Animal and Environment Antimicrobial Resistance Delivery Group meeting: 6 June 2023

Andrew Singer* (AS) - UK Centre for Ecology and Hydrology
Anju Kirby (AK) – Veterinary Medicines Directorate (VMD)
Edward Haynes (EH) – PATH-SAFE
Fraser Broadfoot (FB) – Veterinary Medicines Directorate (VMD)
Gavin Watkins* (GW) – CHAIR – OCVO, Welsh Government
Hebe Carmichael (HC) – Water, Welsh Government
Hywel Morgan* (HM) – Organic Farmer
Iestyn Jones (IeJ) – Farmer /Welsh Lamb and Beef Producers Ltd (WLBP)
Ifan Lloyd* (IL) – Iechyd Da
Llyr Lewis (LL) – Farmer / Welsh Lamb and Beef Producers Ltd (WLBP)
Matthew Witty (MW) – OCVO, Welsh Government
Meryl Davies (MD) - Public Health Wales
Rachel Baird (RB) – PATH-SAFE
Robin Howe* (RH) - Public Health Wales
Sarah Carr* (SC) – Vet / Farmer / Animal Health and Welfare Framework Group Representative
Sian Timms (ST) – OCVO, Welsh Government

Chris Teale* (CT) - Animal and Plant Health Agency (APHA)
Eifiona Williams* (EW) - Head of Water, Welsh Government
Gwen Rees* (GR) - Aberystwyth University
Ian Jones* (IaJ) - Vet
Isobel Stanton* (IS) - UK Centre for Ecology and Hydrology
Kitty Healey* (KH) - Veterinary Medicine Directorate (VMD)
Rachel Edwards* (RE) – Farmers’ Union Wales (FUW)
Rob Smith (RS) – Iechyd Da
* DG Member

GW welcomed all to the meeting. Those present briefly introduced themselves.

The previous meeting was repurposed into an informal introduction with the new CVO for Wales, Richard Irvine.  NOTE: Previous meeting minutes from 06 December 2022 are online.

Only six open actions.  ST & GW both gave brief updates on previous actions prior to March 2023.  GW spoke about training for backyard poultry keepers, being developed by Farming Connect.

Action 64:  GW reported that the water monitoring work will not be funded by ARWAIN DGC.

A presentation was given on Pathogen Surveillance in Agriculture, Food and the Environment (PATH-SAFE) - a pilot for a better national system, comprised of around 25 projects.  It is led by the FSA and has many collaborative partners.

• IL queried abattoir surveillance for cattle and sheep.  Is there any intention to trace findings back to farm of origin?
• AK advised not at present.  But findings of public health significance will be followed up.
   
• FB asked about the challenging process of getting sheep abattoirs involved, and whether cattle abattoirs were more receptive?
• AK advised that recruitment for cattle survey came after the sheep survey.  Lessons were learned and engagement has improved.  However, it’s still a challenge, and we really wish to understand why plants are reluctant to sign up.
   
• IeJ queried how the potential outcomes will be communicated.  Lots of questions are being asked about food production – industry will be very cautious about how the information is published.  There may be people who interpret the results in a way that negatively impacts the industry.
• AK advised that care will be taken not to blindside the industry – communications are open with our partners and groups, and we’ll develop lines before publication.
   
• HM queried the treatment process of wastewater from hospitals, and whether heat treatment kill antibiotics?
• EH passed this question to AS.  This may need to be followed up with Bangor University with their wastewater work.  There is an issue with combined sewer overflows, and the need to better predict weather events/sewage discharging. 
• AS spoke about a chemical investigations programme, which looks at 10 sewage works, using multiple samples from different locations throughout the treatment process.  We have lots of data which could detail exactly what’s happening along the way, but this is not going to help.  We need to look at the broader view – which is basically the more you treat wastewater – the better.

ACTION:  Establish whether heat treatment destroys antibiotics in wastewater.

GW thanked EH and AK for their presentation.  We’ve had regular surveys of abattoirs published in the Veterinary AMR Surveillance and Sales (VARRS) report.  Perhaps the PATH-SAFE results could be published here?

• IeJ spoke about the issues of tracing results back to source, be it human or animal.  IeJ also mentioned data sharing in the project.  There are lots of government agencies and industry stakeholders involved – how do we ensure data safety?

EH advised that data sharing agreements are critical.  It’s a big tranche of work in Workstream 1, and it has been challenging.  This has not been a barrier to engagement but does slow down the delivery of timely agreements.

Brought forward to 11:00.

Before the updates, there was a discussion about treatment of hospital waste.  It was confirmed that heat treatment may not be effective – DNA doesn’t start to break down until it’s heated to 95°C or more. Using Ozone is the more viable solution.

a) One Health (Meryl Davies)

There’s a lot of work feeding ideas into the next UK national action plan, from the human health side.  We are awaiting the WG’s AMR review.

b) VMD (Fraser Broadfoot)

Finished consultation on Veterinary Medicines Regulations.  Summary of feedback on proposed legislation is being prepared.  We do not have a timeline at present.

• GW queried the review of the RCVS guidelines. There is some overlap regarding vet prescribing.  Do you know if/when the under-care regulations have come in?
• FB advised they are due in September or October this year.  The definition of ‘under care’ is being reviewed by RCVS.

An update on the e-Medicine Hub was given.  This is a very important initiative managed by AHDB.  The hub aims to be a UK-wide antibiotic usage collection system, which brings together lots of datasets and presents them in a standardised way.

Some online VMD events were promoted.

GW advised all that the 5 Year National Action Plan (2019-24) is due to expire soon.  The Wales 5 Year Implementation Plan is heavily linked with the NAP.  We want to feed up to the NAP.  We need to make sure this delivery group is feeding into the next 5 Year Programme for Wales.

c) Environment (Andrew Singer)

We have been the given the go-ahead for a surveillance of rivers to ideally start end of summer 2023, finishing end March 2024.  The survey will focus on Combined Sewage Outlets (CSOs) discharges, which are a dominant source of AMR in that stretch of river.

We need to understand what the minimum levels of sewage can be discharged before becoming detectable.  Data in this field is lacking – we need to understand the impact of CSOs on rivers.

• GW queried the threshold detectability – is this the threshold of AMR genes/bacteria or human pathogens generally?  
• AS advised that originally phosphorus levels were measured.  Now we can search for specific genes at a molecular level, or take the Metagenomic approach - which looks at everything in one go, is less sensitive, but gives a broader picture.
   
• GW asked if there’d be anything in the monitoring taking AMR from farms into account.
• AS confirmed it will include everything in the catchment – we will take samples from up and downstream from farms and CSOs.

IeJ queried if it’s possible to differentiate between human and animal antibiotics in wastewater and rivers?

AS advised that this could be determined via genetic fingerprinting rivers, to identify chemicals and genes that are unique in certain areas of the river.

d) ARWAIN DGC Progress (Ifan Lloyd)

This is our major delivery project for AMR in animals and is currently funded through the Rural Development Scheme.   IL spoke to his presentation.

The project was shortlisted in 3 categories at the Antibiotic Awards, London, and won the ‘Prescribing Stewardship’ Award.  It was a very successful evening for Team Wales.

GW thanked IF for all his work, gave great thanks to ARWAIN DGC, and offered congratulations for the award.

e) DG members

          No updates.

f) OCVO (Gavin Watkins and Sian Timms)

There’s a session on AMR control and ARWAIN DGC work at Wales Veterinary Conference in Aberystwyth tomorrow.

We’ve had lots of planning meetings for the next 5-year plan.   Internally in WG – the Health Department has been working on AMR - we have been consulting with them – look forward to outcomes to better manage the governance. 

We will likely to be hosting ARWAIN DGC at the Royal Welsh Show.

In terms of development of the Wales action plan – we hope to get an extended student placement (6 months) to help draft the plan.

We have been very short staffed in recent months.  We are advertising for staff to assist with this work area.  The application deadline is 09 June.

The funding for the ARWAIN DGC project ends this month.  We’ve been working hard with WG colleagues and the Minister to secure new funding.  The new project will focus on specific areas and link in with new 5-year plan. 

HM spoke about the need to gather data and evidence, to support the idea that animals are healthier if they have a diverse diet, compared to being fed a monoculture.  HM reported that his animals have needed less antibiotics, and effective in reducing instances of foot rot.

IJ and LL spoke to their presentation.

• HM queried whether there was any antibiotic usage data for Chicken farms in Wales.
• The VMD publish UK data for antibiotic usage - coverage for poultry is considered wider than cattle and sheep at present. 
• Veterinary Antimicrobial Resistance and Sales Surveillance 2021 - GOV.UK (www.gov.uk) – Published 2022.

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• FB noted with data collected so far, there will usually be a lot of very low Antibiotic users – but a few very high users will push the average up.  The question is how do we validate this data?
• IJ advised that constantly improving policies and guidance, as well as honesty, all help.
   
• GW queried whether the methodology validate the results? 
• LL advised that this is possible, but if a farmer uses multiple vet practices – it becomes more difficult to trace.  If a vet knows another practice used an antibiotic, the information can be manually added - but this risks reducing validity

FB; get data from medicine hub – we are not interested in farm level data.

GW asked FB to please take the message back to colleagues, that we are very strongly of the opinion that the Veterinary Medicines Regulations should enable single 1:1 relationships between the farm, and prescribing vet practice.

• HM queried whether there is a constant use of antibiotics in chicken feed/water?
   
• FB acknowledged that antibiotics may be given in a group feed, but it’s not used all the time.  Only in response to a disease, and under vet restrictions.  The situation has improved in recent years, and some farmers are moving away from habitual use.

IL noted it was good to discuss preventative medicine.  Multiple prescribers is an issue in Wales and farmers should maintain a medicine book in this case.

IL spoke about farmers reducing their dependency on antibiotics.  Some farmers have amazingly low usage without any animal welfare issues - but this can’t be guaranteed across the board without checking.

GW thanked IJ and LL for their presentation and work to date.

With no further updates or comments, the meeting closed at 12:54.

The next meetings of the WAEAMR Delivery Group are:

2023

• Tue 12 Sep 10:30 – 13:30         (Caerdydd 3, CP2, Cardiff / VC)
• Tue 05 Dec  10:00 – 13:00         (VC)
  
   

2024 (TO BE CONFIRMED)

• Tue 05 Mar 10:00 – 13:00          (VC)
• Tue 04 Jun 10:00 – 13:00          (VC)
• Tue 03 Sep 10:30 – 13:30          (Cathays Park, Cardiff / VC)
• Tue 03 Dec 10:00 – 13:00          (VC)