Should we do more to combat AMR?
The global effort to fight antimicrobial resistance continues to build momentum. However, Head of Market Access and Regulatory Turkey, Nedim Üzey asks if we’re really doing enough to face this grave threat.

If you have an interest in human and animal health, then you’re probably all too familiar with the dangers of antimicrobial resistance (or AMR).

Overuse and misuse of antibiotics in humans, animals and plants have accelerated the natural evolutionary processes by which microbes become resistant to these treatments – to the degree that some infections have already been rendered untreatable.

The world has been shaken into an urgent response, and under the leadership of WHO, many nations are issuing Antimicrobial Resistance Plans to reduce the use of critical human antimicrobials in both humans and livestock.

But can we do more beyond reducing our use of these antimicrobials?

I’d like to look at the story of salmonella to answer this question, as I believe it’s an instructive example of AMR and the importance of preventative vaccination.

Salmonella is a zoonoses – an infection that’s transmissible from animals to humans. With 91,000 cases each year, salmonella represents more than a quarter of all such infections reported across the EU (though EFSA research suggests the real number could be somewhere between 455,000 to 9,000,000!).

Although in most cases salmonella is a self-limiting gastro-intestinal illness, it’s far more serious for vulnerable people like the very young, the elderly, and immune-compromised patients. What’s more, there are more invasive strains around that cause severe illness and even death.

Worryingly, EFSA has also found that nearly half of the salmonella strains isolated from humans are resistant against one or more antimicrobial classes in Europe.1 And the tools that healthcare professionals have at their disposal are typically critical antimicrobials for humans, which we must protect and preserve for the treatment of human patients.

This is deeply concerning of course, but there are grounds for optimism. European salmonella control legislation is arguably one of the most comprehensive in the world. And with the help of biosecurity rules that reduce the salmonella burden and improve general hygiene on farms, vaccination is playing an essential role in controlling salmonella in most member states.

In fact, it’s widely acknowledged that vaccination has made a significant contribution to the decline in both human and poultry cases.

Yet despite this reduction – or perhaps because of it – a degree of complacency seems to have kicked in, and even a false sense of security on the part of producers who now feel safe from salmonella.

For me, this makes the need to highlight vaccination and a holistic approach to salmonella control more urgent than ever before globally.

Controlling zoonotic bacteria at the stage of primary production will be absolutely essential in our fight against antimicrobial resistance. These vaccines could potentially reduce the risk of food-borne salmonella infections and protect entire communities against infectious disease.

At its simplest, we need to work harder to nip zoonoses like salmonella in the bud. At present, we have the tools to target particular salmonella serovars with vaccines, but these measures only kick in when poultry flocks exceed a 10 per cent level of infection nationwide.

But is this really enough? Or should we introduce a mandatory vaccination program in poultry to protect vulnerable people from salmonella and us all from the looming threat of AMR.

Because after all, even one death is too many.

1. According to EFSA Journal 2018;16(2):5182

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