Dr. John Prescott
When it comes to managing the impacts of antimicrobial use in animals and the growing problem of antimicrobial resistance, Canada could learn from its Olympic athletes, says an Ontario Veterinary College (OVC) professor.
Dr. John Prescott sees parallels between the issues surrounding antimicrobial resistance and the take-home message from a keynote address delivered a few years ago by cross-country skiing gold medalist Beckie Scott. At a 2011 conference on antimicrobial stewardship in Canadian agriculture and veterinary medicine, Scott said reaching your goals takes time and it takes continuous improvement and refinement of seemingly small details to perfect techniques.
Continuous improvement is key in the ongoing issue of antibiotic resistance, said Prescott, who helped organize the 2011 conference and last week outlined how Canada is faring in this area during a presentation to the Canadian Veterinary Medical Association’s (CVMA) annual meeting in St. John’s, NL. The conference program included the 2014 Summit of Veterinary Leaders, a full day of talks devoted to the theme “Antimicrobial Stewardship: A New World Order.”
“We need to identify the problems, address the issues and move on, so that Canada can achieve a gold in this area,” said Prescott, who retired this spring after a distinguished 39-year career as a bacteriologist at OVC.
There are many areas where continuous improvements need to be made, said Prescott, including “how we use antibiotics, how we dose them, the diagnostic side of things, how we regulate them, who uses them, creating new antibiotics. There are dozens of things we can do to stabilize the resistance problem.”
The concept of stewardship is an important one, he added. “It’s the idea of taking responsibility for long-term management and care of something of enormous value.”
OVC is a leader in the field thanks to the work of scientists including Prescott and Drs. Scott McEwen, Patrick Boerlin and Scott Weese. For many years, they have been involved in research into antibiotics and their use, the epidemiology and movement of resistant bacteria, understanding antibiotic use practices by veterinarians, and in the development of guidelines for practitioners and input into public policy.
McEwen chaired a 2002 national investigation into the impacts of antimicrobial use in animals and its relationship to antimicrobial resistance. The resulting report provided 38 recommendations to Health Canada to better protect the health and interests of Canadians in relation to antibiotic use in food animals.
One of those recommendations supported the development of a Canadian antimicrobial surveillance system. The Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) is coordinated by the Public Health Agency of Canada (PHAC), with the animal component located in the Laboratory for Foodborne Zoonoses (LFZ) in Guelph. It includes antimicrobial resistance and antimicrobial use components. Part of the CIPARS surveillance program includes collecting retail and abattoir meat samples and comparing resistance in selected intestinal-origin bacteria to resistance in selected intestinal bacterial pathogens in Canadians.
There is a great synergy between CIPARS and the University of Guelph, and the CIPARS program has funded numerous graduate students at the OVC, says Prescott. “I think it’s been a great example of a federal government agency synergizing with a university on an important problem. I’m quite in awe of what CIPARS has achieved”.
Prescott co-chaired three national conferences on antimicrobial drug use in animals in Canada in 1999, 2005 and 2011, all of which have involved many faculty from OVC, as well as collaborators from PHAC, from industry, national farm organizations, Ontario Ministry of Agriculture, Food and Rural Affairs, and consumers, among others. A subsequent committee (Ad-Hoc Committee for Antimicrobial Stewardship in Canadian Agriculture and Veterinary Medicine), including several OVC faculty, has continued to teleconference bi-monthly since 2011 to keep a national dialogue going.
Recently the group prioritized what needs to be done in this area, identifying 17 recommendations and ranking Canada’s work in this area against the World Health Organization, World Organization for Animal Health (OIE), Health Canada’s 2002 report and the proposed changes in food animal antibiotic use in the U.S. (Food and Drug Administration Guidance 213). The top nine recommendations relate to regulation, says Prescott.
“Overall, the group gave Canada a C- as a ranking, because we fall below international standards and the recommendations in the 2002 report to Health Canada. This means that we think that, overall, we have somewhere between an adequate and barely satisfactory understanding of the issues, and require somewhere between requiring improvement to marked improvement to meet modern standards”.
While the European Union made changes to stop the development and movement of antibiotic resistance a long time ago, change has been slower here, says Prescott. However, Health Canada recently announced they will be developing options to strengthen veterinary oversight of antibiotic use in animals and removing the use of antibiotics as growth promoters, similar to measures that are being implemented in the U.S.
Resistant bacteria and resistance genes can move around easily, and improved stewardship of antibiotics in companion animals is equally, if not more, important as improved stewardship in food animals.
Changes need to happen at regulatory levels in Canada, adds Prescott, “but we need to have an integrated view of things.” Stewardship is about far more than regulations — it has multiple dimensions. Stewardship is about a culture of continuous improvement in every aspect of the use of antibiotics, an effort as hard and focused as that involved in winning a gold in the Olympics. Ultimately, Prescott says, Canada needs to be on the podium.