1. Christianne Bruschke Chief Veterinary Officer Ministry of Economic Affairs Taking on Antibiotic Resistance Opportunities to keep antibiotics working for our future

2. Livestock production in The Netherlands 4 million cattle 12 million swine 325.000 horses 1,5 million sheep and goats 100 million poultry share 34,000 sq km land with 17 million people 2

3. Risk of emergence of drug resistant pathogens Global Trends in Emerging Infectious Diseases; Kate. E. Jones et al. NATURE;Vol 451| 21 February 2008| doi:10.1038/nature06536 3

4. 2008: sales of antimicrobials Humans Animals Strong appeal for a more responsible and restrictive application of antibiotics in animal production 4

5. 5 Triggers for reduction policy Primary motivation in public health: low level of AMR in human population Risk of resistance transmission from livestock to humans Growing concern about possible human health implications of livestock production in the Netherlands

6. Key elements of reduction policy Self-regulation, combined with public surveillance and enforcement Transparency: all antibiotic use registered in mandatory central databases Benchmarking by the independent Veterinary Medicines Authority (SDa) Reduction targets: -20% in 2011; -50% in 2013; -70% in 2015. 6

7. Benchmarking approach (SDa) Example: frequency distribution of ADD/Y red:immediate action required by vet and farmer orange:attention required green: no specific action 7

8. Government Reduction targets Stringent enforcement New legislation: Ban on profylactic use (2011) Antimicrobials administered exclusively by veterinarian, unless farmer complies with strict conditions Susceptibility testing mandatory for 3d choice antimicrobials (3d, 4th gen. cephalosporins and fluoroquinolones) 8

9. Sales for food-producing species, including horses, in mg/PCU, of the various veterinary antimicrobial classes, for 26 countries in 2013 1 9 Amphenicols, cephalosporins, other quinolones and other antibacterials (classified as such in the ATCvet system). Differences between countries can partly be explained by differences in animal demographics, in the selection of antimicrobial agents, in dosage regimes and in type of data sources, among other factors.

10. Decrease of antimicrobial resistance in broilers, veal calves and pigs: policy is effective 10 Source: Veterinary Medicines Authority: Relaties tussen antibioticagebruik en voorkomen van resistente micro- organismen (february 2016) www.sda.nl

11. Performance & antibiotic use of sows and piglets 11 Source: Good practices, use of antibiotics, Nico Bondt and Harry Kortstee, LEI WUR.

12. Independent Reports Dutch Health Council Further reduction necessary Focus on high users Special attention for Carbapenem and Colistine resistance Veterinary Medicines Authority Further reduction in veal, swine and poultry sector is advisable Dutch Council on Animal Affairs No indication that AMR policy negatively affects animal welfare Animal husbandry without usage of antimicrobials is not realistic 12

13. 13 Critical success factors and challenges Key factors for success: Action taken by all parties involved Private sector well organized enabling public-private cooperation and the possibility to use the Production Chain Quality Systems Challenges: International cooperation to improve prudent use of antibiotics Prevent illegal use and trade of antibiotics