“Medicine cannot greatly reduce the use of antibiotics”

Medicine cannot greatly reduce the use of antibiotics

In France, the health agency Anses has just announced that the use of antibiotics in human and animal medicine had decreased in ten years by 45% for animals, against 18% for humans – excluding the coronavirus crisis -. Nicolas Fortané is a sociologist who works on public animal health policies at the National Institute for Research in Agriculture, Food and the Environment (Inrae): he calls for continued efforts in a global manner.

RFI: Why are we questioning the use of antibiotics?

Nicolas Fortane: These drugs were used for reasons that were not only medical or health. A part of the antibiotics have become the bandages of health systems, agrifood systems which are not sustainable, turned towards performance and profitability objectives rather than towards global public health including the well-being of animals or humans.

We have become dependent on antibiotics, a kind of antibiotic dependence, to compensate for the failures and unsustainability of our health and agrifood systems worldwide. However, this dependence can lead to the development of bacteria resistant to antibiotics, with a risk of incurability of certain diseases. Some bacteria are now resistant, such as tuberculosis: if there are few cases in France or Europe for the moment, there are for example more in India or South Africa.

Are the two medicines, human and animal, therefore concerned?

In some parts of the world, antibiotics have been widely used in animal husbandry to improve farm performance. There has recently been a significant reduction in livestock farming in Europe of around 40-45%, but it is not enough. This decrease concerns the antibiotics whose effectiveness had to be preserved the most, and more traditional molecules, more daily, should also be used less.

In human medicine, we all remember the prevention campaigns of twenty years ago, which had an effect on prescriptions and uses at that time, but this trend was not sustainable. Today, the world of human medicine is struggling to continue reducing the use of these antibiotics. There are therefore efforts to be made on the side of the two medicines, even if they are not the same.

To go further: The Priorité Santé program on antibiotic resistance

How to explain these differences in relation to antibiotics between livestock and humans?

Twenty years ago in Europe, a public health crisis led to the ban of farm-raised antibiotics that were used as growth promoters. In reaction to this crisis, the agricultural world and the veterinary profession have been able to reappropriate the question, question their own practices, which has made it possible to set up public policies, professional and economic incentives.

More broadly, we now understand animal health differently, with more preventive approaches. This does not mean that we are giving fewer drugs: we continue, within the agri-food sectors to have a technologized vision of animal production that does not call into question the intensive and industrial model of breeding, but rather less no longer relies on mono-dependence on the antibiotic.

On the side of human medicine, it seems that public health messages have been less effective, and the transition to other approaches, other ways of dealing with health, has had less effect. The general work of my colleagues shows that our health systems are dependent on antibiotics, that our health and social insurance systems have performance and profitability objectives: patients must be cured quickly, return to work quickly… In a model like that, obviously, the use of antibiotics remains unavoidable.

How could we, in this case, continue to reduce the use of antibiotics?

We must find the means to perpetuate and generalize the current trend. It is possible that this trend is specific to certain regions, certain sectors, so we must ensure that it transforms into a general and homogeneous trend. If things have dropped so quickly and so drastically in animal medicine, it is because we have probably attacked uses of antibiotics that have not really been proven useful. Continuing to lower the proportion of antibiotics whose use is more sedimented, less questioned, will require in-depth work. This will require the sustainability of a certain number of measures, be they incentive or regulatory, for the trend to continue.

More broadly, we should also think about the problem of antibiotics with other major issues in agriculture, such as climate change or agroecological transition, and seriously think about the issue of models of production, circulation and consumption of agrifood goods. … Otherwise we limit ourselves to cosmetic measures that do not change the basic problems.

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