Their report called for implementation of standards on antimicrobial use in a comprehensive manner across all five stages of the antimicrobial life cycle
Three organisations jointly released a report on international policy instruments regarding the use of antimicrobials in the human, animal and plant sectors recently.
The document provides an overview and analysis of the standards related to the use of antimicrobials. The term ‘use’ in the report includes any emission or release into the environment.
It is expected to guide and assist national authorities across the world to adopt relevant international instruments and standards.
The document has been prepared by the Food and Agriculture Organization (FAO), World Organisation for Animal Health (OIE) and World Health Organization (WHO). It was released November 20, 2020.
It outlines areas where there are gaps and opportunities in the current international guidance and regulations.
It also identifies the existing frameworks for the monitoring of implementation of these instruments.
For the human, animal and plant sectors, the instruments are covered across the life cycle of antimicrobials under the following areas: production, regulatory evaluation and marketing authorisation, selection, procurement and supply and lastly, responsible, prudent use and disposal.
Missing standards
The standards related to the human use of antimicrobials are distributed over a large variety of instruments. No single comprehensive international instrument governs the use of antimicrobials in humans.
Most instruments are technical guidelines adopted by the WHO Secretariat or expert committees supported by it.
However, there are areas where there are no international instruments as well. For example, international regulations or guidance on governing the sale of antimicrobials, the treatment guidelines for the vast majority of bacterial infections or on safe disposal of antimicrobials is missing.
Specific standards addressing antimicrobial use in animals are recognised to be fully integrated into two main instruments which are the OIE’s Terrestrial and Aquatic Animal Health Code.
These provide standards for the improvement of animal health and welfare and veterinary public health worldwide.
Additionally, the Codex Alimentarius instruments also provide international food standards, guidelines and codes of practice.
Similar to human health sector, there appear to be no standards on how to go about collection and disposal of unused or expired veterinary antimicrobials. It is also not clear whether these standards can apply to medicated feed containing antimicrobials.
For the use of antimicrobials in plants, the FAO / WHO International code of conduct on pesticide management is recognised as the main instrument.
Currently, no other international environmental standards exist governing the manufacture of pesticides.
The report stated that while general instruments for pesticide use were available, specific guidance on the use of antimicrobial pesticides in plants was lacking.
The Codex Alimentarius Code of Practice to minimise and contain antimicrobial resistance (AMR) is currently under revision and will include the use of antimicrobials in plants.
The instruments related to the environment are included throughout the life cycle.
This is because any related emissions of antimicrobials into the environment can occur at different stages of the life cycle — from spillage into the environment during the production process to the disposal of expired products and related waste and wastewater.
Some international instruments do address certain dimensions of the environmental impact of antimicrobials that could affect their use.
But an international instrument that specifically addresses the impact of antimicrobials on the environment and one that could influence their use is absent.
Standards for water management with respect to antimicrobial use and AMR, despite the important linkages of water, hygiene and sanitation and water management to AMR, are lacking.
The report called for implementation of standards on antimicrobial use in a comprehensive manner covering all the five stages of the antimicrobial life cycle.
This was to be done through effective national legal and policy frameworks, leadership commitment, functional systems and availability of financial resources.
Efficient enforcement mechanisms and the necessary technical capacity were critical for such implementation.
This needed to be coupled with appropriate monitoring of the implementation, by using tools such as the Tripartite AMR Country Self-assessment Survey (TrACSS) and those specifically available with the FAO or OIE.
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