Participatory identification of the causes of antimicrobial use and how they may vary according to differences in sector structure: The case of the Flemish pork and veal sectors.

The increasing threat of antimicrobial resistance (AMR) to human health has prompted many countries to adopt national action plans to reduce antimicrobial use (AMU) in farm animals. To achieve this goal, it is necessary to gain a deeper understanding of the factors driving AMU in farm animals. While previous research has focused on gaining a better understanding of AMU from the perspective of farmers and veterinarians, less emphasis has been placed on examining the systemic and contextual factors that influence AMU from multiple viewpoints within the food supply chain. To this end, this paper describes a participatory approach involving multiple stakeholders from two distinct livestock sectors to identify the underlying drivers of AMU and explore their case-specificity. For each sector, we identified causes of AMU during four online focus groups, by co-creating a "problem tree", which resulted in the identification of over 50 technical, economic, regulatory, and sociocultural causes per sector and exploration of causal links. Following this, we analysed the focus group discussion through a content analysis and clustered causes of AMU that were related into 17 categories (i.e. main drivers of AMU), that we then classified as drivers of AMU at sector level or drivers of AMU at farm level. Finally, we compared the two sectors by assessing whether the generated categories (i.e. main drivers for AMU) had been discussed for both sectors and, if so, whether they involved the same causes and had the same implications. Through our analysis, we gained a better understanding of several main drivers of AMU at sector level, that result from systemic and/or contextual causes. As these cannot always be addressed by farmers and/or their veterinarian, we suggest that interventions should also target other actors related to these causes or consider them to help implement certain strategies. Furthermore, based on the results of our comparative analysis, we suggest that systemic structural differences, such as size and level of supply chain integration/fragmentation, may lead to differences in how animal health management is approached. This in turn may influence AMU's decision-making and the effectiveness of interventions, if they are generic and not tailored to the specificities of the sector.

Reducing Antimicrobial Use and Dependence in Livestock Production Systems: A Social and Economic Sciences Perspective on an Interdisciplinary Approach.

Objective: In livestock production, antimicrobial resistance (AMR) is considered an externality as it is the undesired result of preventive and curative antimicrobial use. To address this biosocial issue, our objective is to present an approach based on interdisciplinary research to develop strategies and policies that aim to contain AMR. Method: To do so, we addressed three fundamental questions on which control policies and strategies for agricultural pollution problems are centered in the light of AMR. To ensure the technical, economic, behavioral and political feasibility of the developed measures, we demonstrated the usefulness of systemic approaches to define who, what and how to target by considering the complexity in which the ultimate decision-maker is embedded. We then define how voluntary or compulsory behavioral change can be achieved via five routes, introducing a clear taxonomy for AMR Interventions. Finally, we present three criteria for ex-ante analysis and ex-post evaluation of policies and strategies. Conclusion: Interdisciplinary systemic approaches enable the development of AMR policies and strategies that are technically, politically, economically and, last but not least, behaviorally feasible by allowing the identification of (a) all actors influencing AMU in livestock production, (b) power relations between these actors, (c) adequate regulatory and intervention bases, (d) what behavioral change strategy to use, (e) whom should implement this, as well as the cost-effective assessment of combinations of interventions. Unfortunately, AMR policies and strategies are often investigated within different disciplines and not in a holistic and systemic way, which is why we advocate for more interdisciplinary work and discuss opportunities for further research.

A systemic integrative framework to describe comprehensively a swine health system, Flanders as an example.

A well-functioning swine health system is crucial to ensure a sustainable pig production. Yet, little attention has been paid to understand it. The objective of this study was to unravel the complexity of a swine health system by using a systems-thinking approach for the case of Flanders (Northern part of Belgium). To that end, qualitative interviews were held with 33 relevant stakeholders. A hybrid thematic analysis was conducted which consisted of two phases. First, an inductive thematic analysis was conducted and second, the resulting themes were classified into the building blocks of a systemic framework. This framework combined a structural and a functional analysis that allowed to identify the key actors and their functions. Additionally, a transformational analysis was performed to evaluate how structures and the entire swine health system enable or disable functions. Findings revealed that the Flemish swine health system presents several merits such as the synchronization of policies and sector's agreements to reduce the antimicrobial use in the pig sector and the presence of a rich network of universities and research institutes that contribute to the education of health professionals. Nevertheless, several systemic failures were observed at different levels such as the lack of a good professional body representing the swine veterinarians, the tradition that veterinary advice is provided for 'free' by feed mill companies, and the shortage of reliable farm productivity data. Both latter failures may hinder swine practitioners to provide integrative advice. While few veterinarians are remunerated per hour or per visit by farmers, the most common business model used by veterinarians is largely based on the sale of medicines. Thus, veterinarians encounter often a conflict of interest when advising on preventive vaccinations and, in turn, farmers distrust their advice. On a positive note, alternatives to the traditional business model were suggested by both veterinarians and farmers which may indicate that there is intention to change; however, the broader institutional and socio-cultural environment does not enable this evolution. The results of this study can aid policy makers to anticipate the effects of proposed interventions and regulations so that they can be fine-tuned before they are enforced.

Farm-economic analysis of reducing antimicrobial use whilst adopting improved management strategies on farrow-to-finish pig farms.

Due to increasing public health concerns that food animals could be reservoirs for antibiotic resistant organisms, calls for reduced current antibiotic use on farms are growing. Nevertheless, it is challenging for farmers to perform this reduction without negatively affecting technical and economic performance. As an alternative, improved management practices based on biosecurity and vaccinations have been proven useful to reduce antimicrobial use without lowering productivity, but issues with insufficient experimental design possibilities have hindered economic analysis. In the present study a quasi-experimental approach was used for assessing the economic impact of reduction of antimicrobial use coupled with improved management strategies, particularly biosecurity strategies. The research was performed on farrow-to-finish pig farms in Flanders (northern region of Belgium). First, to account for technological progress and to avoid selection bias, propensity score analysis was used to compare data on technical parameters. The treatment group (n=48) participated in an intervention study whose aim was to improve management practices to reduce the need for use of antimicrobials. Before and after the change in management, data were collected on the technical parameters, biosecurity status, antimicrobial use, and vaccinations. Treated farms were matched without replacement with control farms (n=69), obtained from the Farm Accountancy Data Network, to estimate the difference in differences (DID) of the technical parameters. Second, the technical parameters' DID, together with the estimated costs of the management intervention and the price volatility of the feed, meat of the finisher pigs, and piglets served as a basis for modelling the profit of 11 virtual farrow-to-finish pig farms representative of the Flemish sector. Costs incurred by new biosecurity measures (median +€3.96/sow/year), and new vaccinations (median €0.00/sow/year) did not exceed the cost reduction achieved by lowering the use of antimicrobials (median -€7.68/sow/year). No negative effect on technical parameters was observed and mortality of the finishers was significantly reduced by -1.1%. Even after a substantial reduction of the antimicrobial treatments, the difference of the enterprise profit increased by +€2.67/finisher pig/year after implementing the interventions. This result proved to be robust after stochastic modelling of input and output price volatility. The results of this study can be used by veterinarians and other stakeholders to incentivise managers of farrow-to-finish operations to use biosecurity practices as a cost-effective way to reduce antimicrobial use.