Communique - Antimicrobial Resistance Roundtable

Representatives from government, animal industries and research institutions met in Canberra on Monday 1 December 2014 to discuss how a future Antimicrobial Resistance (AMR) surveillance program in animals could be implemented in Australia. Discussion focused on the 2014 report to the Department of Agriculture: Surveillance and Reporting of Antimicrobial Resistance and Antibiotic Usage in Animals and Agriculture in Australia (the ‘AMRIA Report’).

The AMRIA Report was produced by a team of AMR experts working through the University of Adelaide and Griffith University. The report was commissioned by the Department of Agriculture via a competitive tender process. It was developed using One Health principles and to complement a June 2013 report commissioned by the Antimicrobial Resistance Standing Committee: National Surveillance and Reporting of AMR and Antibiotic Usage for Human Health in Australia.

This roundtable was the second on AMR in agriculture. The first roundtable took place on 4 July 2013 and discussed a range of issues including what AMR in agriculture is, the risks it poses and actions being taken by government to address these risks.

The key objectives of the second roundtable included:

• Discussing the recommendations of the  AMRIA Report
• Moving from advocacy to action
• Progressing  AMR surveillance mechanisms, gathering stakeholder views on issues and concerns
• Building the One Health approach being progressed in Australia, with both Health and Agriculture addressing AMR and setting up surveillance systems
• Considering the wide range of groups impacted by AMR, and ensuring the surveillance process reflects inputs from all those sectors, and the provision of resources
• Building on existing mechanisms, management systems and regulation to achieve maximum efficiency and effectiveness, in the current resource constrained environment
• Identifying priority areas in which to perform AMR surveillance.

The roundtable was chaired by the Australian Chief Veterinary Officer Dr Mark Schipp, and had AMRIA Report team leader Associate Professor Darren Trott as Master of Ceremonies.

Session one was Chaired by Associate Professor Darren Trott and commenced with a presentation by Professor John Turnidge providing an update on developments regarding AMR in the human sector, and an introduction to the national surveillance program for AMR and antibiotic usage (AU), named Antimicrobial Use and Resistance in Australia (AURA) Surveillance Project. This program has been funded to coordinate national action to prevent and contain antimicrobial resistance through enhanced surveillance systems.

The second presentation by Professor Ramon Shaban provided a detailed background and summary of the AMRIA report, focussing on the recommendations in particular. After the first two presentations the audience posed questions to John and Ramon.

Associate Professor David Jordan provided an update on AMR surveillance in animals in the international context mentioning lessons to be learned and recent developments. 

After his presentation Associate Professor Jordan invited Elanco UK AMR expert Dr Shabbir Simjee to join him in answering questions from the audience about international experiences in AMR surveillance.

The last presentation of the morning provided the Department of Agriculture’s perspective on AMR surveillance in animals. Dr Mark Schipp provided some conceptual proposals to guide further group discussion.  Dr Schipp focussed on the importance of the One Health approach to AMR, a partnership between all the stakeholders, and referred to existing systems that could be adapted and expanded to address AMR surveillance.

Roundtable participants were assigned to one of six industry sector groups chaired by one of the AMRIA group, or their expert steering committee.

The groups and chairs were:

• Beef cattle and small ruminants – Professor Glenn Browning
• Dairy cattle – Associate Professor David Jordan
• Pork – Dr Jane Heller
• Poultry – Dr Stephen Page
• Companion animals and wildlife – Associate Professor Darren Trott
• Aquaculture and other – Professor Mary Barton

Questions were posed to each industry group for discussion with the chair of each group reporting their responses at the end of each session. 

Group discussion questions

1. How could active (taking samples as part of a trial for a defined period)/passive surveillance (taking samples all the time) work in your industry sector?
1. Can you identify existing systems and activities that support active/passive surveillance?
2. At a high level, what else needs to be done to facilitate active/passive surveillance?
2. How could sampling for AMR surveillance be introduced in your industry?
1. Discuss possible sampling points and advantages/disadvantages e.g. on farm, point of slaughter, post slaughter etc
2. Discuss the logistics of sampling at the preferred points, e.g. who, when, how
3. What types of things need to be done to facilitate sampling; what are the enablers and barriers?
3. How should responsibility for AMR surveillance be allocated in your industry?
1. What authority needs to be matched with what responsibility?
2. What roles are needed and who should take them?
4. How can AMR surveillance be funded in your industry?
1. Can you identify incentives/costs/benefits for each of the different ‘players’ in the industry to contribute either in kind or financially? 
2. What funding sources should be investigated, what sources are problematic either politically or practically?
5. How can a common view of the importance of AMR surveillance to your industry be established?
1. Who needs to be involved, in what format, over what time period?
2. How can AMR surveillance be prioritised against other issues in your industry?
3. How can AMR surveillance for your industry be prioritised against other industry sectors?

6. Would you support the establishment of a task group to address further details including possibilities such as:
1. Linking existing management systems adapted for AMR surveillance e.g. NRS (with designated AMR lab), AURA and the Department of Agriculture/Health?
2. The organisms that should be targeted as part of AMR surveillance for your industry?

It was accepted that active surveillance (taking randomized samples from the general population over time) would produce a more representative analysis of AMR in animals in Australia than would passive surveillance (i.e. samples collected through the treatment of sick/diseased animals), although both were regarded as important.

Existing systems that could support surveillance included:

• Microbiological sample collection at abattoirs as carried out by government meat/food hygiene inspectors (for example the Australian Government Meat Export Program E. Coli and Salmonella Monitoring Program (ESAM) and other microbiological testing of carcases)
• Microbiological sample processing and consignment as carried out by the National Residue Survey
• Research projects as currently supported by Research Development Corporations and other levy funded industry organizations
• Private industry based research
• Collecting data from public/private veterinary laboratories which perform antimicrobial sensitivity testing
• The Australian Group on Antimicrobial Resistance (AGAR) Labs network 

Point of slaughter/harvest sampling was generally regarded as the most efficient and effective point of intervention in food producing animals/species. Post slaughter sampling is complicated by increased microbiological contamination from people.

Companion animals were regarded as important. Whilst most AMR surveillance programs overseas focused on food animals, evidence was tendered of AMR risks associated with close contact with companion animals (including horses). 

Laboratory networks and standards for producing comparable data including through harmonized testing arrangements was considered highly important.

Responsibility for AMR surveillance was debated around importance to public health, importance to animal health and importance to trade and consumer affairs. ‘The financial underpinnings of AMR surveillance programs needed to take into account the beneficiaries of AMR surveillance.

High importance was given to how the individual animal sectors and enterprises interacted with government. This included the need for government and industry leaders to be able to clearly articulate the benefits of AMR surveillance to individual animal industries and enterprises, and how AMR data and data analysis will be reported and communicated.  

Linking reporting, analysis and communication of animal AMR surveillance with the Antimicrobial Use and Resistance in Australia (AURA) Surveillance Project was seen as a potential option for overseeing the One Health dimension to the program.

At the conclusion of the roundtable it was agreed that a Task Group would be established to further consider the logistics of implementing Australia’s future AMR surveillance program for animals in the context of the recommendations made in the AMRIA Report. Initial work was agreed to focus on establishing the priorities for involvement of the different agricultural sectors in the program. There was also agreement to undertake the design and implementation of a proof of concept model, utilising existing systems (for example the National Residue Survey) with the capability for transitioning into an ongoing self sustaining program. Interested attendees were invited to submit expressions of interest for involvement on the Task Group to the Department of Agriculture by Friday 9 January 2015. Draft Terms of Reference for the Task Group would be developed by the Department of Agriculture to be considered and endorsed by the future Task Group.

The activities of the Australian Government Department of Agriculture on AMR (including roundtable Communiqués) can be found at Antimicrobial Resistance.

For further information, please email the Office of the Australian Chief Veterinary Officer at OCVO.

On Thursday 4 July 2013 representatives from government, animal industries, research institutions and others met in Canberra to discuss the issue of antimicrobial resistance (AMR) as it relates to the animal sector. The complete list of presenters and participants is at Appendix 1.

This Roundtable event was partly in-preparation for an Australian One Health AMR Colloquium taking place on 18 July 2013, also in Canberra. The Colloquium is being convened at the request of the Secretaries of the Australian Government Department of Agriculture, Fisheries and Forestry (DAFF) and Department of Health and Ageing (DoHA) to provide advice to them on key priorities and strategies across the human and animal sectors to address AMR in Australia with particular reference to surveillance requirements and regulatory reform.

The specific objectives of the Roundtable included to:

• Share information on what AMR is, the problems and risks it poses, and current activities on AMR
• Have an open dialogue on issues relating to AMR and gather stakeholder views on issues and concerns
• Build relationships with and amongst stakeholders, and develop an ongoing platform for further engagement with them
• Identify priority areas on AMR to inform the development of the national framework for future work to deal with the AMR challenge and for presentation to the AMR Colloquium
• Identify animal sector representatives to attend the invitation-only AMR Colloquium (identified representatives are included at Appendix 2)

Session one commenced with a presentation by Dr Stephen Page on the science of AMR as it concerns the animal sector.

Professor John Turnidge provided the second presentation on the science of AMR as it concerns the human sector.

Both presenters defined what AMR is, including as a natural phenomenon dating back many of thousands of years. Resistance mechanisms and selection for them was explained, as was the way in which resistance can transfer between bacterial species. The epidemiology of AMR was acknowledged to be very complex, involving interactions of environmental, clinical and behavioural factors. AMR bacteria were regarded as being capable of being transferred between animals and humans.

Both presenters were of the opinion that the use and overuse of antibiotics in human medicine is the major factor contributing to the development of AMR. Scientific support was provided demonstrating that antibiotic use in animals can affect human health through the transfer of resistant bacteria. However the amount contributed by the use of antibiotics in animals was acknowledged to be difficult to quantify.

Some of the highly prevalent resistance factors in the global community were identified, along with their public health impacts. The international movement of people was considered the key way resistance spread around the world.

Overall in terms of the prevalence of highly resistant bacteria found in people and animals, Australia was acknowledged to compare very favourably to most other countries. It was noted that AMR prevalence varied significantly between different parts of Australia.

Session two commenced with a presentation from Dr Mark Schipp on Australia's current approach to the AMR challenge in the animal sector.

Dr Allen Bryce provided the second presentation on current controls over antibiotics in Australia.

Ms Andriana Koukari provided the third presentation on the work of the AMR Prevention and Containment Steering Group, and the AMR Standing Committee.

Dr Schipp informed participants that the UK Government's 1969 Swann Report was regarded as the foundation for the development of policy on prudent use of antimicrobials and regulation on antimicrobial use. DAFF and DoHA jointly published their own report into the use of antibiotics in food producing animals and AMR bacteria in animals and humans – the 1999 Joint Expert Technical Advisory Committee on Antibiotic Resistance (JETACAR).

The JETACAR recommendations were identified to fall into five key elements:

• Regulatory Controls
• Monitoring and Surveillance
• Infection Prevention Strategies
• Education
• Research

These recommendations for the most part were and continue to be implemented. A Senate Inquiry into the progress in the implementation of the recommendations of JETACAR was completed in June 2013. It made recommendations particularly on monitoring and surveillance, and research. The Australian Government is currently drafting its response to the Inquiry.

DAFF had conducted its own Pilot Survey published in 2007 (in response to JETACAR), into AMR in bacteria of animal origin. The results were reassuring overall. The survey however did not transition into an ongoing monitoring and surveillance program. In common with most other countries Australia does not meet the World Organisation for Animal Health (OIE) standards on AMR surveillance and monitoring.

Dr Bryce stated that all antibiotics used in animals in Australia are imported. They are subject to an assessment process prior to registration by the Australian Pesticides and Veterinary Medicines Authority (APVMA). This included AMR risk assessments. Imported antibiotics are also subject to controls by Customs, the Therapeutic Goods Administration, and DAFF (quarantine controls).

Dr Bryce commented on issues related to restricting the registration of antibiotics listed by the World Health Organization as being of critical importance to human health. Dr Bryce also raised some of the issues on the controls surrounding compounding pharmacies, and on issues surrounding the monitoring of antibiotic usage.

Ms Koukari first presented on the AMR Standing Committee (AMR SC) as formed in April 2012. This was described as an expert committee to provide advice and recommendations on national priorities to the Australian Health Minister's Advisory Council. AMR SC was in the final stages of publishing a report 'National Surveillance and Reporting of AMR and Antibiotic Usage' which has a human sector focus.

Ms Koukari informed participants of the new AMR Prevention and Containment Steering Group. This group was established in February 2013 between DoHA and DAFF bringing together the Secretaries and Chief Medical and Veterinary Officers of the respective departments. Their role is to provide governance and leadership on AMR and oversee the development and implementation of a coherent framework for current and future work related to AMR. Ms Koukari commented on the significance of the high level commitment in the Australian Government to AMR as an indication of its commitment to the AMR challenge.

Dr Stephen Page provided a presentation on international approaches to AMR in the animal sector.

The presentation detailed the G8 Science Ministers Statement of 12 June 2013, expressing its concern on the emerging AMR challenges.

The focus of the presentation was on monitoring and surveillance programs in place in various countries. It was acknowledged that monitoring and surveillance, and even basic controls over antibiotics, was patchy in its existence around the world.

The Danish Integrated Antimicrobial Resistance Monitoring and Research Programme (DANMAP) and the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) program were illustrated as established sophisticated programs on which future activities in Australia could be modelled.

For the discussion session, two questions were provided from which each table of participants was asked to formulate answers for presentation.

The first question asked: 'What do you see as the major risks faced by the agriculture sector from antibiotic use?' The following key points were identified as the major risks faced by the agriculture sector:

• Bans or restrictions on the use of antibiotics in the sector with consequential reduced animal productivity, health, welfare and competitive disadvantage outcomes
• Lack of new antibiotics being developed and commercialized
• Lack of new antibiotics being developed with new modes of action that are able to work for longer before resistance develops
• Loss of industry reputation as a supplier of safe food
• Loss of markets including to large retailers
• Loss of consumers
• Increased importation of food with associated increased risk of AMR importation
• Biosecurity risks to farms from visitors and workers introducing resistant bacteria

The second question asked: 'What do you see as the key priorities for action in the animal health sector for addressing the AMR challenge?' The following key points were identified as the key priorities for action in the animal health sector:

• The need for broad-based, unbiased AMR surveillance data to support risk based assessments of antibiotics to ensure their continued availability in the Australian marketplace
• The need for better antibiotic usage data to support resistance surveillance data
• The need for broad-based, unbiased AMR surveillance data to demonstrate the expected low prevalence of resistant organisms in Australia
• To continue to support research, development and extension to reduce the need for antibiotics
• To ensure laboratories engaged in AMR surveillance have standardized laboratory procedures so that comparable data is generated and interpreted consistently
• To be more proactive in a sustained manner in communicating positive messages and data to support arguments on good farm practices and food safety
• To raise the profile of the various prudent use guidelines/initiatives for the various farm/animal sectors
• To continue to support on-farm biosecurity initiatives
• To continue to support assurance programs aimed at improving farming practices and food hygiene
• To engage in international forums and support antibiotic stewardship initiatives internationally to combat the imported AMR threat

In the near future, this communique and other activities of the department related to AMR will be able to be found at Antimicrobial Resistance.

For further information, please email the Office of the Australian Chief Veterinary Officer.