Antimicrobial resistance: preventive approaches to the rescue? Professional expertise and business model of French "industrial" veterinarians

Demedication without demedicalization? Redefining the medical and economic boundaries of veterinary professional jurisdiction

Veterinarians' professional jurisdiction is nowadays facing major challenges. Regulatory changes in the prescribing and dispensing of medicines, which have historically been at the heart of veterinary jurisdiction, could fragilize the medical power of this professional group. This article analyses the practices and strategies deployed by veterinarians to preserve and readapt their jurisdiction, by discussing recent work in sociology of professions and reflecting on how the case of veterinarians could help rethink the contrasting case of human doctors. This article is based on two field studies in France (in diverse livestock sectors) made of more than 40 interviews and 70 h of ethnographic observation of veterinary activity. We first show how veterinarians' jurisdiction over medicines was built up and how their professional autonomy is put under pressure by recent injunctions to demedicate livestock and to develop preventive approaches to animal health. We then detail how the economic and medical boundaries of veterinary jurisdiction are being redefined through dynamics of protocolization and contractualization of care which allow veterinarians to impose themselves as health managers. Finally, we demonstrate that this situation favors the emergence of new forms of professional legitimacy based on an "evidence-based veterinary medicine" that their competitors cannot contest, and on the development of economic infrastructures that supports and makes it possible to monetize this new professional expertise. Finally, this article discusses contemporary processes of medical professionalization. It argues that, unlike human medicine, veterinary medicine has been able to maintain its professional power even if its historical jurisdiction has been reshaped. This has required a redefinition of professional activity both as a medical (i.e. approaches to animal health) and economic (i.e. business model of veterinary companies) practice.

A participatory approach for building ex ante impact pathways towards a prudent use of antimicrobials in pig and poultry sectors in France

Antimicrobial resistance (AMR) is a global public health threat responsible for 700,000 deaths per year worldwide. There is scientific evidence of the causal relationship between antimicrobial use (AMU) along the food chain and AMR. Improving AMU in livestock is therefore a key component in the fight against AMR. To improve AMU in livestock, there is no one-size-fits-all solution and strategies must be context-adapted and socially acceptable for actors in order to increase AMU sustainability. AMU decision-making is based on an interdependent set of economic, behavioral, ethical, and cultural factors that need to be assessed to advise on the potential impacts of measures. We hypothesized that a participatory strategic planning approach may increase the plausibility and the efficacy of the strategies formulated by facilitating the dialogue between actors of diverse backgrounds, stimulating innovative thinking and constant considerations of contextual factors, actors and impacts. We adapted and applied the ImpresS ex ante approach (IMPact in reSearch in the South, https://impress-impact-recherche.cirad.fr/) within a Living Lab engaging actors from the French pig and poultry sectors in co-creation of innovative strategies towards improved AMU. We conducted semi-structured interviews and participatory workshops between April 2021 and March 2022. The results describe 1) an initial diagnosis of the current AMU situation in the pig and poultry sectors in France; 2) a common vision of the future to which participants would like to contribute through the intervention; 3) an identification of the current problems opposed to this vision of the future; 4) a defined scope of the intervention; 5) a typology of actors protagonist or impacted by those issues and 6) outcome maps to solve a priority problem related to indicators and monitoring. This study provides recommendations for decision-makers on plausible and innovative strategies to sustainably improve AMU in pig and poultry sectors in France and evidence of the benefits of participatory strategic planning approaches.

Knowledge, Attitudes, and Practices of Community Pharmacy Professionals on Poultry Antibiotic Dispensing, Use, and Bacterial Antimicrobial Resistance in Zambia: Implications on Antibiotic Stewardship and WHO AWaRe Classification of Antibiotics

Globally, the inappropriate dispensing and use of antibiotics in animals has contributed to the development of bacterial antimicrobial resistance (AMR). In Zambia, there is insufficient information among community pharmacy professionals on antibiotic use (ABU) and AMR in food-producing animals. This study assessed community pharmacy professionals' knowledge, attitudes, and practices regarding poultry antibiotic dispensing, use, and bacterial AMR in the Lusaka district of Zambia. A cross-sectional study was conducted among 178 community pharmacy professionals between February and April 2022 using a semi-structured questionnaire. Data were analyzed using Stata version 17. Of the total participants (n = 178), 51.1% (n = 91) were pharmacists. The most dispensed antibiotic was oxytetracycline, a Watch antibiotic, mainly without prescriptions. Good knowledge of ABU and AMR was associated with work experience for more than one year (p = 0.016), while good practices were associated with male gender (p = 0.039) and work experience of more than one year (p = 0.011). The study found moderate knowledge, positive attitudes, and moderate practices of pharmacy professionals on poultry ABU and AMR. There was high dispensing of poultry antibiotics without prescriptions, which calls for strict implementation of antimicrobial stewardship and surveillance programs in poultry production in Zambia to reduce AMR.

Access to Veterinary Drugs in Sub-Saharan Africa: Roadblocks and Current Solutions

Background

Access to veterinary drugs for livestock has become a major issue over the last decade. Analysis has tended to focus on the demand for these products, while studies looking at the drivers behind their use generally focus on farmer behavior and interactions between veterinarians and farmers. However, the use of drugs also depends on structural factors that determine the functioning of the drug supply chain and farmers' access to the drugs. This article presents an overview of the factors that limit access to veterinary drugs in sub-Saharan Africa (SSA) as well as the international policy tools and arrangements that claim to improve it.

Methods

We have conducted a scoping review of the scientific and grey literature as well as the publicly-available data from both the animal health industry and international organizations. We aimed to gather information on the veterinary drugs market in SSA as well as on the international norms, recommendations, guidelines, and initiatives that impact SSA farmers' access to these drugs.

Findings

We highlight numerous barriers to veterinary drug access in SSA. The SSA market is highly dependent on imports, yet the region attracts little attention from the international companies capable of exporting to it. It suffers from a high level of fragmentation and weak distribution infrastructures and services, and is driven by the multiplication of private non-professional actors playing a growing role in the veterinary drug supply chain. The distribution system is increasingly dualized, with on the one hand the public sector (supported by development organizations) supplying small scale farmers in rural areas, but with limited and irregular means; and on the other side a private sector largely unregulated which supplies commercial and industrial farming systems. Different innovations have been developed at the international and regional levels to try to reduce barriers, such as homogenizing national legislations, donations, and vaccine banks. Alongside decades-old inter-state cooperation, many new forms of public-private partnerships and other hybrid forums continue to emerge, signaling the private sector's increasing influence in global governance.

Conclusions

Policies on animal health would be bolstered by a better understanding of the drivers behind and the components of access to veterinary drugs in different regional and national contexts. Inequalities in drug access need to be addressed and a market-driven approach adopted in order to strengthen our understanding of what determines veterinary drug use at the farm level. Policies should balance the interests of the various stakeholders, being careful not to reinforce bias toward certain diseases deemed "interesting" and neglect others that could prove to be highly important for veterinary public health.

Veterinary Herd Health Consultancy and Antimicrobial Use in Dairy Herds

The globally increasing level of antimicrobial resistance affects both human and animal health, why it is necessary to identify ways to change our current use of antimicrobials. The veterinary herd health collaboration between veterinarians and dairy farmers provides a useful setting for changing antimicrobial use in livestock. However, farmers and veterinarians work in a complex agricultural setting influenced by socio-economic factors, which complicates their choices regarding antimicrobial usage. It is therefore necessary to be aware of the range of potential influencing factors and to integrate this knowledge in the relevant local settings. This manuscript presents a literature review of relevant factors relating to antimicrobial use within the veterinary herd health consultancy setting, including knowledge gaps of relevance for changing the use of antimicrobials. An enriched version of the framework of the Theory of Planned Behaviour was used to organise the literature review. We identified diverging attitudes on correct treatment practices and perceptions of antimicrobial resistance among veterinarians and farmers, influenced by individual risk perception as well as social norms. Furthermore, disagreements in terms of goal setting and in the frequency of herd visits in relation to herd health consultancy can negatively influence the collaboration and the intention to change antimicrobial use. Farmers and veterinarians emphasise the importance of legislation and the role of the dairy industry in changing antimicrobial use, but the relevance of specific factors depends on the country-specific context. Overall, farmers and veterinarians must communicate better to understand each other's perspectives and establish common goals within the collaboration if they are to work efficiently to reduce antimicrobial use. Farmers and veterinarians both requested changes in individual behaviour; however, they also called for national and structural solutions in terms of balanced legislation and the availability of better diagnostics to facilitate a change in antimicrobial use practices. These various paths to achieving the desired changes in antimicrobial use illustrate the need to bridge methodological research approaches of veterinary science and social sciences for a better understanding of our potential to change antimicrobial use within the dairy farm animal sector.

"They've got to be testing and doing something about it": Farmer and veterinarian views on drivers for Johne's disease control in dairy herds in England

There needs to be an understanding of the reasons why key stakeholders engage in disease control efforts if disease is to be successfully and sustainably controlled. It is increasingly recognised within veterinary epidemiology and policy making in animal health that these 'people factors' are important influences on the success or otherwise of animal disease control programmes. Research methodologies adopted from the social sciences offer ways to understand this important dimension through investigating the attitudes and opinions of the key actors involved. The study reported in this paper, based on qualitative interview research, investigates the views of dairy farmers and cattle veterinarians on the drivers and incentives for controlling Johne's disease in English dairy herds. Twenty semi-structured interviews involving 17 dairy farmers and seven veterinarians were conducted in two dairy-intensive regions of England. The findings demonstrate the varied influences of veterinary advice and encouragement; appreciation of the economic cost of the disease at herd level; a voluntary national control plan; and fear of a future consumer food scare as the main reasons to engage in Johne's disease control on dairy farms. The study demonstrates how a combination of a voluntary industry-led control scheme, compulsory participation through retailer and processor contractual requirements, and threats of reputational harm and market loss have strongly influenced farmer and veterinary behaviour in relation to Johne's control without statutory involvement. The findings illustrate the importance of considering the political economy and societal impact of animal disease.

Drivers of Antibiotic Use in Poultry Production in Bangladesh: Dependencies and Dynamics of a Patron-Client Relationship

Background: There is increasing concern around the use of antibiotics in animal food production and the risk of transmission of antimicrobial resistance within the food chain. In many low and middle-income countries, including Bangladesh, the commercial poultry sector comprises small-scale producers who are dependent on credit from poultry dealers to buy day-old chicks and poultry feed. The same dealers also supply and promote antibiotics. The credit system is reliant upon informal relationships among multiple actors as part of social capital. This paper aims to describe dependencies and relationships between different actors within unregulated broiler poultry production systems to understand the social and contextual determinants of antibiotic use in low-resource settings. Methods: We used a cross-sectional qualitative design including in-depth interviews among purposefully selected commercial poultry farmers (n = 10), poultry dealers (n = 5), sales representatives of livestock pharmaceutical companies (n = 3) and the local government livestock officer as a key-informant (n = 1). We describe the food production cycle and practices relating to credit purchases and sales using social capital theory. Findings: Poultry dealers provide credit and information for small-scale poultry farmers to initiate and operate their business. In return for credit, farmers are obliged to buy poultry feed and medicine from their dealer and sell their market-ready poultry to that same dealer. All farms applied multiple antibiotics to poultry throughout the production cycle, including banned antibiotics such as colistin sulfate. The relationship between dealers and poultry farmers is reciprocal but mostly regulated by the dealers. Dealers were the main influencers of decision-making by farmers, particularly around antibiotic use as an integral part of the production cycle risk management. Our findings suggest that strategies to improve antibiotic stewardship and responsible use should exploit the patron-client relationship which provides the social and information network for small-scale farmers. Conclusion: Social capital theory can be applied to the patron-client relationship observed among poultry farmers and dealers in Bangladesh to identify influences on decision making and antibiotic use. Within unregulated food production systems, strategies to promote the prudent use of antibiotics should target commercial feed producers and livestock pharmaceutical manufacturers as a first step in developing a sustainable poultry value chain.

Drivers of Antibiotic Use in Poultry Production in Bangladesh: Dependencies and Dynamics of a Patron-Client Relationship

Background: There is increasing concern around the use of antibiotics in animal food production and the risk of transmission of antimicrobial resistance within the food chain. In many low and middle-income countries, including Bangladesh, the commercial poultry sector comprises small-scale producers who are dependent on credit from poultry dealers to buy day-old chicks and poultry feed. The same dealers also supply and promote antibiotics. The credit system is reliant upon informal relationships among multiple actors as part of social capital. This paper aims to describe dependencies and relationships between different actors within unregulated broiler poultry production systems to understand the social and contextual determinants of antibiotic use in low-resource settings. Methods: We used a cross-sectional qualitative design including in-depth interviews among purposefully selected commercial poultry farmers (n = 10), poultry dealers (n = 5), sales representatives of livestock pharmaceutical companies (n = 3) and the local government livestock officer as a key-informant (n = 1). We describe the food production cycle and practices relating to credit purchases and sales using social capital theory. Findings: Poultry dealers provide credit and information for small-scale poultry farmers to initiate and operate their business. In return for credit, farmers are obliged to buy poultry feed and medicine from their dealer and sell their market-ready poultry to that same dealer. All farms applied multiple antibiotics to poultry throughout the production cycle, including banned antibiotics such as colistin sulfate. The relationship between dealers and poultry farmers is reciprocal but mostly regulated by the dealers. Dealers were the main influencers of decision-making by farmers, particularly around antibiotic use as an integral part of the production cycle risk management. Our findings suggest that strategies to improve antibiotic stewardship and responsible use should exploit the patron-client relationship which provides the social and information network for small-scale farmers. Conclusion: Social capital theory can be applied to the patron-client relationship observed among poultry farmers and dealers in Bangladesh to identify influences on decision making and antibiotic use. Within unregulated food production systems, strategies to promote the prudent use of antibiotics should target commercial feed producers and livestock pharmaceutical manufacturers as a first step in developing a sustainable poultry value chain.