5 Questions: The Antibiotic Footprint, Dr. Peter Collignon

1) Will you tell us a little about the antibiotic footprint and how this concept was conceived?

The idea was conceived to make it clearer to people how to better know about and then control the amounts of antibiotics used within their own country. The antibiotic footprint is a way of presenting a simpler way of measuring the amounts used within their own country. The antibiotic footprint not only tells us what is happening in the medical arena and in people, but also what is used in animals, agriculture and aquaculture. We are all rightly worried about Superbugs. Whenever larger antibiotic volumes are used, this accelerates both the development, multiplication and then the spread of Superbugs.

2) Consumers have the power to change the way antibiotics are used. In your opinion, what are the most effective steps that individuals can take on a daily basis to reduce their consumption of antibiotics?

First always question how taking any antibiotics will affect us directly. Whenever we go to a doctor and are prescribed antibiotics, we should all routinely ask “will this really make much of a difference to me and how?” In most wealthy countries (e.g., Australia and the US), over half of all antibiotics used in people are still used for respiratory tract infections and these are usually caused by viruses - and against which antibiotics don’t work. However most antibiotics used (and in most countries are) are used in agriculture - often for growth promotion and routine preventive therapy for whole herds of animals. Then Superbugs that develop, because of this excessive antibiotic use, can spread to people. We need to take action via consumers and their choice of products, political involvement, media pressure etc. to awaken all of us of the urgent need to decrease antibiotics usage everywhere and so decrease our footprint everywhere. This means not just in the health sectors but in our farming communities as well. We need to do this locally and globally as Superbugs spread globally.

3) How can the antibiotic footprint of each country be used by policymakers to make decisions about legislation regarding antibiotic use? What parallels can be drawn with the carbon footprint in terms of impact made on policy making?

The footprint allows us to compare our footprint to other countries and especially to those that do it better. We can then influence policy makers, and others to follow the successful examples of others via legislation, consumer pressure, marketing etc. The end result will be that we use less antibiotics.

4) What specific tools or systems need to be in place for countries to be able to collect sufficient data to generate antibiotic footprints? Are there specific sectors that need better/improved transparency on antibiotic use reporting?

We need timely, open, accurate and freely available data on the amounts and types of antibiotics used in all countries, both in agriculture and in people. These data are available now but usually kept secret because of “commercial in confidence” arguments. For such an important public health issue as Superbugs and AMR, that argument needs to be thrown out.

5) What are some of the global targets you would like to see being set using antibiotic footprints as a tool for the reduction of antibiotic consumption?

We need to get consumption levels of antibiotics in people down to the levels that are used in The Netherlands and Scandinavian countries. These countries use less than half the amounts used in Australia and the US per person and without any adverse health outcomes to people or the population – in fact people in their health systems usually have better health outcomes compared to other countries. We need to get antibiotic consumption in food animals in most countries down by more than 70% of current consumption levels. That means, as recommended by recent WHO guidelines, no longer using antibiotics anywhere in the world for growth promotion and also no routine use as preventative therapy in herds or flocks of animals. Many countries achieve this already (e.g., most of Scandinavia). That usually means also looking at other ways of raising food animals (e.g., open pasture and grass fed cattle). High antibiotic use for food animals should be seen as an indicator of poor animal husbandry practices, over-crowding, poor infection prevention (e.g., by vaccines) and/or not enough efforts to stop the transmission of infections. So, excessive antibiotic use in food animals is likely not only an indirect measure of poor housing conditions, but also in my view of relative animal cruelty.