23 November 2020

Well trained animal health workers will help us tackle antimicrobial resistance

The misuse of antibiotics and other antimicrobials is a global health crisis, but we can stop it through a well-trained network of people who use antimicrobials responsibly. Dr James Kithuka, Animal Welfare Officer, writes as part of World Antimicrobial Awareness Week

Covid-19 has shown us that when a huge public health crisis hits the entire world almost simultaneously, governments are able to roll out consistent guidance, and the scientific community is able to collaborate on a level previously unseen on a world scale. But there is a global public health crisis that is hitting us all at a slower rate, but could have an equally? catastrophic effect – Antimicrobial Resistance (AMR). 

Antimicrobials, including the more commonly known antibiotics, exist to kill bacteria, viruses, fungi and parasites that cause diseases and infections in humans, animals and plants, or at least stop them growing. For a long time now we have known that this works, and so antimicrobials are prescribed daily to treat and prevent illness in humans and animals. But the problem comes when these drugs are misused, overused or even underused. When this happens, microorganisms can develop the ability to survive, and so become resistant to antimicrobials, and it makes treating infections more difficult. 

This is a very solemn growing danger to human, animal and environmental health, and these should not be considered separately. Humans, animals, plants and the environment are all linked. Bacteria and disease can affect more than one host or even species, and therefore move between them. This is especially true when it comes to animals and humans – through the food chain, or even just living and working close together. That of course means that misuse of antimicrobial in one animal may lead to antimicrobial resistance in humans.

This all threatens the ability to treat common infections. When microorganisms are non-responsive to drugs and become ‘superbugs’, it leads to humans spending more resources in treating infections. In fact, the global cost is estimated to reach $1.2 trillion by 2050. It leads to more death, prolonged hospital stays and long recovery times. In animals it makes treatments ineffective, increases severity of diseases, reduces productivity and leads to massive economic losses. This leads to use of more drug compounds, and more misuse, further exposing the environment to pollution. The result is more superbugs, more ineffective treatments, and the cycle starts again.

So how does it start? Antimicrobial resistance happens on a global scale, but it starts off local. Over the 20 years of my practice as a veterinary officer in Kenya, I have worked with many animal health service providers. Every one of them had a bottle of antibiotics and some anti-parasitic compounds in their kit. The problem is they give nearly every condition they meet in the field an antibiotic. Also, in many instances they only inject the animal once instead of following the guidance - to maintain the right therapeutic level for around 3 – 5 days. I’ve also seen that service providers sometimes fail to provide sufficient post treatment advice to farmers. To add to this, over 50% of the frontline animal health services are sourced from agrovets (veterinary supply stores), which provide a valuable service but are often staffed by unqualified workers. Farmers get given antimicrobials for almost every condition they present without prescription. They receive little to no advice on the use, precautions or withdrawal of the drugs. Studies carried out in pastoralist communities in Kenya have found that almost all homesteads will have a form of antimicrobial in their family veterinary drug kit. This rampant non-evidence-based prescription and treatment; poor post microbial advice and use of antimicrobials to prevent illness is fuelling antimicrobial resistance.

What is the solution? No doubt, it is complicated and multi-layered, but it’s clear that a One Health approach is essential – where human, animal and environmental health are considered as entwined, and so programmes, policies, legislation and research are designed holistically. The first step, in East Africa at least, is well planned and intensive public awareness of this, so people realise the connections between their own health and that of their animals. After all, we eat animals and animal products. In treatment of animals, some animal health service providers assume that every sick animal is suffering from “antibiotic deficiency” and so a nice big dose of antibiotics will fix many problems. This misconception gets passed on to farmers, who then ask for antibiotics themselves. Agrovets, often driven by a need to make a profit, end up purchasing and selling on poor-quality medicines, some of which may be illegally imported. It should be noted, however, that it’s also a lack of access to other essential medicines that worsens the dependence on antibiotics.

Through supporting working animals and their owners to improve welfare, our experience at Brooke has shown that a network of well-trained, well-regulated animal health professionals can lead to better animal health and reduce AMR. At Brooke we have developed global mentoring schemes that help fill the skills gap amongst animal health practitioners: the Animal Health Mentoring Framework (AHMF) and Agrovet Mentoring Framework. In East Africa alone we have trained 60 agrovets and 120 animal health practitioners. Globally, the AHMF has provided mentoring and training to over 4,000 paraveterinary workers. 

We work hard to make sure proper clinical examinations are done with animals, so that animal health providers prescribe the right medicines and the right dose. We help agrovets to work on their stock of medicines and explain treatment lengths and side effects of them. This all means that antibiotics are prescribed at the right dose, and only when needed. Brooke also trains horse and donkey owning communities on how to keep animals in clean environments to prevent them from getting diseases and seeking health services from qualified providers who can offer good quality services. 

We do not just train people to become better animal health workers or medicine suppliers, we empower them to be able to pass on their knowledge to others, leading to a steady increase in qualified professionals. The trainees become the trainers.

The continued use of antimicrobials is inevitable, but the way we use them is not. The AMR discussion needs to be at the centre stage in our society, and the proper training of people who play key parts in tackling it often gets overlooked.  As well as this, the top political class also need to develop policies and structures that help regulate the use of antimicrobials. The Food and Agriculture Organization of the United Nations (FAO) have already recommend the development and implementation of national action plans to reduce AMR based on assessments, awareness raising and consultations. U.N countries are signed up to this in theory, but it’s clear that there’s vast room for improvement. For the good of people, animals and the environment, Governments need to promote sustainable food and agricultural systems with improved biosecurity to prevent infections. This will reduce the use of antimicrobials and the spread of antimicrobial resistance. If this doesn’t happen, it is the most vulnerable people in the world who will suffer most.