Patchwork regulation won’t stop antimicrobial resistance

Oxford Martin School, University of Oxford, Oxford, UK. Twitter: @kirchhelle

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Shortly after it was revealed that important antibiotics are being used in “unacceptable” quantities on US farms (see, reports surfaced that the United Kingdom might not permanently commit to European Union plans to limit use of the drugs in agriculture (see Loosening regulations to facilitate trade might seem attractive, but it could weaken the only existing transnational antibiotic stewardship coalition.

History shows that global collective action is necessary to tackle antimicrobial resistance (AMR). Since the 1940s, physicians have reported AMR across the world. In 1954, the first ‘superbug’ — Staphylococcus aureus 80/81 — swept around the planet. Knowledge of AMR’s border-defying hazards failed to trigger coordinated responses. Scandinavians restricted medical prescriptions; Americans opted for educational measures. In agriculture, Germans targeted antibiotic residues in food and the United Kingdom restricted medically relevant antibiotic growth promoters (AGPs). Fragmented policies created the current patchwork of antibiotic use (see C. Kirchhelle Palgrave Commun. 4, 96; 2018).

Patchwork regulations won’t work. Take agriculture: the same products are used in medicine and farming, but can be subject to different rules. Overuse in one sector can undermine restrictions in another. The EU banned AGPs in 2006, but initially failed to regulate veterinary surgeons supplying the same drugs for prophylactic or therapeutic purposes. Narrow AGP restrictions and toothless enforcement now also haunt US regulators. Meanwhile, global antibiotic-production centres (such as India and China) no longer align with Western centres of policing.

Promoting international surveillance of AMR and drug use can remedy fragmented policies. In high-income nations, it has aided research and stewardship. These countries have a responsibility to share the burden of stewardship and support poorer countries to improve theirs. National efforts will achieve little on their own.

Nature 563, 473 (2018)

doi: 10.1038/d41586-018-07454-2
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