The Dutch healthcare system currently enjoys the status of having the lowest levels of antimicrobial resistance in the world. Not only are antibiotics used minimally in the country where human health is concerned, but the country has surprised the world by slashing the antibiotic use in veterinary medicine by 60%. As per recent statement by Dutch Health Council, the best way to tackle the issue of antimicrobial resistance is to use “One Health” approach in both the health and agricultural sectors.
Dutch healthcare uses the fewest antibiotics in the world.
— Dutch Health Council
But how did this happen in a country that was considered one of the highest consumers of antibiotics in veterinary medicine? The answer lies in its government’s prompt action and timely measures. The government promptly took notice of the issue and took measures to reduce the use of antibiotics by 60% from the year 2007 to 2015. When the superbug methicillin-resistant staphylococcus aureus (MRSA) infections spread from the animals to the farmers and vets, leading to fatalities, the Dutch Veterinary Medicines Authority was initiated. In two years the initiative had collected data on the antibiotics use of more than 40,000 farms, and found they were being unnecessarily overused. The Dutch Parliament also agreed that a 50% reduction in antibiotics was necessary. According to WHO fact sheet, people with MRSA are estimated to be 64% more likely to die than people with a non-resistant form of the infection.
Also in June this year, the Netherlands successfully convinced 28 countries of the European Union (EU) to adopt the One Health approach as a national antimicrobial resistance action plan, to be executed by 2017. The plan will make sure antibiotics like ‘carbapenems’ are used only when needed in the agricultural and livestock setups.
“If we want to control a problem in healthcare we need to act everywhere where antibiotics are used,” says Dik Mevius, head of National Reference Laboratory on Antimicrobial Resistance at Wageningen University.
Keep in mind the overuse of antibiotics was only prevalent in the Dutch veterinary setting, while the Dutch human healthcare has always shown prudent use of antibiotics. Comparatively, only 11 doses of antibiotics are prescribed daily by Dutch doctors, half the rate of usage in the UK, leading to the lowest levels of MRSA infections among the Dutch population.
Is it possible to use the Dutch example in other countries to control the threat of microbial resistance? Any solution, if properly executed, can be adopted. We have to realize the Dutch did not come up with the solution miraculously overnight; it took decades of hard work and dedication through proper channels and systems which led them to an antimicrobial free environment. One amazing step by the Dutch was to computerize all their farming systems which made keeping tabs decidedly easy.
The Brussels healthcare administration personnel Sascha Marschang has also praised the Dutch One Health approach and asked for more concrete and focused implementation of the plan in their country. According to the Dutch, the healthcare systems in the US and Canada are both trying to follow in their steps with increasing interests.
Superbug Spreads Through Livestock
Previously researchers had found that superbugs have reached the United States. Superbug is a term prescribed to an infectious agent which does not respond to any antibiotic therapy and is basically cureless. The rise of antimicrobial resistance and the blatant misuse of antibiotics have led to the development of superbugs like Mcr-1. Scientists discovered that the gene of these superbugs can be originally found in livestock and their meat.
The news, however, was not a big surprise for Barbara E Murray, MD, Director of the Division of Infectious Diseases at the University of Texas Health Science Center at Houston, since she has been working on antibiotic resistance for the last 30 years. Her long experience has taught her that infections always spread.
“Once [resistance has] appeared somewhere, you know it’s going to appear at other places, so it was just a matter of time,” said Murray, a past President of the Infectious Diseases Society of America.
Murray also shared that the current situation feels dire and doesn’t give them much hope of being able to do anything for the patients. She was shocked when she found Colistin was being used now on animals. The only drug left to which a wide range of infectious agents are not resistant seems to be Colistin, but in time, Murray feels, even the superbugs will develop immunity against it, as there are certain plasmids which carry the resistant gene from one organism to other through DNA exchange and when they share this piece of gene they will gradually develop immunity.
Although, in theory, the immunity will be transferred from animal to animal but in time when people will come in contact with livestock, the superbug will travel into their systems and cause cureless infections. Murray believes the threat is still in its early phases and with continued research involving agencies like the FDA, a solution may be found.
The horrors of antibiotic-resistance and how it can aggravate in future if prompt actions are not undertaken, should alert all countries in the world. In this situation, following the Dutch pattern becomes more than the need of the hour to overcome the gigantic threat of the microscopic assailants.