Tania Herrera, Coordinator of the National Plan against Antimicrobial Resistance: “I hope that by 2025 our achievements may spread to all of Chile’s communities and regions, so that everyone knows about antimicrobial resistance and what we are doing about it.”

During the World Antimicrobial Use Awareness Week 2021, held November 18th to 24th, ChileCarne spoke with Dr. Tania Herrera, from the Ministry of Health, who highlighted the importance of working collaboratively to properly control antimicrobial resistance, as it threatens to become the main cause of death by 2050.

The white meat industry successfully implements the “Good Health Program” to monitor the proper use of antimicrobials. This world awareness week came from the need to raise awareness about antimicrobial resistance. AMR, as it is known by its acronym, occurs when bacteria, viruses, fungi, and parasites resist the effects of medicines, making it difficult to treat common infections and cure animal and human diseases.

Although AMR is a natural phenomenon, the misuse of antimicrobials or their excessive and sometimes irrational use can accelerate the appearance of viruses and bacteria due to the resistance they develop.

– The second version of the National Plan Against Antimicrobial Resistance is already being implemented. How is it different from the previous version?

This time we have many more stakeholders involved. To the ministries of Agriculture, Economy, and Health, we added the ministries of Education, Sciences, and the Environment. This way, cross-sectoral work has expanded and we will be able to address many more aspects that were weaker in the first version.

Another difference is that this plan is much more strategic; it provides the guidelines for our work and is less operative compared to the first one, which set goals with indicators and figures since the beginning. This time we wanted to have a strategic plan that could provide us with the guidelines and goals to make more short-term operational plans as we move forward, for one or two years instead of committing to something that might change in five years.

Today, we have a strategic plan and the operational plan comes second so that we can measure our progress, but under the umbrella of the national plan.

– What goals or experience did you get out of the first version and what aspects still need improvement?

I believe that one of the great achievements of the initial plan, which we continue to strengthen, is cross-sectoral work, being able to implement joint activities with various ministries, which is not always easy. Also, we went beyond the public sector and worked with the private sector, academia, and scientific societies, where many people have joined to be part of this national plan. It’s a great achievement, the dissemination we have had in these sectors helped us position the plan in a short amount of time, which has been key.

Another achievement was the various training courses and seminars we held. Progress in monitoring and controlling the use of antimicrobials, especially in the agricultural and livestock sector, as well as advances in surveilling the entire human process.

What we need is to go beyond central administration, academia, and those who work with us, and present our plan to communities and regions. It’s an important task for this 2021-2025 stage.

Hopefully, by 2025, what we have achieved at the central level, may be extended to the people, because if you ask anyone, they probably have not heard about this issue. We want to reach the general public. For them to know what an antibiotic is, what an antimicrobial is, how and when to use it. For food producers at all levels to also know what it is about and what we are doing.

On the other hand, we must continue with integrated surveillance, usage monitoring, and infection control, in which Chile is well advanced, but we lack a key area that was left behind: research.

Research is its own strategic area. We already work with the Ministry of Science to prioritize antimicrobial resistance issues in research projects, but we still need more information to be able to make good public policy decisions. In that sense, we are in debt with research, both operational and basic.

– In what aspects or areas does the plan involve animal production?

We follow the international “One Health” approach, which is cross-sectoral and allows us to work together on human, animal, and environmental aspects, which include plants too, of course. Everything we do is based on this approach, therefore, everything related to food production is also part of all the strategic lines of the plan.

For example, awareness of use is extremely relevant in food production and the Chilean Agency for Food Safety and Quality (ACHIPIA) plays a vital role in various strategic areas.

We also have professional training to take this message to veterinarians, who prescribe medications in animal production. There is integrated surveillance that goes from the food production farm to the foods produced and sold, up to the consumer. All of the above is part of a relevant project in which we have to keep working to maintain the surveillance on the entire production chain, and therefore, production is key. Therefore, we have included the production of animal-based foods in all strategic lines.

– Why is it important for this plan to be cross-ministerial?

Because otherwise we cannot work together, and to move forward it must be understood that this is a cross-sectoral issue in itself. From an anthropocentric perspective, human health cannot be without the animal component, without food production, without the environment.

We are naturally connected, therefore maintaining coordination is key. For example, when we tell people that they have to use antibiotics prudently, with a prescription from a professional, for the corresponding days and illnesses, we must also tell them that the same goes for their pets. Because it’s easy to take human medicines and give them to animals, unaware of the potential impact on both animal health and antimicrobial resistance, and therefore our health.

And we are not just talking about the fact that people acquire resistant bacteria at home, but also that they transfer to the environment, which in turn will produce resistance elsewhere. Everything is intertwined and therefore we must work collaboratively, work harder, so that we can truly fight this situation.

– In your opinion, what is the best strategy to control antimicrobial resistance?

It is a very complex issue and I am not the only one who compares antimicrobial resistance with climate change. In other words, it is here, it causes us problems, but we do not have enough tools to say, ‘look, this is how we end it,’ because it is not going to end. Antimicrobial resistance is a natural phenomenon of microorganisms’ evolution. Therefore, we need to try to reach some sort of balance and prevent it from having the dramatic speed it currently has and that could cause that by 2050, antimicrobial resistance becomes the main cause of death.

It’s estimated that if we do not control it, it will exceed cancer deaths. So, it will be the main issue in a few years, and the strategy is to control infections, on the one hand, and to manage use control on the other.

Avoiding infections is key and it is a strategic line in itself, such as avoiding farm infections, by following good production practices. There is a lot to be done here, as in vaccine research, which is a whole line of work that could be developed to prevent animals from getting sick.

Once all of that is under control, it is also important to monitor that antimicrobials are used optimally, prudently, and responsibly. To use them correctly, and hopefully with the most limited spectra, to cause the least possible damage both to the recipient, whether animal or human, as well as to the environment, because resistant bacteria are already there and continuing the cycle.