Innovate4Health Food Systems Pillar: Reducing the need to use antimicrobials in food systems​

Infectious diseases importantly affect agricultural productivity and may through zoonotic disease transmission affect human health. In particular, antimicrobial medicines play an important role in treating disease not only in human medicine, but also in animal health. According to the sixth Annual Report on Antimicrobial Agents Intended for Use in Animals, the World Organisation for Animal Health estimated that 76,704 tonnes of antimicrobials were used in animals in 2018. In fact, nearly three-quarters (73%) of all antimicrobials sold globally were intended for use in food animal production. Antimicrobials, especially antifungal drugs, are also used in crop production. In South East Asia, almost 10% of plant protection recommendations issued for growing rice included antibiotics. It was estimated that in South East Asia alone, 63 tons of streptomycin were used each year for rice cultivation. In 2017, an estimated 10,259 tons of antibiotics were used in aquaculture, and this was projected to increase by over 30% in 2030.

Why should this use of antimicrobials in agri-food systems matter? Several key classes of antimicrobials are used not only in agriculture, but also in clinical practice to treat human patients. This makes the drug resistance that develops from their use in food systems also a risk when these microbes become transmitted to human populations. With 600 million cases of foodborne illness each year and nearly 420,000 deaths resulting, pathogens carrying such drug resistance can cross over from the food system into human medicine. While many of these infections are enteric, or affect the gastrointestinal tract, foodborne pathogens also can cause extra-intestinal infections. A form of E. coli urinary tract infections afflicting patients traced to retail poultry meat. Another example was the emergence of plasmid-mediated, colistin resistance. Colistin is an antibiotic seldom used in human medicine because of its side effects, except as a last-resort in the setting of multi-drug resistant infections, but its use in food animal production has now jeopardized its continued value to save lives.

The intensification of animal production has contributed to greater use of antimicrobials. Antimicrobials serve an important therapeutic role to ensure the health and welfare of animals as well as food security and safety. However, their overuse puts at risk their future value of these benefits and can negatively affect agricultural productivity. The risk flows not only from the levels of antimicrobials and drug-resistant pathogens in food products, but also in the waste stream from livestock, where 75 to 90 percent of the antimicrobials applied may be excreted.

The use of antimicrobials in the absence of diagnosed disease or routinely to prevent or treat disease has contributed to antimicrobial resistance (AMR). In 2017, the World Health Organization made several key recommendations on the use of medically important antimicrobials in food-producing animals. Among these, they called for “an overall reduction in the use of all classes of medically important antimicrobials in food-producing animals” and a “complete restriction of use of all classes of medically important antimicrobials in food-producing animals for growth promotion” and “for prevention of infectious diseases that have not yet been clinically diagnosed.” Yet forty countries, or a quarter of those in the sixth World Organisation for Animal Health survey, still reported that antimicrobials were used for growth promotion.

The use of antimicrobials in food animals may generally occur with or without veterinary or laboratory diagnosis. In case of use with diagnosis, antimicrobials may either be used for purposes of treatment of a specific, diagnosed condition, or for metaphylaxis, the administration of antimicrobials to a group of animals perceived to be at immediate threat of a diagnosed disease. When antimicrobials are used without veterinary or laboratory diagnosis, they may be used for prophylaxis against the risk of a disease without any specific diagnosis, or for growth promotion. Antimicrobials are said to be used for growth promotion when they are used in healthy animals to boost feed efficiency and accelerate weight gain. 

The presence of antimicrobial drug residues, AMR organisms or AMR genes in the food chain poses a threat to food safety and health and welfare of humans and animals alike. By looking at the various steps along the food systems value chain at which these threats emerge, we can identify where innovative interventions may help stem emergent AMR through the food systems. As noted in the figure below, the food value chain extends from the producers, through processors, to consumers. In the subsequent section, we shall outline some innovations and efforts to reduce the need to use antimicrobials in food production

 
 

Explore different targets along the value chain, as well as resources for Innovate4Health teams using the drop-down menus below:

  • On the producer side, Innovate4Health teams might target different parts of the value chain, but a key consideration is where can an intervention make the most leveraged difference. Is it more strategic to tackle medicated feed for smallholder farmers through the mill placing antibiotics into the feed or to focus on large-scale farming operations or those to which they sell their product?

    Team submissions for the Innovate4Health design sprint targeting this aspect may focus on pilot testing of interventions that educate how plant clinics manage crop diseases appropriately or how agricultural extension services teach biosecurity measures and lower antimicrobial use to smallholder farmers. Behavioral change interventions or job aids might help smallholder farmers focus on biosecurity, as used in the Global Farmer Field School Platform organized by the Food and Agriculture Organization (FAO) of the United Nations. These interventions may also target the use of phytochemicals or other non-antimicrobial agents, which help in bolstering animal health and welfare and reduce the need to use antimicrobials.

    A key factor behind the use of antimicrobial use in food animals, particularly in peri-urban and rural areas, is the lack of trained veterinary service providers. Innovations may explore the use of hand-held devices and build on teleconsultation platforms to leverage ongoing gains in cellular coverage to connect underserved areas with service providers. These tools could also potentially enable the monitoring of antimicrobial use as well as the indications for such use.

    Resources:

    • Consultative Group on International Agricultural Research (CGIAR) Antimicrobial Resistance Hub, hosted by the International Livestock Research Institute, works to mitigate the risks of AMR in agriculture in low- and middle-income countries.

    • Dr. Phil Taylor and Dr. Rob Reeder of CABI International discuss “The widespread use of antibiotics in crop production and its risks” on this open access platform for the life-science industry.

    • Success stories from the Global Farmer Field School Platform might inspire analogous approaches to address AMR among smallholder farmers.

  • The stage of food processing provides a particularly interesting opportunity to intervene and identify problematic use of antimicrobials in food production. For instance, in many low- and middle-income countries, milk production takes place in smallholder farms, but are brought to the market through cooperatives. These cooperatives will pool the product from many local producers and reduce their costs to bring the product to market. This step provides a chance how testing for antimicrobial residues in milk at the cooperative level could provide feedback and education to the dairy farmers involved. A higher quality product, with no detectable traces of antimicrobial residues, might command a better price, providing an incentive for dairy farmers to reduce antimicrobial use, and to dispose of milk when the animal is under antimicrobial therapy. Team submissions may explore the opportunity to use these cooperatives as convergence points and identify key innovations to pilot test at this level.

    Certification of food products can also play an important role. NKV (Nomor Kontrol Veterinar) is a certification program for farms in Indonesia. This certificate serves as valid written evidence that a farm fulfils the hygiene, sanitation and biosecurity norms laid down by the Ministry of Agriculture, Government of Indonesia. It is expected that that farms following the NKV procedures were able to improve animal health and welfare, reduce the use of antibiotics, and increase their profit margins. The Sustainable Shrimp Partnership is a program which aims to improve aquaculture production practices in Ecuador by establishing farms which adhere to the standards set by the Aquaculture Stewardship Council. Further, it leverages blockchain technology to trace the products, from farm to plate. This allows the program to identify and trace products which test positive for pathogens, antimicrobial residues or other contaminants to the farms, and institute corrective measures. The Sustainable Shrimp Partnership has brought zero antibiotic shrimp to the market. Others have suggested the value of developing a communication tool to capture the “antibiotic footprint” of various products or practices.

    Resources

    • Aquaculture Stewardship Council standards for certifying environmentally and socially responsible practices in aquaculture through labeling products meeting such standards

    • A meta-analysis of studies on how food labeling affects consumer diet behaviors and industry practices found that it can curb consumer dietary intake of some nutrients as well as influence industry practice, such as reducing sodium and trans fat in products being offered.

  • There are several instances where demand-side advocacy has forced producers, distributors, and restaurants to commit to higher standards when it comes to antimicrobial use in food animals. However, wet markets and small-scale retailers play an important role in bringing product to market, especially in low- and middle-income countries. While rapid, low-cost, point-of-use diagnostics to assess antimicrobial use in these products may not be yet readily available, the ties between vendors and loyal, regular customers might build a community of trust. Certification of such practices, by label or with a trusted community, might help empower consumers in buying higher quality food products.

    Innovations may emulate the crowdsourcing experience in the UK, where handheld devices were used by citizens to sample environmental sources for azole resistant Aspergillus. Teams may consider exploring emerging technologies, such as paper-based analytical devices (PADs), that are cheap, can be used easily, and provide reliable outputs, to crowdsource information on AMR, antimicrobial residues in food products and even wastewater from wet markets.

    Another approach might involve developing market signals for food buyers. Consumer scorecards represent a demand-side intervention that can influence the supply-side practices of food producers. Consumer scorecards measure the performance of leading distributors, supermarkets, restaurants, or grocery chains on their commitment to support suppliers that raise their food animals without the routine use of antimicrobials. These reports can highlight the gap between the commitment made and the actions implemented, showing where some have led and others fallen short. The leading supermarkets, restaurants, or grocery chains source their products from a significant share of the market, and their buying practices can send ripples upstream to farmers and food producers supplying this market. When collectively organized, school systems or hospital networks can also influence supplier practices by incorporating how antimicrobials are used in the products that they buy.

    Resources

    • Over the first few years, the U.S.-focused Chain Reaction report registered significant gains in reducing the use of antimicrobials in poultry production. The number of top restaurant chains receiving the passing grade for antimicrobial use in poultry meats increased from five in the first report, to nine in the second, and fourteen in the third report. The sixth Chain Reaction report had switched the focus to beef supply chains and gave an “F” grade to 12 out of the top 20 food chains. It highlighted the fact that most of these companies had made very little progress on their commitments to reduce antibiotic use in beef supplies.

    • Some consumer scorecards have also targeted the leading grocery stores. A key example is the work by the Alliance to Save Our Antibiotics to monitor leading supermarkets in the United Kingdom. Published in November 2021, its Resistance & Responsibility Report from UK scores these supermarket chains on their commitment to meet demands for responsible antibiotic use in food products, both among own-brand suppliers and also among other branded animal products on its store shelves. The report notes the lack of a uniform approach to curb antimicrobial use in food product supply chains for the surveyed supermarkets.

    • Going back a decade, a Consumer Reports survey in the United States found that more than half of the consumers were willing to pay 5 cents/pound more for antimicrobial-free meat products, and a third were willing to pay $1/pound more, signaling a consumer base willing to pay.

    • The Centre for Science and Environment’s (CSE) Double Standards report highlights the fact that fast food chains, under international pressure, committed to measurable objectives and clear timelines to meet the demand to reduce antibiotic use in their food products in markets outside of India, such as in the United States. However, they had not made similar commitments in India, thereby setting double standards across these markets.

Call to Action for Teams

The teams are invited to envision innovative interventions to disrupt the flow of antimicrobial residues, AMR organisms and AMR genes in food systems and their spillover into the environment or into human healthcare delivery system. Teams should build on existing technological innovations and diagnostic tools, and focus on “inside the box” (Tedx Link) innovations, focusing on what is possible, given the resources and technological tools available.

Student teams will work with the support of expert coaches, speakers, and members of the Coordinating Team to address these issues. Students will learn foundational material related to health equity and systems thinking to better contextualize and address challenging issues in AMR, how to consider the needs and biases of a diverse range of stakeholders and to shift behaviors in a positive direction, and how to advocate for change.