The onslaught of antimicrobial resistance (AMR) is of global concern for human and animal health, as well as the environment.
Similar to human medicine, antimicrobials are often used in agriculture to treat or prevent infections, and the high use and misuse of antibiotics can lead to resistant infections among animals. Because livestock finds its way to people’s dinner table, this creates a risk that resistant bacteria can be passed on to humans.
As the development and spread of AMR in humans and animals often intersect, a multisectoral approach – “One Health” – in which the human and animal health sectors work closely together is required to tackle AMR.
How would a One Health approach to fighting AMR work? For an answer to this question, one can look to Italy.
Animal and human health connected under one ministry
According to Dr Annalisa Pantosti and Dr Luca Busani, who work in the human health and animal health fields, respectively, at the National Institute of Health in Italy, the country finds itself in a strong position to combat AMR through a One Health approach because both human health and animal health are coordinated by the same ministry, the Ministry of Health. “This is an advantage that Italy has. It makes it easier to coordinate both sectors.”
The 2 sectors were brought together to combat AMR under the National Action Plan on Antimicrobial Resistance (PNCAR) 2017–2020. However, cooperation between the 2 sides is not new.
One of the best early examples of cooperation between the 2 sectors is Italy’s fight against the West Nile Virus starting in the late 1990s. At that time, it was necessary for the different sides to work together because the need was urgent, and legislation was adopted to help pave the way to better integration. From then, the government started to think about how this integrated approach could be adapted to tackle a variety of health issues, including AMR.
The West Nile Virus outbreaks helped kick start the One Health vision in Italy – the integration and better coordination between the human health and animal health sectors. It provided a system for preparedness, as in the case of outbreaks such as enteric pathogens, which continues to be used. However, it functions primarily for management of emerging infections, when immediate action is needed, rather than common routine monitoring or prevention, as would be ideal.
Finding common ground
Dr Busani describes what was needed to get the 2 sides working together on common goals for tackling AMR, and some of the challenges they faced at the outset: “At first, we did not immediately find many common lines, mainly because the legal backgrounds and requirements of both sides were quite different. For instance, the use of antimicrobials in the animal health sector is strongly regulated, with stringent EU regulations to be followed, while in human health it is much less so.
“But we continued to work on finding common areas of interest, focussing mainly on surveillance of zoonotic pathogens – such as Salmonella and Campylobacter, which are transmitted by food animals and cause infections in humans – and surveillance of the use of critically important antimicrobials in both sectors.”
Dr Pantosti describes how integration between the 2 sides works in reality: “Under the first National Action Plan, both sides were present at coordination meetings to decide strategies and report results. And at these meetings, sharing knowledge and experience proved to be useful; veterinarians have had the opportunity to learn about the burden of AMR in human medicine, while hospital doctors and general practitioners have learned about the contribution of antibiotics use in farmed animals to the problem of AMR. Many initiatives were also taken together, for instance promoting European Antibiotics Awareness Day”.
Looking ahead – “Improving the quality of the integration”
On the future of One Health and AMR in Italy, Dr Pantosti and Dr Busani note the following: “Up to now, all the work in the field, such as surveillance of AMR, has been run along 2 parallel paths – the human health side and the animal health side. We know what each path is doing, and we know what each other’s challenges are.
“However, what we want to do under the next National Action Plan, which is currently being developed, is achieve deeper integration in the field. This would require, for example, determining which aspects of surveillance are important to both sides, and how interventions on one side can have an impact on the other side.
“Once we better identify common areas, it will be much easier to improve the quality of the integration. Now that we know each other, working for common goals has become more natural to us.”