Tackling antimicrobial resistance in food producing environments
Antimicrobial resistance (AMR) is major public health threat globally. The role of natural and food-producing environments in the emergence, selection, dissemination and ultimately transmission of AMR has received much less attention than the direct selection and transmission within and between humans and animals. However, the need to tackle the AMR problem within the One Health approach has been internationally acknowledged and is included in the EU AMR Action plans. Future changes in food production to comply with the EU Green Deal/Farm to Fork Strategy, climate change and other socioeconomic factors will have an impact on the role played by the food-producing environments on the emergence and transmission of AMR. There are large data gaps in the magnitude and direction of these effects. In this session, we aim to discuss the potential consequences that those changes could have on the emergence and spread of AMR through food-producing environments and how this could be considered for future AMR risk management. This will be achieved by: (1) providing a general overview on current AMR issues of public health relevance linked to the food-producing environment and how the EU Health-related agencies are supporting European efforts; (2) exploring how new agricultural practices and climate change may influence AMR linked to environmental sources in different food producing systems; (3) identifying areas/gaps needed to be addressed for better preparedness; (4) discussing possibilities to improve the sharing of data and expertise, breaking regulatory silos to ensure a more holistic One Health approach; and (5) making recommendations for future action.
Future changes in food production in response to the European Commission’s Farm to Fork strategy, climate change and/or other socioeconomic factors will have an impact on the role played by food-producing environments on the emergence and transmission of antimicrobial resistance (AMR). However, there are several data gaps concerning the magnitude and impact (improving or worsening) of these effects on AMR. Considering that the environment is one of the pillars of ‘One Health’ AMR risk assessments, early identification of future challenges and possible solutions will contribute to the success of the European Green Deal.
Background – Challenges and opportunities
AMR is currently a major global health threat as recognised by international organisations such as World Health Organization (WHO), Food and Agriculture Organization of the United Nations (FAO) and World Organisation for Animal Health (OIE) , with hundreds of thousands of human deaths estimated annually worldwide, including around 33,000 annual fatalities in the EU alone . Policy makers across the globe are taking action against AMR. In 2011, the European Commission (EC) published its first Action Plan , which covers the period 2011-2016, targeting the increasing threat from AMR . It identified seven priority areas for action. One of these priority actions is to contain and limit the possible spread of AMR via the wider environment. The evaluation of the 2011 EC action plan  highlighted the need to improve scientific understanding of the role played by the environment in the emergence and transmission of resistance through animal, human and manufacturing waste in water and soil, and to explore necessary actions to reduce the spread of AMR. In 2017, the EC launched its second European One Health Action Plan against AMR  covering the period 2017–2022. This plan included specific actions to promote the EU as a ‘best practice region’ and included addressing the role of the environment and closing knowledge gaps on the spread of AMR in the environment. Both EC action plans integrated ‘One Health’ (human, animal and environment) considerations to address the threat of AMR in a holistic and transdisciplinary manner.
In general, the role of natural and food-producing environments in the emergence, selection, dissemination and ultimately transmission of AMR has received much less attention than selection and transmission of AMR within and between human and animal populations, with most reports and policy documents focussing on the clinical perspective. Human and animal waste can introduce antimicrobial resistant bacteria (ARB) and antimicrobials into the environment, and more specifically into the food-producing environment, where selection for AMR may occur with some evidence of onward transmission to humans, animals and the wider environment. One of the main drivers of AMR is the use of antimicrobials (AMU) in humans and in animals (EMA and EFSA, 2017). The prevalence and diversity of AMR in livestock-associated bacteria are a function of the nature and magnitude of AMU in food-producing animals and of husbandry/biosecurity practices. The selection pressure of AMU in the food-producing environments depends on the concentrations of antimicrobials in faecal waste, the fate of antimicrobials in the environment and/or process components from environmental sources entering food production systems (e.g., water contaminated with antimicrobials). Manure or organic wastes of human or animal origin via surface water, and potentially wastewater used for irrigation, are also sources of AMR. Antimicrobials also have the potential to disseminate antimicrobial residues and ARB to the environment and contaminate food (vegetables, fish, meat). Climate change and its associated environmental effects such as flooding will accelerate the spread of AMR in difficult to control scenarios.
The European Green Deal /Farm to Fork Strategy  highlight risks associated with AMR, and it is clear that there is a need for greater consideration of antimicrobial resistance (AMR) in a ‘One Health’ and ‘Farm to Fork’ context. The effect on AMR linked to food-producing environments, future changes in production linked to changes in the use of antimicrobials and heavy metal used for food animals, climate change, expansion of production and food/feed exports from third countries, ongoing agricultural intensification, use of more environmentally “friendly” agriculture practices (biopesticides, biofertilisers, reclaimed water for irrigation, etc.), increasingly widespread consumption of meat-free alternative foods, etc. are unknown. It is a complex challenge with multiple interrelated drivers, data gaps, and targeted surveillance studies are needed to close current data gaps regarding the control of AMR spread. Opportunities are linked to the correct implementation of regulations.
EFSA has worked in close collaboration with EMA, EEA and ECDC, on a BIOHAZ Panel self-task on “the role of the food-producing environment in the emergence and transfer of AMR” (EFSA BIOHAZ Panel, 2021), where the sources and transmission pathways, the bacteria and AMR genes of public health relevance and mitigation measures for different food-production sectors have been reviewed. Several data gaps and “hot topics” that need further research as well as recommendations to fulfil these gaps have been identified and will serve as a basis for the AMR Session
Scope and objectives
The aim of the session is to provide a platform to discuss from the public health perspective the potential consequences that changes triggered by the Green Deal/Farm to Fork targets, climate change, etc. could have on the emergence and spread of AMR through food-producing environments, as well as how this should be considered in future EU AMR risk assessments and One Health Action Plans against AMR.
The specific objectives are:
- To provide a general overview of current AMR issues of public health relevance that could be linked to the food-producing environment and explore how the EU’s health-related Agencies are addressing/supporting the European efforts.
- To explore how new agricultural practices and climate change may influence AMR linked to environmental sources in different food producing systems including plant-based agriculture, terrestrial animals/food producing animals, and aquaculture (e.g., reclaimed water, fertilizers, sustainable aquaculture, reduction of antimicrobials, water pollution, feed).
- To identify areas/gaps needed to be improved/addressed for better preparedness. This includes discussion on the suitability of the current regulatory context and scientific developments to detect/prevent emerging AMR issues (e.g., new data requirements/uniform principles for biopesticides, use of new technologies for AMR assessments, the need for specific target surveillance).
- To discuss possibilities to improve the sharing of data and expertise across different regulatory areas relevant to the food producing environment to ensure a more holistic One Health approach.
- To make recommendations for future actions and their implementation in the next generation of AMR risk assessments.
Opening and welcome
Beatriz Guerra Roman, European Food Safety Authority (EFSA)
Part I - One-health AMR issues of public health relevance
One-health AMR issues from a public health perspective
Robert Skov, Statens Serum Institut
AMR in food-producing environments
Luisa Peixe , University of Porto
Part II - Influence of agricultural practices and climate change
AMR and climate change
Amy Pruden , Virginia Tech
Future changes on agri-food systems and AMR
Junxia Song, Food and Agriculture Organization of the United Nations (FAO)
The need for reclaimed water reuse for irrigation: Current challenges & ongoing developments
Despo Fatta-Kassinos, University of Cyprus
Analysis of data on antimicrobial consumption and resistance: Jiacra-report
Christina Greko, National Veterinary Institute (SVA)
Part III - Improving preparedness for AMR
Surveillance of AMR in food producing environments
Rene S. Hendriksen, Technical University of Denmark, National Food Institute (DTU)
Regulation- AMR EC Requirements for micro-organisms used as active substances in Plant protection products
Domenico Deserio, European Commission
CRISPR-Cas as a tool to fight AMR: challenges and future prospects
Stineke Van Houte, University of Exeter
FED-AMR: The role of free extracellular DNA in dissemination of antimicrobial resistance over ecosystem boundaries along the food/feed chain (One Health EJP)
Werner Ruppitsch, Austrian Agency for Health and Food Safety (AGES)
Part IV - Final discussion and feed-back session
Wrap up and concluding remarks
Lieve Herman, Institute for Agricultural, Fisheries and Food Research (ILVO) | Beatriz Guerra Roman, European Food Safety Authority (EFSA) | Caroline Whalley, European Environment Agency (EEA) | Dominique Monnet, European Centre for Disease Prevention and Control (ECDC) | Barbara Freischem, European Medicines Agency (EMA)