AMR Control Implementation in Animal Health and

Agriculture : Asia region and Indonesia

James McGrane FAO ECTAD Team Leader

Workshop to Evaluate the National Actiopn Plan on AMR Control 2017-19
and Preparation for AMR NAP 2020-2024
Jakarta, Indonesia
May 2-3, 2019
 • Introduction – antimicrobial resistance vs.
antimicrobial residues
• Overview of FAO activities on AMR in Asia
Outline • Overview of FAO activities on AMR in Indonesia
• Lessons learned from implementation of AMR
in agriculture
A little bit of a background
Does antibiotic residue avoidance = antimicrobial resistance avoidance?
No! Antibiotic residue avoidance ≠ antimicrobial resistance avoidance!
Antimicrobial Residue Antimicrobial Resistance
• Chemical hazard: Antimicrobial drug • Microbial hazard - Resistant
or metabolite present in the meat or bacteria/genes are isolated from the
milk from an animal meat or milk of an animal
• Intervention: • Dissemination of resistant bacteria/genes
• Observe the withdrawal period continues beyond the residue withdrawal
(on-farm) period – environment (MoEF)
• AM residue < Max Res Limits • Intervention:
• Antimicrobial stewardship
• “5 Rs”
The role of the agriculture sector
• Antimicrobial stewardship (5Rs): Professional management to reduce
resistance selection and to preserve the efficacy of antimicrobial agents
• Responsibility
• Veterinarians assesses risk/benefit; assumes responsibility for adverse impacts
• Reduction
• Can take many forms: %Rations medicated, duration of exposure…
• Through management/husbandry:
• Flock environment: Comfort/stress, nutrition, facility design
• Infection control (biosecurity, hygiene) and maximizing immunity (vaccination)
• Measured through monitoring/surveillance; industry initiatives/interventions
• Refinement
• To minimise AMR through “Right drug, right time, right dose, right duration”
• Replacement
• Available efficacious alternative – an issue! Probiotics?
• Review
• Regular; continuous improvement… contemporary best practice; industry initiatives NAP review
J. Scott Weese, Stephen W. Page, and John E. Prescott. Antimicrobial Stewardship in Animals. In: S. Giguère, J.F. Prescott, P.M Dowling eds. Antimicrobial Therapy in Veterinary Medicine 5th Ed. Ames Iowa: John
Wiley & Sons, Inc., 2013:117-132

• Identify information gaps

• What information do you need to monitor and implement stewardship practices?
• Veterinary prescription and oversight
FAO’s activities to improve monitoring
of AMU/AMR and stewardship in the
agriculture sector
Cascading the FAO Action Plan on AMR in the Asia-Pacific Region

GLOBAL FAO FAO RAP

ACTION ACTION REGIONAL DIRECTIONS

PLAN PLAN
FAO-RAP AMR Initiatives in Asia and the focus areas of the FAO Action Plan
FAO-RAP AMR Initiatives in Asia and the focus areas of the FAO Action Plan

AWARENESS

SURVEILLANCE

GOVERNANCE

GOOD PRACTICES
FAO-RAP AMR Initiatives in Asia: AWARENESS

Development of KAP + Guideline

Communication & Advocacy (e.g. WAAW)

ASEAN communication strategy

Regional Tool Kit

Specific country awareness-raising activities

IMPROVE AWARENESS ON AMR AND RELATED THREATS

FAO-RAP AMR Initiatives in Asia: SURVEILLANCE

Regional AMR Surveillance Guidelines

FAO Assessment Tool for AMR Surveillance (ATLASS)

Facilitate establishment of FAO Reference Center

(Chulalongkorn University is now in the final stages of approval)

Collaboration with ASEAN Reference Food Lab

(Bureau of Quality Control of Livestock Products) and BBPMSPH in
Indonesia

DEVELOP CAPACITIES FOR AMR/AMU SURVEILLANCE

FAO-RAP AMR Initiatives in Asia: SURVEILLANCE

Regional Training on Harmonized and

Standardized Antimicrobial Susceptibility Testing
(In collaboration with Chulalongkorn University) - BBPMSPH

Proficiency Testing on AST (BBPMSPH)

In-country capacity building (AST and Nanopore)

Assessment and capacity building on AM Residues

DEVELOP CAPACITIES FOR AMR/AMU SURVEILLANCE

FAO-RAP AMR Initiatives in Asia: SURVEILLANCE

Country activities on AMR surveillance

VIET NAM

AMR surveillance in swine and poultry

LAO PDR

AMR surveillance in swine and poultry PHILIPPINES

AMR surveillance in swine and poultry

INDONESIA
AMR surveillance in broiler/ layer poultry

CAMBODIA AMR surveillance in swine

DEVELOP CAPACITIES FOR AMR/AMU SURVEILLANCE

FAO-RAP AMR Initiatives in Asia: SURVEILLANCE

ULTIMATELY: INTEGRATED SURVEILLANCE  JOINT RISK ANALYSIS  MANAGE AM USAGE

FAO-RAP AMR Initiatives in Asia: SURVEILLANCE

Development of AMR/AMU surveillance guidelines

FAO RAP has embarked on the development of a series of regionally harmonized guidelines relevant to
this sector:

Guideline #1: AMR Guideline #2: AMR Guideline #3: AMR Guideline #4: AMR Guideline #5:
surveillance in food- surveillance in animal surveillance in monitoring in animal Guideline on AMU
borne bacteria from pathogens recovered aquaculture settings/environment data collection
healthy animals from clinically or sub-
intended for food clinically diseased
consumption livestock and poultry
FAO-RAP AMR Initiatives in Asia: GOVERNANCE

Policy Review Framework

Guidance Document for National Legal Consultants

National Legislation Reviews

AMU-AMR Technical Advisory Group for SEA

FAO-OIE Regional Initiatives Mapping on AMR

STRENGTHEN AMU/AMR GOVERNANCE IN FOOD & AGRI

FAO-RAP AMR Initiatives in Asia: GOOD PRACTICES

Documentation of AMU (Liverpool University)

Thailand, Vietnam, Indonesia

IHPP Thailand - Antibiotic consumption in citrus

trees and its potential environmental impacts

Network of Aquaculture Centers in Asia (NACA) -

Detailed mapping/description of the aquaculture production systems and
practices of selected species in Myanmar (freshwater finfish), Thailand
(shrimps) and Vietnam (pangas catfish) and Indonesia ( grouper species),
Philippines (milkfish)

PROMOTE GOOD PRACTICES IN FOOD & AGRI SYSTEMS

FAO-RAP AMR Initiatives in Asia: GOOD PRACTICES

Documentation of Good Practices

Participatory tools to enhance awareness

and promote prudent use of
antimicrobials (Bangladesh)

Smart App System – Linking field diagnosis and clinical

data with antimicrobial use guidelines

PROMOTE GOOD PRACTICES IN FOOD & AGRI SYSTEMS

 FAO AMR – AMU Project in Indonesia

iSIKHNAS
EXISTING AND
ACCESSIBLE
SUPPORTING PVUK/Vet Service Officers
RESOURCES

Ongoing FAO projects

(e.g., Healthy Poultry, Healthy People)

Outcomes from previous projects

(e.g. Course materials)

Veterinary Schools
COMPONENT 1: DICs will be sensitized and enabled to detect (through ISIKHNAS or other
means), isolate, identify, and obtain AST profile of identified priority bacterial disease in
poultry in Indonesia.

• Identify priority bacterial disease burden in layer

poultry farms through consultation and data review
1
T
EN

• Improve capacity of DICs to detect, isolate, identify, and

N

Detection, isolat ion,

CO M PO

perform AST of this priority

identification and AST of
*PRIORITY
BACTERIAL DISEASE • Improve capacity of DVPH for data collation, interpretation, analysis,
in layer poultry farms
synthesis, and sharing with stakeholders
 COMPONENT 2: To further reinforce health practices, farmers and workers in the
sentinel farms will be offered to access a learning platform for layer poultry health
management and engage better with PVUKs.

N EN T 2
PO
M • Layer poultry health distance learning course
CO

Enabling
LAYER POULTRY
FARM ERS • Enhancing engagement with PVUKs
to routinely perform and
promote good pract ices
• Facilitating access to previous projec outomes
(e.g., biosecurity concept)
COMPONENT 3: Combined with the planned AMU data collection, a more robust data
gathering from enrolled sentinel farms will be done, including AMR profile of
commensals.

N EN T 3 • AMU data (existing project)

PO
M

CO
• AMR data in commensals
Adding value to exist ing
AM U PROJECT • Knowledge, attitude, practices
which will determine AM
usage in sent inel farms
• Status of biosecurity

• Production data

• Flock health data

COMPONENT 4: To reinforce the program, advanced trainings for PVUKs on *respiratory
diseases of poultry will be periodically conducted by poultry health experts.

EN T4
N
PO

M
• Advance training/mentoring/distance learning of PVUKs

CO
on *priority syndrome of poultry Bridging access to
POULTRY HEALTH
• Development of mechanisms for service access SERVICES

• Improving capacity of pilot DIC to address *priority syndrome of poultry

• Improving feedback mechanisms to end-users of results and findings

 Treatment guidelines

Improved KAP of farmers towards prudent AMU

Cost-benefit analysis

$
Protocols and mechanisms for operational, routine monitoring &
surveillance
JULY to SEPTEMBER 2018
PHASE 2.0 - PRE-INITIATION
CONTEXT DEVELOPMENT
• Stakeholder consultation and on *priority poultry
bacterial diseases, project design and sentinel
enrolment
• Literature review on *priority poultry bacterial
diseases in Indonesia
• Literature review on new technologies and rapid
diagnosis for *priority poultry bacterial diseases
• Development of inclusion criteria for participation
as sentinel farm
• Refinement and finalization of project design
MATERIALS DEVELOPMENT
• Development of survey forms
• Setting up of modules/scripts for the layer
poultry health course for PVUKs
• Setting up of modules/scripts for the layer
poultry health course for farmers
• Development of protocols
for operationalization
• TORs of partners and players
• Procurement
SEPTEMBER to DECEMBER 2018
PHASE 2.1 – INITIAL IMPLEMENTATION

IMPLEMENTATION 1: WATES IMPLEMENTATION 1: DICs

- Identification of sentinel farms - Capacity building of DICs on identified
priority bacterial disease in layers
- Data collection from sentinel farms (in
collaboration with existing project) - Initial data collection from DICs

- Capacity building activities for PVUKs - Protocols/Guideline development for

and farmers operationalization

- Protocols/Guideline development for

operationalization
JANUARY to SEPTEMBER 2019
PHASE 2.2 – DATA GENERATION, ANALYSIS, REPORTING

IMPLEMENTATION 2: WATES IMPLEMENTATION 2: DICs

- Continued capacity building of PVUKs - Continued data collection from DICs
and farmers
- Refinement of mechanisms for clinical
- Post-implementation data collection disease and AMR surveillance in layers

- Refinement of mechanisms for bridging - Development of treatment guidelines

farms to DICs

- Cost-benefit analysis
Addressing future
challenges
Progressive Management Pathway, national action plan implementation
 What lawyers see….

Animal Health law

Farming and animal
production legislation
Food Safety
law

Pesticide legislation
Waste management Law Soil quality

Water law
Antimicrobial usage in humans,
animals and agriculture, and resulting
dispersion of antimicrobial residues
into aquatic and terrestrial
environments () Waste disposal law
(Berkner et al., 2014) Aquaculture law

Governance
Governance/ Strengthening Regulatory Frameworks

Working at global, regional and country level on animal, plant health and food safety
legislation

Recommendations to
Identification of legal Support to
mainstream AMU-
elements and areas participatory
related obligations and
relevant for AMR processes for legal
responsibilities in the
and AMU reform
relevant legislation

www.fao.org/legal

LEGAL INFORMATION – FAOLEX (faolextfao.org/faolex)

Laboratories: ATLASS progressive improvement approach: 5 stages

5
4 Sustainable
3 Demonstrated capacity
2 Developed capacity
1 Limited capacity
No capacity capacity

Laboratories
Epidemiological unit
Authorities
Communication to stakeholders
Sustainability
COUNTRY

Goal is to provide reliable data to inform policies and measure the success of intervention steps
Success stories, examples (Netherlands)

• Measuring the overall impact of the implementation of national

action plan through surveillance.
Example: Netherlands
Success stories, examples (Canada)

• Measuring the overall impact of the implementation of national

action plan.

Surveillance – will be used

to monitor the progress of
stewardship, awareness
and good practices in
countries and in the region