In the second of a series of international perspectives articles looking at antibiotic stewardship activities outside of the UK, RUMA talks to Darren Trott, Professor of Veterinary Microbiology and Director of the Australian Centre for Antimicrobial Resistance Ecology at The University of Adelaide, and Dr. Kylie Hewson, Lead Animal Health and Environment for the Minimising AMR Mission coordinated out of Commonwealth Scientific and Industrial Research Organisation (CSIRO) , to find out more about Australia’s farmed livestock industry and its antibiotic stewardship activities and initiatives, as well as the journey ahead.
Darren has been researching AMR for the last 23 years and has undertaken numerous Australian surveys of antimicrobial resistance in pathogens of livestock and companion animals and commensals of livestock.
Kylie has established and coordinated AMR, AMS and AMU programs across the Australian livestock sectors and helped to establish cross-sectoral AMS initiatives.
Chris Lloyd from RUMA interviewed Darren and Kylie recently to learn more about Australia’s response to AMR.
RUMA: Is there anything like RUMA UK in Australia which works across all of the livestock sectors to champion the responsible use of medicines?
ANSWER: The Animal Industries Antimicrobial Stewardship RD&E Strategy (AIAS; https://aiasrdestrategy.com.au/about/), was established to bring together the research funding organisations and peak bodies for the major livestock sectors in Australia to work collectively on, and co-invest in antimicrobial stewardship efforts. This formalised a community of practice that was established in 2015 after the release of Australia’s first National AMR Strategy.
There is a steering committee that oversees this strategy which has observers from governments, veterinary association representatives, and smaller industries that may not be able to contribute funding to the operations. The AIAS also oversees a biennial conference (the Australian Veterinary Antimicrobial Stewardship conference; AVAMS https://aiasrdestrategy.com.au/conference/) which is opened by the Australian Chief Veterinary officer. The AIAS develops project ideas for co-investment and releases a report in conjunction with each AVAMS conference, ‘antimicrobial stewardship in Australia livestock industries’ https://aiasrdestrategy.com.au/wp-content/uploads/2023/12/AMS-Report-2023-v3.pdf. It has become a central point for engagement on issues relating to AMS in Australian animal industries and has generated momentum for positive change.
There are other animal AMS initiatives that bring together key stakeholders too, including:
- the National Centre for Antimicrobial Stewardship (https://www.ncas-australia.org/) which works on progressing AMS in animal and human health sectors and has produced several resources, initiatives and projects supported by government
- the AMR Vet Collective (https://www.amrvetcollective.com/) which develops meaningful and practical tools, including education, to support veterinarians in making informed, evidence-based decisions in their daily practice
RUMA: Is there anything similar in the Companion Animal and Equine sectors?
ANSWER: NCAS has a strong companion animal focus, including equine, and the AMR Vet Collective has a strong focus on companion animal veterinarians (which is expanding to tailor support for livestock sectors). The government, Australian Veterinary Association and NCAS work with these sectors on AMR initiatives.
RUMA: Can you explain how the principle of responsible use of antibiotics / medicines in farmed animals is encouraged in Australia? Is it legislative or voluntary and does it work?
ANSWER: There are a number of elements to this:
A cornerstone of AMS involves the work of the Australian Pesticides and Veterinary Medicines Agency (APVMA) – the national agency that is responsible for registration of veterinary chemicals (including antimicrobials) for use in animals (APVMA, 2018). Antibiotics are schedule 4 listed substances, meaning that they are only to be dispensed with a prescription from vets. The APVMA strictly applies a process of scientific review for new antimicrobial products, which includes an antimicrobial resistance risk assessment to determine the possible impact of use on the health of Australians and sets risk management controls on use accordingly. This approach is uniquely conservative by global standards; wherein there are no antimicrobial products registered for use in food-producing animals in Australia that contain fluoroquinolones, carbapenems, colistin (a last-resort antibiotic for humans), or fourth generation cephalosporins. There is also legislation at the state and territory government level relating to the supply and use of veterinary medicines in Australia. Veterinarians have regulations around prescribing practices, including label and off-label use (including in feed/water), and the need to have a valid veterinarian-client relationship.
So, from a legislative perspective, regulations are quite strict and always have been.
Although the APVMA is the regulator for veterinary medicines, it relies on other agencies to inform its final decision to register a remedy and the conditions of such registration. One of these is the Poisons Scheduling Committee of the Therapeutic Goods Administration in the Department of Health. Their consideration of the safety and toxicity data in a registration application in relation to humans (as consumers of animal products, or handlers of companion animals and livestock) determines their decision on the degree of regulation, such as veterinary prescription, as reflected in the remedy’s assigned Schedule.
Australian livestock sectors aren’t subsidised by the government and operate in a free market, so there is often a reliance on export markets for growth. This means businesses need to be constantly innovating to improve efficiencies and remain competitive, hence why biosecurity and disease prevention have been core to operations for a long time. As a result (and with the help of being an island nation with strict rules around importation of products), there is generally a low burden of disease in the livestock sectors in Australia.
With increased acute focus on appropriate use of antibiotics as a consideration in the market, so too has the focus on what appropriateness of use for antibiotics means in the context of Australian production and limited available uses of antimicrobials in livestock. There can always be improvements made, but voluntary efforts are the driver at the moment.
RUMA: We can see that there is an Animal Sector Antimicrobial Resistance Action Plan in place. Can you tell us more about this?
ANSWER: The animal sector AMR action plan released in 2018 was the first consolidated approach across all sectors. However, most livestock sectors and the Australian veterinary association had appropriateness of use/codes of practice in place for a long time prior to that (see the Australian Animal AMS timeline: https://aiasrdestrategy.com.au/timeline/).
An updated Animal AMR Action Plan was released in September 2023 (https://www.agriculture.gov.au/sites/default/files/documents/australias-animal-sector-amr-action-plan-2023-2028.pdf) which was created with much engagement between industry and government, and aligns with the One Health Master Action plan for the National AMR Strategy (https://www.amr.gov.au/resources/one-health-master-action-plan-australias-national-antimicrobial-resistance-strategy-2020-and-beyond).
RUMA: We can see that the Australian Government and industry collect data to monitor AMR in pigs, chicken meat, chicken eggs, barramundi and salmon. How is this antibiotic data collected and what about other sectors such as cattle and sheep?
ANSWER: The reason these industries are mentioned by the government is because the government provided part or full funding to support these surveys. The red meat sector has been undertaking AMR surveys for several years and fund this data collection independently. Most of this is undertaken and published by Meat & Livestock Australia e.g. https://www.mla.com.au/research-and-development/reports/2020/antimicrobial-resistance-in-commensal-bacteria-in-bovine-faeces-at-slaughter/.
RUMA: Is the data that is collected done so voluntarily or is it mandatory?
ANSWER: These AMR surveys are voluntary and undertaken ad hoc. The results have indicated a very low prevalence of AMR bacteria in Australian livestock with little change over time, meaning it can be difficult to justify the cost in undertaking more frequent surveys (https://www.amr.gov.au/about-amr/amr-australia/animal-health).
Surveys at the retail food end of the supply chain are also undertaken on occasion. The federal government is currently undertaking a survey of AMR in the Australian food supply chain using robotic processing (https://www.health.gov.au/ministers/the-hon-ged-kearney-mp/media/protecting-australians-from-antimicrobial-resistance-in-food).
RUMA: How are the results shared? E.g. in the UK we publish an annual RUMA TTF report and the UK government publishes the annual VARSS report. Is there anything similar in Australia?
ANSWER: Results from AMR surveys are made publicly available either as full reports and/or as academic publications. At the moment, the information is not consolidated, but there are plans to improve how the data are presented.
RUMA: Are there any mechanisms for collecting other medicines used in livestock, such as anthelmintics?
ANSWER: There is no coordinated mechanism for public reporting.
RUMA: Are you able to elaborate more on the AMR surveillance in place in Australia?
ANSWER: Because Australian livestock haven’t had access to many antimicrobials of importance to human medicine, they have developed production systems that don’t rely on them. Therefore, the focus has been on minimising diseases and improving biosecurity, which includes maintaining strict import controls of animal products from countries which have diseases that aren’t present in Australia.
Ad-hoc surveys of animal pathogen AMR are undertaken at national levels when veterinarians notice the antimicrobials they have available aren’t as effective anymore and there is a suspicion of resistance development. National level surveillance for AMR in pathogens of human relevance isolated from animals are also ad-hoc, and usually with funding from the federal Department of Agriculture, Fisheries and Forestry. Industry funding for R&D activities is through the Rural Research and Development Corporations and their income is based on levies from producers which is matched by the federal government. It can be difficult to argue for industry to fund large, expensive surveillance programs given the levels of AMR are generally low, and the focus is on disease prevention.
RUMA: Is data sharing something that producers support?
ANSWER: Producers want to be informed about the purposes for sharing their data as part of their overall determination of risk. In some instances, such as sharing antimicrobial usage data, the data alone does not provide the full picture on AMR, sharing data may breach competition law and in other cases the data may be considered sensitive. They need to be able to understand the implications to their business beyond demonstrating their commitment to AMS/AMR alone from the sharing of data, however generally AMR data is made publicly available. Professor Sam Abraham, from Murdoch University, has developed a robotic process for AMR surveillance. Sam obtained funding from the Federal Department of Agriculture’s Rural Research for Profit grant programme together with the Australian Pig and Poultry Industries to find a more efficient (cost efficient way) to monitor AMR in healthy animals. Since the development of this technology, livestock industries and the Australian government have trialled the use of Prof Abraham’s technology for AMR surveillance in various contexts in Australia with a lot of success and published the outcomes in various peer-reviewed papers. It is expected that this technology will become central to surveillance for AMR in Australian agriculture given its accuracy, cost-effectiveness and ability to generate highly granular data.
RUMA: Is there any surveillance in place for human medication/antibiotics to measure AMR?
ANSWER: The Australian Antimicrobial Use and Resistance in Australia (AURA) reports capture AMR and AMU in Australian medical settings https://www.amr.gov.au/australias-response/objective-5-integrated-surveillance-and-response-resistance-and-usage/surveillance-antimicrobial-use-and-resistance-human-health.
RUMA: Does Australia deliver any specific campaigns to communicate best practice or change vet / farmer behaviour with regard to antibiotic stewardship/general responsible use of medicines messages?
ANSWER: Each major livestock sector undertakes various communications regarding antimicrobial stewardship, biosecurity and animal health (refer to the AMS in livestock report).
The Australian Veterinary Association also delivers communications and campaigns on a variety of topics relevant to Australian vets, including antimicrobial stewardship. The association has recently partnered with Animal Medicines Australia to complete best-practice antimicrobial prescribing guidelines for pigs, poultry, sheep, dairy cattle and feedlot cattle, with guidelines for horses and extensive beef cattle to come. (https://www.ava.com.au/library-journals-and-resources/ava-other-resources/fighting-antimicrobial-resistance/amr-resources/).
There is also the AMR Vet Collective (https://www.amrvetcollective.com/) which produces education and communications materials for veterinarians and animal health professionals and the National Centre for Antimicrobial Stewardship (NCAS) (https://www.ncas-australia.org/animal) also deliver these types of resources.
RUMA: How does Australia respond to any challenges it receives to the way medicines / antibiotics are use in farmed animals and how do consumers view the farming industry in Australia?
ANSWER: In some cases, media reporting misconstrues the actual situation regarding antimicrobials and livestock and creates more harm to our AMS efforts than good (i.e. people spending time correcting misconceptions which removes resources from being proactive and also increases defensiveness and reduced willingness to cooperate).
The farming industry as whole is admired and respected for the risks they take on – the sheer volume of animals produced in a country prone to seasonal risks. Australia is the driest continent on earth and is subjected to frequent drought and flooding events. Managing livestock production with these environmental impacts is certainly challenging.
RUMA: Can you tell us more about the overall use of antibiotics in Australian livestock. Is it reducing and are there reduction targets in place?
ANSWER: Each industry is determining the most appropriate approach – a single approach dismisses the importance of context and leads to inappropriate use and expectations (e.g. regional AMR-resistant animal pathogen populations would mean in some regions it might be more appropriate to be utilising antimicrobials than in others), including negative unintended consequences for animal health and welfare. As such, the focus is on AMS and appropriateness of use as a way to reduce usage overall, as opposed to indiscriminate focus on reductions in use.
RUMA: What have been the biggest influences in changing behaviour?
ANSWER: It’s hard to say as the limited availability of antimicrobials has meant the focus for decades has been on reducing disease. Increased research and implementation of vaccination programs has had a large impact on reducing reliance on antimicrobials where they were used. The update of the Antimicrobial Importance Rating list in Australia (the first list was created in 2002) in association with the release of the first National AMR strategy, generated understanding of what’s important for human medicine, plus the creation/update of prescribing guidelines for each sector by the Australian Veterinary Association appear to be influencing the prioritisation of refinement in use and identification of alternatives in the livestock sector.
Our efforts have focused more on curtailing/preventing the use of critically important antimicrobials in Australian livestock, in particular the ban that has been in place on the use of fluoroquinolones in food producing animals since their first development. Strengthening education at veterinary schools as well, as part of continuing education, has also had an influence.
RUMA: Are there any sector targets for livestock antibiotic use, or goals to reduce their use?
ANSWER: We don’t have specific targets beyond minimum residue limits and relevant residue testing completed via the National Residue Survey (https://www.agriculture.gov.au/agriculture-land/farm-food-drought/food/nrs/about-residues-and-residue-testing).
The focus here is on appropriateness of use given we have access to so few antibiotics in Australian livestock. In many cases, it would not be appropriate to reduce use further (a focus on reducing use implies zero use is the target, which is not considered appropriate in Australia from an animal health and welfare perspective).
RUMA: What would make the most positive impact on future antibiotic use in Australia in your opinion?
ANSWER: Improved access and availability of alternatives, including vaccines.
RUMA: Bovine respiratory disease is a major issue in Australia and the main reason for treating cattle in feedlots with an antibiotic. Is there any work/initiatives underway to help address this?
ANSWER: Bovine respiratory disease is the major health issue in Australian feedlots (feedlots represent about one third of total beef production in Australia) and costs the industry around $40 million annually. Meat & Livestock Australia is the research services entity for the red meat sector and they undertake regular BRD research and initiatives to minimise the disease burden and reduce reliance on antimicrobials (https://www.mla.com.au/research-and-development/animal-health-welfare-and-biosecurity/diseases/infectious/bovine-respiratory-disease/).
RUMA: For poultry there is virtually no antibiotic usage at all and vaccines play a key role for the sector. Can you share more detail?
ANSWER: For laying hens in particular there are almost no antibiotics available for use. For meat chickens and other meat poultry birds, there is some more availability however, it is still highly restricted and when available for use is often not practical or cost-effective to use them given the production cycle is 6-10 weeks.
Australia has a low disease burden given the strict import controls so the types of diseases that the industry focus on are coccidiosis, E. coli, infectious laryngotracheitis virus and spotty liver (laying hens). The industry relies heavily on vaccinations (refer to the appendix in the AMS in livestock industry report https://aiasrdestrategy.com.au/wp-content/uploads/2023/12/AMS-Report-2023-v3.pdf.), but when vaccines aren’t available this can cause difficulties in managing disease.
RUMA: Respiratory disease in the Australian pig sector is an ongoing challenge. Are there moves to tackle this disease going forward?
ANSWER: Reducing disease burden is a high priority for the pig sector in Australia and it invests heavily in a range of preventative biosecurity steps to, as far as practical on farm, reduce the prevalence on risk of respiratory disease. This includes investment in the detection of respiratory disease through development of technology capable of simultaneously monitoring multiple markers for 12 respiratory and 19 enteric pathogens. In addition to being costly for the producers, disease outbreaks impact market access (domestic and international). It is also contrary to producer, veterinary and community expectations to allow animals to be sick, so, where treatment is required and available, it is provided.
The optimal outcome is for animals to be healthy throughout their lives to slaughter (https://australianpork.com.au/pig-health-and-welfare/antimicrobial-stewardship). There are already examples of key companies reducing usage through their sustainability programs (“We had a 78% reduction in antibiotic use in the last four years” https://www.sunporkgroup.com.au/sustainability/). In terms of encouraging this change, moving from continuous flow to all-in-all-out production systems is one strategy being adopted.
RUMA: What next for stewardship in Australia? Opportunities, risks, challenges?
ANSWER: There are a number of positive actions underway:
- The Animal Industries Antimicrobial Stewardship RD&E Strategy is being renewed to continue collaborative efforts
- The Australian Government has released the Animal Sector AMR Action Plan which is the sector specific plan for delivery of the One Health Master Action plan on AMR which will guide government and industry efforts
- The Minimising Antimicrobial Resistance Mission (https://www.csiro.au/en/about/challenges-missions/antimicrobial-resistance/) has been launched and includes an animal health component
- The Australian Veterinary Antimicrobial Stewardship Conference was held again in 2023 – at which we were delighted to have RUMA in attendance and hear all about UK livestock AMS activity and achievements
- Antimicrobial prescribing guidelines for sectors that don’t yet have them will continue to be created
The Challenges we face include:
- Resources being diverted to react to unfounded claims
- Access to appropriate alternatives including vaccines
- Access to cost-effective/useful diagnostics
- Trade requirements that seek to influence production practices in Australia
- General lack of resources to undertake the breadth of activities needed to continue making progress
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