“One Health” Policies Fail to Address the Root Cause of Antimicrobial Resistance

This piece was written by Farm Forward’s Summer Intern, Molly Mulvaney.

As a result of the widespread use of antibiotics on industrial animal farms antimicrobial resistance (AMR) has emerged as a pressing global health issue.1 AMR both threatens the effectiveness of modern medicines and creates conditions for the rapid spread of deadly illnesses. The links between industrial animal farming and the antimicrobial resistance crisis, and the connection between deforestation and risk of new zoonotic diseases, are examples of how human health is inextricably linked to the health of nonhuman animals and to the health of the environment. The scientific and public health community have long recognized these connections and now describe the connections as “One Health.” The World Health Organization (WHO) defines One Health as “an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems. In the past decade the One Health framework has grown in prominence and is increasingly accepted by national governments and international bodies.

Antimicrobial Resistance is an increasing threat to human and animal health. Solving the problem requires significant reforms to agricultural policy and industrial animal farming practices. Yet, the largest international One Health programs largely fail to acknowledge industrial animal farming as a key threat to the One Health mission. While governments in low- and middle-income countries take the risk of AMR and zoonoses head on, high-income countries continue to dodge root causes and point their fingers elsewhere. To seriously address the AMR crisis, culpable nations must integrate agricultural reform into their One Health frameworks and public policies.

Today, over a dozen countries and international agencies have published variations of “One Health” policies, including the Centers for Disease Control and Prevention in the United States, India, the Netherlands, China , and the UN Food and Agriculture Organization. The foci of One Health vary among countries and international agencies, but most are concerned with AMR, zoonotic diseases, food safety, public health, environmental degradation, and vector-borne illnesses. The growing number of One Health initiatives use the framework as a guide for public policy, but none adequately address any root issues of AMR, particularly industrial animal agriculture. The One Health framework must incorporate both systemic reform of animal agriculture and preventative measures in developed countries. Without both objectives One Health approaches fail to ensure a better future for humans, animals, and the planet.

Antimicrobial Resistance is a Factory Farming Problem

In 2019, AMR indirectly contributed to nearly 5 million deaths and directly caused over a million. Animal agriculture is a large contributor to AMR due to producers’ widespread use of antimicrobials to prevent disease and to promote animal growth. The WHO declared that “approximately 80% of total consumption of medically important antibiotics is in the animal sector” of certain countries.2 The United States is one of the largest contributors to antibiotic overuse, with consumption per kilogram of livestock almost twice as high than that of all of Europe in 2020. Despite the efforts of groups like the US and UN, however, One Health action plans have failed to take seriously the prevention of AMR within animal agriculture.

What Are Countries and International Agencies Doing to Address AMR? Not Enough.

One of the largest One Health programs is the One Health Quadripartite (OHQ), made up of the Food & Agriculture Organization of the United Nations, the UN Environment Programme, the World Health Organization, and the World Organization for Animal Health (formerly OIE). This consortium of international organizations has communicated strong goals for tackling AMR but misses the mark. The OHQ published a “One Health Joint Plan of Action” that dictates their plans for the years 2022-2026. Although the plan emphasizes preventive measures, it lacks any focus on problems stemming from the animal agriculture sector. The document acknowledges that “livestock and fish production systems are not specifically addressed” despite their importance in both preventing and solving AMR. In the OHQ’s lengthy AMR research agenda, they boast that their focus lies “at the interface between sectors that are most relevant to low- and middle-income countries (LMICs),” even though these countries are doing the least to contribute to the AMR crisis. The OHQ’s attitude resembles US remarks that other countries must work to solve climate change while not doing enough itself to reduce emissions. Mitigation and treatment of AMR in LMICs is important, but entirely overlooks causes of AMR attributable to massive meat companies in countries like the US.

The EU Commission on One Health (“Commission”) has similar goals to OHQ but focuses slightly more on the importance of animal agriculture in solving AMR. Animal agriculture reforms from the Commission are vague or unenforceable, leading to minimal or no changes in the production system. Their guidelines on antimicrobial use on animals read, “training courses and guidance materials given to farmers should include information on preventive measures that promote animal health, in particular, implementation of biosecurity measures, good farming practices and herd health planning.” Training courses and guidance materials are valuable but the Commission lacks specific standards, regulations, and rules to gain meaningful change. The Commission does describe some specific methods for addressing AMR, including supplying quality feed and water, improving housing, and using safe alternatives to antimicrobials. While these changes may begin to address the AMR crisis, they have not yet been translated into legislative policies or other regulatory actions.

In the United States, the One Health Federal Interagency Coordination Committee (OH-FICC), run by the Centers for Disease Control and Prevention (CDC), is the leading organization for One Health. OH-FICC works with numerous federal regulatory bodies including the USDA and FDA. Despite the extensive network of OH-FICC, the initiative lacks appreciable calls for animal agriculture reform or preventative measures. OH-FICC fails to take accountability for the massive amount of antibiotics used on animals within the food system. The organization contains a National Antimicrobial Resistance Monitoring System, yet will not publicly acknowledge that most of the antibiotics used in the United States are on animals raised for food. In the last few years, OH-FICC has focused much of its resources on projects that evaluate livestock farming in LMICs and find alternative practices that reduce disease and AMR. Animal agriculture can surely use reform, but it is hypocritical of the CDC to ask LMICs to change small farming operations when the United States has some of the most unethical, disease-ridden, AMR-causing livestock practices in the world.

Although previous examples demonstrate One Health failures, Rwanda’s lengthy One Health framework displays thorough and promising initiatives against AMR. Rwanda has developed a report on their One Health plans through 2026 in addition to an entire action plan on AMR. Their AMR plan includes a focus on both animal agriculture and prevention and breaks down objectives including increased education, surveillance, sanitation, and hygiene. Perhaps their most important efforts include training for agricultural workers, veterinarians, and agronomists while also implementing biosecurity guidelines for farms, slaughter plants, and aquaculture facilities. Moreover, the Rwandan government seeks to “restrict broad or generalized use of antimicrobials as growth promoters or as feed additives” and “strengthen regulation and oversight for the supply chain and use of antimicrobials in agriculture and veterinary medicine.” Rwanda’s plan for preventing and treating AMR is highly sophisticated compared to other nations. The CDC, for example, includes minimal AMR prevention, despite the US having 72 times the amount of cattle as Rwanda. Rwanda’s work exhibits a strong start for combating AMR that other, more culpable countries must follow and augment.

Conclusion

Climate change and the intensification of animal production will continue to exacerbate AMR, zoonoses, and emerging health threats. Powerful countries and international organizations must take greater responsibility for public health and develop thorough, accountable One Health approaches.