World Antimicrobial Resistance Awareness Week is a time to reflect and recognize action and a mindset shift in addressing antimicrobial resistance. The food animal sector has acted and continues to act to address antimicrobial resistance at the farm level. The action is affirmed as represented by the World Organisation for Animal Health (WOAH), founded as OIE, 7th Annual Report on Antimicrobial Agents Intended for Use in Animals, noting, “… using the normalised amount of milligrams of antimicrobials used per kilogram of estimated animal biomass. Collected data, representing 65% of the global animal biomass, show an overall decrease of 13% in the mg/kg at the global level, moving from 111.45 mg/kg in 2017 to 96.73 mg/kg, in 2019.” This is notable as more countries track and report antimicrobial use data.

Data reporting in recent years of countries and regions affirms the reduction in use seen at the global level, specifically, countries such as the United States are down 38% for medically important antimicrobials from 2015 to 2021 and the European Union region is down 46.5% from 2011 to 2021. The trend is encouraging, recognizing evolving farm management practices to avoid use, disease challenges necessitating use and typically increasing animal numbers. (Note: It is important to view full reports for context and details around numbers.)

Antimicrobials are precious medicines for which all stakeholders need to act to ensure their ongoing availability and efficacy to tackle bacterial infections in human and animal care. This requires action guided by the One Health concept considering humans, animals and the environment. Action, in the end, comes down to antimicrobial use. Any antimicrobial use potentially leads to antimicrobial resistance, thus impacting efficacy to treat disease.

Antibiotic resistance is a natural biological process of bacterial survival; it is the bacteria’s defense against antibiotic drugs designed to kill them. Resistance is either intrinsic, meaning preexisting and transferable only to offspring, or acquired, meaning developed through chromosomal mutations or DNA transfer. Antimicrobial use results in resistance selection pressure, whereas no antimicrobial use means no resistance selection pressure.

In the past decades, the message has been to reduce the use of antimicrobials. The mindset shift is to implement best practices that avoid the need for use of antimicrobials. This mindset shift aligned with action at the farm level is a game changer.

Analyzing this game changer of a mindset shift involves looking at the basics and what can drive change. The focus is to manage the cause for antimicrobial use, a bacterial disease and ideally negate the need for use which, by default, reduces use.

Through the past decades of addressing antimicrobial resistance and seeking to reduce use, farmers, producers and veterinarians, working together, have identified and implemented farm management practices that avoid the need for antimicrobial use. These practices, as defined within the International Poultry Council’s (IPC) Best Practice Guidance to Reduce the Need for Antibiotics in Poultry Production, serve as core guidance to avoid disease, including practices around areas of stockmanship and training, biosecurity — external environment, biosecurity — internal environment, bird environment, hygiene — houses, hygiene — hatcheries, flock health and welfare plans, and nutrition. Applied properly, these practices avoid the need for use.

Decades of effort and learnings can now be framed in three phases based on experiences at the farm level to address bacterial infection and disease challenges. The phases are: 1) best practices to avoid the need for use, 2) antimicrobial stewardship principles for use and 3) measure results and implement learnings post use.

These three phases of a thought process recognize reality in that farmers and producers first act to minimize the risk of bacterial disease exposure. A healthy, disease-free food animal is the most productive. Second, if exposed to infection, farmers minimize antimicrobial use through stewardship principles that work to identify the bug, the drug and the dose. And third, in relation to all decisions, measure and learn for applying to future action.

The reduced use terminology has helped directionally address antimicrobial resistance in the past decades. But now, it is known that implementing best practices to avoid the need for use will further accelerate decreasing antimicrobial resistance globally. This mindset shift is a game changer, as it places the focus and resources on bird health and, thus, the avoidance for need of use. This focus eliminates the cause and, thus, the use — a true benefit for One Health globally.