Solving AMR through a One-Health lens

The newly-funded Antimicrobial Resistance – One Health Consortium managed out of UCalgary* is about to play an important role in how we safeguard the eroding ability of antibiotics to save lives and prevent illness. Its role will be to leverage the capacity and expertise across Alberta, nationally and internationally to find solutions to a looming antimicrobial resistance (AMR) crisis in humans and animals that spills over to the environment—hence the one health approach. Currently, several thousand Canadians die every year from infections with multiple drug-resistant bacteria, and the rate of increase is exponential. Worldwide, the economic impact of these infections is estimated at US$100 trillion/year.

“In the beef industry, there’s a lot we don’t know,” says Dr. Herman Barkema, Scientific Director of the Consortium and NSERC Industrial Research Chair in Infectious Diseases at UCalgary’s Faculty of Veterinary Medicine. “And we can’t even talk about cow/calf and feedlot operations in the same breath because antimicrobial use and resistance differs in each sector.”

For example, calves are treated with antimicrobials on arrival at the feedlot, then they get medicated feed for the duration of their stay. How much resistance that produces, and whether it causes problems in run-off? Who knows? Then, there’s the health of the animal to consider. The public is playing an enormous role in wanting meat products that are raised without antibiotics, which is reducing on-farm use—but perhaps at the cost of sick animals not getting the drugs they need to stay healthy and productive. And of course, there are people—the producers and their families, and the workers in the industry all of whom may be impacted by AMR.

“If we get resistance against frequently-used drugs in the feedlot, we have a problem—and emerging evidence shows that antimicrobials ARE becoming less effective,” says Barkema. “The only way to protect people will be with drugs of last resort, and we should really be careful not to overuse those because they are exactly that… last resort!”

The Consortium’s 27 projects focus on treatment optimization, AMR surveillance, and infection prevention and control under three thematic areas: innovation and commercialization, education and societal impact, and policy, economics and sustainability.

So why are pharmaceutical companies not investing in new antibiotics? Any new drug is likely to be safeguarded like gold, and used only to treat multi-drug resistant infections. So, minimizing drug use is one way to combat resistance—but it doesn’t result in the large sale volumes needed to recoup the $2-4 billion costs to develop and receive regulatory approval for use of an antimicrobial.

Instead, the Consortium is looking to alternatives like phage therapy, new targets, biomarkers, stewardship, the microbiome, as well as optimizing the use of current treatments. It is also developing protocols to change the prescribing habits of veterinarians, pharmacists and doctors, and the usage practices of farmers and people. Vaccine development, hygiene protocols for people and animals, and genetic selection for disease resistance can all lower antimicrobial use.

“We are excited to be involved in this initiative as we know that some animals are more resilient to infectious disease than others,” says Plastow. “Identifying them is the challenge; however, our work in pigs and cattle is helping develop tools to do this. The team. including others at UCalgary like Karin Orsel and Frank van der Meer. have generated phenotypes and samples to push this effort forward. And Gentec’s Janelle Jiminez will be working with these researchers from April to find new funding to exploit these resources.”

Use practices are already starting to change. As of December 1, 2018, the over-the-counter sale of medically-important antimicrobials is no longer allowed. Such products can only be purchased with a prescription issued by a veterinarian. Those are the (relatively) “easy” administrative changes. The Consortium’s innovative solutions will take years to develop, test and employ, although consumer and retailer push (A&W, McDonalds, Maple Leaf, Sobeys, etc.) may accelerate uptake.

“Then,” says Barkema, “we’d better be ready to follow. Our results in beef will apply to other livestock, and connect to people and the environment. If we use less antibiotics in agriculture, there’s less run-off and less soil contamination. That means better drinking water and environment. Everything is linked.”

* The Consortium is Alberta-wide, comprising the universities of Calgary, Alberta and Lethbridge as well as Lethbridge Research Centre, Olds College, Lakeland College, Southern Alberta Institute of Technology and Northern Alberta Institute of Technology.

Posted in Industry.