One Health: efforts to find new antibiotics go beyond science

Because of its sys­tem­ic nature, anti­bi­ot­ic res­ist­ance forces us to rethink the cat­egor­ies used to clas­si­fy liv­ing organ­isms. This aware­ness extends bey­ond sci­entif­ic circles, shak­ing up com­mu­nic­a­tion and impos­ing new forms of governance.

For Jocelyne Arquem­bourg, anti­bi­ot­ic res­ist­ance is a para­dox. “I work on the way in which health prob­lems become pub­lic and are put out in the media,” explains the asso­ci­ate research­er at Télé­com Par­is. And when she was asked by micro­bi­o­lo­gists to look into anti­bi­ot­ic res­ist­ance, she dis­covered a new pat­tern. “Anti­bi­ot­ic res­ist­ance has dif­fi­culty gain­ing pub­lic accept­ance des­pite the import­ance of the issue from a med­ic­al point of view.” The com­mu­nic­a­tion spe­cial­ist is there­fore try­ing to under­stand how this came about.

“In North­ern Europe, patients con­fron­ted with anti­bi­ot­ic res­ist­ance have organ­ised them­selves to speak out against the con­sump­tion of growth hor­mone in live­stock,” describes Jocelyne Arquem­bourg. But in France, there has been no pub­lic mobil­isa­tion and the sub­ject remains largely unknown to the population.

“Anti­bi­ot­ics are not auto­mat­ic” was the slo­gan of the 2002 cam­paign in France, that has nev­er­the­less been retained. “It is easy to remem­ber. But then? Nobody knows why anti­bi­ot­ics are not auto­mat­ic,” she says. It was more a cam­paign to sup­port the prescriber’s decision than a cam­paign to raise aware­ness of the sub­ject. Its object­ive? To jus­ti­fy to the patient a refus­al to pre­scribe antibiotics.

The suc­cess of this cam­paign was imme­di­ate, with a 10% reduc­tion in anti­bi­ot­ic pre­scrip­tions in the first six months, and its effect remains vis­ible over sev­er­al years¹. But in 2009, con­sump­tion is on the rise again. Com­pared to oth­er European coun­tries, France remains very poorly posi­tioned. It is 26^th out of 29 accord­ing to data from Santé pub­lique France, par­tic­u­larly in terms of con­sump­tion in human health. Jean-Luc Angot, veter­in­ary pub­lic health inspect­or, former pres­id­ent of the French veter­in­ary academy and former deputy dir­ect­or gen­er­al of the World Organ­isa­tion for Anim­al Health, laments, “even cov­id has led to an increase in anti­bi­ot­ic con­sump­tion because of the risk of superinfection.”

In veter­in­ary medi­cine, how­ever, pro­gress has been made. “Eco­anti­bio plans have reduced anti­bi­ot­ic con­sump­tion by 45% in nine years,” says Jocelyne Arquem­bourg. “These good res­ults are the res­ult of the Eco­anti­bio 1 plan, which was asso­ci­ated with reg­u­lat­ory changes [the ban on growth pro­moters in the form of anti­bi­ot­ics in Europe in 2006, edit­or­’s note²]. Plans 2 and 3 inves­ted more in rais­ing the aware­ness of stake­hold­ers,” adds Jean-Luc Angot. His col­league, Karine Boquet, Chief Veter­in­ary Pub­lic Health Inspect­or and Deputy Dir­ect­or of Envir­on­ment­al Health, Chem­ic­als and Agri­cul­ture, test­i­fies: “Veter­in­ari­ans, through the nature of the crises they have had to man­age, such as bovine spon­gi­form enceph­alo­pathy, have developed a pro­fes­sion­al cul­ture in risk man­age­ment that includes the links between human health and anim­al health, and the environment.”

These links are sum­mar­ised today by the concept of One Health. “The idea is to emphas­ise the inter­ac­tion between anim­als, includ­ing humans, and nature,” says Jean-Luc Angot. It emerged at the end of the 1970s in the wake of wor­ry­ing zoonoses such as bovine spon­gi­form enceph­alo­pathy. In the late 1990s, more and more anti­bi­ot­ic-res­ist­ant bac­teria were dis­covered in pig farms, but also in human patients. The use of avo­par­cin as a growth pro­moter was respons­ible. “In Sweden, Den­mark and the United King­dom, the press echoed a very vir­u­lent debate, which led to a ban on the use of avo­par­cin for growth pro­mo­tion in Europe,” recalls Jean-Luc Angot. 

Karine Boquet adds, “the One Health concept is estab­lished under the aegis of four inter­na­tion­al bod­ies: the FAO, the OIE, the WHO and the UN Envir­on­ment Pro­gramme. This integ­rated approach aims to optim­ise the three dimen­sions of health: human, anim­al, and eco­sys­tem. The inter­de­pend­ence of the three sys­tems must be recog­nised to take these links into account in risk management.”

“75% of emer­ging infec­tious dis­eases are zoonoses and the US Cen­ter for Dis­ease Con­trol and Pre­ven­tion (CDC) estim­ates that 60% of all infec­tious dis­eases are anim­al-related,” insists Jean-Luc Angot. And these trans­itions from spe­cies to spe­cies can encour­age the appear­ance of resistance.

One Health also artic­u­lates these links. “This implies think­ing on sev­er­al scales: glob­al, region­al, nation­al, and loc­al. The responses can vary accord­ing to the ter­rit­ory,” says Jean-Luc Angot. For example, loc­al actions often tar­get live­stock, but their organ­isa­tion var­ies from one ter­rit­ory to anoth­er. The approaches can­not be identic­al in Cor­sica and Normandy.

But although the concept is now well known in aca­dem­ic, polit­ic­al, and reg­u­lat­ory circles, it is still strug­gling to be trans­lated into prac­tice. “One Health means that we have to stop work­ing in silos, but it is very dif­fi­cult to break down the bar­ri­ers between dis­cip­lines,” Jean-Luc Angot acknowledged.

Karine Boquet explains her approach with­in the Min­istry of Eco­logy, “it is a ques­tion of integ­rat­ing this dimen­sion into an inter­min­is­teri­al approach, between the depart­ments in charge of health, agri­cul­ture and eco­logy, but not only. One Health is a way of con­ceiv­ing policy with the ambi­tion of mak­ing the envir­on­ment more favour­able to over­all health. The Nation­al Envir­on­ment­al Health Plan (PNSE) thus involves around ten ministries.”

And pro­gress is being made. Karine Boquet refers to the latest opin­ion of the Anses (Nation­al Agency for Food, Envir­on­ment­al and Occu­pa­tion­al Health Safety)³, which shows how biocid­al products pro­mote anti­bi­ot­ic res­ist­ance, some­times indir­ectly. The Min­istry of Eco­logy thus sup­ports the man­u­fac­tur­ers of biocides to encour­age the devel­op­ment of less harm­ful products.

“The pub­lic author­it­ies thus use sev­er­al levers: reg­u­la­tions, incent­ive policies and the devel­op­ment of a favour­able inter­min­is­teri­al eco­sys­tem,” says Karine Boquet. But here again, this the­ory is being chal­lenged in prac­tice. For example, the Min­istry of Agri­cul­ture is not involved in the fourth part of the PNSE, which was launched in May 2021.

One Health gov­ernance remains a chal­lenge for pub­lic action. Karine Boquet agrees, “it is an import­ant ele­ment of the PNSE IV. It is made up of an inter­min­is­teri­al group, a Health and Envir­on­ment Group bring­ing togeth­er dif­fer­ent stake­hold­ers, and vari­ous mon­it­or­ing of the imple­ment­a­tion of the One Health approach by a com­mit­tee chaired by Jean-Luc Angot.” The lat­ter adds, “bey­ond the dis­play of a great prin­ciple, the chal­lenge is to guide actions.” For her part, Jocelyne Arquem­bourg wor­ries that the concept acts more “like an umbrella, shel­ter­ing an increas­ingly large num­ber of insti­tu­tions and sci­entif­ic dis­cip­lines, without any real reflec­tion or effect­ive link­ages”⁴. In short, the paradigm shift has yet to take place.