Animal and Environment Antimicrobial Resistance Delivery Group meeting: 24 September 2021

Gavin Watkins (GW)
Christianne Glossop (CG)
Ifan Lloyd (IF)
Sarah Carr (SC)
Andrew Singer (AS)
Gwen Rees (GR)
Kitty Healy (KH)
Geraint Hamer (GH) 
Becca Roberts (BR)
Christopher Teale (CT) 
Sian Timms (ST)
Wyn Evans (WE) 
Tomaz Andrade (TA)
Isobel Stanton (IS)

Marion Lyons 
Ann Davies 
Eifiona Williams 
Gareth Thomas
Ian Jones
Catherine Cody 
Rob Smith
Robin Howe 
Amelia Stevens
Eleri Davies

• Welcome and thanks for giving up your time today. Introduced new group member Isobel Stanton. IS introduced and provided background on experience on AMR. Tomaz Andrade welcomed as a guest speaker from NRW.

• Comments or amendments to the minutes via email by the 8 October. Actions that remain outstanding from previous meetings - 032,036,037,039. Action 040 GW – ongoing legal considerations being taken forward, no active surveillance of AMR in sheep. WE – are there any recent outbreaks, not aware of anything recently, aware of a case from a few years ago, but nothing more recent? GW – not aware of any big clusters recently. CG confirmed GW’s position.
• Annual Review poster shared and no comments received. Therefore document taken as signed-off by the DG. Document will be published in Gwlad and the Winter Update, will also be added to the WG website and supporting tweets issued.

• ST – Harmonised Surveillance legislation being taken forward in line with other Administrations. Regular engagement with the other Administrations now continuing on a regular basis. NAP and HCAI reporting updated to capture work of Arwain DGC. Arwain DGC launch planned for 4 October, meeting scheduled for the 6 October to discuss and agree deliverables and presence at the Winter Fair on the FC stand. JB started as the DG’s new secretariat.
• CG – Iechyd Da very supportive and ready to take ADGC forward. One Health focus now being considered by the WG. AHWFG Implementation Plan update – much of it connected to improving health and what we’re focussed on here today. Will make sure that AMR is properly recognised in the AHWFG plan. We will ensure that all work areas are joined up.
• GW – regular meetings with our health colleagues in the CMO group continuing. CMO keen to strengthen the One Health approach across the WG. Great to see the medics driving the One Health agenda and it’s a genuine collaborative approach. It needs to work in the field of AMR. Companion animal survey being taken forward by BR to establish a baseline understanding of the use of antibiotics based on factual information. Delighted to welcome BR on a PhD student placement scheme.
• GH – recent work is focussing on how we establish AMR surveillance in the environment in Wales. TA will provide further information on what NRW monitor in Wales. AS and IS have also submitted proposals for monitoring, looking to progress next week when we’re meeting to take forward.
• AS – Having discussions about which interventions to start with. Came to the conclusion that CSO would be suitable and could nest within existing programmes. Could be a synergistic output. Although new approaches, they complement each other. At the earliest phases of this kind of research so a scatter approach of methods may be applied. GW – have you decided what we’re going to look for? Antibiotics are just a small component of the large mix of pollution so it may be too narrow to focus on just antibiotics. Will likely be a suite of considerations. Culture work v’s molecular work to be considered.
• CT question for GH – which catchment is under consideration for particular study? GH haven’t got to the stage of identifying a catchment, ongoing discussions to identify the best potential catchment area.
• GW – would it be sensible to also look at farm waste alongside?  
• IS – Focussed on working on same proposals as AS.
• SC – Slides presented on the AHWFG Implementation Plan 2022-2024.
• GW – is it safe to say that AMR carries forward? SC – yes one of our top three priorities that works through everything.
• WE – thank you for presenting the slides. The market has had buoyant prices but inflation is now seeing prices of feed etc. skyrocketing and this should be monitored over the next 12 months as it could become unaffordable for farmers in the future. Concern from industry about how they’d cope with these increasing prices. GW – Agreed that the sector will face challenges in the coming years.
• IL – Iechyd Da keen to take forward the ADGC work. Are due to shortly issue a press release about the project. To note that the projects will take up individual vet times so keeping an eye on the workforce, especially given demand and lack of veterinary resource at the moment. Farm vets working with WLBP and continuing with the medicine reviews. Launch of the AMU calculator to collect current and historic usage started. Hopefully putting the beef and sheep sectors in Wales ahead of the curve. CAGG meetings – group currently undertaking an annual review to publish a report in the autumn to highlight activities being taken forward in the UK cattle sector. BCVA annual congress is being held in Wales Mid-October. Iechyd Da will have a stand there and everyone welcome to attend Action – share the annual review poster with IL for display at the stand
• TA – Often a lack consumption data, if information on usage becomes available could it be shared to identify hotspot locations? Action - IL to consider and GW to share livestock density maps, to show where the greatest amount of animals are located.
• IL – ADGC includes a project looking at AMR in the environment.
• AS – any data on land spreading of manure would also be very useful? GW – the SFS will be looking into the safe use of manure and slurry.
• GR – within ADGC Bristol University will be doing some on farm environmental sampling and could possibly incorporate this element?
• GR – ADGC work already mentioned by others. Everyone is very pleased that this is moving forward. It means that the VPC element of AVC can continue and expand on the existing network. Looking to develop some prescribing guidelines between practices. First step of the next phase includes CVO/DCVO meeting the VPCs to have an open discussion on direction of travel. VPCs are grateful for this opportunity of direct conversation. Aber University welcome their first cohort of veterinary students on Monday and responsible prescribing will be a key component of their training.
• CT – Res Alert system – a within government committee due to the sensitive nature. System does then release information about emerging issues. Pig sector, zinc ban coming into force which will have implications to the industry as zinc is often used when weening. May see an increased use in therapeutic use of antimicrobials. Similar concerns when the ban on growth promoters come into force. Ban is being introduced from an environmental perspective. GW – asked CT to mention the res alert system to highlight our risk management system, which generates some important findings. Identifies and manages potential threats.
• WE – Picking up a lot of useful information and we are moving in the right direction in Wales. The group does encourage joined up working and this is vitally important as we move forward.

• Covered as part of round table updates.

• Medics unable to send a representative to today’s meeting.

• VMR Update – UK consultation not planned before the end of this year. Aim is to support the sector rather than to create an adverse effect on the responsible use of antibiotics.
• Trade negotiations – main things to note are that the discussions with Australia and New Zealand are almost completed, and agreements include AMR components. Our position is to use all available tools to enhance progress of AMR as set out in the UK vision. CODEX Alimentarius taskforce (UN body that focusses on food safety) taking place next month. Would be a big step forward if the UN could agree that a ban on the use of antibiotics as growth promoters would be a big achievement.
• AS – are you able to say what the feelings towards antibiotics as growth promoters are when it’s clear what the impacts are – why is this still a consideration at a global level? KH - it’s been a topic of discussion for a number of years, but there isn’t a global agreement. Trade and competition angles can represent an economic advantage. From an AMR perspective you would want to see these medicines remaining effective for future use.
• CG – trade – would like to reassure the group that we’re doing what we can to support the notion that we must uphold our current high standards. There is a plan to publish a statement setting out the UK position. We do not expect our standards to be damaged in any way and would encourage group members to remain engaged with this issue.
• GW – VMR – channels to feed into the discussions are open as the consultation package is being developed. We are passing on the DG views to the VMD. The consultation will be a new proposed set of regulations rather than a set of open questions.  KH – the starting text for the proposals is the EU text that can be found online, as the VMD contributed to the development of this text. We want to make sure that the text works and helps industry/AMR.
• GW – Oral v’s written only prescriptions has been discussed. One prescriber per animal group is something taken to the VMD for consideration.
• GR – how closely is the VMD working with the RCVS on this given how closely linked to ‘under our care’ model? KH – not directly involved in these discussions but aware that the team are linked in with these discussions. Trying to establish where the ‘under our care’ definition sits – with the VMD or with the RCVS. The upcoming consultation will help people who have first-hand experience provide their input.
• GW – have good relations with Marion Boss and have received assurance that regular discussions with the RCVS are happening to consider these issues.
• SC – do the new regulations consider amending the cascade with regard to AMR concerns trumping the prescribing order? KH – the cascade is more complex in the proposals, personal view is that it needs to be reflected. Action – KH to provide a more detailed answer.

• Slides presented covered: Emerging contaminants in Wales – Screening method – Passive sampling programme – Data summary – Substances on PEWS – Crossover with proposed PNECs – Carbamazepine – Notes on pharmaceuticals – Future work using passive monitors – Veterinary medicines
• Discussion regarding which chemicals have the greatest AMR concerns.
• AS – Is it chronic?
• TA – It’s chronic. The disadvantage is that it’s a weighted average and you won’t have the peak, not particularly good for acute exposure.
• AS – You can model what you should see in a river based on prescribing practice. When it doesn’t match it’s possibly because a CSO is present. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0221568
• GW – If you monitored CSO outflows would this tell you if these were samples from humans or animals? TA – don’t know how easy that would be to convert to a pharmaceutical. You definitely need combined datasets to see that picture.
• GW – large overlap in human and veterinary medicines products. We should identify those higher risk substances. Fluoroquinolones are excreted largely unchanged so we assume a lot are going into the sewage systems.
• TA – Diazinon is very high in the list for attention as it’s already in the current regulation for classification. Very large number of parameters in this list. On the chemical front Diazinon is classed as a pesticide in TA’s grouping. NRW is soon investigating failures – where they’re coming from, measures to reduce the risks etc. NRW will form a working group to consider this and could be a potential area to share discussions. Action – GW and TA to consider taking this forward and joining up offline.
• CT – might be a few compounds used in vet medicine only.
• IL – If we’re finding reasonable or high levels of Diazinon – wouldn’t it follow that other substances used on these farms would also show up in these samples if they were present? TA – could be due to how the residue ends up in the river – what is the pathway – wash off from sheep fleece etc. Also depends on quantities, degradation etc.
• TA – Happy to circulate a list of substances or data for the group to consider further. Is there a list of highest priority substances?
• WE – going back to the Diazinon situation as you alluded to it is used in a number of chemicals. I think we need to look at the geographical spread of use and where you’re finding traces within rivers and then consult with the DG and the agricultural bodies where relevant when this information is available.
• TA – we have held consultations on our river catchment plans and shared on the Water Watch Wales website for people to feed in comments and feedback. Specific to Diazinon, the final classification will be published in the next few months. 10-15 locations have been identified for further consideration. There will be no changes until a public consultation etc. has been completed.
• Action – CT/TA/AS/IS to identify substances that need to be priorities for AMR concerns between now and the December meeting. A list of first priority antimicrobials to focus on.
• AS – Research on Diazinon selection or co-selection seems like it hasn’t been addressed so could be some scope to include things that aren’t an antibiotic but act like one as far as the bacteria is concerned. Diazon could be similar to the zinc situation. Literature might not be there to support this, but it could be on a reserve list.
• GW – thanks to TA, good to know this monitoring is going on.

• Slides presented and DG members asked to agree with the approach being proposed.
• GW – approval from the Minister to commission an external expert to review our work via a quick light-touch review. DG – in agreement with this approach.
• Further info to be shared via email.

• SC - Raw pet food – can this be raised as part of the communications messages around WAAW?
• IL – RUMA conference in November. Can we share the info with group members? Should we WG be presenting at this conference?

(Via email, following the meeting)

Antibiotic Awareness Day/Week (18-24 November):

• We will be focussing our activities on a series of Tweets from the Minister’s and CVO’s accounts.

Date of the next meeting:

• 14th December 2021 – We will circulate papers and joining instructions closer to the time.

Meeting Dates for 2022:

These have now been confirmed and calendar invites have been circulated.