π Health and biotech
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)
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
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.

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