ECOANTIBIO Containment of Antimicrobial Resistance (AMR): actions and lessons from the Veterinary Sector in France

1. Why fight antibiotic resistance? Antibiotics need to be preserved as a common tool: For human health: Currently, 25,000 deaths per year in the EU (ECDC) and 12,500 deaths per year in France (SantéPubliqueFrance) By 2050: 10 million deaths per year predicted globally (O’Neill report) For animal health For animal welfare For food security: 9 billion people in 2050, demand for animal protein +50% by 2020 Between 2010 and 2030 : AMU increase by 67% (Van Boeckel et.al) For farmers income There are few new antibiotics on the market

2. How to fight antibiotic resistance? Reduce and improve antibiotic use to preserve antibiotics Develop alternative solutions Utilize recommendations set by international authorities Consider AMR as a shared responsibility among private and public stakeholders Implement the One Health approach, which is universal and collaborative: Animal health, human health and ecosystem health are all interdependent

3. The French commitment: the Ecoantibio Action Plan

Ecoantibio is part of the agro-ecological project led by the Ministry of Agriculture «  The agro-ecological project aims to meet many challenges French agriculture is facing: competitiveness, climate change, global health security, preservation of natural resources, food quality and safety, reduced use of chemical inputs »

Five-year objective plan: 2012 - 2016 Ecoantibio1 highlighted that antibiotic use should be: Responsible Cautious Ecoantibio1 set two types of objective: Quantitative objectives: Qualitative objectives: - 25 % animal exposure to antibiotics in 5 years Fluoroquinolones 3rd and 4th generation of cephalosporins

How to reach the objectives? A comprehensive plan which involves all stakeholders

Example of an incentive measure Communication Campaign Targeting Pet owners: « Antibiotics are not automatic for us either » Farmers: « Fed, Housed, Vaccinated »

Examples of 2 Mandatory Measures Restrict the use of critically important antibiotics Objective : avoid the use of critically important antibiotics (CIA) (which should be used only to treat human diseases) whenever other medicine or antibiotics can be used successfully Legal tools: Preventive use of CIA is forbidden Curative and metaphylactic use possible only after: Clinical examination or necropsy Sampling and identifying the bacteria Sensitivity testing 2) Ban on discounts for antibiotics sales

Results of antimicrobial use monitoring Monitoring antibiotic use and AMR is essential: Recorded antibiotic sales since 1999 enable the calculation of the ALEA (animal level of exposure to antibiotics) AMR: downward trend since 2006 to most antibiotics State financial support: $7.7 M 2012-2016 (research, training, communication) ECOANTIBIO CIA ALEA in 2016 : 75% fluoroquinolones vs. 2013 81% C3/C4G vs. 2013 55% colistine vs. 2011 -37 % in 5 years (2012-2016)

Sales of veterinary antimicrobial agents in 30 European countries in 2015 Moyenne 135,5 mg/PCU Report from the European Medicines Agency, October 2017

Exposure of animals to antimicrobials in mg/ PCU in 2015 Sales of veterinary antimicrobial agents in 30 European countries in 2015 2010 Decrease: - 13,4% 2010 Decrease - 48% In descending order of exposure, France is #12  twice lower than the European average exposure Exposure of animals to antimicrobials in mg/ PCU in 2015

Promotion of Ecoantibio at EU and international levels France supports the need for: An AMR action plan in each country respecting WHO/FAO/OIE guidelines Clear definition of responsible and prudent use of antibiotics: Antibiotics should be used mainly for therapeutic use and in case there is no other solution Antibiotics should never be used as growth promoters AMR should be fought globally: Only global actions will be efficient To avoid competitive distortions

Conclusion Ecoantibio1 (2012-2016) Ecoantibio1 has been successful : Quantitative results are far beyond the initial -25% objective Due to veterinarians and farmers commitment Due to collaboration between all partners before the plan was launched ⇒ success of the public-private partnership However, for long term results the following efforts should continue: To decrease animal exposure to antimicrobials, especially to CIA To improve prevention of animal diseases To find and develop alternatives To improve communication

4. Ecoantibio²: 2017-2021 Part of the interministerial roadmap for controlling AMR: http://agriculture.gouv.fr/le-plan-ecoantibio-2-2017-2021

Ecoantibio²: main objectives Evaluate Ecoantibio1: Cost/Benefit Analysis of implemented actions Comparative Analysis of Ecoantibio versus actions of other countries Consolidate Ecoantibio1: Maintain ongoing action Start the actions planned in Ecoantibio1 Promote Ecoantibio1: Communicate achievements to public and stakeholders Keep all stakeholders involved Affirm and defend our positions internationally  A more targeted plan with more incentive measures and less mandatory measures

Focus of Ecoantibio² (20 actions) Develop preventive measures for infectious diseases and ease the procedure for using alternative treatments (4 actions) Communicate and train on the issues of fighting AMR, on reasonable prescription of antibiotics and on methods to fight infectious diseases (4 actions) Shared tools : Make evaluation and monitoring tools regarding AMU more widely available, as well as tools for the responsible prescription and administration (9 actions) Shared efforts : Make sure the rules of correct use are applied at the national level and encourage their adoption at the EU and international levels (3 actions)

Focus on an Ecoantibio2 incentive measure communication campaign for farmers and vets « Antibiotics, as needed, when needed » 18

Take-home messages Include all stakeholders in dynamic virtuous cycle: policy makers, vets, farmers, scientists and risk assessors, pharmacists, the pharmaceutical industry, public opinion including all animal owners Co-construction of the plan, and co-implementation of the measures Improving husbandry practices i.e. hygiene, farm building maintenance, animal health monitoring Reinforcing partnership between prescribers and animal owners Promoting prevention and alternatives such as vaccines

To find more, please visit the Ecoantibio section: Thank you for your attention  To find more, please visit the Ecoantibio section: http://agriculture.gouv.fr/ecoantibio © Ministère de l’Agriculture et de l’Alimentation 20