Expert views on Antimicrobial Resistance (AMR)

Many a time certain media reports project the Indian Poultry and livestock industry as the major source of spreading AMR in human beings which is largely based on assumptions rather than scientific facts. Such claims may be based on inaccurate estimates or inappropriate methods or extrapolating a narrow database whereas ground realities is quite different. Still, as a responsible industry, we are working towards the AMR-NAP intervention plan 2017-21 to combat this issue. Think Grain Think Feed virtually interacted with various experts to know their opinion on the subject. Please read the excerpts below:

Dr. V. Ramasubramanian, Infectious Disease Expert, Apollo Hospitals, Chennai quoted Dr Stuart B. Levy (Pioneer on Antibiotic Resistance), “Antibiotic resistance is inevitable”. When you start using antibiotics it is just a matter of time when antibiotic resistance starts emerging.
A bug that is resistant to one antibiotic is likely to develop resistance to others. When antibiotics is used on one person, the entire community gets affected as it changes the gut microbiome and the resistant bacteria is transmitted one to another through plasmids and can get into the community.
“Till now it was believed that antibiotic is connected only to human use while recently it is found that 75% of the usage of global antibiotic is in the non-human arena i.e., poultry, sericulture, fish, meat, pork producing farms where maximum usage of antibiotic is observed,” said the human expert with more than three decades of experience.
Antimicrobial resistance is one of the major health challenges of the current century. We lack sufficient data on the use of antibiotics in Indian food animals.

“A massive awareness drive should be conducted among the poultry, dairy and swine farmers along with veterinarians on the issue,” said Dr Ani Bency Jacob, Animal Nutritionist, Ministry of Fisheries, Animal Husbandry and Dairying, Government of India.
National Action Plan
The Indian NAP for AMR is a well-designed comprehensive plan that addresses the important policy and regulatory issues in relation to antibiotic use. Though there are many challenges AMR being a very complex issue with the involvement of many stakeholders, there has been a continued effort across the sectors to create awareness and to rationalize the use of antibiotics.
“Govt of India has implemented a few stringent regulations to minimize the use of antibiotics including enforcement of Schedule H1 categorization for all-important antibiotics, restriction on animal use of critically important antibiotic Colistin etc. There have been on-going efforts from organizations like ICMR, ICAR on disease surveillance and to create a comprehensive database on the prevalence of AMR infections,” said Dr Arun Atrey, INFAH.
Further mentioning on the role of INFAH, he said the association has been supporting the ‘One Health approach’ and actively participating with scientists, institutes, and organizations like IVRI, FAO, DAHD, FSSAI, IAAVR to create awareness for Judicious use of Antibiotics.
“With the increased awareness within the concerned departments and consistent pursuance of INFAH, a separate veterinary division was established at CDSCO in 2018 for the regulation of veterinary drugs & biologicals. INFAH is closely working with the authorities for formulating specific regulatory processes & guidelines applicable to animal healthcare products,” he added.

Ministry of Fisheries, Animal Husbandry & Dairying is the competent authority that outlines the standards & guidelines of feed additives. Currently, FSSAI is also in the process of framing out policies & guidelines for the regulation of Animal Feed & Feed Additives. INFAH is closely working with FSSAI for the formulation of the new regulations.
“The NAP is based on one health approach, which is the need of the hour. Priority should be given to regular vaccinations of meat and milch animals, which would reduce the frequency of incidence of diseases and thereby use of antibiotics,” said Dr Ani.
Medicated feed additives play a very important role in controlling many infectious diseases in animals and also to produce safe food for humans. Animals require an appropriate method of providing the desired AGPs for their better growth so that they can help improve productivity & provide the best quality of food, milk, and other secondary products. The Animal Health industry is currently focusing on biosecurity solutions, vaccinations, and the use of suitable alternatives like Probiotics, organic acid, etc. to reduce the use of antibiotics in farm animals to the extent possible.

“It is worth noting that the total withdrawal of these effective representatives of feed additives may lead to the enhanced use of prescribed antimicrobial drugs for treatment which might raise complexities with possible loss of production as well as economic returns for the farmer, as experienced in many countries,” said Dr Atrey.

INFAH stated many scientific reviews have concluded that antibiotics used in humans is one of the major driving forces behind the antibiotic resistance problems encountered in human drugs. The practice of feeding low levels of antibiotics to food-producing animals poses no immediate or imminent threat to human health. Many Antibiotics used in animal feed are not critically important antibiotics and some of them are exclusive for veterinary use.
Kerala – first state to address the issue
In addressing issues such as AMR, it must recognize that the drivers for this complex issue lie across domains encompassing human health, animal health, environment, fisheries, and water sanitation, hence can only be resolved through intersectoral Action Plans, which are the cornerstone for action by the State. Such Action Plans are the starting point for the implementation of control strategies and these action plans have to identify all the relevant stakeholders followed by the mapping of available infrastructure and capabilities of these stakeholders to arrive at a tangible One Health Action Plan.
In India although health is a state subject and individual states can formulate decisively actions only very few states have developed a Strategic Action Plan based on National Action Plan against this silent pandemic. Kerala was the first state in the country to have ramped up efforts to control AMR, and this plan was guided by WHO and was launched by the Chief Minister of Kerala in October 2018. The state plan is called Kerala AMR Strategic Action Plan (KARSAP) and has been operationalized through a One Health response which was formulated under the leadership of the Health Minister Ms K K Shylaja.

“In the first year of implementation of KSRSAP the focus was on improving Awareness & Understanding AMR and start some AMR surveillance systems. The extension & training wing of the Livestock Management Training Centres (LMTCs) located across various districts of Kerala. Each of these centres trains around 200 farmers every month. The Kerala State Veterinary Council the statutory registration body controlling veterinary practice is now conducting the Continuing Veterinary Education (CVE) program for Veterinarians on AMR. The Veterinary University has AMR included in its curriculum with an aim to improve the understanding of AMR and promote prudent use of antibiotics,” said Dr. Robin Paul, Public Health, State Veterinary Department, Kerala.
“Regarding Surveillance, the Veterinary Department has completed staff training to the lab personnel of microbiology divisions on WHO-NET, an Information System for Monitoring Antimicrobial Resistance. These labs are now doing AMR surveillance in Animals and Foods with an aim to develop baseline data on AMR in Kerala, based on this baseline information further AMR control strategies are to be developed,” he added.

“Although some work on tackling AMR has started, but still, Kerala has a lot of work to do like the lack of details of Antimicrobial Usage (AMU) and molecular epidemiological data on the full spectrum of Antibiotic-Resistant Genes (ARGs) will impact the ability to interpret prevalence/surveillance data on AMR when they are available. The absence of regulatory compliance on the existing weak regulations for feed safety and poor stakeholder awareness further complicates the issue,” he further added.
Updating medical professional
During a virtual interaction, Prof. G Devegowda, renowned Poultry expert for more than 4 decades and President of Veterinarians of Poultry industry based in Bangalore also updated Dr Ramasubramanian about the present scenario of the Indian Poultry Industry which is quite different from previous decade or so.

“Nearly 30-40% of the producers are not using antibiotics but using alternatives to antibiotics – like organic acids, probiotics, enzymes, etc. Two years back, when FSSAI lied down guidance for antibiotic usage in all animals including poultry, it clearly mentioned permitted and non-permitted antibiotics and also laid down the maximum residual limit of antibiotics if at all it is to be used in case of disease outbreak. Whenever there is a disease outbreak, we use antibiotic but we withdraw at a certain period under the guidance of qualified veterinarian,” said Dr Devegowda.
“Due to good quality of produced products, India is able to export egg powder to Japan some European countries like Germany,” he added.
“Even many Quick Service Restaurants in India like KFC, McDonald, Dominos, etc. specify their requirement of antibiotic-free eggs and chicken. Nearly 80% of poultry production under the organized sector providing sanitized water, sterilized feed along with good biosecurity measures due to which bacterial load drastically come down,” he added.
The poultry expert agreed that 20 years ago antibiotics was used in poultry as growth promoters but now due to better awareness among producers and consumers for antibiotic-free chicken and eggs, the scenario is completely different now. Hence it is assured that egg and chicken produced in India is antibiotic-residue-free though not antibiotic-free.

Mr. OP Singh, Poultry entrepreneur with more than 3 decades of experience also participated in the virtual meeting to present scientific facts among the human expert. When he asked various authorities like ICMR and FSSAI about the residue that one can accumulate from per capita consumption of 5 kg chicken per annum, nobody could answer.
“Every gram of broiler or layer feed produced in India is designed under supervision of qualified nutritionist. Chances of error in chicken industry is very rare. The quality of feed fed to chicken is far better in quality nutrition and balance than human food. Biosecurity plans implemented at various levels in breeding farm is far better than living standards of villages etc. where most of population is living in,” he said while assuring about safe chicken and egg production in India.

Moreover, as per CDSCO data, 48% of antibiotic are freely sold from medical stores without prescription. Then how it is justified to focus on industry which is farmer oriented. Risk is much more in case of human as it is highly unorganized in terms of consumption of antibiotics, hygiene and sanitization, conductance of the antibiotic delivery mechanism.
Mr. Singh added commodities like water, food crop (grains, pulses) etc. are also not regulated. Even hospital born disease resistance issues data is also not available with government of India.
“I believe western world is trying to target Indian poultry industry which is growing by leaps and bounces and threatening their existence on cost of production. We are surely going to compete in global trade with our scale of production and existence,” he added.
Mr. Singh opined that all scientist should work on National Action Plan which is comprehensive in countering the challenge instead targeting an industry which is already practicing sizeable ethical production process.
Legislation is the only way
After listening to both Poultry experts, Dr Ramasubramanian shared the concern is the impact that is faced on a regular basis when several patients lose their life due to AMR issues.
“India has various laws but the problem is the enforcement of the laws. It is the question of hygiene and sanitation. Use of over-the-counter antibiotics. Human is also a huge contributor to it. We are not looking at antibiotic residues which end up in human plate but at antibiotic-resistant bacteria which may be found in fish, chicken or even vegetables consumed by human and then change their microbiome. Legislation and enforcement of rules is the only way to minimize or control this issue,” he added.
He concluded while saying that it is the responsibility of every citizen of India to use antibiotic appropriately.
Dr Devegowda suggested having more regular interaction with medical professionals to avoid such confusion about poultry, dairy, and other livestock products. This would help us to send the right message to the general public and also mass media.

Disclaimer: A special thanks to Dr Jeetendra Verma, INFAH (Imports and Exports subcommittee) for sharing the inputs and references.