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Should farmers in low- and middle- income countries be able to give their livestock antibiotics that are important in human medicine?

Indoor poultry farm

Tess Johnson, Postdoctoral Researcher in the ethics of pandemic preparedness, surveillance and response, Ethox Centre, Oxford Population Health, University of Oxford

Antibiotic resistance (ABR) is a threat to global health. If not enough is done to address the problem, 10 million people will die from AMR every year by 2050. So, with stocks of antibiotics quickly becoming ineffective for treating disease in humans, we might wonder where most antibiotics are used and how we can minimise overuse. In many countries, many more antibiotics are used in livestock than in humans. Farmers sometimes use antibiotics to treat an individual animal, prevent a whole group from becoming sick, or to promote growth.

In the UK, there is a lot of support available to farmers for improving animal welfare and husbandry, leading to less need for antibiotic use. Antibiotic use in animals in the UK was halved in the six years from 2014 to 2020. But in many low- and middle- income countries (LMICs), farmers receive a lot less state support, and have much smaller profit margins. They may rely more on antibiotics to keep animals healthy.

It's important that we address ABR by minimising overuse of antibiotics, especially those important for human health. But at the same time, we need to make sure that the ways in which we reduce use (who is prevented from accessing antibiotics, and for what purposes) is fair, not just nationally, but globally. One of the key questions, then, is: ‘should farmers in low- and middle- income countries be able to give their livestock antibiotics that are important in human medicine?’

ARGUMENTS IN FAVOUR OF FARMERS IN LMICS HAVING ACCESS TO ANTIBIOTICS FOR THEIR LIVESTOCK

ARGUMENTS AGAINST FARMERS IN LMICS HAVING ACCESS TO ANTIBIOTICS FOR THEIR LIVESTOCK
  • Antibiotics are often used to prevent disease in animals living in overcrowded conditions; without antibiotics, animals would get sick more often, compromising animal welfare.
  • Farmers in LMICs often live on razor-thin profit margins. Their financial security relies on keeping their animals healthy up to slaughter.
  • Many high-income countries (HICs) have livestock sectors that previously relied on antibiotics just as much as many LMIC farmers do now. It’s unfair to change the standards of antibiotic stewardship now that there is more support for farmers in HICs allowing them to not rely on antibiotics.
  • While antibiotic use in the livestock sector is high, it’s not the only way to protect antibiotics important for human medicine. Over-prescription of antibiotics though too-long courses is rampant in many HICs, so we should address this area of unnecessary overuse, first.
  • Due to less strict regulations in some LMICs, antibiotics are often still used for growth promotion, not only disease treatment, which is a particularly unnecessary use.
  • Where antibiotics are used to prevent or treat disease, animal welfare can be protected in better ways than through antibiotics, like by keeping animals in less crowded conditions.
  • The populations of many LMICs are already at greater risk of resistant disease outbreaks, and are already experiencing the effects of ABR. It is, if anything, more important to reduce use in LMICs to protect populations who may not have access to adequate healthcare if they do become sick with a resistant infection.

 

 WHAT DO YOU THINK?

 

 

READ MORE

Stewardship according to context: justifications for coercive antimicrobial stewardship policies in agriculture and their limitations – Tess Johnson (forthcoming) Bioethics 

An ethical analysis of key tensions for interventions to address antimicrobial resistance and how they apply in low- and middle- income countries – Sunil Pokharel, Bipin Adhikari, Tess Johnson, and Phaik Yeong Cheah (2024) BMJ Global Health 

A just transition for antimicrobial resistance: planning for an equitable and sustainable future with antimicrobial resistance – Just Transitions for AMR Working Group (2023) The Lancet