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It is clearly written with both human and veterinary professionals in mind, although I'm not sure how many will read it. BEVA, BVA and BSAVA have of course already produced their own ‘general and species ‘specific prescribing guidelines.’ RUMA has done something similar for food production species.
The strategy specifically cites "...The addition by the RCVS of a requirement within the Code of Professional Conduct for Veterinary Surgeons 2012 for veterinarians to use antimicrobials responsibly to minimise development of resistance." So there you are if you didn't already know it, it's an obligation.....stuff antibacterials into animals with diarrhoea of unknown aetiology at your peril!!!
Much of the emphasis was on human health and inevitably reflects the difficulties of dealing with an increasingly demanding public. It says for example: "....We recognise that GP consultations can often be challenging, particularly when patients expect to receive antibiotics and may be unwilling to accept that they do not need them.”As interesting I think as the information provided by the likes of RUMA are some of the resources cited for human healthcare professionals. "To provide support for GPs in 2012, a GP toolkit called Target was developed by the then Health Protection Agency in collaboration with other professional bodies." That’s at http://www.rcgp.org.uk/TARGETantibiotics/ Worth a look to see how GPs are expected to deal with the problem? Or just worth noting that public pressure for access to antibiotics is out there.
Despite the focus on human healthcare prescribing it also states "....use of antibiotics in animals (which includes fish, birds, bees and reptiles) is an important factor contributing to the wider pool of resistance which may have long term consequences." So it recognises fish, birds, bees and reptiles as being important...I wonder how they felt at the DOH about all those pigeon antibiotics for sale on eBay. Or maybe they were just too busy with producing their strategy to be looking at eBay.
I felt when I read it that the strategy was very worthy, very well-intentioned, even just quite well-written. However, I also thought that when it came to implementation, given the short time-frames within which they expect to be able to measure a difference, the objectives within the implementation section were rather woolly.
The following quote was interesting: "In view of the global nature of the challenge and the real threat to our future health and prosperity, the government is working internationally to promote the importance of containing AMR. This includes influencing the EU regulatory landscape, especially new animal health law." As a nation we are not very good at influencing the EU regulatory landscape and not much in EU law changes within a five year timeframe. It also says as a suggested action, "...Making veterinary antibiotics available in pack sizes that facilitate and encourage appropriate use." I wondered if whoever wrote that had ever taken a pack change project through a large, international or multinational pharmaceutical company and experienced just how long it takes. Anyway, these days if you can't get the pack size you want here you can just buy it online can't you
?In addition to rather woolly objectives it also had objectives like "....Encouraging animal keepers to work closely with their veterinary surgeons to prioritise diagnosis of disease in livestock and companion animals." DEFRA are busy trying to cut their budgets at the moment and are somewhat preoccupied with bovine tuberculosis, including lay-TB testing, so you have to wonder where the 'encouragement' is going to come from.
There is to be an "Interdepartmental High Level Steering Group." But they are at high level so I'm not quite clear what they are going to be doing; probably not a lot of implementation - and I couldn't see what kind of budget they had.
How much difference it will all make I don't know and for me there was one MASSIVE omission. A few years ago during the anthrax terrorism scares in the US, the US public stockpiled quinolones, much of which will have been bought without prescription. I have already met people who have bought antibiotics online via Canadian pharmacies. Yet despite all this, I couldn't see much in this strategy document dealing with the power of the internet.
The strategy was also expected to encompass animal keepers, improving bio security and husbandry, training farmers who have to give antibiotics to do so properly etc. However, it also states as an objective "...Minimising use of preventative antibiotics in animal health." If it achieves that then sales in the animal health sector will go down, so pharmaceutical companies are going to have less to spend on education programmes. It appears to me that if they want to do all that lot with a high level steering group in a short time-frame in a time of austerity, including educating farmers, and with no apparent budget then they are going to need to keep veterinary professionals on side. It's not just a question of saying "..if you want continued access to antibacterials then play ball." If domestic UK access is restricted, people can just go online.
So I hope that in whatever changes they make to "EU Law" they don't plan to penalise vets in any way. I also hope in their monitoring programme they are going to be monitoring the levels of antibiotic resistant bacteria in the guts of people arriving from parts of the world that have never read the DOH UK Antimicrobial Resistance Strategy.