and to be given the opportunity to speak on this important topic.
Antimicrobial resistance is a critical issue being addressed through a One Health approach in Australia, with both Departments of Health and Agriculture involved.
A wide range of groups are impacted by AMR, and the response should reflect inputs and resourcing from all those sectors.
Both the Department and industry have already performed various AMR surveillance trials on an ad hoc basis.
Whilst these have been useful, further development of surveillance should lead to a sustainable, repeatable system.
In the current resource constrained and deregulation environment it makes sense to build on existing mechanisms and regulation to achieve maximum efficiency and effectiveness.
Australia is committed to the One Health approach, and the Departments of Agriculture and Health continue to develop a National AMR Strategy for the World Health Assembly meeting in May 2015 to consider the World Health Organization Global Action Plan for AMR.
Australia’s stated goal in approaching AMR is “To slow the development and spread of AMR and conserve the effectiveness of antimicrobials”
By :
preventing infections and the spread of resistant infections
improving surveillance, and
improving the appropriate use of antimicrobials
The draft Australian strategy is being developed around 7 key action areas:
Infection prevention and control,
Surveillance,
Antimicrobial stewardship,
communication and education,
international engagement,
research and development,
and governance
I would like to address each of these …
Infection prevention and control
National (country) biosecurity
Our highly developed national biosecurity system means we are free of many diseases including some that require treatment with antimicrobials.
Compared with many other countries, Australian farming methods have a stronger reliance on extensive animal production without housing – we don’t have European winters of farming methods - and we don’t import livestock and very little fresh meat.
These biosecurity measures appear to have excluded some important antimicrobial resistant pathogens from entry into Australia and subsequent colonisation of livestock (eg. specific types of multidrug-resistant non-typhoidal Salmonella).
We are free of many animal diseases including those that require antimicrobial treatment, (diseases such as heartwater, enzootic abortion) and on the plant side we have remained free of fire blight, a big user of antimicrobials such as oxytetracycline and streptomycin on fruit trees in some countries.
Farm Biosecurity
Our intensive primary industries have highly developed on farm biosecurity programs such as the Australian Pork Industry Biosecurity Program, and the National Farm Biosecurity Manual for Chicken Growers.
Our extensive farming methods, in which many animals are never housed tend to decrease requirements for antimicrobial use.
The second key action area is Surveillance
AMR surveillance
The Commonwealth Government recently committed some $11 Million to developing AMR surveillance and usage monitoring.
Australia’s role as a major food producer and exporter demands that our produce be of the highest quality and integrity and that it conforms to international standards.
Those cattle and sheep industries that rely heavily on export, have been proactive; Meat and Livestock Australia (MLA) have surveyed and confirmed low levels of AMR in cattle.
Work in this area is ongoing, last week, we held a highly productive roundtable, in which representatives from the agricultural industries, veterinary and human health discussed strategies to develop an ongoing AMR surveillance programme in animals.
This builds on our One Health approach to the problem of AMR, and we are progressing AMR surveillance in agriculture and looking to build upon existing systems in both agriculture and human health.
The One Health approach harnesses the expertise, bioinformatic capacity and quality management systems that already exist in sampling systems and labs.
Various AMR surveys performed over the years indicate that resistance levels in Australia are relatively low, both from the human and the animal perspective, and many treatments using old antibiotics still remain effective in animals.
Surveillance continued
Antibiotic usage
The Australian Pesticides and Veterinary Medicines Authority (APVMA) released a report on antimicrobial usage earlier this year covering the years from July 2005 to June 2010.
The report suggests that 98% of the total antimicrobials by weight sold for veterinary use in Australia were for use in food-producing animals, with only 2% to 3% for non-food animals.
The annual mean total tonnage of antimicrobials sold in Australia for animal use over the five year period was 587 tonnes. Over half is used for the control of coccidiosis in chickens. Most of the cocciodiostats used are of the ionophore class, unrelated to any human antimicrobials.
Therapeutic or prophylactic usage accounted for 43% of usage and in the most recent year reported growth promotion usage was a low 4% of the total antimicrobials
The point I want to make here is that Australia is not the US. It is not appropriate to extrapolate from US results into Australia where we have extensive grazing systems with a much smaller amount of lot feeding. The quote shown on this slide is from a workshop organised by Meat and Livestock Australia earlier this year to review the results of a pilot surveillance project in sheep and cattle.
Although quantitative measures of usage do not account for quality of use – for example use of critically important antibiotics may result in lower quantitative figures, applying the European population corrected sales usage system shows Australia using around 25 mg/PCU/year – similar use levels to that of Finland and considerably less than in Denmark.
Antimicrobial stewardship
With rare (and minor) exceptions all therapeutics antibiotics are available only via a veterinary prescription.
The WHO has identified fluoroquinolones and third and fourth generation cephalosporins as critically important antibiotics.
Australia is the only country that has regulatory measures in place to exclude the use of the vital fluoroquinolone class of antimicrobial in food-animal species, and only one third generation cephalosporin is approved as an injection and is uncommonly used and only in individual animals.
The Australian Veterinary Association (AVA) has AMR as one 5 key strategic issues facing the profession.
The AVA is committed to combating AMR, and has been actively involved in fighting resistance for more than 30 years with the development of guidelines, codes of practice and policies on appropriate use.
Communication and education
Awareness campaigns
The cattle industry has commissioned surveys of AU and AMR in their industry and Meat and Livestock Australia (MLA) hosted a one-day symposium in May 2014 to provide a forum for cattle industry representatives and stakeholders to review the results of these surveys.
Antibiotic Awareness Week (AAW) is held annually in November and is launched by my esteemed colleague the Commonwealth Chief Medical Officer. I am proud to support him in this, to promote a consistent message across human and animal health and agriculture, human health, veterinary medicine and government.
Professional education and support
As part of ongoing registration requirements, veterinarians are required to maintain Continuing Professional Education (CPE). AMR has been covered at several AVA conferences which count towards CPE, but there are currently no specific courses on AMR.
International engagement
The Departments of Agriculture and Health continue to develop a National AMR Strategy for the World Health Assembly meeting in May 2015 to consider the World Health Organization Global Action Plan for AMR.
A discussion paper outlining the proposed goal, objectives and key elements of the National AMR Strategy was released in early October, and submissions have been received.
We are active in the OIE which has developed codes and guidance on AMR. We consult closely with stakeholders on preparing Australian comments on OIE Codes. A recent OIE initiative is to establish a global database on antimicrobial use.
The Global Health Security agenda is being led by the US with a launch by President Obama at the White House in September of this year. Australia is a GHSA participant which has addressing AMR as a key plank.
Australia has a well developed research infrastructure, an example is the Commonwealth Scientific and Industrial Research Organisation (CSIRO) who are utilising genome engineering techniques to develop disease resistant livestock and new diagnostics, vaccines and therapeutics to protect animal and human health.
Their ‘Biosecurity Flagship’ is focussed on biosecurity research and managing the risks of exotic pest species and disease.
Pharmaceutical firms are also responding to the AMR challenge - a new vaccine on the Australian market is used to treat a common cattle disease, infectious bovine kerato-conjunctivitis. This has reduced the need for tetracyclines and other antibiotics in its treatment. Vaccines against Bovine and Porcine Respiratory diseases have led to long lasting reductions in the need for antibiotics.
People often don’t realise the breadth of vaccines available in veterinary medicines
Currently in Australia, there are 116 vaccine antigens included in more than 200 registered vaccines providing protection against 86 diseases of animals.
There is a tendency to focus on AMR in food animals, so it’s important to remember the importance of AMR in companion animals namely cats, dogs and horses.
Many of these animals live very close to us, as family members.
The Australian Infectious Diseases Advisory Panel, a body of independent experts advising veterinarians on the correct management of infectious diseases in companion animals, was able to secure funding from a pharmaceutical firm, Zoetis, for a 1-year pilot survey of AMR.
22 veterinary diagnostic laboratories in Australia were recruited for the pilot study that focused on pathogenic E. coli and coagulase-positive Staphylococcus. Over 2600 isolates were obtained with an approximate ratio of companion animal to livestock of 4:1.
The study confirmed a very low incidence of resistance to critically important antibiotics.
Interestingly, isolates from companion animals have a resistance frequency similar to that identified in humans in Australia from equivalent surveillance studies.
The survey has led to a successful research grant to characterise resistant genotypes.
Governance
Australia’s AMR governance structures reflect our One Health approach - to progress the National AMR strategy - establishing the AMR Prevention and Containment (AMRPC) Steering Group, which is co – chaired by the Secretaries of Agriculture and Health;
and also the Australian Strategic and Technical Advisory Group on Antimicrobial Resistance (ASTAG) which is co-chaired by Prof Chris Baggoley, Australian Government Chief Medical Officer, and Dr Mark Schipp, Australian Government Chief Veterinary Officer.
The ASTAG includes experts from across the health spectrum both human and veterinary, providing advice and technical support to progress the AMR strategy.
All new antimicrobials registered for use in livestock are subject to a rigorous risk assessment for AMR risks to human populations, this is performed by the registration body the Australian Pesticides and Veterinary Medicines Authority (APVMA).
Conclusion
We are in a strong position. Our farming systems are different to those of the northern hemisphere. Our antimicrobial controls are more stringent than most countries. Consequently much of what we could do on AMR has been, or is being done.
At the same time there is more to be done. One vulnerability is the lack of historical and cumulative data on AMR in Australian agriculture. We are addressing this now through establishing an agriculture surveillance program based on expert advice recently provided to the department by another Murdoch alumnus – Darren Trott and his colleagues.
We are fortunate to have a strong collaborative approach established in Australia with positive and cooperative relationships between agriculture and health, and between government and industry.
I am confident that we will achieve our objective “To slow the development and spread of AMR and conserve the effectiveness of antimicrobials”
I am confident that Australia has a competitive advantage over many other countries and indeed that Australia has much to contribute on this topic and to our region.
Thank you.
