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How to overcome the growing antibiotic resistance problem

One Health: efforts to find new antibiotics go beyond science

Agnès Vernet, Science journalist
On June 16th, 2022 |
4 min reading time
Jocelyne Arquembourg
Jocelyne Arquembourg
Professor at Université Sorbonne Nouvelle and Associate Researcher at Télécom Paris (IP Paris)
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Karine Boquet
Deputy Director for Environmental Health, Chemicals and Agriculture at the Ministry of Ecological Transition
Jean-Luc Angot
Jean-Luc Angot
Inspector General of Veterinary Public Health and Honorary President of the French Veterinary Academy
Key takeaways
  • The 2002 French campaign to reduce antibiotic consumption led to a 10% reduction in antibiotic prescriptions in the first six months of its launch.
  • But compared to other European countries, France remains very poorly positioned, 26th out of 29 according to data from Santé publique France, particularly in terms of consumption in human health.
  • “One health” governance remains a challenge for public action. The paradigm shift needs to be initiated at all levels to properly orientate actions.

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 26th 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.”

The One Health movement

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.

Integrating governance

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.

1Thèse de médecine, 17 juin 2014 Elise JANIN MONARD
2https://​ec​.europa​.eu/​c​o​m​m​i​s​s​i​o​n​/​p​r​e​s​s​c​o​r​n​e​r​/​d​e​t​a​i​l​/​e​n​/​I​P​_​0​5​_1687
3Éval­u­a­tion de la résis­tance des bio­cides antimi­cro­bi­ens, Ans­es, juin 2020
4J, Arquem­bourg « Car­togra­phie d’un objet-fron­tière et de ses ter­ri­toires : l’antibiorésistance au prisme de la per­spec­tive One Health. » dans « Les nou­veaux ter­ri­toires de la san­té », I Pail­lard, édi­tion ISTE, 2020.