In the first of a series of international perspectives articles looking at antibiotic stewardship activities outside of the UK, RUMA talks to the General Manager of the Spanish Technology Platform for Animal Health (Vet+i Foundation), María Jaureguízar Redondo, to find out more about the country’s farmed livestock industry antibiotic stewardship activities and initiatives to date, and the journey ahead.
After graduation from the Veterinary Faculty of the Complutense University of Madrid, Maria started her career in the industry of animal health in Spain in the department of pharmacovigilance at an international animal health company. In her current role she leads on a project called Vet+i Foundation.
Chris Lloyd from RUMA interviewed Maria recently to learn more about Spain’s response to AMR.
Chris: “Maria, please tell us more about Vet+i and is this similar to RUMA UK in that it works across all of the livestock sectors to champion the responsible use of medicines?”
Maria: “Vet+i was created in 2008 to improve research, development and innovation in the field of animal health in Spain and to position the Platform as a hub of knowledge for applied research relating to animal health throughout Spain, Europe and the Mediterranean area. Vet+i acts as satellite group of the European Technology Platform for Global Animal Health (ETPGAH) led by AnimalHealthEurope. It is a cross-industry forum that integrates all relevant stakeholders from academia, research, farmers, veterinarians, industry, regulators, etc that helps facilitate networking and discussion. Its main goal is to enable the efficient transfer of research developed in Spain and accelerate the development and delivery of the most effective tools for controlling animal diseases of priority for Spain, thereby improving human and animal health, food safety and quality, animal welfare and market access.
“Within Vet+i we have developed specific Guidelines on the Responsible Use of Veterinary Medicine Products for food-producing, companion animals and wildlife. We also have a website called vetresponsable which was created in 2011 (www.vetresponsable.es) covering the responsible use of veterinary medicines, including antimicrobials. This is a wonderful platform that provides vital support and resources to the Spanish farmed livestock industry, veterinarians, farmers and owners to help support antibiotic stewardship.
“Additionally, the Vet+i initiative supports the implementation of the Spanish Strategic Action Plan against Antibiotic Resistance (PRAN – 2014) coordinated by the Spanish Agency for Medicines and Sanitary Products (AEMPS), and contributes to its priorities to minimise the risk of selection and spread of antimicrobial resistance .
The European Union Council, European Parliament, European Commission and its Agencies (EMA, ECDC, HMA and EFSA) identified the need to establish a common European strategy in order to understand and tackle the problem of antimicrobial resistance. This led to a number of official documents being produced since 2011 which highlight the need for the impact of antimicrobial resistance to be jointly addressed from human and animal health and setting out a series of actions to address AMR.
“The Spanish National Plan has six strategies aimed at addressing resistance and protect the effectiveness of antibiotics in treating bacterial disease long into the future (surveillance, control, prevention, research, training and communication and awareness of the population). The Plan follows a One Health approach with multisectoral representation, (human medicine, veterinary medicine, research, animal husbandry, education and communication).
“The Spanish National Plan is underpinned by a communications strategy targeted to vets, farmers, pet owners and vet students. Our online resource, www.vetresponsable.es, is used by almost all Veterinary Schools in Spain and we have received a very good feedback from all interested parties. At Vetresponsable, we have been working since 2011 on a range of responsible use initiatives.
“It certainly has many similarities in approach to RUMA UK, as it is all about multi-sector, voluntary collaboration.”
Chris: “According to the latest ESVAC Report , Spain has seen an overall decline in antibiotic sales since 2016, with the lowest recorded in 2019, but there was a slight uplift in 2021. What was the reason for this?”
Maria: “Yes that’s correct. The overall decline in sales is a result of years of active work by all interested parties including the adoption of the Spanish National Plan against Antibiotic Resistance which has brought those aforementioned six strategic priorities together across the veterinary, human and environmental sectors. The aim is to encourage voluntary reductions; each species has different targets and reduction goals, focusing on promoting appropriate antimicrobial use, ensuring effective surveillance systems, promoting research and innovation and developing different awareness-raising campaigns.
These initiatives have included the implementation of a plan to encourage voluntary reductions in the use of antibiotics in all species mainly those included in category B. For example, overall reduction of colistin in pigs has been adopted; this plan is focused on the voluntary reduction of colistin usage by the porcine sector. An epidemiological clinical pathogens map has also been developed to facilitate the prescription process, and several training courses have been provided for veterinarians, farmers and the general public.
Also, we have to follow the ‘Farm to Fork’ European targets of 50% reduction of antimicrobials for livestock and aquaculture by 2030. The Spanish Ministry of Agriculture is working towards sustainable benchmarks. The objective is not just to reduce but to ensure a sustainable use of antibiotics at farm level. This means responsible use of antibiotics and all medicines, but also the improvement of biosecurity systems, good animal management, vaccination, welfare, among others.
“These initiatives contributed to the overall reduction in antimicrobial VMPs sales in Spain. In animal health, the 12th ESVAC Report corresponding to the consumption of veterinary antibiotics in 2021 in 31 Member States was published. The report shows how Spain has decreased the consumption of veterinary antibiotics by 62.5% since 2014, the year the National Plan began, until 2021. Although it is true that the trend in the decrease in consumption is very favorable , a slight increase in consumption of 1.8% can be seen from the year 2020 to the year 2021. Despite this, Spain presents the most favorable evolution of the 31 Member States that participate in the ESVAC report and this is demonstrated, above all, in the decrease in the consumption of critically important antibiotics from 91.5% from 2014 to 2021 and from 10.5% in the last year, despite the small overall increase. And there has also been a reduction in HPCIA use too (like Polimixines, Cefalosporines, and so on); this again is the result of years of proactive work to highlight AMR.
“In the 2022-2024 National Plan , voluntary reduction continues. There are reduction programmes in place across all sectors and the Plan is coordinated by the Spanish Agency of Medicines; this is a One Health approach and they work together across human, vet and environmental areas. These voluntary plans across each species are proving very successful.
Chris: “How do you drive positive change and champion the work done by the Spanish agriculture industry to use medicines responsibly?
Maria: “Antibiotics is a key focus of course, but our work also covers the responsible use of all medicines in order to maintain efficacy, prevention and control of animal diseases, and to reinforce the veterinary pharmacovigilance system (NOTIFICAVET system among others. The key to some of our successes is very much the result of sector and industry collaboration and Government support across Vet+i activity. We have representation of all stakeholders on our Council which ensures a holistic approach. All Vetresponsable activities are agreed by all parties in our council: Spanish Medicines Agency (AEMPS) representatives, veterinary profession, CVO representative, ministry of agriculture, Industry, Producers, and of course, Vet+i as secretariat coordinate all the activities.
“We work across a number of initiatives to communicate projects and progress. On the Vetresponsable website for example, we have species guidelines which were produced by our stakeholders and we organise regular events to focus on these and raise awareness. We also have a collaboration agreement with General Council of Veterinary Colleges of Spain – the guidelines are prefaced by its President – and with the Conference of the Deans of the Spanish Veterinary Universities. This has allowed us to organise specific workshops to promote the responsible use of medicines, in collaboration with the AEMPS and we have organised a lot of workshops in all Veterinary Faculties of Spain in order to share our guidelines with students and use social media as a way of driving ongoing awareness and engagement.
Chris: “Do you work with the Spanish media to shine a spotlight on your work too?”
Maria: “Yes. This is another important way of demonstrating Spain’s commitment to tackling AMR and through the media it helps to reach a wider audience – not just vets and farmers, but consumers too.”
Chris: “Are there any specific antibiotic stewardship campaigns that you deliver and how are they received?”
Maria: “Once a year we have a big face to face event which attracts around 250 attendees across the veterinary and farming professions. This is a great opportunity to learn and share. Each year we have a specific headline focus; previous themes have looked at European and National co-ordination of legislation and last year, Communication strategies was a core focus i.e., how do we communicate effectively to the new generations coming into livestock farming and help ensure the antibiotic stewardship message continues to evolve and strengthen.
“Vet+i also has as much visibility as possible at industry events – not only across the agriculture industry but companion animals too, as antibiotic stewardship is just as important in the companion animal world. In addition, we deliver a range of online courses, as well as visit universities and vet practices to champion the resources and support discussions about AMR.
“We also work closely with our European colleagues and have shared the Spanish Plan and the work of Vet+i with the European team to ensure ongoing collaboration and sharing of insights.”
Chris: “The collection of data is vital in making informed and responsible decisions about antibiotic use. In the UK we have a number of initiatives in place and in development that help build a national picture. How is antibiotic data collected in Spain?”
Maria: “In Spain the data is collected at two levels; firstly sales data provided by marketing authorisations from retailers, pharmacies and livestock entities. The ESVAC PROJECT, as you know is the European initiative for the collection and evaluation of data on sales of veterinary medicines that contain antibiotics as an active ingredient. In Spain, the ESVAC project is included in our National Plan against Antibiotic Resistance and Spain has been contributing to this data since 2011 with the sales from the Marketing Authorisation Holders. Secondly, there is a notification of prescription data for antibiotics of livestock which is compulsory for vets to upload into a national database
“In January 2018 Spain introduced the compulsory recording of prescription data, notified only by vets; this helps in building a national picture of sales use by medicine type. It is mandatory to record antibiotic prescriptions, including for medicated feed, for food producing animals and this is done monthly via an electronic database managed by the Ministry of Agriculture (called PRESVET). This database has been developed in conjunction with the livestock sector and it takes into account the specific data for each species. It isn’t about having specific reduction targets – the focus is on responsible use. Equally, it’s not about zero use – antibiotics are a vital tool in managing disease challenges and protecting animal welfare. Every farmer can consult and compare themselves with other like-for-like farmers on use at farm level by production category. The system allows to analyse data by vet, farm, specie and antibiotic. At present, if a farm is at an above average level then they would need to look at addressing that. The Government has released new rules in order to achieve sustainable use of antimicrobials in livestock and aquaculture. In time, the goal is to facilitate self-monitoring of antibiotic consumption in livestock farms in the context and to have benchmarking of use at farm level by productive category.
“There is also a big focus on the vet-farmer relationship; we know how important this is. In Spain, a farm has to choose one key vet to work with on antibiotic stewardship activity and health plans. In companion animals it is not mandatory to record antibiotic prescriptions yet, but this could change in future years.”
Chris: “What would make the most positive impact on responsible antibiotic use in Spain in the future?”
Maria: “Well we now have the latest Spanish plan (2022-2024) and without doubt, the Plan to date has been fundamental to the successes so far and has helped underpin and mobilise focus and efforts on tackling AMR. The latest plan will continue to drive efforts forward positively in my opinion. Within the Plan, collaboration across all sectors remains vital of course. We are still working together with the same focus: we want to continue using these important tools in animal health and align to the objective of ‘as little as possible, but as much as necessary’.
“Vetresponsable will continue to disseminate important guidance and resources on the responsible use of medicines. In fact, this initiative has recently been recognised with an award and has received the “PRAN 2018 award for the best training and information initiative for healthcare professionals on antibiotic resistance” as part of the Spanish Plan. This of course makes us all incredibly proud and we want the platform to continue to have a positive impact.”