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.