Secrets to the Danish success in combating antimicrobial resistance

The global consumption of antimicrobial agents for animals is almost twice the size of human consumption. Since the mid-1990s, Denmark has reduced animal consumption of antimicrobial agents by 60% without reducing its agricultural output. In a comment in the journal Nature, Professor Frank Møller Aarestrup, the National Food Institute, Technical University of Denmark, gives his explanation of the success of the Danish efforts.

In many countries,antimicrobial agents are still used as growth promoters in animal husbandry to boost animal growth rates. Denmark was the first country to ban growth promoters on a scientific basis and to establish a national surveillance. The National Food Institute was involved from the outset, and has participated in the surveillance of antimicrobial agent consumption and resistance since the mid-90s.

Cross-sector collaboration

Professor Frank Møller Aarestrup, the National Food Institute, Technical University of Denmark, has been part of the process from the very beginning and in the scientific journal Nature, he offers his explanation of the good Danish experiences.

"There are three secrets to the Danish success. Since 1995, we have had a national surveillance programme, DANMAP, which enables us to continually monitor changes in resistance and document any problems. The 1990s saw political willingness to introduce regulations of the consumption of antimicrobial agents. And there was and still is cross-sector collaboration between farmers, the food industry, researchers and authorities," says Professor Frank Møller Aarestrup.

One of the key steps was the ban on growth promoters, but an essential element is also the Danish surveillance system which documents resistance developments and is able to propose solutions. Each year, the DANMAP surveillance programme monitors the consumption of antimicrobial agents - from farm to table to hospital bed - and investigates the incidence of antimicrobial resistance in animals, food and humans. The programme is a joint initiative of the National Food Institute, Statens Serum Institut and the National Veterinary Institute, Technical University of Denmark.

Denmark a source of inspiration

The DANMAP programme was the first of its kind in the world, but has now been emulated in many countries. In some countries, data are not available from all animal species and the programmes do not integrate data from animals and humans in the same way as in Denmark.

"All countries that wish to limit their consumption of antimicrobial agents for livestock could learn from the Danish experiences. It only takes some adaptation to local conditions, and we have evidence to show that reducing the consumption of antimicrobial agents prevents the incidence of resistant bacteria. One very effective initiative is that Denmark introduced a ban on veterinarians profiting from writing prescriptions for antimicrobial agents. The consumption of therapeutic antimicrobial agents dropped by almost 30% in 1995, and in Denmark the ban has not resulted in falling agricultural productivity," says Professor Frank Møller Aarestrup.

From 14 to 15 March 2012, the Danish EU Presidency hosted a conference on antimicrobial resistance at which Denmark was recognised as a pioneer in the area. Several researchers from the National Food Institute, including Frank Møller Aarestrup, attended the conference. At a council meeting between the EU ministers of health on 22 June, the recommended conference conclusions were adopted. The ministers agreed on increased focus on reducing antimicrobial consumption and expanding collaboration between the human and the veterinary sector.

Voluntary stop and 'Yellow Card' working

In July 2010, the Danish Veterinary and Food Administration introduced the so-called 'Yellow Card' scheme aimed at reducing the increasing antimicrobial consumption. At the same time, Danish agriculture introduced a voluntary ban on one of the antimicrobial agents, cephalosporins, which is essential for treating humans. The initiatives helped reduce antimicrobial consumption by almost 25% over two years, and consumption of cephalosporins decreased by almost 49% in 2010 for pigs.

"It is indeed positive to see that both the total consumption and the consumption of cephalosporins have dropped. Resistance to cephalosporins is a rapidly increasing problem in both humans and animals. It is therefore important to maintain the positive development," says Frank Møller Aarestrup.