ADVISORY COMMITTEE REPORTS TO HEALTH CANADA ON “ANTIMICROBIALS IN FOOD ANIMALS IN CANADA: IMPACT ON RESISTANCE AND ANIMAL HEALTH”

The report of the Committee formed to advise the Veterinary Drugs Directorate of Health Canada on animal uses of antimicrobials and their impact on resistance and human health has just been published (http://www.hc-sc.gc.ca/vetdrugs-medsvet/amr/e_policy_dev.html). Chaired by Dr Scott McEwen of the Department of Population Medicine, University of Guelph, the 20-person committee included representatives of farm organizations, the animal pharmaceutical and feed industries, medical and veterinary microbiologists, public health, consumer, and animal welfare organizations. The CVMA was represented by Dr Deb Stark. The report, if acted on, will have a major impact on how antimicrobials are used in food animals in Canada, with a significant increase in veterinary responsibility for their use. The Committee worked for 3 years to produce the 165-page report, focussed on agricultural use of antimicrobial drugs. The report contains a fairly detailed discussion of the evidence of human and animal health impacts of antimicrobial use in food animals, the international response to the problem, stakeholder perspectives on the benefits of antimicrobials in animals, and the options for managing resistance risks. The 38 recommendations are based on its analysis of how to reduce the potential resistance and human health and safety impacts of such use. Six major recommendations are made as follows: Make all antimicrobials used for disease treatment and control available by prescription only. Develop an extra-label use policy, which ensures that this practice does not endanger human health. Such a policy should include the ability to prohibit the extra-label use of specific drugs of critical importance to human health. Evaluate, register, and assign a drug identification number (DIN) to all antimicrobials used for food animals, whether they are manufactured domestically or imported. This includes antimicrobials imported in bulk (active pharmaceutical ingredients [APIs]), which should be allowed into Canada only under permit. The intent of this recommendation is to stop the direct use of APIs in food animals. Stop the importation, sale, and use of antimicrobials not evaluated and registered by Health Canada. The intent of this recommendation is to stop the “own use” loophole. Evaluate antimicrobials for growth promotion or feed efficiency by using sound risk analysis principles and rapidly phase out antimicrobial claims not fulfilling the following criteria: demonstrably effective; rarely, if ever, used in human therapy; and not likely to impair the efficacy of any other prescribed antimicrobial for human infections through development of resistant strains. In consultation with the provinces, other federal agencies, and industry groups, design and implement an ongoing, permanent national surveillance system for antimicrobial resistance arising from food-animal production. Surveillance should include indicator and pathogenic bacteria isolated from animals, food, and imported animal products. Among the more minor recommendations, aimed at veterinarians, the report recommends the following: Recommendation 20: Veterinarians and veterinary medical organizations should effectively implement the prudent-use principles developed by the CVMA and periodically review the principles and their implementation. Recommendation 21: Provincial licensing bodies and veterinary medical associations should endorse and promote the CVMA's prudent-use principles. Recommendation 38: Encourage Canadian veterinary colleges and veterinary associations to ensure that preventative medicine, prudent use of antimicrobials, and antimicrobial resistance are given high priority in veterinary undergraduate, postgraduate, and continuing education programs. The report discusses producer concerns that prescription-only access to antimicrobial drugs would drive up the cost of animal health care through higher drug costs. While not a formal recommendation, the report suggests that veterinarians are in a conflict of interest when they profit from the sale of antimicrobial drugs, and that ways be found to remove this conflict. Dr. Peter Provis, chair of the CVMA Prudent Use of Antimicrobials Working Group, commented, “The CVMA welcomes this well-argued and authoritative report, including its endorsement of the 1999 CVMA prudent-use principles. The key recommendations of the report should result in more prudent use of antimicrobial drugs in food animals in Canada, and an enhanced responsibility for veterinarians in ensuring better use of these precious resources. The CVMA will support the Veterinary Drug Directorate in its implementation of the recommendations of the report, and will continue its own commitment to prudent use through the education of its members, development and endorsement of species specific guidelines, promotion of involvement of veterinarians in on-farm food safety programs, and in other ways. Reducing antimicrobial resistance requires a long-term effort by everyone using antimicrobial drugs, and implementation of this report will be an important boost to this effort.” (by John F. Prescott, DVM, University of Guelph)

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