AMR0033 - Evidence on Antimicrobial resistance

AMR0033

Written evidence from RUMA

Background to RUMA

RUMA is a unique, independent non-profit Alliance of organisations, representing the animal food chain from ‘farm to fork’, that have an interest in the stewardship of animal medicines in agriculture (see annex A for RUMA membership and officers). RUMA is committed to supporting a One Health strategy to address the risk of antimicrobial resistance.

RUMA provides leadership on the responsible use of antibiotics and other medicines helping to develop a UK livestock industry which is innovative and proactive in efforts to continually improve the responsible use of medicines while ensuring optimum animal welfare.

RUMA provides best practice advice on the use of medicines to farmers and veterinary surgeons by publishing free guidelines on its website https://www.ruma.org.uk/antimicrobials/guidelines/ . RUMA guidelines highlight the importance of good farm management and health planning to reduce disease challenge and, therefore, the need to use medicines. RUMA does not support the use of medicines as a substitute for good farm management and animal husbandry.

The Social Care Committee seeks evidence on the progress of the Government to date in responding to the challenge of AMR:

What results have been delivered by the UK AMR 2013-2018 strategy?

RUMA 5 Year Response Document - Over the duration of the UK AMR strategy, RUMA has compiled a running log of activity which its membership or associated organisations have contributed relating to the specific elements of the strategy. This document is tabled in Annex B.

RUMA Guidelines on Responsible Use – RUMA has published guidelines on the responsible use of medicines featuring antibiotics since its inception in 1997. These guidelines have been used as the basis of assurance schemes and supply chain protocols, to the point that that are now a widespread component of food production across all food chains. This brings the issue of AMR and the responsible use of antibiotics to the forefront of farmer:vet relationships in the modern production system. Interest in these guidelines has increased over the duration of the UK AMR strategy as players across food supply chains review their position and commitment to responsible use of medicines in particular antibiotics.

RUMA Targets Task Force (TTF) – The agriculture industry is very diverse, and often each sector works in isolation to tackle its issues. It was clear to RUMA that across industry collaboration was a key factor in achieving the mind set change required to reach the governments antibiotic use target. For this reason, RUMA convened a meeting of sector representatives in May 2016 and proposed what was to develop into the TTF. The driver was the establishment of a set of sector targets which reflected the different industry structures and different starting points in terms of data collection and disease challenges. The TTF had a leading farmer and veterinary representative from eight food producing sectors – beef, dairy, eggs, fish, gamebirds, pigs, poultry meat and sheep. The Veterinary Medicines Directorate (VMD), British Veterinary Association, Food Standards Agency and Red Tractor agreed to observe and support the group. The first meeting was in December 2016, and over the course of 2017, the TTF representatives engaged with stakeholders within their respective sectors to identify starting points, targets, barriers and opportunities. The resulting targets show some sectors are using a centralised ‘medicines book’; some accessing aggregated data from private companies; others have identified ‘disease hot spots’ and measure success via the sales of vaccine as a proxy for a change in farmer behaviour. However, all are progressing to a position where better data on Antibiotic use in the sector is achievable.

In October 2017 the Targets Task Force report was published which set out the respective targets and action plans for each of the sectors running to 2020, and which look to responsibly reduce antibiotic use in that sector without detrimental effect on the welfare of the animals it influences. The full report and sector targets can be found at :- https://www.ruma.org.uk/wp-content/uploads/2017/10/RUMA-Targets-Task-Force-Report-2017-FINAL.pdf

The TTF continues to monitor the targets, encouraging collaboration within the sector and supporting where relevant activity to communicate messages or data collection. It was a unanimous winner of the Prescribing & Stewardship Category at the Antibiotic Guardian Awards, June 27th 2018.

Targets Task Force Examples

a) Dairy -the sector aims to halve the use of total antibiotics and the highest-priority Critically Important Antibiotics prescribed by 2020. A key activity towards achieving this is reducing reliance on intra-mammary antibiotic tubes for routine prevention of mastitis when cows finish their lactation. This is being encouraged by promoting the benefits of using teat sealants instead of antibiotics, and conducting risk assessments for each cow’s quarter before ‘drying off’. A programme called MilkSure has launched a special training programme to help farmers apply teat sealants correctly and effectively. There is an additional target is for teat sealant use to increase by 40% by 2020.

b) Sheep – Treatments relevant for sheep tend to be licensed for a variety of different species, making collection of usage data specific to sheep difficult. The sector has adopted the approach of identifying the main ‘Disease Hotspot’ areas which are lameness control, late pregnancy abortion control and neonatal lamb diseases. For each one of these diseases the industry group is coordinating communications and activities under seasonal campaigns which promote best practice in disease prevention through actions such as vaccination and improved colostrum management. For example the sector took full advantage of promoting the value of colostrum use under the Colostrum is Gold campaign coordinated by RUMA in the spring of 2018.

c) The gamebird sector is very traditional, and the overriding goal is to rear sufficient birds each year to sustain the industry. Mycoplasma, a key disease, was historically mostly controlled through routine preventative treatments, but this had to change. The TTF gamebird representatives coordinated an all sector meeting with vets, keepers, rearers and shoot managers to outline the challenges faced, and together they calculated use and identified a goal of reducing this by 35% in one year, focusing on better biosecurity, disease management and vaccination. They have already achieved their target by tackling the low hanging fruit and will be revising their target downwards for the next phase.

Farm Antibiotics web site https://www.farmantibiotics.org/ – In response to the need for accurate facts and information on the issue of AMR and antibiotic use in agriculture, RUMA launched a dedicated web in 2016 focusing on antibiotics & UK farming. It provides news, facts, statistics, science and reports and is aimed at improving knowledge of the subject and busting some of the myths which arise from a lack of knowledge. It is aimed not just at farmers, but also the media and interested members of the public. There are progress updates on how vets and farmers are managing antibiotic use to treat and prevent disease – as an industry and by livestock sector. It also contains best practice case studies and inspiration for farmers who want to work with their vets to ensure they are using antibiotics responsibly.

RUMA Communication Campaigns – to support the work of the TTF sector groups and the wider communication of best practice for medicine use as laid out in the RUMA guidelines, RUMA coordinated an industry wide campaign to promote the value of colostrum in young suckled animals in the spring of 2018. It generated materials which gave simple technical information and encouraged the respective sectors to create their own messages which could be delivered under the umbrella campaign, to raise awareness across all sectors to the value of this important management practice. Again, the success was not just the direct information from RUMA, but the coordination of a raft of supporting activity delivered by vets and stakeholder organisations within the Pork, Dairy, Beef and Lamb sectors. The initiative generated various communication opportunities via social media and press articles and was supported by a micro web site with key colostrum facts and information.

#colostrumisgold won the Community Communications category at the 2018 Antibiotic Guardians awards June 2018.

This initial campaign will be repeated in 2019, and RUMA will run a similar umbrella campaign to endorse and encourage the use of vaccination as a mode of best practice to combat certain diseases across the livestock sectors. Plans are already in place for its delivery in the autumn of 2018.

What should be the key actions and priorities for the Government’s next AMR strategy, due to be published at the end of this year.

Overview

Looking to the next UK 5 year strategy with a focus on livestock farming RUMA would like to see a move away from the current focus on numbers and targets. The initial government target for agriculture was the motivation to drive change in the industry, but as sectors adopt new practices and rules on antibiotic use the scale of reduction will slow down to a point where RUMA believes further reduction will result in compromises to welfare, which is at odds with the other Government target of a high welfare industry. RUMA appreciates that an eye needs to be kept on usage to measure and benchmark performance but we need to adopt a much more holistic approach where AMR and responsible antibiotic use are seen as the benefits of adopting sensible and best practice systems of production. Engaging with the sector in this way will deliver competitive businesses and the requirements of an AMR strategy and high animal welfare.

RUMA believes the next strategy should include: -

A continuation of the partnership approach between Government and its agencies and the agriculture sectors. This has seen the development of initiatives such as the Targets Task Force and each sector taking ownership of their own efforts to address antibiotic use. Regulation should be seen as the last resort to effect change.
Given the scale of existing voluntary engagement to the issue of AMR by the agriculture sector, which has seen the Government target for the use of antibiotics in agriculture reached ahead of schedule. RUMA would urge government to continue to take a pragmatic approach to any future regulation of medicine use in agriculture. In particular where pressure groups call for tighter regulation and even bans on use of certain medicines in agriculture, the response should be based on scientific evidence and be proportionate to the risk to furthering AMR posed by their use in farmed animals.
Government support and encouragement to an industry focus on controlling endemic diseases leading to a more robust livestock sector in terms of disease resistance/control. Delivered through improved producer knowledge (via programmes such as the NOAH AMR training modules) and vet producer relationships.
The promotion of higher standards of production through assurance schemes and supply chain arrangements which reward those who reach them, but which would see those who cannot meet these standards leaving the industry
Government assistance to help the sectors where infrastructure improvements to deliver improved welfare and lower disease challenges are needed. Helping through investment incentives or tax breaks to stimulate private long term investment to improve.
Proper and meaningful bio-security – understood and practiced by farmers with a high price to pay for not reaching required standards. Supported by industry schemes such as the Livestock Industry Exchange Hub (LIDEH) which join up industry and government databases to promote health status at the point of sale or movement of animals. http://r.search.yahoo.com/_ylt=AwrJQ5rDwjRbwUEAGEUM34lQ;_ylu=X3oDMTByaW11dnNvBGNvbG8DaXIyBHBvcwMxBHZ0aWQDBHNlYwNzcg--/RV=2/RE=1530213188/RO=10/RU=http%3a%2f%2fbeefandlamb.ahdb.org.uk%2fwp%2fwp-content%2fuploads%2f2016%2f09%2fLivestock-industry-data-exchange-hub-Stewart-Hall-190916.pdf/RK=2/RS=LumO_vlOfhI9QuHvTFCofijAApI-

More vaccine development and communication of their role in healthy livestock systems
R&D to deliver rapid diagnostic tests, which inform veterinary advice and any prescription of any critically important medicine. Plus near market research / demonstration applied on farm through KE/Strategic Farms and to encourage the uptake of best practice and innovation
R&D and delivery of genetic editing or breeding selection programmes for breeding traits which can deliver long term benefits to reducing disease on farm
Robust Farm Assurance schemes leading to better traceability and higher standards overall
Industry collaboration which sees all aspects of the food chain working properly and sensibly together to deliver on ‘One Health’. To involve RUMA on behalf of the agriculture sector stakeholders/VMD/FSA/Retailers/Companion Animals/Human Medicine and including a no blame culture, but encouraging a lessons learnt approach
A National Database for the collection of livestock antibiotic data such as the AHDB eMB’s for pigs and now cattle, delivering properly recorded medicine use based on farm records encouraging farmer and veterinary ownership of the issue.
Companion Animals – RUMA would like to see similar developments in veterinary and owner awareness to the AMR issue, to include the recording or medicine use at practice level and communication of AMR messages to pet owners to encourage better vet client dialogue and awareness to the AMR issue.
Through the delivery of a sensible and joined up AMR strategy the UK should demonstrate its place as the leading country producing substantial amounts of food to the highest welfare standards, coupled with the responsible (and low) use of antibiotics

29th June 2018

ANNEX A - RUMA MEMBERS JANUARY 2018

There are two categories of membership, Category A members make up the RUMA board, and Category B members join the Category A members on the Alliance.

Current Category A RUMA members are:

AHDB Dairy / Beef & Lamb

AHDB Pork

Agricultural Industries Confederation (AIC)

Animal Medicines Training Regulatory Authority (AMTRA)

Assured Food Standards

British Egg Industry Council

British Meat Processors Association

British Poultry Council

British Retail Consortium

British Veterinary Association

Dairy UK

NFU

National Pig Association

NOAH

Category B RUMA Members

Animal Health Distributors Association

British Trout Association

City and Guilds

Game Farmers Association

National Sheep Association

NFU Scotland

Royal Association of British Dairy Farmers

RSPCA

Scottish Salmon Producers Association

Ulster Farmers Union

RUMA Officers

Chairman Gwyn Jones

Vice Chairman Cat McLaughlin

Treasurer Tim Brigstocke

Secretary General Chris Lloyd

Targets Task Force Group Chair Gwyn Jones

Independent Scientific Group Chair Cat McLaughlin

Annex B – RUMA Alliance activity contributing to the UK Gov 5 Year Antimicrobial Strategy 2013 – 2018

The following table has been collated by RUMA over 2013 - 2018 as a running record of activity, delivered by organisations associated to RUMA, which has contributed to the Government AMR strategy. It has been collated from discussion at RUMA meetings over this period as a standing agenda item. It is by no means a complete list of activities by all these organisations as additional work will have occurred which was not reported to RUMA. It does however provide a good flavour of the huge commitment undertaken by agriculture to address the AMR issue.

UK AMR Strategy actions – Annex B	Section 5.6 Actions for Animal Health (Bold text added by RUMA)	Actions and Progress reported by RUMA Alliance Members
Key area 1: improving infection prevention and control practices Actions needed to further improve infection prevention and control in human and animal systems are:	- considering the use of farm assurance schemes as a mechanism to increase adherence to best husbandry including isolation of sick animals, testing of new stock and responsible use of antibiotic principles, while ensuring animal health and welfare, NFU, Species Groups, Red Tractor - encouraging retailers to review their standards for meat and animal products and to set clear specifications, concerning bio-security, antimicrobial stewardship and good husbandry throughout the supply chain for overseas as well as nationally sourced UK meat and animal products, working with suppliers and veterinarians to ensure compliance, BRC, FSA	Red Tractor guidelines have included recommendations on the recording of antibiotic use and specifically rules for HP CIA’s for Pigs (2016) Dairy, Beef and Lamb – May 2018 Retailers have taken the issue of antibiotic use and recording seriously and have taken steps to engage with their supply chains. As a minimum self declaration on the use of critically important antibiotics is common place.
ensuring adherence to evidence-based guidelines for preventing healthcare associated infections and clinical best practice guidance for infections caused by managing multi-drug resistant organisms		BVA has provided evidence-based guidelines for preventing healthcare associated infections and clinical best practice guidance on its website

encouraging and supporting animal keepers to improve bio-security and husbandry practices to minimise disease occurrence; for example, through appropriate housing design and good disinfection procedures,	encouraging livestock farmers to adhere to government guidance on bio-security, animal husbandry and on farm health planning for each of the major farming sectors and to take proactive action to reduce the risk of disease occurring in their animals, Defra, NFU, Species Groups, RUMA	City & Guilds have revised their safe use of medicines qualification to include a responsible use module. RUMA and City & Guilds have produced a toolkit for trainers on the content of responsible use training and this is freely available. Red Tractor’s revised Farm Assurance Standards include a more review focussed approach to health planning to identify potential disease and biosecurity issues to minimise the spread of disease within the farm and between other farms. NPA and AHDB Pork have produced biosecurity Standard Operating Procedures for the entire pig production chain, from feed deliveries and visitors on farm to fallen stock collection and lorry washing at abattoirs in an attempt to raise biosecurity standards on farm. AHDB Pork released their BioRisk biohazard perception tool in May 2016 to increase awareness amongst pig farm staff of the biosecurity risks that exist and to help them identify the risks on their own farms in order to be able to mitigate future risk.
encouraging appropriate use of best practice in disease control, for example through isolation of sick animals, testing of new stock prior to mixing, use of vaccines and disease eradication programmes,		BVA, with NI Branch, responded to DARDNI on compulsory testing for BVD, and revisions to Brucellosis testing regime. BVA presented at the 3rd International Conference on Antimicrobial Resistance in Animals on "Veterinarians role and options regarding disease detection, diagnosis, treatment and presentation" RUMA Guidelines promote the use of best practice in disease control. These guidelines are regularly updated and are all available free to download from the RUMA website www.ruma.org.uk RUMA and Red Tractor have produced a Red Tractor assessor guidance note on responsible use. AIC has implemented lorry scheduling to reduce the risk of disease transfer to high health units. Red Tractor’s Farm Assurance Standards require producers to provide evidence of planning and implementation of appropriate biosecurity measures. This must include measures to manage incoming stock (segregation), isolation of infectious animals and specify both measures adopted routinely and those to be implemented in the event of a disease outbreak. Assessors will be looking for a documented farm biosecurity plan. NPA has developed import protocols with the UK pig breeding companies which outline testing required for imported stock and semen in order to prevent the entry of diseases of concern into the UK including LA-MRSA. Red Tractor members must prove that they are abiding by the protocol in order to gain the derogation required to import any live animals or semen into the UK. BVA, with Welsh Branch, have developed a biosecurity SOP to help ensure good infection control during the 6 day standstill exemption on visits to veterinary practices during disease outbreaks. This will help to prevent welfare issues. BVA, with NI Branch, responded to DARDNI on compulsory testing for BVD, and revisions to Brucellosis testing regime. BVA support immediate disposal of persistently infected animals and legislation to prevent breeding from persistently infected animals; compulsory measures to achieve eradication; making BVD notifiable. A compulsory BVD eradication programme was launched in Scotland in 2013 and in Northern Ireland in March 2016 and a voluntary BVD programme in England in July 2016 with a programme also under development in Wales. BVD is associated with immunosuppression and more severe secondary bacterial infections. BVD virus elimination from the UK will improve cattle health and help to reduce the need to use antimicrobials. An Action Johnes Initiative targeting improved prevention and control of Johnes Disease was launched in April 2015. Johnes Disease is not treated with antimicrobials but is associated with increased risk of mastitis and lameness. AHDB Dairy Mastitis Control Plan and AHDB Dairy Healthy Feet Programme for which Plan Deliverers and Mobility Mentors, respectively, work with farm staff to assess risks, interpret the health records data, define the issues and develop action plans specific to the farms needs to target better prevention and control of mastitis and lameness respectively.
sharing intelligence on emerging issues in human and animal health; as well as making better use of early warning systems to trigger appropriate containment measures at a national and global level to limit spread of AMR,		The APHA Pig Expert Group flags resistance issues as early warning and both NPA and AHDB-Pigs sit on this group.
cost-effective use of licensed vaccines to reduce the incidence of infections as well as promotion of the development of new vaccines, including those against multi-drug resistant organisms.		BPC have campaigned for the introduction of a vaccine for blackhead in turkeys but it is likely this will remain uneconomic to develop. BPC is considering funding options under the European Innovation Platform to undertake collaborative research with other Member States on a preventative cure for Blackhead. Once again the initial response has not been favourable. RUMA Targets Task Force targets have highlighted the benefits of vaccine use and this is reflected in RUMA Guidelines. Some sectors have included the promotion of vaccine use as best practice, and are monitoring vaccine sales to track the uptake. A campaign to promote the value of vaccines and their best practice will be coordinated by RUMA in Autumn 2018.

Key area 2: optimising prescribing practice Actions needed to further improve antimicrobial conservation and stewardship through optimising prescribing practice are:	- improving adherence to responsible prescribing and responsible administration principles for antibiotics by ensuring provision of practice prescribing policies and by dissemination of education material aimed at aiding compliance with medication instructions, RUMA	BVA has revised and re-issued its best practice guidance on responsible use of antimicrobials poster. Ongoing – BVA has held initial discussions within the BVA Medicines Group and with Medicated Feed Industry. Liaising with FVE on EU MF legislation as it moves through the committee process. BVA reminded members of responsibilities on advertising POMs to the public via Community/e-news. The RVC has completed a project using veterinary practice records to look at antimicrobial prescribing in cats and dogs. The final report is to be published later in 2016. (Aug 16)
developing enhanced education and training in prescribing and administration of antibiotics,	- strengthening and embedding an understanding of AMR issues throughout undergraduate courses, RCVS/BVA - considering influencing uptake of training through statutory professional standards, for example, for veterinary surgeons by inclusion in the RCVS Day One Competency Framework and/or through the annual continuing professional development (CPD) requirements necessary to retain membership of the RCVS or other professional body, RCVS/BVA - increasing the level of provision of targeted CPD for veterinary professionals, RCVS/BVA - increasing access to relevant training for animal keepers, RUMA, NFU, NOAH, BVA, Species Groups	BVA has embedded responsible use into its veterinary surgeon CPD provision. City & Guilds revised veterinary medicines qualification launched in May 2016 includes responsible use and practical training on administering medicines. NOAH is leading a RUMA project to develop co-ordinated farmer training opportunities in the responsible use of antibiotics. (Modules for all sectors to be launched July 2018) BVA provided input into the RCVS Day One Competences Review in June 2013 to ask that Practical Competences include knowledge of responsible use of medicines, in particular antimicrobials and anthelmintics. The Day One Competences Guide, which was published in February 2014, includes reference to prescribing and dispensing medicines correctly and responsibly in accordance with legislation and latest guidance. It makes particular reference to taking care to minimise the risk of antimicrobial resistance. BVA officers raised the issue of resistance and responsible use with the Heads of UK Veterinary Schools at their meeting in March 2014. There was broad agreement that the curriculum in all schools already more than adequately addresses the teaching of responsible use of medicines and in particular antimicrobials and the challenge of antimicrobial resistance in the context of One Health. The schools keep the teaching of these topics constantly under review to ensure they are accorded the appropriate attention. The Pig Veterinary Society (PVS) produced prescribing guidelines for pig vets. The PVS, with the PHWC, has also developed guidance for pig vets on reviewing antibiotic use on pig farms. All guidance is available to all vets at www.pvs.org.uk. The BPC Antibiotic Stewardship programme contains prescribing guidance. The BCVA issued prescribing guidance to its members in 2017.
identifying the optimum arrangements for recording and reporting of data (including the use of electronic prescribing), as well as analysis of data on antibiotic use, resistance and clinical outcomes		BVA involved in discussions with VMD on this issue. Will continue to feed into VMD work as appropriate. RUMA TTF was established to set species targets for antibiotic use reduction, refinement and replacement. Systems to record use in pigs, poultry meat, eggs, fish and game have been developed while cattle and sheep systems are being established for these less integrated producers. Targets for all sectors were published in November 2017. https://www.ruma.org.uk/wp-content/uploads/2017/10/RUMA-Targets-Task-Force-Report-2017-FINAL.pdf Red Tractor’s revised Farm Assurance Standards, effective from October 2014, introduced new requirements for an annual review of antibiotic use on each farm. - In the beef and lamb sector (England only), producers are required to discuss antibiotic use with the vet during the annual vet visit. - In the dairy sector, the herd health and performance review includes a review of medicine antibiotic purchase and use. - In the pig sector, assessors will check that the VHP contains an annual collation of total antibiotics used (including in feed medication) and that this use has been reviewed by the vet. - - For broiler chickens, medicines records are required to contain an annual collation (mg active/kg LWt) of total antibiotic used for each crop and a new standard specifies that the routine use of fluoroquinolones is not permitted and the use of 3rd or 4th generation cephalosporins is not permitted in broiler chicks at any time and there must be no routine use. (Oct 14) Red Tractor has started a standards review in preparation for the next edition(s) to be published in Oct 2017. This review covers all aspects including housing/biosecurity/medicines use & recording etc. The formal consultation will be issued in October 2016. (May 16) Red Tractor – new standards for the Dairy, Beef and Lamb secotrs will be introduced in May 2018 covering antibiotic use records and the use of HP- CIA’s as a course of last resort and only after diagnostic testing. NPA AIC has developed an agreed report with the major feed companies to ensure annual use data of antimicrobials in in-feed medicines is available to producers for their RT annual statement. (Apr 15) AHDB-Pork launched an electronic medicines book (eMB) for recording and benchmarking antimicrobial and other medicine use in April 2016. The Pig Industry eMB will also be available to other species. By July, 41 producers had submitted antibiotic use data to the eMB, covering 176 sites, 861,000 finishers and 47,000 sows and boars. Therefore, data for 12% of the national breeding herd and 18% of the national growing and finishing herd has been shared to date. Nearly three hundred users have registered to use the eMB but not yet submitted data. (Aug 16) The cattle sector working together under the Cattle Health & Welfare Group (CHAWG, www.chawg.co.uk) have undertaken a scoping study for the VMD mapping what antibiotic usage data is currently being captured and what more could be done in the UK cattle sector. Overall the amount of data collected is limited to “medicine book” entries and remains largely paper based but the 30 organisations contacted recognised the importance of this subject and the need to find viable solutions that both answered the needs of the EU and the European Medicines Agency and also provide valuable aggregated industry information. An agreed “route of entry” was via the vet practice working to an agreed standardised template. (April 2015) A CHAWG industry workshop in January 2016 considered how to collect antimicrobial use data and CHAWG is consulting the industry on the options. (Feb 16) The BPC’s Antibiotic Stewardship Scheme set up in 2011 developed a mechanism of collecting usage data from the poultry meat sector on an annual basis. It was the first livestock sector to pioneer data collection covering 90% of UK poultry meat production across chicken (meat), turkeys and ducks. It was also the first sector to share its data with the VMD and the 2012-2014 data was included in their annual VARRS report. 2015 data has been submitted to the VMD for the next VARSS report. Over the period 2012-2015, the total amount of antibiotics used by the poultry meat sector decreased by 44% while production increased by 5% over the same period. The sector saw a 27% reduction in 2015 from 63.46 tonnes in 2014 to 46.17 tonnes in 2015. Between 2014 and 2015 the Scheme reduced its total antibiotic use in chickens by 39%. BEIC - have introduced a reporting form for Lion Code members to enable antimicrobial usage to be ascertained Lion Code subscribers record any usage and return report form to BEIC every quarter. This includes data on the product used, active ingredient, dosage, type of stock treated, and their age to enable a ‘flock treatment days’ figure to be calculated. AHDB Good data industry collection systems are now established through the eMB with developments for Dairy, Beef and Lamb, in progress.
improving the quality and standardisation of routine antibiotic testing and interpretation of results to improve diagnosis and treatment of infections,	- encouraging animal keepers to work closely with their veterinary surgeons to prioritise diagnosis of disease in livestock and companion animals; and to encourage early use of appropriate diagnostic testing, in particular, bacterial culture and sensitivity tests, RUMA, NFU, BVA	RUMA raised the need for the development of quick and inexpensive diagnostic test kits in evidence to the Science and Technology Select Committee on 29 January 2014 and BVA submitted a follow-up paper on 18 February 2014.

auditing local prescribing practices and outcomes across the system to assess the effects of antimicrobial stewardship programmes in human and animal settings,		BVA - RCVS now covers responsible use as part of their veterinary practice inspections. VMD inspectors, during veterinary practice premises inspections, ask if there is an AMR protocol in place and draw attention to various published guidance, such as the BSAVA’s PROTECT information. BPC Antibiotic Stewardship Scheme is working with the poultry veterinary profession to take a standardised approach to antibiotic usage. NPA launched the pig industry Antibiotic Stewardship Programme in May. The programme aims to capture and collate antibiotic use data recorded on pig farms, benchmark antibiotic use against farms of a similar type, extend education in effective disease control strategies, reduce antibiotic use, consistent with responsible human and food-animal medicine, promote PVS prescribing principles to strictly limit the use of antibiotics of critical importance to human health and appoint Stewardship Commissars to continually review industry’s use of antimicrobials and champion initiatives. (May 16) Antimicrobial Stewardship policies have been developed for poultry and pigs. A Dairy Antimicrobial Stewardship Group was set up in 2017 and groups have been established to coordinate activity for the beef, sheep and game sectors.
facilitating development of sector specific prescribing guidelines, which, for example advocate minimising the routine use of preventative antibiotics in animal health and to promote responsible use practices including engaging with representatives across the animal health spectrum to ensure effective dissemination of guidance.	- facilitating development of sector-specific prescribing guidelines and promoting responsible use practices, including effective dissemination of guidance. RUMA, BVA, Species Groups	The Pig Veterinary Society (PVS) produced prescribing advice for pig vets in February 2014 and has developed prescribing guidelines for pig vets. The PVS, with the PHWC, has also developed guidance for pig vets on reviewing antibiotic use on pig farms. All guidance is available to all vets at www.pvs.org.uk. The BPC Antibiotic Stewardship Scheme’s key focus is responsible use and when possible a reduction in use of those antibiotics considered to be of most highly critical importance by the WHO. Measures are in place to ensure that most highly critical antibiotics are only permitted if they are the sole therapeutic option to alleviate bird pain and suffering. In 2012 the BPC introduced a voluntary ban on the use of third and fourth generation cephalosporins and a commitment to reduce the use of fluroquinolones. The BPC recognised the increasing importance of colistin as an antibiotic of last resort for human medicine and stopped its use in September 2015. In 2016 the Scheme made a further commitment to stop the prophylactic use of fluoroquinolones in day old chickens. Through RUMA, in December 2015, the UK livestock industry agreed to restrict the use of colistin to an antibiotic of last resort and will be used only after susceptibility testing had shown it was the only effective antibiotic available for treating the sick animals. RUMA launched updated guidelines for farmers on the responsible use of antimicrobials in poultry and game production on 11 April 2014. RUMA launched new Guidelines on the Responsible Use of Antimicrobials in Dry Cow Management on 29 April 2015. RUMA launched new Guidelines on the Responsible Use of Antimicrobials in Cattle on 4 August 2015. GFA issued the revised RUMA Guideline on Antimicrobials for Poultry and Game Farmers to all their members.
Key area 3: improving professional education, training and public engagement Actions needed to improve education, training and engagement are:		NOAH - The NOAH AMR Best Practice Training Project will provide on line modules on general AMR use and principles, as well as sector specific modules. It will be hosted on the Lantra portal which is widely recognised by farmers for training materials. There will also be a vet portal to encourage vets to cascade the information to their farmers. It is due for launch July 2018
identifying mechanisms to improve the uptake of guidance for professionals, including through commissioning and audit of prescribing, infection prevention and control		BVA supports and promotes EAAD primarily through a comms programme and the antibiotic guardian campaign. BVA is promoting a video from Animal Welfare Foundation’s discussion forum on AMR: the real world view.

ensuring that generic prescribing competences, which are being developed, are adopted and embedded in curricula, and that antimicrobial stewardship competences are included in professional curricula and continuing professional development,		BVA has embedded responsible use into its veterinary surgeon CPD provision. See entries for BPC, BCVA and PVS prescribing guidance under item 7.
increasing public engagement to promote key messages about antimicrobial use, including promotion of training of non-health professionals, like farmers, with responsibility for administering antibiotics,	- continuing to expand activities aimed at raising awareness and encouraging behaviour change by veterinary and farming associations, for example, through use of farming sector events and trade publications to disseminate responsible use messages, and by concerted active participation across all relevant groups in the European Antibiotics Awareness Day, RUMA, VMD	VMD offered speakers on antimicrobial resistance and responsible use to agricultural colleges. City & Guilds have revised their safe use of medicines qualification to include a responsible use module. RUMA and City & Guilds have produced a toolkit for trainers on the content of responsible use training and this is freely available. NOAH is leading a RUMA project to develop co-ordinated farmer training opportunities in the responsible use of antibiotics. (To be launched July 2018) RUMA and Red Tractor have produced a Red Tractor assessor guidance note on responsible use.
facilitating public debate to shift the societal view to raise awareness of antibiotics and ways to limit their use. This could include considering the potential for restricting the use of antibiotics for low risk self-limiting infections and/or restricting antibiotic use more widely to affect behaviour change.		RUMA published its Antibiotic Resistance Information Note on 23 April 2014. BVA has produced a set of client leaflets for pet owners and farmers which outline their roles and responsibilities in relation to antibiotic use. BVA has also produced a set of 6 myth busters tackling common misconceptions about the use of antibiotics in animals and worked with the VMD to produce a poster for veterinary practice waiting rooms. All of these resources are freely available on the BVA website and are promoted, particularly in the lead up to European Antibiotic Awareness Day. RUMA launched a new website to help educate the public on how antibiotics are used in livestock www.framantibiotics.org

Key area 4: developing new drugs, treatments and diagnostics Actions needed to accelerate the discovery and development of new drugs, vaccines, rapid diagnostics and treatments are:
encouraging innovation and providing an impetus for improved collaborative action to develop rapid diagnostics and new treatments and vaccines,		NOAH members actively encourage innovation and research into these issues. Such research takes place with a European or even a global focus and scope. The main NOAH focus is ensuring the regulatory landscape encourages innovation. This is an ongoing action as the EU Vet Med regulatory review progresses. NOAH is providing its views on an ongoing basis to the VMD. RUMA raised the need for the development of quick and inexpensive diagnostic test kits in evidence to the Science and Technology Select Committee on 29 January 2014 and BVA submitted a follow-up paper on 18 February 2014.

addressing the commercial viability issues that are hampering investment in antibiotic development, assessing the relative merits of possible incentives to stimulate research and development in new antibiotics and other products and fast-track priority review arrangements for new antimicrobials,		NOAH members actively encourage innovation and research to address the commercial viability issues in antibiotic development. Such research takes place with a European or even a global focus and scope. The main NOAH focus is ensuring the regulatory landscape encourages innovation which is an ongoing action as the EU’s Veterinary Medicine regulatory review progresses. NOAH is providing its views on the proposals to the VMD. It is too early to say what the final text will say regarding improved data protection for antibiotics. NOAH is also seeking improvements to the regulatory processes to encourage vaccine development.


Key area 5: better access to and use of surveillance data Actions needed to strengthen surveillance in the human and animal sector are:	working collaboratively to strengthen the available evidence base, in particular through the collection and sharing of surveillance and usage data in order to benchmark current levels of resistance and antibiotic consumption and improve early warning systems at national and global levels, Defra, Devolved Administrations - continuing to explore options for the collection and analysis of veterinary medicine prescription data, including the use of local audit, VMD - ensuring that any new data-collection initiatives use methodologies and analytical techniques that harmonise with on-going EU- led projects, to maximise their potential to enhance the wider evidence base. Defra	AHDB Good data industry collection systems are now established through the eMB with developments for Dairy, Beef and Lamb, in progress.
linking clinical and laboratory data in human health to improve control of the most resistant bacteria and to identify key ‘drug-bug’ combinations detailed at Annex C,		VMD is considering drug-bug combinations for surveillance across MS. (Nov 15)
developing antimicrobial usage and resistance surveillance programmes that can link to electronic prescribing systems as they are introduced,		RUMA met with VMD on 6 March 2014 to discuss and offer support to their project considering options for collecting usage data. See entries for AHDB-Pork, BEIC, BPC and CHAWG under item 8.
improving the quality and standardisation of routine antibiotic testing and interpretation of results as well as making better use of surveillance data to improve diagnosis and treatment of infections,		Dairy UK and dairy first purchasers are looking at ways they could share information on antibiotic failures with Red Tractor and as a next step RTA is working closely with one first purchaser to see how this could be done in practice.



Key area 6: better identification and prioritisation of AMR research needs Actions to support the better identification and prioritisation of AMR research needs are:	encouraging the research needed to gain a greater understanding of the impact of interventions intended to minimise development and spread of antibiotic resistance, ALL


ensuring that research funders continue to collaborate so that both research needs continue to be identified as the evidence base evolves and key priorities continue to be funded,		RUMA independent Scientific Group formed in 2017 and considering whether to extend its role to include R&D collaboration.



Key area 7: strengthened international collaboration Actions needed to strengthen international collaboration with international bodies to improve knowledge and understanding of AMR, improve conservation and stewardship of existing antibiotics and facilitate development of new antibiotics, diagnostics and novel therapies are:
continuing to demonstrate leadership in the task of building political support for action at a global and national level,		RUMA has issued evidence submissions to the Science and technology Select Committee (Dec 2013) and the APPG on Eggs, Pigs and Poultry (Feb 14). RUMA advising the Irish industry and Brazil, Thailand and Mexico have expressed interest in consulting RUMA on the possibility of establishing a RUMA equivalent.
supporting efforts to strengthen international partnerships and coalitions to facilitate the development of new antibiotics and other treatments		NOAH members actively encourage innovation and research to address the commercial viability issues in antibiotic development. Such research takes place with a European or even a global focus and scope. The main NOAH focus is ensuring the regulatory landscape encourages innovation which is an ongoing action as the EU’s Veterinary Medicine regulatory review progresses. NOAH is providing its views on the proposals to the VMD. It is too early to say what the final text will say regarding improved data protection for antibiotics. NOAH is also seeking improvements to the regulatory processes to encourage vaccine development. AHDB Dairy have an international forum to share best practice on antimicrobials with Dairy Australia, DairyNZ and Teagasc Ireland. Its Dairy and Pig sectors are collaborating in EU wide Horizon 2020 Knowledge exchange projects on AMR.