One Health and the fight against antimicrobial resistance in Italy

The onslaught of antimicrobial resistance (AMR) is a global concern for human and animal health, as well as the environment.

Similar to human medicine, antimicrobials are often used in agriculture to treat or prevent infections, and the overuse and misuse of antibiotics can lead to resistant infections in animals. Because livestock ends up on people’s tables, it creates a risk that resistant bacteria could be transmitted to humans.

Since the development and spread of AMR in humans and animals often overlaps, a multisectoral approach – “One Health” – in which the human and animal health sectors work closely together is needed to combat AMR. RAM.

How would a One Health approach to tackling antimicrobial resistance work? To answer this question, we can turn to Italy.

Animal and human health linked under the same ministry

According to Dr Annalisa Pantosti and Dr Luca Busani, who work respectively in the areas of human health and animal health at the National Institute of Health in Italy, the country is in a strong position to fight against the RAM through a One Health approach because both human health and animal health are coordinated by the same ministry, the Ministry of Health. “It’s an advantage that Italy has. It facilitates the coordination of the two sectors.

The 2 sectors have been brought together to fight against AMR within the framework of the National Action Plan on Antimicrobial Resistance (PNCAR) 2017-2020. However, the cooperation between the 2 parties is not new.

One of the best early examples of cooperation between the 2 sectors is Italy’s fight against West Nile virus from the late 1990s. At that time, it was necessary for the different parties to work together because the need was urgent, and legislation was passed to help pave the way for better integration. From then on, the government started thinking about how this integrated approach could be adapted to tackle a variety of health issues, including antimicrobial resistance.

The West Nile virus outbreaks helped launch the One Health vision in Italy – integration and better coordination between the human health and animal health sectors. It provided a preparedness system, as in the case of epidemics such as enteric pathogens, which continues to be used. However, it works primarily for the management of emerging infections, when immediate action is needed, rather than routine routine surveillance or prevention, as would be ideal.

Find common ground

Dr Busani describes what was needed to get the two parties to work together on common goals to tackle AMR, and some of the challenges they faced initially: “At first, we didn’t immediately find many common lines, mainly because the requirements of the two parties were very different. For example, the use of antimicrobials in the animal health sector is highly regulated, with strict European regulations to follow, whereas it is much less so in the field of human health.

“But we continued to work on finding common areas of interest, focusing primarily on monitoring zoonotic pathogens – such as Salmonella and Campylobacter, which are transmitted by food animals and cause infections. in humans – and monitoring the use of critically important antimicrobials in both sectors”.

Dr Pantosti describes how the integration between the two parties works in reality: “Under the first national action plan, both parties were present at coordination meetings to decide on strategies and report on results. And during these meetings, the sharing of knowledge and experiences has proven useful; veterinarians had the opportunity to learn about the burden of AMR in human medicine, while hospital doctors and general practitioners learned about the contribution of antibiotic use in farm animals to the AMR problem . Many initiatives have also been taken together, such as the promotion of European Antibiotic Awareness Day”.

Looking Ahead – “Improving the Quality of Integration”

On the future of One Health and AMR in Italy, Dr Pantosti and Dr Busani note the following: “So far, all field work, such as AMR surveillance, has followed 2 tracks parallels – the human health side and the animal health side We know what each path does and we know what the challenges are for each.

“However, what we want to do in the next national action plan, which is being developed, is to achieve deeper integration on the ground. This would require, for example, determining which aspects of monitoring are important to both parties and how interventions on one side may impact the other side.

“Once we have better identified common areas, it will be much easier to improve the quality of integration. Now that we know each other, working for common goals has become more natural for us.

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