THE NETHERLANDS VETERINARY MEDICINES AUTHORITY

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1 THE NETHERLANDS VETERINARY MEDICINES AUTHORITY Workshop Lithuania, Oktober 2016 Reducing usage of antimicrobials in livestock: The Dutch approach Hetty van Beers-Schreurs, DVM, PhD

2 SHORT INTRODUCTION Educated in Utrecht, DVM PhD 1996 Worked - at the Animal Health Service Ltd - as a practioner July 2012, managing director of the SDa

3 CONTENTS Focus on the Netherlands what happened between 2005 and 2010 Plan of Action, implementation, results

4 THE NETHERLANDS Number of agricultural livestock (x1,000) in the Netherlands people 17,000 Chicken 104,000 Pigs 13,000 Dairy cattle 2,953 Beef cattle 258 Veal calves 939 Beef bulls 17 (Source: Statistics Netherlands, 2014 ) 2nd in exporting of agricultural products

WHAT HAPPENED 2004-2010 Q-fever usage of AM

5 WHAT HAPPENED Q-fever usage of AM in animals Livestock MRSa Party for the animals

6 USAGE OF ANTIMICROBIALS IN EUROPE (sales in kg) In animals In humans

7 WHAT HAPPENED Q-fever ESBLs usage of AM in animals Livestock MRSa Party for the animals Licence to produce? For farmer and government

8 CONTENTS Focus on the Netherlands Plan of Action

9 ACTIONS TAKEN Ministry of Health: asks for Ministry of Agriculture advice of the Health Council on use of AM in production animals you take your own measures, or I have to make new laws!

10 RESULTS OF THEIR ACTIONS Health Council Ban Critically Important Antimicrobials for human use (WHO-list) cephalosporines, fluoroquinolones Redefine 1st, 2nd, 3rd choice antimicrobials (selection for ESBLs) Reconsider formularia Covenant with private parties All antimicrobial use on farms transparent by end of 2011 (SDa) Bench marking allowing identification of high users/prescribers (SDa) 1 to 1 relationship between a vet and a farmer farm health and farm treatment plan

11 OTHER MEASURES Topic Premedicated feed Preventive use of antibiotics Conditions for administering of AB by farmers themselves Checks for correct use of antibiotics Action/actor Forbidden (private) Forbidden (public) Rules set by our government Carried out by the Food Authority

12 ADDED BY THE GOVERNMENT: Mandatory 20% reduction in 2011, 50% in 2013 and 70% in 2015 (reference to 2009 and based on sales data)

13 ACTION PLAN Implementation Who takes the measures Results Effects on AMR Looking ahead

14 THE NETHERLANDS VETERINARY MEDICINES AUTHORITY SDa Government Livestock Production sectors by government and livestock production sectors analysis of anonymised data, calculations and setting bench mark values

15 CALCULATING USE AND SETTING TRESHOLDS An ADDD/Y of 1 means that the average animal in the population was exposed to an antimicrobial for one day per year. This measure is similar to that proposed by ESVAC.

16 Implementation Who takes measures Results Effects on AMR Looking ahead

17 WHO TAKES THE MEASURES SDa sets thresholds Integral quality assurance systems of farmers and vets set their measures and if farmers and vets employ not enough effort The Food and Consumer Product Safety Authority visits the farms and practices (similar to the Danish Yellow Card)

18 ACTION PLAN Implementation Who takes measures Results Effects on AMR Looking ahead

19 RESULTS SO FAR Developments in sales of antimicrobial agents between 1999 and 2015, in number of kilograms of active substances sold (x1000) (source: FIDIN), by main pharmacotherapeutic group in 2015.

20 ACTION PLAN Implementation Who takes measures Results Effects on AMR Looking ahead

21 USAGE VERSUS RESISTANCE Usage in DDDA F in veal calves, broilers, sows/piglets, fattening pigs

22 USAGE VERSUS RESISTANCE Usage in DDDA F in veal calves, broilers, pigs, cattle

23 USAGE VERSUS RESISTANCE species AMU (%) AMR (%) Veal calves -/- 37 -/- 28 Pigs -/- 54 -/- 22 Poultry -/- 57 -/- 8 Ruminants -/- 43 -/- 79

24 Implementation Who takes measures Results Effects on AMR Conclusions and looking ahead

25 CONCLUSIONS Critical success factors of the Dutch approach Farmers were personally confronted with MRSA positivity Public pressure Clear targets defined by the government Measures initiated by private animal production sectors and veterinary association Usage fully transparent: from > 42,000 farms ADDDs available Independent institution (SDa) accepted by all parties involved

26 WHAT HAS CHANGED AT FARM LEVEL Reduction in usage: Preventive measures (eradication of specific diseases, vaccination), no preventive use, more individual treatments; antimicrobial stewardship! Transition towards new husbandry systems Research for alternatives

27 CONCLUSIONS AND FUTURE analysis of critical success factors at farms new treshold levels get insight in the AMU in other sectors (companion animals, rabbits, horses...) effect of reduced AMU on AMR in humans?

28 THANKS FOR YOUR ATTENTION

29 COLLECTION OF DATA

30 CONCLUSIONS WHO High proportions of resistant bacteria are reported in all regions Treatment options are running out Surveillance gaps No agreement on surveillance standards

31 BURDEN OF AMR WORLDWIDE

32 INTRODUCTION Antimicrobials are used worldwide to treat humans and animals Eventually micro-organisms will develop an resistance (insensitivity) when exposed to an antibiotic. This phenomenon was already described late forties. Bacteria are always looking for new mechanisms to survive.

33 CONTENTS Introduction Antimicrobial resistance: the main question, does AMR in livestock contribute to AMR in humans? Focus on the Netherlands Plan of Action

34 EUROPE

35 ANALYSIS OF DATA Positive associations: no causality!!

36 CONCLUSION using the precautionary principle.

120 mln. 17 mln. The Netherlands. 12 million swine. 100 million poultry. 1,5 million dairy cows. 1 million veal calves. 1,5 million sheep and goats

120 mln. 17 mln. The Netherlands. 12 million swine. 100 million poultry. 1,5 million dairy cows. 1 million veal calves. 1,5 million sheep and goats FMM/RAS/298: Strengthening capacities, policies and national action plans on prudent and responsible use of antimicrobials in fisheries Final Workshop in cooperation with AVA Singapore and INFOFISH 12-14