In­dia drags its feet Why EU suc­ceeds and US fails

EU has curbed an­tibi­otic re­sis­tance by ban­ning an­tibi­otics

Down to Earth - - COVER STORY -

OVERUSE and mis­use of an­tibi­otics con­trib­ute to the rise of an­tibi­otic re­sis­tance. So do poor or unen­forced reg­u­la­tions. In­dia seems to suf­fer from both.So far, it does not have an effective in­te­grated pol­icy to con­trol the use of an­tibi­otics in live­stock and poul­try with a view­point of con­tain­ing an­tibi­otic re­sis­tance, ex­cept for a few spo­radic ini­tia­tives that ei­ther do not tar­get an­tibi­otic re­sis­tance or lack teeth (see ‘In­dia’s lax at­ti­tude’).

The lat­est is a cir­cu­lar is­sued by the Depart­ment of An­i­mal Hus­bandry, Dairy­ing and Fish­eries (dadf ) in June 2014, re­quest­ing states to ad­vise vet­eri­nar­i­ans on ju­di­cious use of an­tibi­otics and to bar the use of an­tibi­otics in feed.But it does not men­tion how to im­ple­ment and mon­i­tor the ad­vi­sories. Nei­ther is there any men­tion of al­ter­na­tives, time frame and puni­tive mea­sures.

When dte asked dadf about how it plans to im­ple­ment the ad­vi­sory, as­sis­tant com­mis­sioner Su­jit Ku­mar Dutta said, “Since an­i­mal health care and other an­i­mal hus­bandry prac­tices are looked af­ter by the state gov­ern­ments, it is their pri­mary re­spon­si­bil­ity to im­ple­ment the ad­vi­sory in con­sul­ta­tion with the state drug con­trollers.” Dutta, how­ever, ad­mit­ted that “not very sub­stan­tive work has been done on an­tibi­otic residues in an­i­mals”.

In the ab­sence of data on an­tibi­otic residues, no one knows about the ex­tent of an­timi­cro­bial re­sis­tance in the coun­try. The only planned sur­veil­lance of an­timi­cro­bial re­sis­tance, un­der the Na­tional Pro­gramme on Con­tain­ment on An­timi­cro­bial Re­sis­tance, 20122017, is in hu­mans and has not yet started. There is no ap­par­ent plan for in­te­grated sur­veil­lance, in­clud­ing an­i­mals and food, which has been in­stru­men­tal in con­tain­ing an­tibi­otic re­sis­tance in sev­eral EU coun­tries.

Even the 2011 Na­tional Pol­icy for Con­tain­ment of An­timi­cro­bial Re­sis­tance over­see­ing the pro­gramme does not fo­cus on re­sis­tance other than in hu­mans, says Chand Wat­tal, chair­per­son of Depart­ment of Clin­i­cal Mi­cro­bi­ol­ogy, Sir Ganga Ram Hos­pi­tal, Delhi, who was a mem­ber of the task force that drafted the pol­icy. “It was a waste of time. We had made pre­sen­ta­tion show­ing im­por­tance of con­tain­ing re­sis­tance com­ing through poul­try. But we were told the poul­try in­dus­try will protest and the gov­ern­ment can­not risk it.We can­not have half-hearted ways of deal­ing with a big prob­lem like this.You can­not cover only half a route in sci­ence. Tough mea­sures have to be taken, ”he says. Gov­ern­ments world­wide are adopt­ing reg­u­la­tions to con­trol the use of an­tibi­otics. But only those coun­tries have shown signs of im­prove­ment that have tak-

en strin­gent ac­tions. Euro­pean coun­tries were the first ones to ban peni­cillin, strep­to­mycin and tetra­cy­clines as feed ad­di­tives in the 1970s. In 1986,Swe­den banned all an­tibi­otic growth pro­mot­ers in feed. Den­mark,a ma­jor live­stock pro­ducer in Europe and the largest ex­porter of pork in the world, fol­lowed the suit and started reg­u­lat­ing the use of an­tibi­otics in the early 1990s.Based on sci­en­tific ev­i­dence, it banned avoparcin, vir­gini­amycin, ty­losin, spi­ramycin and zinc bac­i­tracin as growth pro­mot­ers between 1995 and 1998. In 2002, it re­stricted the use of flu­o­ro­quinolones, a cru­cial an­tibi­otic for hu­mans, in an­i­mals.The cat­tle and broiler in­dus­try vol­un­tar­ily stopped use of all an­tibi­otics as growth pro­mot­ers in 1998 and the swine in­dus­try fol­lowed it in 2000.

Es­ti­mates show that the use of an­tibi­otics has de­creased by 90 per cent in poul­try and 51 per cent in pigs between 1995 and 2008.Pro­duc­tiv­ity of poul­try farms was not af­fected dur­ing this time, while the cost of pro­duc­tion re­mained al­most same. An­tibi­otic re­sis­tance sig­nif­i­cantly de­creased in both broil­ers and pigs (see ‘An­tibi­otic re­sis­tance is...’).

“We sep­a­rated sale of an­tibi­otics from ve­teri­nary ad­vice, so that vet­eri­nar­i­ans had no economic in­cen­tive to pre­scribe large quan­ti­ties,” says Jan Dahl, ve­teri­nary epi­demi­ol­o­gist, Dan­ish Agri­cul­ture and Food Coun­cil. “Vet­stat (Den­mark’s an­tibi­otics data­base) was in­tro­duced to know what was used in the poul­try farms. You can­not ex­pect to change things if you have no in­for­ma­tion,” Dahl adds. Den­mark’s suc­cess prompted the EU to ban all an­tibi­otic growth pro­mot­ers by 2006.

The US, where 80 per cent of an­tibi­otics (13,542 tonnes) are at­trib­uted to non-hu­man use, recog­nised the prob­lem around the same time as EU, but is far be- hind in ad­dress­ing it. In 1977, the US Food and Drug Ad­min­is­tra­tion (usfda) pro­posed ban­ning tetra­cy­clines and peni­cillins as ad­di­tives in feed, but is yet to do it. Amid protests from public health ad­vo­cates, usfda in­tro­duced two pol­icy doc­u­ments in 2013 as guid­ances for the in­dus­try.Its ob­jec­tive was to phase out the use of med­i­cally im­por­tant an­tibi­otics in food-pro­duc­ing an­i­mals and bring ther­a­peu­tic uses of such drugs un­der the over­sight of li­censed vet­eri­nar­i­ans. But un­like the EU, th­ese guid­ances do not ban the use of an­tibi­otics as growth pro­mot­ers.In the name of ju­di­cious use th­ese guid­ances do not strictly con­trol use of an­tibi­otics in an­i­mals.

While the ini­tia­tive is con­sid­ered an im­por­tant first step, they are vol­un­tary in na­ture.In re­cent years there is a sig­nif­i­cant in­crease in the use of lin­cosamides, peni­cillins and tetra­cy­clines an­tibi­otics.In chicken, re­sis­tance in se­lect bac­te­ria has been in­creas­ing against an­tibi­otics of public health im­por­tance (see ‘In US, re­sis­tance...’). Re­sis­tance in Sal­mo­nella was also found to be in­creas­ing in re­tail poul­try meat against third gen­er­a­tion cephalosporins and ampi­cillin between 2001 and 2011.Dur­ing the same pe­riod in­creased re­sis­tance was found in Campy­lobac­ter against ciprofloxacin.

Poul­try meat ac­counts for half of the to­tal meat

pro­duced in In­dia

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