Animal and Environment Antimicrobial Resistance Delivery Group meeting: 14 December 2021

Gavin Watkins (GW) 
Christianne Glossop (CG) 
Ifan Lloyd (IF)
Sarah Carr (SC)
Andrew Singer (AS)
Isobel Stanton (IS)
Rob Smith (RS) 
Kitty Healy (KH)
Geraint Hamer (GH) 
Gwen Rees (GR)
Sian Timms (ST)
Steve Howard (SH) RUMA
Gwyn Jones (GJ) RUMA
Rosie Clover (RC)
Becca Roberts (BR
Johanne Ellis-Iversen (JE-I)

Marion Lyons 
Ann Davies 
Eifiona Williams 
Ian Jones
Gareth Thomas
Christopher Teale
Catherine Cody 
Robin Howe
Eleri Davies
Wyn Evans 
Debbie Tynen

Welcomed Rosie Clover, Becca Roberts and James Brake. Introduced JE-I who explained the work she will be doing for OCVO and her independent review of the Wales Animal and Environment AMR Implementation Plan.

• Action032: Gareth Thomas agreed to engage with Wales YFC – remains outstanding for time being.
• Action039: Raise the work of Arwain DGC at the WG HCAI Steering Group – can be closed as this discussion has taken place.
• Action043: Kitty Healey to provide a more detailed answer to: Do new regulations consider amending the cascade with regard to AMR concerns trumping the prescribing order? – Update from Kitty regarding question
• KH: This was discussed in the recent NRC Meeting. Until recently the proposal was split between putting up a consultation which is closely linked to the EU regulations or to devise something totally new in the UK. The discussion led to the conclusion that the first option was preferred, staying in line with EU regulations. That’s what we can expect the consultation to cover. So we will be fairly familiar with how this will apply to AMR and the prescribing cascade. Please feel free to engage with the consultation if you have any issues or queries with this.
• Action044: GW and TA to work offline to consider the working group being formed by NRW regarding Diazinon presence in watercourses.
• ST: One meeting has already taken place and another meeting is to take place in the new year.
• GW: I think we can close this action now as it isn’t strictly an AMR issue.
• Action045: To identify substances that need to be prioritised for AMR concerns. A list of first priority antimicrobials to focus on. To be established between now and December meeting.
• ST: Main issue is getting Public Health Wales (PHW) to attend a meeting I believe?
• GH: That’s right, as PHW input is vital to this discussion. Still trying to get them in a room.
• GW: Appreciate they have other priorities right now with covid-19.We may be able to present PHW with Public Health England’s shortlist of priorities, may shortcut that bit of work for them.

• KH: VMD Update: Publication of VARSS report. Top lines we aren’t seeing the big drops in antibiotics sales as we saw in previous years. A very fractional reduction. But a 52% reduction since 2014. Critical antibiotic sales 0.5% of total sales. Reduction in sales held and critical antibiotic sales still low.
• Work is progressing in all sectors. Still some work to do in cattle sector but positive steps are being seen.
• Working with Animal and Plant Health Agency (APHA) to expand coverage data to include some private labs. Also been looking to update our methodology to improve our gold standard of data.
• European Surveillance of Veterinary Antimicrobial Consumption (ESVAC) Report: Generally good news there. Biggest implication for us is we’ve gone from 4^th lowest to 7^th lowest. Pipped by Luxemburg and Lithuania. Not sure why but with the size of our agriculture sector in Europe, we are lower than equivalents in EU.
• VMD is working on anthelmintic resistance. Had a recent workshop with equine sector.
• Legislation: Public consultation planned for next year. Coming into Force date not yet confirmed. Regarding AMR, EU regulations are published, get asked a lot if we’ll be doing the same. Essentially a lot of the EU Regulations reflect our own ambitions. One area of resistance is against the blanket ban on preventative use of antibiotics but we still want to remain ambitious in this area.
• GW: “Under our care” definition is of interest in this group. One question from me is how this group can feed into these decisions?
• KH: Two main ways. Welsh Government can actively input in those legislation meetings. For the rest, the consultation is the main way for the VMD to hear people’s views. If you think that any particular article is a bad idea, really helpful to hear why you think it’s a bad idea and also what could work instead of it.
• IL: Does the UK continue to feed into the ESVAC figures now that we’re out of EU?
• KH: Yes we do and we intend to continue. Other non-EU countries feed into it such as Switzerland. It is our hope and intention to continue.
• GW: We should mark going forward to ensure that this group feeds into that consultation.
• KH: Codex Alimentarius has been working on a code of practice to minimise AMR through the food chain. Work started in 2016 and completed in October this year. Successful and finalised last month. Broadly speaking it is a useful and practical guide. Useful for us but more so for countries currently without surveillance systems. Principle 12 has the strongest wording on antimicrobials as growth promoters. Just says it shouldn’t be used. Full stop. A really positive result.
• On the downside however, it permitted the use of medically important antibiotics for therapeutic use in animal and plants. We’re trying to get the plant health body to push against this. General principle is if you use antibiotic in human medicine then it is medically important.
• VMD had an open day at end of November. If interested there are a number of presentations that can be viewed online. (Joint VMD and VPC open information day - 29 November 2021 - GOV.UK (www.gov.uk))
• GW: Going back to usage data. Our goal is to have farm level antibiotics usage data for Wales. To get a measure of the effectiveness of our initiatives. And this data can then be fed into the UK data.
• GR: Is there an appetite for the VARRS report to be published by each devolved nation?
• KH: Has come up in the past but not recently. There is a strong argument there when you consider the different activities in each nation. However we wouldn’t want it to become a competition or politicised. All for further collaboration and if this helps happy to support. Happy to receive your views on this.
• GR: Totally see where you’re coming from regarding it being politicised. Sometimes a bit of competition is a good thing however.
• KH: One suggestion is a Wales report, similar to Scottish governments Sonar One Health Report
• IL: Agree with Gwen. If we start to generate good data here in Wales we can share and promote this data to incentivise farmers. If one nation introduces a new measure and can be shared as good practice with the other nations, then it’s a good thing
• SC regarding Animal Health and Welfare Framework Group: Action from AHWFG for a joint approach regarding raw pet food. Decided to put this on the backburner for now due to ongoing Covid concerns.
• GR Arwain DGC Update: in general, pace is good. Recruiting for various areas. Done a re-recruitment round for prescribing champions in practices. Also recruited to both working groups on clinical guidelines group and code of conduct group.
• RS Arwain DGC Update: Things are progressing nicely. WLBP AMU calculator is being rolled out on farms and training on how to use the tool rolled out to veterinary practices. Discussion with Bristol University about sample collection process. Iechyd Da, enrolling veterinary practice for work streams. Trialling data collection with WVSC early next year.
• IL update on Cattle Antibiotic Guardian Group (CAGG): Focus has been on electronic medicine book which is about farm and vet practices to link into this. Will share minutes with secretariat for them to be shared with the DG.
• GW: RE on farm sampling Rob, may be worth someone getting in touch with Tamsin Dewe on small projects that VMD could fund. Want to link the two of you to join up and compliment work. Who should I contact?
• RS: Send it to me and I’ll copy in relevant people my end.
• GW: Shall email you.

Presentation by Rosie Clover

No questions were raised.

Presentation by Isobel Stanton

Content:

1. Proposed project – what impact does CSO have on AMR in environment?
2. What is a CSO – Combined Sewer Overflow
3. English CSO Data
4. Dwr Cymru Data
5. Proposed Project – split into two phases 1. Hazard Map and identify sampling locations 2. Field sampling and lab analysis
6. Current work in England similar to phase 1.
7. Phase 2

• IL: Reason for red overflow areas in England on the map?
• AS: Structural problems generally, not rainfall.
• IS: Initially 60 overflow incidents was the cut-off but this didn’t reduce the number enough
• AS: Can report back next time with a similar map for Wales.

Presentation by: Becca Roberts

1. Background – implementation plan
2. Aims – awareness, prescribing patterns, access to information
3. Survey Design – split into 4 sections

• SH: Happy to promote this on our website and newsletter.
• GW: Any help the group can give us to promote completion would be much appreciated.

Presentation by Steve Howard and Gwyn Jones

1. Introduction
2. Vision and Mission
3. Responsibilities
4. Website and Comms
5. Next Steps
6. Round table event – Summer 2022 – Sectors agreeing priorities and approach to measures
7. Reporting on progress – VARSS Report and CA&E Report

• SC: Benchmarking of practices against each other is a great idea. Any suggestions or ideas about engaging with independent practices?
• SH: They do have their own representative bodies so will be reaching out to them. They will be key participants in any round table events we have in the upcoming year. Difficult with independent practices to get the widespread message and participation out there. They are definitely on our radar.
• SC: Are you aware of any moves by major employers to incentivise responsible antimicrobial use in any way?

SH: Not that I’m aware of. Major Employers Group discuss professional matters only and do not discuss commercial measures in any meetings we have with them.

• GW: Spoken about having some sort of quality assurance brand a practice could use to say its “antibiotic safe” for want of a better word.
• SH: Definitely something that has been discussed, we have built in the ability to do so in website planning and this will be considered further by us in the future.
• GR: Any social science initiatives in the pipeline?
• SH: Human behaviour approach is becoming more and more relevant. Worth us thinking about that, especially around us cascading measures around Q1 2022.
• GJ: More akin to human medicine in terms of emotional importance of companion animals.
• RS: Arwain Vet Cymru are looking into providing plaques to vet practices that took part in the scheme. Definitely worth it.
• GW: A definite vacuum in this area of our implementation plan and so very grateful for you stepping up and doing important work in this area.

World Antimicrobial Awareness Week (18-24 November 2021)

• We ran a social media campaign on the CVO’s twitter account. Based on our figures, the total number of people who saw at least part of the campaign was 3154.

• Amelia Steven’s departure from the Delivery Group created a vacancy. After further consideration, it was agreed that the vacancy will not be filled at this stage as the depth of experience and knowledge within the Delivery Group is more than sufficient at present.

• Thank you to those who have already completed the Future Steps survey. The deadline for the Survey has now been extended to 15^th January 2022 for those who have not yet had an opportunity to partake. We will be going over the results of the survey in our March meeting to coincide with the independent review currently being led by Johanne Ellis-Iversen.

Our next quarterly meeting is due to take place on 22^nd March 2022.