A framework for improved one health governance and policy making for antimicrobial use

The urban political ecology of antimicrobial resistance: A critical lens on integrative governance

The objective of this paper is to integrate Urban Political Ecology (UPE) as a theory for identifying under-exposed urban dimensions of Antimicrobial Resistance (AMR). A UPE lens allows us to conceptualize urbanization as a ubiquitous socio-ecological process and an interpretive frame that could inform AMR governance strategies across related contexts by: a) situating AMR risks in relation to urbanization processes shaping social and political co-determinants of such systemic threats as climate change; b) aligning UPE scholarship with One Health (OH) approaches that address AMR to reveal the under-exposed link of AMR to environmental threats and broader structural dimensions that influence these threats; and c) identifying shared AMR and environmental governance pathways that inform the rationale for more equitable governance arrangements. We delineate a context in which the speed and scale of human activity in the larger context of urbanization, driven by global market integration strategies, impacts human-animal-environmental health threats such as AMR. We demonstrate how UPE scholarship can be leveraged to offer theoretical depth to approaches considering the interdependencies of AMR and climate change threats. We then propose a strategic approach focused on identifying shared governance pathways and intersectoral accountability frameworks to address upstream structural drivers of AM-Environmental threats. The co-benefits of a UPE-informed framework to human-animal-environmental health that leverages enabling policy environments to foster a more collaborative, equitable and sustainable approach to address systemic global health threats are clarified. Just as the concept of "health in all policies" emphasized taking health implications into account in all public policy development, the integration of UPE in AMR governance arrangements would emphasize the need to take other sectors into account through an intersectoral whole-of-government approach that fosters shared AMR - climate change governance pathways.

Toward One Health: a spatial indicator system to model the facilitation of the spread of zoonotic diseases

Recurrent outbreaks of zoonotic infectious diseases highlight the importance of considering the interconnections between human, animal, and environmental health in disease prevention and control. This has given rise to the concept of One Health, which recognizes the interconnectedness of between human and animal health within their ecosystems. As a contribution to the One Health approach, this study aims to develop an indicator system to model the facilitation of the spread of zoonotic diseases. Initially, a literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to identify relevant indicators related to One Health. The selected indicators focused on demographics, socioeconomic aspects, interactions between animal and human populations and water bodies, as well as environmental conditions related to air quality and climate. These indicators were characterized using values obtained from the literature or calculated through distance analysis, geoprocessing tasks, and other methods. Subsequently, Multi-Criteria Decision-Making (MCDM) techniques, specifically the Entropy and Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) methods, were utilized to combine the indicators and create a composite metric for assessing the spread of zoonotic diseases. The final indicators selected were then tested against recorded zoonoses in the Valencian Community (Spain) for 2021, and a strong positive correlation was identified. Therefore, the proposed indicator system can be valuable in guiding the development of planning strategies that align with the One Health principles. Based on the results achieved, such strategies may prioritize the preservation of natural landscape features to mitigate habitat encroachment, protect land and water resources, and attenuate extreme atmospheric conditions.

The Marginal Abatement Cost of Antimicrobials for Dairy Cow Mastitis: A Bioeconomic Optimization Perspective

Maintaining udder health is the primary indication for antimicrobial use (AMU) in dairy production, and modulating this application is a key factor in decreasing AMU. Defining the optimal AMU and the associated practical rules is challenging since AMU interacts with many parameters. To define the trade-offs between decreased AMU, labor and economic performance, the bioeconomic stochastic simulation model DairyHealthSim (DHS)© was applied to dairy cow mastitis management and coupled to a mean variance optimization model and marginal abatement cost curve (MACC) analysis. The scenarios included three antimicrobial (AM) treatment strategies at dry-off, five types of general barn hygiene practices, five milking practices focused on parlor hygiene levels and three milk withdrawal strategies. The first part of economic results showed similar economic performances for the blanked dry-off strategy and selective strategy but demonstrated the trade-off between AMU reduction and farmers' workload. The second part of the results demonstrated the optimal value of the animal level of exposure to AM (ALEA). The MACC analysis showed that reducing ALEA below 1.5 was associated with a EUR 10,000 loss per unit of ALEA on average for the farmer. The results call for more integrative farm decision processes and bioeconomic reasoning to prompt efficient public interventions.

Economic evaluation of antimicrobial use practices in animal agriculture: a case of poultry farming

Background

The growing evidence of the contribution of antimicrobial use (AMU) in animal agriculture to the public health threat of antimicrobial resistance has highlighted to policymakers the importance of the need for prudent AMU in animal production. Livestock farming is an economic process, where farmers are using inputs such as antimicrobials to minimize their losses.

Objectives

Using a large and unique dataset combining time-series data on economic performance and health records in conventional broiler production in France, we identify how improved healthcare management and disease prevention impact economic performance, AMU reduction and health outcomes.

Methods

We analyse the main characteristics of the economic performance of farms measured by the profit per m², by performing advanced regression models investigating the relative importance of medication and veterinary procedures.

Results

In our study, 50% of the treatments (expressed as number of new treatments) are attributable to only 30% of all flocks. There is an inverted U-shaped relationship between AMU and economic performance. This finding implies that the marginal profit of antimicrobials is decreasing, meaning that using antimicrobials is only profitable up to a certain threshold. Results also show that the profit increases as the number of preventive treatments increase.

Conclusions

Our findings suggest that policies encouraging farmers to work upstream from the occurrence of disease have the potential to perform better than regulations, as they would maintain a profitable activity while diminishing AMU. Encouraging adequate infection control practices by subsidizing or providing other incentives would benefit farmers and society.

Ethical health security in the age of antimicrobial resistance

OBJECTIVE

Owing to its potential human, social and economic costs, antimicrobial resistance (AMR) is frequently referred to as a threat to health security. Simultaneously, health security and the preservation of antimicrobials are often described as a global public good. However, how the term 'public good' is used in the context of health security, and the values that underpin it, remains ambiguous. Policymaking is never value-free, and a better examination of such values is critical to understanding how issues such as AMR are problematised and how policy decisions are informed.

DESIGN

We used McDougall's version of critical interpretive synthesis to capture the recurring concepts and arguments within public policy, political science and applied ethics literature on AMR. Articles were analysed by identifying recurring ideas and developing themes across the literature.

RESULTS

A total of 77 papers were included in our review. In the context of health security and AMR, the concept of 'public good' appears to be used interchangeably with 'common good', reflecting confusion, but sometimes meaningful differences, regarding how antimicrobials, as a good, are conceived. Main approaches to addressing AMR are statism, globalism and regionalism, which appeal to different values in guiding policymakers. Common justificatory values underpinning preservation of antimicrobials as a public good were prevention of harm, solidarity, justice and rights.

CONCLUSION

The findings suggest that within the literature there is a lack of conceptual clarity as to whether antimicrobials constitute a public good or a common good. Moreover, the way in which antimicrobials are conceived and the approaches through which AMR as a threat to health security is addressed appear to be grounded in values that are often implicit. Being explicit about the values that underpin AMR and health security is not simply an intellectual exercise but has very real policy and programmatic implications.

Reducing Antimicrobial Use and Dependence in Livestock Production Systems: A Social and Economic Sciences Perspective on an Interdisciplinary Approach

Objective: In livestock production, antimicrobial resistance (AMR) is considered an externality as it is the undesired result of preventive and curative antimicrobial use. To address this biosocial issue, our objective is to present an approach based on interdisciplinary research to develop strategies and policies that aim to contain AMR.

Method: To do so, we addressed three fundamental questions on which control policies and strategies for agricultural pollution problems are centered in the light of AMR. To ensure the technical, economic, behavioral and political feasibility of the developed measures, we demonstrated the usefulness of systemic approaches to define who, what and how to target by considering the complexity in which the ultimate decision-maker is embedded. We then define how voluntary or compulsory behavioral change can be achieved via five routes, introducing a clear taxonomy for AMR Interventions. Finally, we present three criteria for ex-ante analysis and ex-post evaluation of policies and strategies.

Conclusion: Interdisciplinary systemic approaches enable the development of AMR policies and strategies that are technically, politically, economically and, last but not least, behaviorally feasible by allowing the identification of (a) all actors influencing AMU in livestock production, (b) power relations between these actors, (c) adequate regulatory and intervention bases, (d) what behavioral change strategy to use, (e) whom should implement this, as well as the cost-effective assessment of combinations of interventions. Unfortunately, AMR policies and strategies are often investigated within different disciplines and not in a holistic and systemic way, which is why we advocate for more interdisciplinary work and discuss opportunities for further research.

Effect of Urban Wastewater Discharge on the Abundance of Antibiotic Resistance Genes and Antibiotic-Resistant Escherichia coli in Two Italian Rivers

Background: Wastewater treatment plants (WWTPs) are microbial factories aimed to reduce the amount of nutrients and pathogenic microorganisms in the treated wastewater before its discharge into the environment. We studied the impact of urban WWTP effluents on the abundance of antibiotic resistance genes (ARGs) and antibiotic-resistant Escherichia coli (AR-E. coli) in the last stretch of two rivers (Arrone and Tiber) in Central Italy that differ in size and flow volume. Methods: Water samples were collected in three seasons upstream and downstream of the WWTP, at the WWTP outlet, and at sea sites near the river mouth, and analyzed for the abundance of ARGs by qPCR and AR-E. coli using cultivation followed by disk diffusion assays. Results: For all studied genes (16S rRNA, intI1, sul1, ermB, blaTEM, tetW and qnrS), absolute concentrations were significantly higher in the Tiber than in the Arrone at all sampling sites, despite their collection date, but the prevalence of target ARGs within bacterial communities in both rivers was similar. The absolute concentrations of most ARGs were also generally higher in the WWTP effluent with median levels between log 4 and log 6 copies per ml but did not show differences along the studied stretches of rivers. Statistically significant site effect was found for E. coli phenotypic resistance to tetracycline and ciprofloxacin in the Arrone but not in the Tiber. Conclusions: In both rivers, diffuse or point pollution sources other than the studied WWTP effluents may account for the observed resistance pattern, although the Arrone appears as more sensitive to the wastewater impact considering its lower flow volume.

The Governance of UK Dairy Antibiotic Use: Industry-Led Policy in Action

This article analyses the progress made in the UK with regard to tackling antibiotic "misuse and overuse" in food-producing animals. Moving beyond statistical realities, the paper examines how the UK's industry-led policy approach is shaping practice. Using a multi-sited ethnography situated in Actor Network Theory and Callon's sociology of markets, the UK dairy supply chain policies and practices were studied. Findings reveal that dairy industry policies only partially address the complex network of people, animals, and the environment in which dairy antibiotics circulate. Antibiotic "misuse and overuse" in agriculture is far from a behavioural matter, with solely farmers and veterinarians to blame. Instead, antibiotic use in food animals is embedded in complex economic networks that constrain radical changes in dairy husbandry management and antibiotic use on farms. More attention toward the needs of the dairy supply chain actors and wider environmental considerations is essential to reduce the dairy sector's dependency on antibiotics and support transition toward responsible farming in the UK.