Antibiotic Stewardship in the Human Sector

1. Antibiotic stewardship
in the human sector
Dr Berit Muller-Pebody
AMR Section Lead
HCAI & AMR Division, National Infection Service

2. ANVISA visit March 2017
UK Five Year Antimicrobial
Resistance Strategy
2013 to 2018
1. Improving infection prevention and control
practices
2. Optimising prescribing (through antimicrobial
stewardship)
3. Improving professional education, training and
public engagement
4. Developing new drugs, treatments and
diagnostics
5. Better access to and use of surveillance data
6. Better identification and prioritization of AMR
research needs
7. Strengthened international Collaboration
UK 5-YearAMR Strategy
7 KeyAreas for Future Action

3. Butcanwemeasureantibioticuse…?
ANVISA visit March 2017

4. ANVISA visit March 2017

5. ANVISA visit March 2017
Primary care data
NHS Business Services Authority (NHS BSA)
Secondary care data
NHS Trusts
IQVIA - Information technology services company
Political clout helps…….

6. ESPAUR report 2014
ANVISA visit March 2017
Total consumption of antibiotics, England 2010-2013

7. Antibiotic usage by prescriber, England, 2016
Royal Society of Chemistry 16 September 2018

8. Quality and Innovation (CQUIN) & Quality
Premiums
Improved antibiotic prescribing in primary and
secondary care through payments to Hospital
Trusts and Clinical Commissioning Groups
(CCGs)
• reduction in the number of antibiotics prescribed in
primary care
• reduction in the proportion of broad spectrum antibiotics
prescribed in primary care
• secondary care providers validating their total antibiotic
prescription data
• secondary care providers reviewing antibiotic prescribing
within 72 hours of the beginning of treatment
Royal Society of Chemistry 16 September 2018

9. Antibiotic Stewardship
Royal Society of Chemistry 16 September 2018

10. Antibiotic usage, England, 2012-2016
Royal Society of Chemistry 16 September 2018
ESPAUR Report 2017

11. Information for action – PHE Fingertips
PHE conference 2018 One Health

12. Antibiotic prescribing: reduction potential between 8.8% and
23.0% of all primary care prescriptions (Smieszek et al.)
Inappropriate (guidelines)
Inappropriate (expert opinion)
Appropriate (expert opinion)
Appropriate (guidelines)
Not understood regarding appropriateness
Diagnostic code present but lacking crucial
information e.g. guidelines / severity
No diagnostic code / no informative
diagnostic code
11.2% 78.1% 10.7%
33.8% 44.3%
The majority of prescriptions fall into the ‘grey zone’, this is where further
potential for reductions resides
Potential for reducing inappropriate prescribing in English primary care. Smieszek T, Pouwels KB, Dolk FCK, Smith DRM,
Hopkins S, Sharland M, Hay AD, Moore MV, Robotham JV. J Antimicrob Chemother. 2018 Feb 1;73(suppl_2):ii36-ii43.Royal Society of Chemistry 16 September 2018

13. Antibiotic Guardian
Launched by PHE in 2014 to support European Antibiotic Awareness Day
(EAAD)
• move from raising awareness to increased engagement & knowledge
• stimulating behaviour change among both healthcare professionals and
the public
Campaigns (‘Keep Antibiotics Working’)
• online pledge to help save antibiotics
(current pledges: 48,546)
Resources and toolkits for
• Healthcare professionals/students
• Veterinary and livestock professionals
• Community pharmacists
•
Webinars (Prescribing and Stewardship)
Antibiotic Guardian Awards
•
• PHE conference 2018 One Health

14. ANVISA visit March 2017

15. Royal Society of Chemistry 16 September 2018
Acknowledgements
HCAI & AMR Division, National Infection Service, PHE
Especially to:
Rebecca Guy
Kate Wilson
Rachel Freeman
Amelia Au-Yeung
Mehdi Minaji
Emma Budd
Alan Johnson
Susan Hopkins

16. SUSTAINING AND IMPROVING ANIMAL
HEALTH THROUGH APPROPRIATE
ANTIBIOTIC USE
The future of animal health and antibiotic
use
Dawn Howard
Chief Executive
d.howard@noah.co.uk
+44 (0)20 8367 3131

17. NOAH represents the UK animal health industry.
We promote the benefits of safe, effective,
quality products and services for the health and
welfare of all animals.

19. The future of animal health and
antibiotic use
• Society expects good animal welfare – animal
health is integral to this
• Despite best efforts animals may succumb to
disease
• Many diseases can be prevented, eg by
vaccination, but there will be cases where
animal disease needs to be treated with
antibiotics
• Antibiotics have a vital role in treating,
controlling & sometimes preventing the
spread of bacterial diseases in our animals
•
•

20. The future of animal health and
antibiotic use
• An important aspect of antibiotic use is the role in helping vets and
farmers with the production of safe food from healthy animals
• Without the use of appropriate antibiotics, pets and farm livestock
may endure pain & suffering. The production of safe food could be
endangered
•

21. The global animal health commitment

23. Better communication – working
together

26. UK AMR priorities
• UK Five Year AMR Strategy 2013 to 2018: Key area 3:
improving professional education, training and public
engagement. … promotion of training of non-health
professionals, like farmers, with responsibility for
administering antibiotics..
• UK cross sector integrated strategy
• Demonstrate farmers have the skills and training to use
antibiotics responsibly

27. • Farmer training - responsible use of antibiotics
• Working with the dairy, beef, sheep and pig sectors to
produce training materials on responsible antibiotic use
• Co-ordinate efforts and standardise approach to
responsible use
• Evidence based, best practice
•

28. Aspirations: what did we
want to achieve?
üConverge with UK AMR response e.g. RUMA Targets Task Force
Report 2017, Red Tractor review of standards on AMR
ü
üAddress key concerns along food supply chain: reassurance to
retailers, food service providers, consumers, media and policy
makers: deliver tangible action, consistent, co-ordinated
ü
üSupport producers and vets in task ahead: raise awareness,
improve knowledge and understanding, reinforce collaborative
relationship, drive best practice on farm
ü

29. AMBP partners

30. Farmer Training: wish
list
üAccessible: multiplatform, online and via vet, flexible delivery
üAffordable: reduce barrier to uptake
üCore and sector specific materials: mix of practical and theory
with sector specific application
üWork with industry to develop: partnership approach
üMeet & support development of farm assurance standards on
AMR e.g. Red Tractor

31. LANTRA: nationally
recognised awarding
organisation

32. Sectors & Modules
Dairy
• Core 1 and Core 2 modules
• Choice of focus dairy modules: mastitis, lameness, respiratory disease, calf scour,
disposal of antibiotic waste
Beef
• Core 1 and Core 2 modules
• Choice of focus beef modules: lameness, respiratory disease, calf septicaemia, joint ill
and navel ill, the calving cow
Sheep
• Core 1 and Core 2 modules
• Sheep focus module 3: Enzootic Abortion in Ewes (EAE), lameness, watery mouth
disease and joint ill
Pig
• Core 1 and Core 2 modules
• Pig focus module 3: disease in pig populations, factors affecting disease, antibiotic
use strategies, routes of administration for antibiotics and pig sector initiatives

35. • July/Aug 2018: Launch farmer modules
• Sept 2018: complete vet resource centre
• Oct 2018: BCVA congress workshop, launch of vet resources
• Monitor and measure progress: consider future development of
project

37. The future of animal health and
antibiotic use
Whilst we work hard to reduce the need to use antibiotics -
they will continue to have a vital role in treating & controlling
the spread of bacterial diseases in our animals
We are committed to sustaining & improving animal health
through:
üa unified One Health approach
üensuring appropriate access & responsible use of medicines
for all animals
•

38. Thank you for your attention
Dawn Howard
Chief Executive
d.howard@noah.co.uk
+44 (0)20 8367 3131

39. USING fewer antibiotics in
livestock agriculture
– utilising farm
benchmarking to drive
behaviour
Steve McLean
Head of Agriculture and Fisheries
Sourcing

40. Who we are
• Established in 1884
• Grown from single market stall to
international multi-channel retailer
• Operate in 56 territories globally and
employ 81,000 people
• UK business split 61% food and 39%
clothing and homeware

41. Who we are
• 1035 UK stores
• £10.7bn group revenue
• Around 32 million
customers

42. OUR VALUES
We will
engage,
excite and
inspire our
customers.
We will
create a
deeper
connection
with our
suppliers, our
customers
and their
communities.
We will
always strive
to do the
right thing.
We will lead
our sector in
sustainable
consumption
&
production.
We are
restless in
our aim to
improve
things for
the better.
Inspiration
Integrity
In Touch
Innovation

43. OUR STRATEGY –
PUT THE CUSTOMER AT
THE HEART OF EVERTHING
WE DO

44. § Plan A – our eco- and ethical plan at
the heart of what we do
§ Long track record of leading animal
welfare standards
§ Tier 1 in BBFAW for last two years
§ Work with farms we know and trust
§ All farms follow our Codes of Practice
Committed to ‘doing the right thing’

45. § Antibiotic use in livestock agriculture a key
issue – linked to increasing AMR
§ Need to ensure responsible use with very
highest standards of animal welfare
§ Our approach follows 4Rs:
§
§ Record
§ Replace
§ Reduce
§ Refine
antibiotics

46. § All antibiotic use must be recorded
§ No animal treated unless it is ill and vet and
farmer have considered all other treatment
options
§ Committed to achieving annual reduction
§ Monitor welfare through outcome measures
§ Critical antibiotics prohibited
§ Working closely with farmers to drive
behaviour
What this means…

47. § Started dedicated milk pool in 2000
§ One of the longest-running dedicated
retailer pools
§ Payment model designed to smooth
volatility and give a fair price
§ RSPCA Assured farms delivering leading
standards of welfare
§ Health and welfare audits delivered by Nick
Bell, independent vet and dairy specialist
Our milk pool…

48. § Antibiotic use recorded across milk pool
§ Records submitted quarterly
§ Farmers receive annual benchmarking report
§ Graded Gold/Silver/Bronze/Red
§ Allows comparison yr. on yr. on own farm and vs. rest of pool
§ Record use by condition and actives used
§ Allows farms to see where they are using antibiotics as well as how much
they use
Antibiotic reduction

49. § Farm workshops run for pool to focus on key
areas:
§
§ Selective Dry Cow Therapy
§ Use of antibiotics in foot health/digital
dermatitis
§ Practical and technical advice
§ Peer support has encouraged others to
change
Key developments

50. § Consistent reduction in antibiotic
use in dairy pool
§ Already ahead of RUMA 2020 target
and top 25% below 3Mg/PCU
§ Animal welfare enhanced across
period
§ Good producer buy-in to drive
change
results

51. § Antibiotic reduction essential to reduce AMR
§ But animal welfare must not be compromised
§ Essential to have clear standards but farmers
must be supported to deliver change
§ Peer benchmarking and workshops highly
effective in driving progress
summary

52. Working with supply chains to
support responsible antibiotic
use
Gael O’Neill
Head of Product Safety & Nutrition
Tesco

53. 53
What we’ll cover today
• Brief introduction to Tesco
• Tesco approach to supporting responsible antibiotic use
• Mechanisms for working with our supplychains to deliver on our
commitments
• Case studies to illustrate the approach and what can be achieved
•

54. 54
Our Businesses
460,000
Colleague
s
6,809
Stores
79m
Shopping
trips

55. 55
Tesco UK
310,000
Colleagues
3,500
Stores
“Serving Britain's shoppers
a little better every day”

56. 56
People Products Places
Little Helps Plan
Sourcing
Reduce Food
Waste Health

57. 57
AMR

58. 58
Implementing the recommendations on reducing
agricultural use
Source VMD

59. 59
What did we already have in place?
• We had a policy on antibiotic use based on the RUMA principles
• Minimise the use of antibiotics by encouraging our producers to optimise welfare, health,
hygiene, husbandry and biosecurity of animals
• Where antibiotic use was needed this must be done under veterinary supervision
• We did not allow the use of antibiotics as growth promoters in our supplychains (relevant for
supplychains outside the EU)
• We required that all producers had veterinary health plans in place and antibiotic use was
recorded as part of these
• We assessed compliance with the policy via sector specific, independently audited
welfare standards and welfare outcome measures that included antibiotic use
• We had mechanisms in place for working with our directly with our farmers
• Tesco Sustainable Farming Groups: TSDG & TCG, Beef, Lamb, Pigs, Broilers & Eggs
• Tesco Future Farmer Foundation
• Centres of Excellence

60. 60
We asked ourselves: How can Tesco
better support responsible use of
antibiotics and implementation of
the O’Neill report recommendations?

61. 61
Developing the Tesco Commitments
• Following the publication of the O’Neill report in May 2016 we reviewed our
policy in light of the recommendations
• We began development of a set of commitments that we believed would help
support the sector in enhancing responsible use
• We engaged with a range of stakeholders across the supplychain and beyond
in an iterative process to drive development of the commitments
• In July 2017 we held a workshop with our suppliers, representatives from
agriculture, relevant Government Departments and others to sense-check
them
• Following feedback from that meeting we finalised these and published them
in October 2017
•
https://www.tescoplc.com/little-helps-plan/reports-and-policies/animal-welfare-policy/more-information-on-our-uk-animal-welfare/

62. 62
Tesco Commitments
1. We restrict the use of the highest priority “critically important” antibiotics for human health (fluoroquinolones, 3rd and 4th
generation cephalosporins and colistin)* in our supply chain and make sure these antibiotics are used only as a treatment of last
resort, where no other viable treatment is available to prevent animal welfare issues. We are working with our suppliers to reduce
the use of other critically important antibiotics, including the macrolides
2. We work with our suppliers to make sure there is no unauthorised use of veterinary medicines, including antibiotics, in our
supply chain
3. We do not allow the routine use of antibiotics for prophylactic purposes in our supply chain. Preventative treatment is only
allowed where animals are diagnosed at high risk of bacterial disease, and must only occur under prescription by a veterinarian
on the basis of epidemiological and clinical knowledge
4. We measure antibiotic use in our supply chain. We have made antibiotic usage and records a key feature of our farm audit
programme. Visibility of records of any antibiotic usage at Tesco supplying farms is required to enable us to monitor levels of use
and to help target reduction strategies
5. We will implement the UK species specific targets for antibiotic reduction (as defined by RUMA and the VMD) in our supply
chain. From 2018, once we have sufficient data to establish a baseline, we will make sure that each of our animal sector supply
chains have targeted reduction strategies in place to make sure they meet the specific national target for that species
6. We will help build farmers capability on antibiotic use and animal health in our supply chain, to help them to reduce use without
compromising animal welfare. We will work with our Product Partners, wider suppliers and other bodies to identify the right
educational approaches and the best ways to share this knowledge among farmers.
7. We will support Research and Development (R&D) opportunities that will help drive the reduction of on farm antibiotic use.
With our Product Partners we are already working with the Government Agritech Centres of Innovation to identify R&D
opportunities
8. Progress against our commitments will be published

63. 63
Implementing the Tesco Commitments
• Determine the current status of each species
specific supply chain that supply Tesco own
brand products
• Do they meet the commitments already?
• Where do we need to focus effort to
ensure they meet the commitments?
• Insight from antbiotic use data is key to
deliver
• BUT Suppliers experiencing challenges
should be supported to improve not
penalised
• Determine the key partnerships needed to
implement the commitments in the Tesco
supply chain
• Understand the role that Tesco can make in
supporting the industry in the area
• Our approach is underpinned by
education and training
•

64. 64
Case Studies
Dairy & Broilers

65. 65
Tesco Sustainable Dairy Group
• Since 2007 - work directly with over 600 farmers who supply fresh milk
• All milk is British from herds ranging in size from 60-1800 cows
• We pay guaranteed prices and agree long term contracts
• In 2016 we launched the Tesco Cheese Group to help support dairy farmers who
supply us with milk for our cheese
• This means this year our farming group will expand to around 800 farmers
• We also have the Tesco Dairy Centre of Excellence in partnership with
Liverpool University
• teaching and research resource at a working farm for Tesco farmers, veterinary
surgeons and students
• allows sharing expertise of and knowledge with farming colleagues from across the
country
•

66. 66
TDSG & Responsible Use of Antibiotics
• Has been a focus of the group for many years
• 2011 – regional workshops for our farmers on responsible antibiotic use & introduction of
livestock code of practice with mandatory antibiotic recording of all antimicrobials and CIAs
(FQs, 3rd & 4th Generation cephalosporins)
• 2015 - Updated Livestock code of practice with increased detail of antibiotic recording for
different indications
• 2017 - Introduced requirement for evidence of culture and sensitivity to support any ongoing
use of CIAs.
• Eleven workshops held across the country by University of Liverpool explain the
rational and alternatives available for common treatment scenarios
• Impact of the policy change on antibiotic use was then assessed for us by University
of Liverpool.
• Over the winter of 2017/18 we held focus groups with our Dairy farmers to understand
how they viewed implementing the new requirements

67. 67
Reduction in antibiotic use – University of Liverpool
study
• The median use per farm is now zero – most farms are
not using any CIAs in their cows
• 73% of farms had introduced selective dry cow therapy
• Response from farmers about policy changes was
positive in the majority of cases

68. 68
Reduction of Antibiotic Use in the Broiler Supplychain
• The British Poultry Council has had a highly successful antibiotic stewardship
programme in place since 2011
• In 2017, the sector had achieved an 82% reduction in the net use of antibiotics as
compared to 2012
• The sector produces almost half the meat eaten in the UK but uses only 10% of the
antibiotics licensed for use in food producing animals
• Great overall performance across the sector
But
• We need to understand how our supplychains perform

69. 69
Reduction of Antibiotic Use in the Broiler Supplychain
UK Target for the sector is 25mg/PCU

70. 70
Antibiotic use by Company
70
●Company ●% Change
● A1 ●-70
●A2 ●-81
●A3 ●-41
●B1 ●+39
●B2 ●+600** - low base line value
hence apparently large %
change
●C1 ●-31%
●C2 ●+28%* -low base line value
hence apparently large %
change
●D ●-14
●E ●-21.5
●F ●+36
●G ●+68
●H ●-23
●I ●-50
●G ●-35

71. 71
Large % Reductions still
continue in previously high
users which is driving reduction
in total supply base average
Companies with % increase are
still within supply base average
BUT must evaluate root cause
for increase in use
Apparently large % changes
most notable in
companies/sectors with
smallest absolute values
Trends

72. Questions?

73. Dr Tim Nuttall
RCVS Specialist in Veterinary Dermatology
Head of Dermatology
Antimicrobial stewardship:
how you can make a difference

75. Controlling Antimicrobial Resistance Scotland (CARS)

76. Livestock
Health
Scotland

77. Controlling Antimicrobial Resistance in Scotland
• Intelligence and Surveillance
– AMR - Scottish One Health Antimicrobial Use and AMR Report (SONAAR)
• Second report 12 Nov 2018
– Antimicrobial Usage – veterinary practices and SAVSNET (mySavsnet AMR tool)
– Behavioural Insights - Glasgow Caledonian University
• Education and Engagement
– Scottish Animal Health and AMR Group
– Scottish Veterinary Antimicrobial Prescribing Group
– Scotland’s Healthy Animals website
– Developing and building long term relationships
– Sharing best practice and identifying knowledge gaps
–

78. www.scotlandshealthyanimals.scot

79. Vet-client
interaction
Vet-client
interactionCommunicationCommunication
TrustTrust
AMR
knowledge
AMR
knowledge
Client demandClient demand
Consult timeConsult time
Just in caseJust in case
Practice culturePractice culture

81. Pan European consensus: GRAM book
Treatment diagrams & colour-
coded antibiotic guidance
Sampling, interpretation,
treatment failure & multidrug
resistant infections
Hygiene, pharmacology &
antibiotic resistance

82. Antimicrobial
susceptibility tests
Antimicrobial
susceptibility tests
Post-operative
infections
Post-operative
infections
Clinical
outcomes
Clinical
outcomes
Morbidity and
mortality
Morbidity and
mortality
Review of data by
clinical audit group
Review of data by
clinical audit group
Recommendations by
clinical audit group
Recommendations by
clinical audit group
Record keeping and
data collection
Record keeping and
data collection
Clinical practiceClinical practice
www.liverpool.ac.uk/savsnet/my-savsnet-amr/

83. • AB use reduced by >50 % since 2006
• Delayed effect of MRSP outbreak
• Bottom up process
• Many actors including authorities
involved in stewardship education
• Legal restrictions accelerated trends
• AB use reduced by 10 % since 2012
• Swift effect but less sustained
• Adequate dissemination;
little active implementation
• Few actors involved; no authorities
• Effect most evident where
educational activities performed
Lessons from Scandinavia

84. Getting the message across
Chris Laurence FRCVS
Bella Moss Foundation

85. The blame game
“Doctors are the cause of the problem because they have
dished out antibiotics when patients asked even when they
were not necessary.”
“Vets are to blame because there is far much antibiotic us in
farming and particularly as growth promoters.”
Multi-species and multi-disciplinary group

86. Behaviour change
Motivating change
Behavioural Insights Team
“We use insights from behavioural science to encourage
people to make better choices for themselves and society.”
Consistent message
Simple message
Frequent presentation

88. CANresist

89. © The Business Benchmark on Farm Animal Welfare
2018
Building a business case for AMR
Stewardship
Nicky Amos, Executive Director
Business Benchmark on Farm Animal Welfare
&
Inês Ajuda, Research Manager
Compassion in World Farming

90. © The Business Benchmark on Farm Animal Welfare
2018
Overview
90
How are the world’s
largest food companies
addressing antimicrobial
resistance?

91. © The Business Benchmark on Farm Animal Welfare
2018
Business Benchmark
on Farm Animal
Welfare (BBFAW)
91
Leading global measure of farm animal
welfare management, performance and
disclosure in food companies.
Enables stakeholders to understand
corporate practice and drive
improvements in the welfare of animals
reared for food.

92. © The Business Benchmark on Farm Animal Welfare
2018
BBFAW Aims
92
1. To improve corporate reporting on farm
animal welfare management and
performance.
2.
3. Over time, contribute to tangible
improvements to the welfare of animals
reared for food within company supply
chains.

93. © The Business Benchmark on Farm Animal Welfare
2018
93
BBFAW Resources
2012 - 2017
Annual Report
Assessment Report & Summary
Company Report
https://www.bbfaw.com
BBFAW Website
USD 1.9 tn in AUM
Investor Statement

94. © The Business Benchmark on Farm Animal Welfare
2018
94
BBFAW Coverage: 2017

95. © The Business Benchmark on Farm Animal Welfare
2018
95
BBFAW Methodology: Published
data
Management Commitment & Policy
28% of score
Governance & Management
11% of score
Innovation & Leadership
35% of score
Performance Reporting & Impact
26% of score

96. © The Business Benchmark on Farm Animal Welfare
2018
Tier ranking
96
Companies are ranked into 6 tiers,
where Tier 1 (>80% score) indicates
leadership in farm animal welfare and
Tier 6 (<11% score) indicates no
evidence of farm animal welfare on the
business agenda

97. © The Business Benchmark on Farm Animal Welfare
2018
97
Animal welfare is moving up the business
agenda and is becoming a strategic issue

98. © The Business Benchmark on Farm Animal Welfare
2018
98
Corporate commitments on animal
welfare (BBFAW: 2017)

99. © The Business Benchmark on Farm Animal Welfare
2018
99
Drivers for corporate action
Consumer concern
Legislation NGO/Media campaigns
CSR Agenda

100. © The Business Benchmark on Farm Animal Welfare
2018
100
Companies are increasingly promoting
animal welfare to consumers (BBFAW: 2017)

101. © The Business Benchmark on Farm Animal Welfare
2018
101
Marketing of antibiotics avoidance

102. © The Business Benchmark on Farm Animal Welfare
2018
Performance
Reporting
102
Food companies are beginning
to disclose performance data
on antibiotics use

103. © The Business Benchmark on Farm Animal Welfare
2018
103
So, job done? No.
1. Consumers are being misled about the use of antibiotics in livestock farms –
What does ‘No antibiotics ever’ actually mean?
– Does it apply across the animal’s life cycle?
– Does it apply to a proportion of the supply chain?
– Is it limited to therapeutic use?
2. Adopting a ’no antibiotic’ strategy can be flawed if the underlying conditions in
which animals are reared are not adequately addressed.
– The use of other antimicrobials (e.g. coccidiostats) also have resistance
mechanisms
– The delayed treatment of animals that truly need antibiotics
– Is it simply a traceability exercise, where animals that do not receive antibiotic
treatment are put through an antibiotic-free supply chain?

104. © The Business Benchmark on Farm Animal Welfare
2018
104
Around 130,000 tonnes of
antibiotics are given to food
animals annually. China alone
accounts for 78,000 of these*
“We project that antimicrobial
consumption will rise by 67% by
2030, and nearly double in
Brazil, Russia, India, China, and
South Africa. This rise is likely to
be driven by the growth in
consumer demand for livestock
products in middle-income
countries and a shift to large-
scale farms where antimicrobials
are used routinely.”
Van Boeckel, 2015
* Swiss Federal Institute of Technology ETH Zurich

105. © The Business Benchmark on Farm Animal Welfare
2018
105
Promoting
corporate
antibiotic
stewardshipSource: How to
Develop an
Antibiotics
Stewardship
Programme,
Compassion
in World
Farming
(2018)

106. © The Business Benchmark on Farm Animal Welfare
2018
106
Future management approaches
Work with producers to
define and publish a policy
and action plan, and
commit to report on
progress at least annually
Strategy
Implement
measures to
improve animal
health and
welfare
Implementation
Measure volume, type
and use of antibiotics
against baseline and
industry benchmarks
Measurement
Report data and
performance trends and
publish clear consumer
communications
Reporting & Communications

107. © The Business Benchmark on Farm Animal Welfare
2018
107
Waitrose Antibiotics Management
vFormed cross-species Responsible Animal Health Group to share
best practice.
vCritically important antibiotics (CIAs) are rarely prescribed and
Waitrose supply chains never use Colistin to treat livestock.
vAll own label supply chains are working with urgency towards
continuous and significant year on year reductions in usage of all
antibiotics and have pledged to end the use of all CIAs as soon as
possible.
vWaitrose supply chains are focusing on the collation of antibiotic
usage data for all livestock and aquaculture and are placing greater
emphasis on preventative screening for disease and the use of
vaccination to prevent disease occurring.

108. © The Business Benchmark on Farm Animal Welfare
2018
BBFAW 2018
published
February 2019
108
150 companies assessed
across 23 countries.
For more information contact
secretariat@bbfaw.com

109. Richard Griffiths
Chief Executive
British Poultry Council
Leadership on
responsible use
of antibiotics

110. What does
leadership look
like?

111. Over a billion
birds are reared
for food every
year, providing
half the meat
that the country
eats.

112. British Food
Values
Set us apart from the
rest of the world
Nurture the trust and
confidence that our
consumers have in our
food

114. 2012 – 2017

115. • Our drive for excellence in bird health and
welfare is delivering responsible use of
antibiotics and safeguarding their efficacy
across the supply chain.
• Our farmers need antibiotics in their toolbox
to preserve the health and welfare of our
birds.
• Antibiotic therapies are used with good
animal husbandry techniques, ‘only when
necessary’, and under the direction of a
veterinarian, to protect the health and
welfare of birds under our care.
Responsible
food
production

116. THANK YOU

117. Cornwall Antimicrobial Resistance
Group & Cornwall Veterinary
Association Dairy Antibiotic
Benchmarking
Neil Powell
neil.powell2@nhs.net
Consultant Antimicrobial Pharmacist
Royal Cornwall Hospital Trust

118. Cornwall Antimicrobial Resistance Group
•Set up in response to the UK Five Year Resistance
Strategy 2013 – 2018
•One Health group to deliver the national AMR strategy
locally in Cornwall.
•Primarily to facilitate primary and secondary care
antimicrobial stewardship in response to escalating
Clostridium difficile-associated diarrhoea.
•Representing environmental, animal and human health
in Cornwall.
•The inaugural CARG convened 23rd January 2014.
•

119. It focusses activities around 3
strategic aims:
• improve the knowledge and
understanding of AMR,
• conserve and steward the
effectiveness of existing
treatments
• stimulate the development
of new antibiotics,
diagnostics and novel
therapies

121. Antibiotic consumption and benchmarking
• AMR Fingertips – human antibiotic consumption
• Animal antibiotic consumption – VARRS report
•

122. •

124. VARSS
•“What about Cornwall?”
• “Well, which sector? Dairy probably the biggest sector
in Cornwall”
• “Lets look at that then. How?”
• “Vets are not going to want to extract data and will not
give it to you”
• “OK, lets ask them”

125. Cornwall Veterinary Association
• Meeting June 2017 sponsored by Zoetis and invited all large
animal vet practices (13)
• Eight practices reps attended and the initiative (benchmarking
antibiotic use) was well supported and all pledged to send
data.
• Four practices submitted data.

129. August 2018
• Through CVA arranged a meeting again kindly
sponsored by Zoetis and attended by Jenny Bellini
and Max from Friars Moor in Dorset.
• Promoted Friars Moor’s work
• Discussed the Red Tractor rules
• Discussed data submission
• Widely agreed a useful exercise (bench marking)
• Work with Zoetis to reduce HP-CIAs and total
antibiotic use.

130. The Grand Plan
• Bench mark vet practices
• Practices to reflect on their usage
• Develop strategies to reduce antibiotic use
•Teat sealants - uptake low
•Optimise vaccine use
•Improve animal housing
• Maybe look at the work Lisa Morgans has done with farmers
and do the same with vets - ask vets in Cornwall to come up
with their own ways to reduce antibiotic use
• Thanks to Ben Hutley and the CVA, Zoetis, Lisa Morgans.
•

131. Responsible antimicrobial
use in dairy practice
Gwen Rees MRCVS

132. Outline
• Who is responsible?
• Medicine resources
• Prescribing behaviours
• Conclusions
• Case study: Langford Farm Practice

133. Who’s responsible?
• Vets are the gatekeepers
• Prescribe to “animals under their care”
• Clinical assessment Diagnosis Prescription
• Ultimately responsible for POM-V use
• Not just dispensers!
HOWEVER
• Farmers are often the main users
• Partial compliance is a common challenge1
1SAWANT, A. A., SORDILLO, L. M. & JAYARAO, B. M. 2005. A Survey on
Antibiotic Usage in Dairy Herds in Pennsylvania. Journal of Dairy Science,
88, 2991-2999.

134. Who’s responsible?
• Majority of POM-V administered
in the absence of the prescribing vet
• Farmers will use the medicine resources available to
them
• Dairy farmers want more information about
responsible antimicrobial use
• Vets are not seen to be delivering on this front

135. Medicine resources
• Dairy farms store varying amounts
of antimicrobial
• Dairy farms store expired
antimicrobials
• Dairy farms store HP-CIAs
• Storage practices vary widely
between farms

136. Medicine Storage

139. Prescribing behaviour
• Uncertainty drives risk-averse antimicrobial use
• Each farm is perceived by the farmer as unique
and requiring tailored medicine advice
• Trust between vet and farmer is vital
• Protocols reduce autonomy but also reduce
uncertainty
• Treatments are often given because they
represent positive action
•

140. Conclusions
• Dairy farmers want more training on medicine use
• Developing bespoke treatment protocols improves
responsible use
• Vets need to take more responsibility for the medicines
they prescribe to a farm
• Use of off-license and expired medicines needs reviewing

141. Case Study – Langford Farm Practice
• University farm teaching practice
• Aimed to phase out use of HP-CIAs
• Practice-wide policy change
• Collaborative and participatory
• Multi-faceted approach

142. 2012
■ Farmer workshops
■ Changed prescribing
policy for CIAs
■ Scoping options for
medicines audits
■
Thebeginning…
■ Active HHM
■ Building partnerships
■ First-line treatments
■ Halted FQ use
2011
■ First-line treatments
■ Focussed reduction
of use of 3rd/4th
gen
cephalosporins

143. 2015
■ Medicines
audits*
2013
■ Farmers meetings
■ Medicines audits*
■ Medicines auditing
tool
development
■ Integration into
HHM
2014
■ Farmers meetings
■ Progress update
■ Medicines audits*
■ Medicines auditing
tool refinement
* Integrated into farm animal elective teaching

144. Major changes AM policy
• Fluoroquinolone use stopped
• Intramammary use
• 4th gen cephs phased out in favour of penicillins and aminoglycoside combinations
• Systemic use
• 3rd gen cephs substituted with 1st gen or aminopenicillins
• Calf pneumonia
• Treated with oxytetracycline or florfenicol, replacing the longer-acting macrolides
•

145. What did we measure?
• Farm level
• Animal Daily Doses (ADD)
• Courses per animal year at risk
• Economic measures (ppl)
•
• Practice level
• Total mg
• Health Measures
• Fertility
• Mastitis
• Lameness
•
• Medicine use
• NSAIDs
• Teat sealants
•

146. ResultsResults

148. 91% reduction in
systemic use of CIAs
82% reduction in the
total use of CIAs
100% reduction in
intra-mammary use of
CIAs
No perceived or actual
reduction in treatment
outcomes or farm
animal health

149. Conclusions
• Farm clients have been consistently positive about tackling the
issue of AMR in partnership with the practice.
• Reduction/cessation of HP-CIA use is possible without negative
health or economic effects
• Measuring and monitoring use is essential part of good
antimicrobial stewardship
• Medicines auditing should be incorporated into all herd health
planning
•
•

150. 150

151. abagri.com

152. abagri.com
Driving commercial food productivity
through focus on livestock health
Experience of a piglet feed manufacturer
Dr Ian Wellock
Primary Diets , AB Agri, ABF

153. abagri.com
AB Foods and AB Agri
Who are we?

154. SUGAR
AGRICULTURE
INGREDIENTS
RETAIL
GROCERY

155. AB Agri is a unique
community of leading
agricultural businesses
operating across the entire
agri-food supply chain.
Our focus is on sustainable
food security, safety,
efficiency delivered by
driving the use of
technology and metrics
across supply chains.
AB Agri

156. •
Providing nutritional feedstuffs in the UK to
• 7 in every 10 pigs
• 1 in 2 chickens
• 1 in 3 pints of milk
•
•
•
•
A unique community of leading agricultural businesses

157. abagri.com
AMR – a global and
highly complex challenge

158. abagri.com
“Some problems are so
complex that you have to
be highly intelligent and
well informed just to be
undecided about them.”
Dr Laurence J. Peter (1919-1990)

159. abagri.com
Primary Diets
antibiotic use in UK
piglet feed
Recent rapid reduction
-24%

160. abagri.com
Feed becomes food
Healthy animals to good quality safe food
Nutrient content
(variability)
Production method
Raw materials
EU Feed
Livestock in EU-27
consume ≈ 467
million tones of
feed/year
≈150 million tonnes
produced by feed
manufacturers
Livestock
Genetics
Farm management
Health
Quantity Quality Safety
Economic cost Perception
Environmental footprint
Traceability Food security
Effect on human health
Feed Food
(meat, fish, milk, eggs)

161. abagri.com
Feed becomes food
Healthy animals to good quality safe food
Nutrient content
(variability)
Production method
Raw materials
EU Feed
Livestock in EU-27
consume ≈ 467
million tones of
feed/year
≈150 million tonnes
produced by feed
manufacturers
Livestock
Genetics
Farm management
Health
Quantity Quality Safety
Economic cost Perception
Environmental footprint
Traceability Food security
Effect on human health
Feed Food
(meat, fish, milk, eggs)
Antibiotics
Injection
Water

162. abagri.com
Potential impact of reduced antibiotic use
- Poorer health, welfare, growth and increased cost
Decreased health
Antibiotics
Mortality
Welfare
Cost of productionGrowth
Efficiency of nutrient use
(sustainability)

163. abagri.com
A healthy animal is a commercially productive animal
- With less need for antibiotics
Increased health
Antibiotics
Mortality
Welfare
Growth
Efficiency of nutrient use
(sustainability)
Cost of production

164. abagri.com
1. You can’t manage what you don’t measure
– Introduction of eMB
2.
3. Influencing animal health (and productivity) through nutrition
– Continued R&D
4.
5. Existing ingredients used differently and new ingredients are part of the solution
– Introduction of superdosing phytase
6.
7. Working closely with partners on the supply chain
– Not a one size fits all
8.
9.
A high livestock health status industry is a commercially competitive one
(and likely to need fewer antibiotics)! Challenge is how to seize the opportunity
10.
11.
12.
Reducing reliance on antibiotics
Feed plays an important role

165. abagri.com
1. Successful introduction of eMB
- You can’t manage what you don’t measure
Antibiotic usage on pig farms
dropped from 183 mg/PCU to 131
mg/PCU within 12 months
The 2017 reduction means the
pig industry has more than
halved its antibiotic usage
within the last two years
34 per cent cut in usage
between 2015 and 2016
183
mg/PCU
131
mg/PCU
Antibiotic use
1/2 34%Cut between
‘15-’16

166. abagri.com
2. R&D to improve animal health & productivity
- Understanding nutrition's role in supporting health
NIR spectra Ingredients
matrix
Latest requirements

167. abagri.com
• Feeding for health
– Understand and manipulate immune responses (costly to ‘feed’)
– Inhibiting pathogens
– Feeding the gut and its microflora
•
•
•
2. R&D to improve animal health & productivity
- Understanding nutrition's role in supporting health

168. abagri.com
• >10 trials conducted at University of Leeds (2007-2010)
– Superdose (>1250 FTU) levels of phytase improves performance
–
• Launched commercially in UK (2010), Europe, Asia, and US (2011-)
•
• Further R&D insight (2011-)
– Extra phosphoric effects of phytase (more than just P-release)
– Lowers acid/mucin production (lowers AA and energy cost)
– Generation of myo-inositol
– Restoration of P/Ca proportionate release
–
• Migrated into other species (turkey and broiler)
• Other feed companies adopting (2012-)
•
•
•
•
•
3. Existing ingredients used differently
- Superdosing phytase lead to unexpected benefits

169. abagri.com
• Improved Performance1
– +6% ADG, -4% FCR
•
• Lower diet costs1
– Ability to use higher levels of soya
•
• Decreased cost of production2
– -12% cost/kg gain
•
• Decreased environmental cost3, 4
– Lower P and heavy metal (Cu, Fe, Zn) excretion /
pollution
•
• Improved health and welfare4, 5
– Less post wean scour and increased bone strength
•
• Less reliance on ZnO1,6 (and antibiotics?)
•
3. Existing ingredients used differently
- Superdosing phytase lead to unexpected benefits
Zn excretion (ppm/g faeces) in weaner pigs4
- 19.3%
Phytase
Zn
Improved ADG 6.3%
80% success rate
Improved ADG 6.3%
80% success rate
1Walk et al., 2014, 2015; 2internal data; 3Ledoux & Walk, 2006,
4Walk et al., 2013; 5Santos et al., 2013; 6Wellock et al., 2014

170. abagri.com
4. Reducing use of antibiotics
- Working in partnership

171. abagri.com
4. Reducing use of antibiotics
- Working in partnership

172. abagri.com
• Supportive and enabling regulatory landscape
– Understanding solutions before removing existing aids (e.g. Cu)
– ‘Health benefit’ claims
• A shared industry vision
– From academia to retailer
– Appropriate antibiotic use not minimal use
•
•
•
Future solutions to reduce reliance on medication
- Maximising our potential

173. abagri.com
In summary

174. abagri.com
• The ‘food’ supply chain must work together to reduce reliance on antibiotics
• A healthy animal is a productive and efficient animal less likely to require antibiotics
• The feed industry is playing an important role in decreasing the use and need for
antibiotics
– Monitoring and measuring
– R&D to understand better animal health
– Close co-operation with pig producers
– Partnerships with industry bodies and government
•
•
•
•
Summary

175. abagri.com
Thank you
Dr Ian Wellock
ian.wellock@abagri.com