1. Prof. dr. J.Fink-Gremmels DVM, PhD, Dip ECVPT President EAVPT J.Fink@uu.nl 22-04-2015 MP-EU EPP: Antimicrobial resistance: urgent need to act in human & veterinary medicine Implementing the One Health Concept

2. Medical Faculty Part Veterinay Faculty, Utrecht University Part of Utrecht Life Sciences

3. The point of departure: the global emergence of AMR Global trade and global mobility have become major drivers of the spread of infectious diseases AND antimicrobial resistance Humans & animals share the same bacteria and often also the same resistance genes Wendlandt et al., 2015

4. The antibiotic eco-system: need for a multi-actor approach Animal health care Industry Human health care Community & Hospital (ICU) Agriculture FAO-WHO-OIE Tripartite action plan

5. Antibiotic use in veterinary medicine Raising awareness & implementing the an action plan Human (humane) responsibility for animal health and wellbeing Animal health care & (global) food demands Urgent need to act in veterinary medicine : Enforcement of triple R Reduction – Refinement - Replacement See also EIP-AGRI Focus Groups

6. The triple R action plan R eduction: The use of antimicrobial as herd managment tools is no longer accepted  Improvement of hygiene programmes  biosecurity  Improvement of disease prevention  vaccination  Improvement of health monitoring & diagnostics (sensor based disease monitoring)  Improvement of immune competence: feed quality – life cycle management Creating Awareness – improving sustainability Action points 1 & 2 FAO/WHO/OIE

7. In the Netherlands between 2009 (reference) and 2013: a decrease of the antibiotic use by 58% was achieved, with a further decline in 2014 Reduction of antibiotic use (ADD): the primary target The point of concern: Extreme reduction without accompanying measures endangers animal welfare!

8. The triple R action plan Refinement: Re-evaluating current prescription attitudes Diagnosis-based prescriptions (capacity building) Pathogen-susceptibility testing (rapid diagnostics) Onset of treatment (cure rate) Duration of treatments – need of supportive treatments Ranking of antibiotics (critical important – specialist oversight) Meeting expectations? Expectation of (human) patients Expectations of farmers CONTINUING EDUCATION & COMMUNICATION CAPACITY BUILDING

9. The gut microbiota are an undesirable target Long persistence in the intestines ….selecting for resistant bacterial populations Impairment of the microbiome results in immune-mediated diseases (allergies, diabetes, inflammatory bowel diseases 1000 000 000 000 000 bacteria; > 500 species 10 x more than body cells Reservoir for resistant bacteria / resistance genes Refinement: Avoidance of collateral damage: Intra-intestinal antibiotics concentrations:

10. The triple R action plan R eplacement:  Improvement of hygiene programmes  biosecurity  Improvement of disease prevention  vaccination  Improvement of health monitoring & diagnostics  Improvement of immune competence: feed quality – life cycle management Animal health care Starts at the 1 st day of life Chang in mind-set: From Cure to Care

11. From cure to care: options & opportunities Vaccines (including PNAG-like surface antigen antibodies) Hygiene programs Biosecurity Bacteriophages Peptides Bacteriocines Defensin inducers Killing factors (complement opsonins) non-antibiotic antibacterials (ZnO) Quorum sensing modulators Phytobiotics ProbioticsPrebiotics Improvement of animal health – reduces the need for antibiotics Building strategic cooperation

12. Food Safety & Food Security One health – our responsibility Thank you!