Global antimicrobial use in livestock farming: an estimate for cattle, chickens, and pigs.

Livestock farming substantially contributes to the global economy and food security. However, it poses crucial environmental, animal welfare, and public health challenges. The main objective of this study is to quantify the global antimicrobial use (AMU) in cattle, chicken, and pig farming. This information is important for understanding the potential impact of farm AMU on the emergence and spread of antimicrobial resistance among animals and humans. Using the United States Department of Agriculture Production, Supply, and Distribution and the Food and Agriculture Organization databases, we estimated the total supply of cattle (in heads) and its distribution into four weight categories: calves (26%), cows (41%), heifers (4%), and bulls of more than one year (29%). Similarly, we calculated the total supply of pigs (in heads) and divided it into two weight categories: pigs (96%) and sows (4%). For chickens, we considered one weight category. We attributed to each category a standard weight according to the parameters set by the European Medicines Agency (EMA) to determine the animal biomass at risk of antimicrobial treatment, or population correction unit (PCU). Finally, we estimated the global PCUs and then the global AMU based on the average administered to the three species (in mg of active ingredients per kg PCU). With this method, we estimated a global annual AMU of 76 060 tonnes of antimicrobial active ingredients (2019-2021 average), of which 40 697 tonnes (or 53.5%) for cattle, 4 243 tonnes (or 5.6%) for chickens, and 31 120 tonnes (or 40.9%) for pigs. According to our assessment, global AMU leads to almost 20 000 tonnes less than the previous estimates due to a different evaluation of PCUs. In previous studies, PCUs were calculated on the liveweight at slaughtering of animals, while our method considers the age and sex of animals and their average weight at treatment. Our results are consistent with the World Organization for Animal Health (WOAH) estimate of 76 704 tonnes of veterinary antimicrobials globally consumed in 2018 for the total of food-producing animals (the WOAH estimation is based on sales and import data).

Evaluating the contribution of antimicrobial use in farmed animals to global antimicrobial resistance in humans.

Antimicrobial resistance (AMR) is currently regarded by the World Health Organization (WHO) as one of the most significant risks to global public health. The most critical causes of AMR infections in humans are the misuse and overuse of antimicrobials in humans and farmed animals. The rising global demand for food of animal origin encourages the increase of animal production worldwide, especially in developing countries. Simultaneously, current farming practices often extensively use antimicrobials on animals, influencing bacterial AMR incidence. This study aims to evaluate the correlation between antimicrobial use (AMU) in farmed animals and the detection of AMR infections in humans, the effects of enforcing laws in animal farming in a country on AMR situation in the neighbors, and the potential of AMR to spread from one country to another. Using data from 30 largest animal-producing countries in different regions of the world, between 2010 and 2020, and a Spatial Durbin Model (SDM), we found that AMU in farmed animals increases AMR in humans and there is a spatial dependence between countries regarding AMR spreading. Such findings indicate that a globally coordinated strategy regulating AMU on farmed animals may reduce AMR emergence and worldwide spreading.

Capturing systematically users' experience of evaluation tools for integrated AMU and AMR surveillance.

Tackling antimicrobial resistance (AMR) is a goal for many countries. Integrated surveillance of antimicrobial use (AMU) and resistance is a prerequisite for effective risk mitigation. Regular evaluation of any surveillance is needed to ensure its effectiveness and efficiency. The question is how to evaluate specifically integrated surveillance for AMU and AMR. In an international network called CoEvalAMR, we have developed guidelines for selection of the most appropriate tools for such an evaluation. Moreover, we have assessed different evaluation tools as examples using a country case format and a methodology with a focus on the user's experience. This paper describes the updated methodology, which consists of a brief introduction to the case and to the tool separately. Moreover, there are 12 functional aspects and nine content themes which should be scored using a 4-tiered scale. Additionally, four Strengths, Weaknesses, Opportunities, Threats (SWOT) questions should be addressed. Results are illustrated using radar diagrams. An example of application of the updated methodology is given using the ECoSur evaluation tool. No tool can cover all evaluation aspects comprehensively in a user-friendly manner, so the choice of tool must be based upon the specific evaluation purpose. Moreover, adequate resources, time and training are needed to obtain useful outputs from the evaluation. Our updated methodology can be used by tool users to share their experience with available tools, and hereby assist other users in identifying the most suited tool for their evaluation purpose. Additionally, tool developers can get valuable information for further improvements of their tool.

A One-Health evaluation of the burden of cystic echinococcosis and its prevention costs: Case study from a hypo-endemic area in Italy.

An integrated model, based on a One Health approach, was implemented to estimate the epidemiological and economic outcomes of cystic echinococcosis (CE) in Veneto region, an hypo-endemic area of Northern Italy, and the costs for its prevention. Data and information needed to populate the model were retrieved from published literature, official statistics, expert opinions, or actively searched through data mining (i.e., Hospital and slaughterhouse data), when fundamental data were not available. Human-health and animal-health costs, both public and private, were considered. The overall impact of CE in the study area was estimated in an yearly cost of about 0.5 million €, due to an average of 19.5 human hospitalized cases and about 200 infected animals among cattle and sheep, per year. The human:animal costs ratio was about 8:1. Most of the infected animals were autochthonous, while the identification of an autochthonous source of the infection for the human cases was extremely difficult, and unlikely in most cases. No specific action resulted to be in place for human surveillance, while veterinary surveillance accounted for a yearly cost of about 22,000 €. Sheepherders were found to pay privately an overall amount of around 2000 € for the preventive treatment of their dogs every year, but the applied protocol proved to be sub-optimal. The source of most of the human cases was likely external to the study area, and their economic impact accounts for a cost that is far exceeding that of surveillance and preventive actions in place in the veterinary sector. Although autochthonous human cases appeared to be very rare, the strengthening of preventive actions and surveillance systems can reduce the risk of their increment.

One Health Evaluation: A Case Study at the University of Bologna.

The level of One Health (OH), or "One Health-ness," of health interventions has been defined as the capacity to operate according to six dimensions concerning OH operations and OH infrastructures, respectively (thinking, planning, and working; and information sharing, reciprocal learning, and systemic organization). Although health initiatives and research increasingly claim their orientation toward OH, such a capacity is rarely assessed. The objective of this study is to evaluate the One Health-ness of the academic team of the University of Bologna (UNIBO Team) working in the "ELEPHANT" project (Empowering universities' Learning and rEsearch caPacities in the one Health Approach for the maNagement of animals at the wildlife, livestock and human interface in SouTh Africa). This project involves universities, six from South Africa and two from Europe, and aims at embedding OH in research and learning to enable the control of diseases at the human, animal, and environmental interface, and to emphasize the interests of local African communities with wildlife conservation. The methodology adopts the NEOH method, developed in 2018 by the EU-COST Action, "Network for the Evaluation of One Health." The approach is based on questionnaires delivered to participants, which focus on the six OH dimensions, and then translate answers into quantitative metrics through the OH Index (OHI) and the OH Ratio (OHR). The following two evaluation levels are foreseen: the whole project and the single partner institutions. The evaluations are carried on in parallel, with preliminary, mid-term, and final assessments, to monitor the efficacy of the project actions. The preliminary evaluation of the UNIBO Team resulted in the OHI of 0.23 and the OHR of 1.69 which indicate a low degree of OH-ness and an imbalance between OH operation and OH infrastructure. The UNIBO case study will be the baseline for the evaluation of the other partner institutions involved in the ELEPHANT project. This type of evaluation can support the implementation of OH practices inside a project and underpin the strategies that allow to achieving more effective results. Any improvement in the OH-ness of each single academic team can be also considered as a result of the ELEPHANT project, thus showing its multiplier effect in the context.

Integrating epidemiological and economic models to identify the cost of foodborne diseases.

Despite food technology advancements, food safety policies and alert systems, foodborne diseases are still a relevant concern for consumers and public health authorities, with great impacts on the economy and the society. Evaluating the cost of foodborne diseases may support the design and the implementation of policy interventions. This paper proposes a simple method for cost identification of foodborne diseases, accessible to researchers and practitioners who are not specialist in economics. The method is based on the assumption that epidemiological and economic models can be integrated to understand how the burden of disease determines costs in a wider socio-economic perspective. Systems thinking and interdisciplinary approach are the pivotal conceptual tools of the method. Systems thinking allows for the understanding of the complex relationships working among the elementary units of a system (e.g. wildlife, bred animals, consumers, environment, agro-food industry) in the occurrence of a health problem such foodborne diseases. Complex systemic relationships usually cross the traditional boundaries of scientific knowledge (human medicine, veterinary science, economics) and sectoral institutional responsibilities (e.g. ministry of health, ministry of agriculture). For these reasons more scientific disciplines, institutional competences and social bodies need to work together to face complex health problems, in an interdisciplinary framework. The first step of the proposed method is the identification of the potential cost of the disease. To this aim, the authors first focus on the links between epidemiological and economic models, based on the fact that foodborne diseases, likewise other diseases, hit people's and animals' aptitude to produce utility and goods for the society (e.g. wellbeing, revenue, safe food). These utility losses are real economic costs. Then they show how simple economic models, such as the food supply chain, can help understand the way costs spread across the economic sectors and the society. It should be underlined that the authors adopt already existing and well rooted scientific tools, focusing in particular that their integration in an interdisciplinary framework can effectively contribute to increase the understanding of complex health problems in a viable way.

Epidemiologic-economic models and the One Health paradigm: echinococcosis and leishmaniasis, case studies in Veneto region, Northeastern Italy.

Epidemiology and health economics have systemic interdependencies. The identification of the economic outcomes of any disease is operated by overlapping its epidemiology with the economic functions of the impacted entities. This communication presents two epidemiologic-economic models designed to evaluate the economic burden of cystic echinococcosis and leishmaniasis in Veneto (Northeastern Italy). Following a One Health approach, the research integrates expertise from different disciplines and institutions and fulfilled its first stage by defining the relevant cost categories and the data collection strategy for the two diseases in the study area. The two models identify the relevant epidemiological factors and the economic outcomes of infections in both animals and humans. The results, visualized in flow charts indicating the types of costs associated with these zoonoses, will guide data collection and the epidemiologic and economic assessment in the next research stages. This experience shows that One Health methods, although still innovative or unusual in many scientific and professional contexts, can be applied by using relatively limited resources and already available professional skills.

Brucellosis Control in Malta and Serbia: A One Health Evaluation.

Brucellosis, also known as "undulant fever" or "Malta fever", is a zoonotic infection caused by microorganisms belonging to Brucella, a genus of gram-negative coccobacilli that behave as facultative intracellular pathogens of ruminants, swine and other animals. Brucellosis is a threat to public health, hence identifying the optimal way of preventing disease spread is important. Under certain circumstances, integrated, multidisciplinary "One Health" (OH) initiatives provide added value compared to unidisciplinary or conventional health initiatives. Conceptualizing and conducting evaluations of OH approaches may help facilitate decisions on resource allocation. This article historically describes and compares Malta's 1995-1997 with Serbia's 2004-2006 brucellosis control programmes and quantitatively assesses the extent to which they were compliant with a OH approach. For both case studies, we describe the OH initiative and the system within which it operates. Characteristic OH operations (i.e., thinking, planning, working) and supporting infrastructures (to allow sharing, learning and systemic organization) were evaluated. We scored the different aspects of these programmes, with values ranging from zero to one (1 = strong integration of OH). Malta demonstrated a higher OH index (0.54) and ratio (1.37) than Serbia (0.49 and 1.14 respectively). We conclude that context and timing are key to determining how, when and why a One Health approach should be applied. The adoption of a true OH approach that involved systemic organization, leadership clarity and transdisciplinary communication, collaboration, and co-ordination was essential to Malta's successful eradication of brucellosis after several failed attempts. In contrast, contextual factors in Serbia permitted the successful adoption of a primarily sectorial approach for short term control of brucellosis. However, while a fully-fledged transdisciplinary OH approach was not initially required, it is likely to be key to maintenance of brucellosis control in the medium and long term. Through these two case studies, we demonstrate that One Health initiatives should be applied at the right place, at the right time, with the right people and using the appropriate conditions/infrastructure. Lastly, OH evaluations should include economic assessments to identify optimal of resources in these situations, thereby justifying funding and political support required.

Control of Cattle Ticks and Tick-Borne Diseases by Acaricide in Southern Province of Zambia: A Retrospective Evaluation of Animal Health Measures According to Current One Health Concepts.

One health thinking for health interventions is increasingly being used to capture previously unseen stakeholders and impacts across people, animals, and the environment. The Network for One Health Evaluation (NEOH) proposes a systems-based framework to quantitatively assess integration and highlight the added value (theory of change) that this approach will bring to a project. This case study will retrospectively evaluate the pioneering use of a One Health (OH) approach during an international collaboration (satellite project to tackle production losses due to tick-borne disease in cattle in Southern Zambia in late 1980s). The objective of the evaluation is twofold: retrospective evaluation the OH-ness of the satellite project and identification of costs and benefits. Data for evaluation was recovered from publications, project documents, and witness interviews. A mixed qualitative and quantitative evaluation was undertaken. In this case study, a transdisciplinary approach allowed for the identification of a serious public health risk arising from the unexpected reuse of chemical containers by the local public against advice. Should this pioneering project not have been completed then it is assumed this behavior could have had a large impact on public wellbeing and ultimately reduced regional productivity and compromised welfare. From the economic evaluation, the costs of implementing this OH approach, helping to avoid harm, were small in comparison to overall project costs. The overall OH Index was 0.34. The satellite project demonstrated good OH operations by managing to incorporate the input across multiple dimensions but was slightly weaker on OH infrastructures (OH Ratio = 1.20). These quantitative results can be used in the initial validation and benchmarking of this novel framework. Limitations of the evaluation were mainly a lack of data due to the length of time since project completion and a lack of formal monitoring of program impact. In future health strategy development and execution, routine monitoring and evaluation from an OH perspective (by utilizing the framework proposed by NEOH), could prove valuable or used as a tool for retrospective evaluation of existing policies.

Knowledge integration in One Health policy formulation, implementation and evaluation.

The One Health concept covers the interrelationship between human, animal and environmental health and requires multistakeholder collaboration across many cultural, disciplinary, institutional and sectoral boundaries. Yet, the implementation of the One Health approach appears hampered by shortcomings in the global framework for health governance. Knowledge integration approaches, at all stages of policy development, could help to address these shortcomings. The identification of key objectives, the resolving of trade-offs and the creation of a common vision and a common direction can be supported by multicriteria analyses. Evidence-based decision-making and transformation of observations into narratives detailing how situations emerge and might unfold in the future can be achieved by systems thinking. Finally, transdisciplinary approaches can be used both to improve the effectiveness of existing systems and to develop novel networks for collective action. To strengthen One Health governance, we propose that knowledge integration becomes a key feature of all stages in the development of related policies. We suggest several ways in which such integration could be promoted.

Le concept «Un monde, une santé¼ a trait aux corrélations entre la santé humaine, la santé animale et l'environnement, et requiert la collaboration de différentes parties prenantes sur de nombreux plans culturels, disciplinaires, institutionnels et sectoriels. Or, la mise en œuvre de ce principe est rendue difficile par des défauts du cadre mondial de gouvernance en matière de santé. Les approches qui visent à regrouper les connaissances, à toutes les étapes de l'élaboration des politiques, pourraient permettre de résoudre ces défauts. Des analyses multicritères pourraient contribuer à définir des objectifs clés, à résoudre les compromis et à créer une vision et une direction communes. Une pensée systémique pourrait déboucher sur une prise de décisions d'après des éléments probants et transformer les observations en descriptions détaillant la manière dont des situations surviennent et pourraient évoluer dans l'avenir. Enfin, des approches transdisciplinaires pourraient permettre d'améliorer l'efficacité des systèmes existants tout en développant de nouveaux réseaux d'action collective. Afin de renforcer la gouvernance du principe «Un monde, une santé¼, nous proposons que le regroupement des connaissances devienne un élément clé de toutes les étapes de l'élaboration des politiques relatives à ce principe et suggérons plusieurs manières de favoriser ce regroupement.

El concepto de One Health cubre la interrelación entre la salud humana, animal y ambiental, y exige la colaboración de varias partes interesadas atravesando diversos límites culturales, disciplinarios, institucionales y sectoriales. Sin embargo, la implementación del enfoque de One Health parece verse obstaculizado por deficiencias en el marco global de la gobernanza sanitaria. Los enfoques de integración de conocimientos, en todas las etapas del desarrollo de la política, podrían contribuir a abordar estas deficiencias. Los análisis basados en numerosos criterios permiten respaldar la identificación de objetivos claves, la resolución de dilemas y la creación de una visión común y una dirección común. El pensamiento sistémico puede lograr la toma de decisiones basadas en pruebas y la transformación de las observaciones en textos donde se describa detalladamente cómo surgen las situaciones y cómo estas podrían desarrollarse en el futuro. Por último, pueden emplearse enfoques transdisciplinarios para mejorar la efectividad de los sistemas existentes y desarrollar redes innovadoras para la acción colectiva. A fin de fortalecer la gobernanza de One Health, proponemos que la integración de conocimientos se convierta en un aspecto clave de todas las etapas del desarrollo de las políticas relacionadas con One-Health. Sugerimos diferentes maneras de promover dicha integración.

A Systems Approach to Evaluate One Health Initiatives.

Challenges calling for integrated approaches to health, such as the One Health (OH) approach, typically arise from the intertwined spheres of humans, animals, and ecosystems constituting their environment. Initiatives addressing such wicked problems commonly consist of complex structures and dynamics. As a result of the EU COST Action (TD 1404) "Network for Evaluation of One Health" (NEOH), we propose an evaluation framework anchored in systems theory to address the intrinsic complexity of OH initiatives and regard them as subsystems of the context within which they operate. Typically, they intend to influence a system with a view to improve human, animal, and environmental health. The NEOH evaluation framework consists of four overarching elements, namely: (1) the definition of the initiative and its context, (2) the description of the theory of change with an assessment of expected and unexpected outcomes, (3) the process evaluation of operational and supporting infrastructures (the "OH-ness"), and (4) an assessment of the association(s) between the process evaluation and the outcomes produced. It relies on a mixed methods approach by combining a descriptive and qualitative assessment with a semi-quantitative scoring for the evaluation of the degree and structural balance of "OH-ness" (summarised in an OH-index and OH-ratio, respectively) and conventional metrics for different outcomes in a multi-criteria-decision-analysis. Here, we focus on the methodology for Elements (1) and (3) including ready-to-use Microsoft Excel spreadsheets for the assessment of the "OH-ness". We also provide an overview of Element (2), and refer to the NEOH handbook for further details, also regarding Element (4) (http://neoh.onehealthglobal.net). The presented approach helps researchers, practitioners, and evaluators to conceptualise and conduct evaluations of integrated approaches to health and facilitates comparison and learning across different OH activities thereby facilitating decisions on resource allocation. The application of the framework has been described in eight case studies in the same Frontiers research topic and provides first data on OH-index and OH-ratio, which is an important step towards their validation and the creation of a dataset for future benchmarking, and to demonstrate under which circumstances OH initiatives provide added value compared to disciplinary or conventional health initiatives.

A Blueprint to Evaluate One Health.

One Health (OH) positions health professionals as agents for change and provides a platform to manage determinants of health that are often not comprehensively captured in medicine or public health alone. However, due to the organization of societies and disciplines, and the sectoral allocation of resources, the development of transdisciplinary approaches requires effort and perseverance. Therefore, there is a need to provide evidence on the added value of OH for governments, researchers, funding bodies, and stakeholders. This paper outlines a conceptual framework of what OH approaches can encompass and the added values they can provide. The framework was developed during a workshop conducted by the "Network for Evaluation of One Health," an Action funded by the European Cooperation in Science and Technology. By systematically describing the various aspects of OH, we provide the basis for measuring and monitoring the integration of disciplines, sectors, and stakeholders in health initiatives. The framework identifies the social, economic, and environmental drivers leading to integrated approaches to health and illustrates how these evoke characteristic OH operations, i.e., thinking, planning, and working, and require supporting infrastructures to allow learning, sharing, and systemic organization. It also describes the OH outcomes (i.e., sustainability, health and welfare, interspecies equity and stewardship, effectiveness, and efficiency), which are not possible to obtain through sectoral approaches alone, and their alignment with aspects of sustainable development based on society, environment, and economy.

Status report on education in the economics of animal health: results from a European survey.

Education on the use of economics applied to animal health (EAH) has been offered since the 1980s. However, it has never been institutionalized within veterinary curricula, and there is no systematic information on current teaching and education activities in Europe. Nevertheless, the need for economic skills in animal health has never been greater. Economics can add value to disease impact assessments; improve understanding of people's incentives to participate in animal health measures; and help refine resource allocation for public animal health budgets. The use of economics should improve animal health decision making. An online questionnaire was conducted in European countries to assess current and future needs and expectations of people using EAH. The main conclusion from the survey is that education in economics appears to be offered inconsistently in Europe, and information about the availability of training opportunities in this field is scarce. There is a lack of harmonization of EAH education and significant gaps exist in the veterinary curricula of many countries. Depending on whether respondents belonged to educational institutions, public bodies, or private organizations, they expressed concerns regarding the limited education on decision making and impact assessment for animal diseases or on the use of economics for general management. Both public and private organizations recognized the increasing importance of EAH in the future. This should motivate the development of teaching methods and materials that aim at developing the understanding of animal health problems for the benefit of students and professional veterinarians.