Joint AVMA-FVE-CVMA statement on continuous monitoring of antimicrobial use and antimicrobial resistance

Comment on this policy

Note: This statement has been adopted jointly by the AVMA, Federation of Veterinarians of Europe and Canadian Veterinary Medical Association.

Considering that

  1. The AVMA, CVMA and FVE developed a joint statement in 2011 on Responsible and Judicious Use of Antimicrobials, which was revised in 20181.
  2. The development of antimicrobials has contributed enormously to improving the health and welfare of people and animals throughout the world. However, any increase in antimicrobial resistance and spread of resistant bacteria poses a global threat to human and animal health and welfare.
  3. A "One Health" holistic approach through cooperation among stakeholders spanning human and animal health and welfare, food, agriculture, aquaculture and the environment, is vitally important to be able to best address the growing problem of antimicrobial resistance. This approach will promote and ensure the availability of effective antimicrobial treatments whilst minimizing resistance.
  4. Continuous availability of a range of effective antimicrobials is vital, and preservation of antimicrobial efficacy through a responsible and judicious use of antimicrobials is in the best interests of animal health and welfare, food safety, human health and the sustainability of our planet.
  5. The veterinary profession has a great deal to offer through knowledge and practice of preventive healthcare, animal husbandry, and, biosecurity, to reduce the need to use antimicrobials in animals, with the ultimate goal to reduce antimicrobial resistance. The profession plays a major role in raising awareness and informing people about the need and best practices for the preservation of the effectiveness of antimicrobials.
  6. The 7th World Organisation for Animal Health (WOAH) annual report on antimicrobial agents intended for use in animals2 showed an increasing trend of countries monitoring antibiotic use, with details on antimicrobial quantities by type of use and route of administration. The WOAH created ANIMUSE, a global database on ANImal antiMicrobial USE3, an interactive and automated database that allows countries to report, access, analyse and communicate data on antimicrobials intended for use in animals.
  7. The World Health Organisation (WHO) launched in 2016 the Global Antimicrobial Resistance and Use Surveillance Systems (GLASS) which includes national data on antimicrobial use and resistance in human health. Since then, GLASS has expanded in scope and coverage and comprises several modules such as routine surveillance on AMR in common bacterial and fungal pathogens, periodic nationally representative surveys to estimate antimicrobial resistance and its attributable mortality, and surveillance of antimicrobial use in the community and health care settings. As of December 2022, 127 countries contributed data to GLASS on AMR (GLASS-AMR) and/or antimicrobial use (GLASS-AMC)4.
  8. Associations have been demonstrated between the development of antimicrobial resistance and both the use of antimicrobials in human and veterinary medicine and the international movement of people and domestic and wild animals5 6.
  9. It is important to reduce the need to use antimicrobials in all sectors (animal, human and environment) without compromising animal and human health and welfare, environmental and public health, and food safety and security.
  10. Many actions have been taken to promote responsible use of antimicrobials, find alternatives for the use of antimicrobials, including vaccine-based approaches, and identify best practices to reduce the need to use antimicrobials.
  11. The Transatlantic Taskforce on Antimicrobial Resistance (TATFAR)7 has as one of its aims to develop robust surveillance systems for antimicrobial use and resistance, to ensure and monitor appropriate therapeutic use of antimicrobial drugs in human and veterinary medicine.
  12. The AVMA, CVMA and FVE support the work being coordinated internationally (e.g. through the WOAH, Food and Agriculture Organization of the United Nations (FAO), TATFAR, WHO and others) to address antimicrobial resistance development.
     

    Recommendations

  13. A robust national regulatory system on authorization, manufacturing and distribution of antimicrobials is crucial. All countries shall have a robust regulatory system in place in respect to the authorization and manufacture of medicinal products, including antimicrobials in all sectors. In addition, a legislative system shall be in place to regulate the distribution, sales, including internet sales, and use of antimicrobials. Illegal manufacture, importation, distribution or sales of medicines should be identified and violations dealt with by the appropriate agencies.
  14. All antimicrobials and especially medically important antimicrobials, as defined by the relevant national health authority, or in its absence, the WHO8, have to be used responsibly and prudently. Antimicrobials should only be administered to animals with the oversight of a licensed veterinarian, or other authorized allied animal health professional as defined by national legislation.
  15. In accordance with the WOAH recommendations, the use of medically important antimicrobials should be restricted solely to veterinary medical use and should not be used for growth promotion.
  16. Veterinarians must retain access to effective antimicrobials for therapeutic purposes for animals suffering from or at elevated risk of bacterial disease to safeguard animal health and welfare and public health; therefore, antimicrobials must not be unilaterally limited for use in humans only.
  17. In order to establish a truly One Health system and to be able to compare what is happening in the different sectors, harmonised standards for measuring, evaluating and interpreting data on antimicrobial use and resistance need to be developed. The AVMA, CVMA and FVE shall support the work of the WOAH and American, Canadian and European5 agencies in this area.
  18. In order to evaluate the effectiveness of actions taken to reduce antimicrobial use and resistance, a robust global network of surveillance and monitoring systems for antimicrobial use and resistance development shall be established. Antimicrobial use and resistance shall be monitored both in the human and animal health sectors and any other sector in which antimicrobials are used.
  19. Effective, rapid and standardized diagnostic tests shall be available in order to carry out susceptibility testing. The results of these tests shall be made available to facilitate evidence-based decisions about antimicrobials. Development of national or regional databases for collecting and sharing susceptibility data and metadata is encouraged.
  20. Record keeping at the patient or practice level is essential for evaluating the success, and where necessary, modification, of antimicrobial treatments. In addition to the evaluation of individual cases, there is also a need to monitor the overall use of antimicrobials in all sectors according to the One Health approach. Healthcare professionals must keep comprehensive medical records with significant and informative data (e.g. patient details, indication/diagnosis, diagnostic test results, ..) of all antimicrobial use to enhance responsible use and reduce the need to use antimicrobials. Healthcare professionals should participate in official jurisdictional surveillance programs of antimicrobial resistance development and use as required.
  21. Sufficient coordinated and targeted funding for all sectors shall be available for further research and development of robust surveillance systems, national One Health AMR Action plans (NAPs), preventive healthcare, development of vaccines and other alternatives to the use of antimicrobials (including bacteriophages, polyclonal antibodies or host-directed therapies), stewardship programs/training and rapid and affordable diagnostic tests9.
  22. The AVMA, CVMA and FVE call on all organizations working to address antimicrobial resistance at a local, national and global level (i.e., WOAH, WHO, TATFAR, and others) to ensure that our organizations are always consulted.
  23. The AVMA, CVMA and FVE calls upon our members, veterinary professional organisations, all veterinarians, allied animal health professionals and animal keepers to actively engage and contribute to the collection of relevant data on antimicrobial use in animal health and on the occurrence and spread of antimicrobial resistance.
  24. The AVMA, CVMA and FVE call on decision-makers to ensure that when trade standards are established and agreed to, these take into account the monitoring of antimicrobial use and resistance development, antimicrobial stewardship and animal welfare standards. Treatment options should remain available to protect animal welfare and, in turn, high animal welfare standards can reduce the need to use antimicrobials.
  25. The AVMA, CVMA and FVE will collaborate in promoting responsible use of antimicrobials in animal production and animal care in all countries.
  26. The AVMA, CVMA and FVE, will continue to take a leadership role in promoting global antimicrobial stewardship.

Background information of partners concerned

  • The American Veterinary Medical Association (AVMA), the Canadian Veterinary Medical Association CVMA) and the Federation of Veterinarians of Europe (FVE) are three of the leading veterinary professional organisations in the World. Together they represent over 380,000 veterinarians in all disciplines of the veterinary profession.
  • The mission of the AVMA is to lead the veterinary medical profession by advocating for its members and advancing the science and practice of veterinary medicine to improve animal and human health.
  • The CVMA is the national voice for the veterinary profession dedicated to serving and representing the veterinarians of Canada. The Association is committed to excellence within the profession and to the well-being of animals. It promotes public awareness of the contribution of animals and veterinarians to society.
  • The European veterinary profession, embodied by FVE, strives to promote animal health, animal welfare and public health across Europe. Together with its members, FVE aims to support veterinarians in delivering their professional responsibilities at the best possible level, recognized and valued by society.

1 AVMA-CVMA-FVE Joint Statement on Responsible and Judicious Use of Antimicrobials (2018): https://www.avma.org/resources-tools/avma-policies/joint-avma-fve-cvma-statement-responsible-and- judicious-use-antimicrobials
2 WOAH 7th Annual report on antimicrobial agents intended for use in animals (2023)
3 WOAH ANIMUSE: https://amu.woah.org/amu-system-portal/home
4 WOAH GLASS system: https://www.who.int/news/item/13-02-2024-information-note---glass-data- visualization-dashboard
5 Codex Alimentarius focus on AMR: https://www.fao.org/fao-who-codexalimentarius/thematic- areas/antimicrobial-resistance/en/
6 Fourth joint inter-agency report on integrated analysis of antimicrobial agent consumption and occurrence of antimicrobial resistance in bacteria from humans and food-producing animals in the EU/EEA JIACRA IV – 2019−2021: https://www.ema.europa.eu/en/documents/report/ema-ecdc-efsa-fourth-joint-report- integrated-analysis-antimicrobial-agent-consumption-occurrence-antimicrobial-resistance-bacteria- humans-food-producing-animals-eu-eea-jiacra-iv_en.pdf
7 Transatlantic Taskforce on Antimicrobial Resistance (TATFAR): https://www.cdc.gov/drugresistance/tatfar/index.html
8 WHO List of Medically Important Antimicrobials: https://cdn.who.int/media/docs/default-source/gcp/who- mia-list-2024-lv.pdf?sfvrsn=3320dd3d_2
9 WOAH - Accelerating action against antimicrobial resistance: closing the gaps in the animal health sector (2024) https://www.woah.org/app/uploads/2024/04/accelerating-action-against-amr-closing-gaps-in-the-ah- sector.pdf

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