The Responsible Use of Medicines in Agriculture Alliance (RUMA) was established in 1997 to promote the highest standards of food safety, animal health and animal welfare in the British livestock industry. It is an independent non-profit group with a unique cross-sector role comprising representatives from organisations covering all stages of the food chain from ‘farm to fork’. RUMA brings together organisations from right across the livestock supply chain and seeks to promote a co-ordinated and integrated approach to best practice in the use of medicines. RUMA champions responsible use of animal medicines in UK livestock by producing specific ‘guidelines on responsible use’ and has a current focus on antimicrobial resistance (AMR), which is co-ordinated through a range of collaborative activities that contribute to the UK 5-year AMR strategy, most notably driven through the RUMA Targets Task Force (TTF).
AMR is one of the biggest challenges facing society and the medical and agricultural sectors globally. A core part of the RUMA's role is to ensure that the UK is appreciated and recognised as a major food producing country that adopts responsible use of animal medicines to deliver world leading farm animal health and associated welfare.
The RUMA Targets Task Force
The TTF group was conceived in spring 2016 in response to Lord Jim O'Neill's seminal AMR review (O'Neill, 2016). The report, commissioned by the UK government in 2014 to assess the global problem of increasing drug resistance, put forward a number of actions to address the issue, one of which was to develop industry-led, sector-specific targets for antibiotic stewardship in UK livestock farming.
The goal of the TTF has been to respond directly to that report and recommendations, and to identify realistic, evidence-based goals for the UK agriculture industry. Benchmarks are set and owned by each of the sectors with recognition that each sector has individual challenges and that reductions should be sustainable.
The ‘infrastructure’ of the TTF is key to driving the best possible outcomes. It comprises a specialist veterinary surgeon and leading farmer or sector representative for each key UK live-stock group and they act as the contact point for each of the represented sectors. The group also comprises industry observers such as Veterinary Medicines Directorate (VMD), the National Office of Animal Health (NOAH), Food Standards Agency (FSA) and the Agriculture and Horticulture Development Board (AHDB). Collaboration underpins everything that the TTF does; there is shared responsibility with shared experiences of the journey so far. The TTF represents an important ‘coming together’ and ‘collective responsibility ethos’ with a recognition that a ‘one size fits all’ approach is neither possible nor appropriate. Each sector is at different stages of the AMR journey with different usage levels and varying levels of relevant data available. Giving each sector autonomy to define the right targets for their areas with engagement from the relevant stakeholders, has been key to some of the significant early successes that have been achieved through this voluntary mobilisation across the UK livestock sectors.
The first set of targets issued in 2017 (Table 1) created in this collaborative, sector relevant way, became the industry roadmap and focus for everyone along the supply chain across each of the sectors (RUMA, 2017). The TTF defined 40 sector-specific targets for responsible stewardship of antibiotics to be achieved across nine different livestock sectors by 2020. Last year the latest set of targets up to 2024 was released.
Table 1. Summary of the progress against targets in each sector 2017-2020
| Species and target | Status |
|---|---|
| Beef | |
| Reduce to 10 mg/kg overall use | Data unavailable |
| Dairy | |
| Reduce to 21.5 mg/kg overall use | Data unavailable |
| 10% fall in intramammary lactating cow tube sales | Achieved (2019 sales data) |
| 20% fall in intramammary dry cow tube sales | Achieved (2019 sales data) |
| Increase sealant tube sales from 0.5 to 0.7 courses/cow | 2018: 0.5 courses/cow; 2021 data due 2022 |
| Halve sales of highest priority intramammary tubes | Achieved (2018 and 2019 sales data) |
| Dairy and beef | |
| Halve sales of highest priority injectable products | Achieved (2019 sales data) |
| Annual increase in vaccine sales for respiratory disease | Uptake static 2019; 2020 data due 2021 |
| Monitor health and welfare metrics | Measures reported in 2020 industry report |
| Develop standardised antibiotic usage metrics | Dairy metrics published 2018; Beef 2019 |
| Development of centralised database | Database developed, live 2021 |
| Farmer and veterinary training | Widespread training continuing to take place |
| Disseminate responsible use messages | Strong communication throughout media and knowledge exchange initiatives |
| Sheep | |
| Reduce overall use by 10% | Data unavailable |
| Halve use of highest priority antibiotics use data | Data unavailable |
| Co-ordinate colllection of antibiotic use data | Metrics published 2019/centralised database live 2021 |
| Reduce lameness (including 5% yearly rise in footrot vaccine sales) | Vaccine sales 2019 up 1% on 2018; 2020 data due 2021 |
| Reduce abortion (including 5% yearly rise in enzootic abortion vaccine sales) | Vaccine sales 2019 up 1% on 2018; 2020 data due 2021 |
| Reduce antibiotic use in neonatal lambs by 10% yearly | Achieved targeted 34% reduction 2016–2020 |
| Plan to tackle veterinary and farmer behaviour | Communcations ongoing — communications campaigns on ‘Plan Prevent Protect’ |
| Pigs | |
| Reduce overall use to 99 mg/kg by 2020 | Data due 2021, 104 mg/kg reported Q1 and Q2 2020 (usage data) |
| Highest priority antibiotic use stays below specified levels | Achieved (2019 sales data) |
| Salmon | |
| 100% usage data captured for Scottish salmon | Achieved (2017–2019) |
| Overall use maintained at 5 mg/kg or less | Data due in 2021; use at low (but fluctuating) levels |
| No highest priority antibiotics used routinely | Achieved (2017–2019 usage data) |
| Atlantic salmon vaccinated before seawater phase | Achieved (2017–2019) |
| Autogenous vaccine developement | Achieved (2017–2019) |
| Trout | |
| 90% usage data captured for trout | Achieved (2018–2019) |
| Overall use maintained at 20 mg/kg or less | Achieved (2017–2019 usage data) |
| No highest priority antibiotics used routinely | Achieved (2017–2019 usage data) |
| Compliance with Code of Good Practice | Achieved (2017–2019) |
| Vaccines used for seagrown trout | Achieved (2017–2019) |
| Vaccines promoted in freshwater farms | Achieved (2017–2019) |
| Autogenous vaccine developement | Working closely with vaccine developers |
| Gamebirds | |
| Halve total tonnes of antibiotics used | Data due 2021, achieved 52% in 2018 (2019: 49%) |
| Reduce highest priority antibiotics use by 25% | Data due 2021, achieved 27% in 2018 (2019: 10%) |
| Laying hens | |
| Maintain <1% birds medicated/day | Achieved (2016–2019 usage data) |
| Maintain <0.5% HP-CIA days medicated | Achieved (2016–2019 usage data) |
| Poultry meat | |
| Reduce overall use in broilers to 25 mg/kg or less | Achieved (2015–2019 usage data) |
| Reduce overall use to turkeys to 50 mg/kg or less | Achieved (2017–2019 usage data) |
HP-CIA = highest priority critically important antibiotic
Key: ☐ targets met ☐ in progress ☐ targets difficult to prove or achieve yet ☐ Data unavailable
The targets and progress against 2017–2020 targets
Progress across the first set of targets has been significant (RUMA, 2020). UK sales of antibiotics to treat food producing animals have halved since 2014 and the UK retains a position of fifth-lowest sales of antibiotics for food producing animals in Europe, the lowest among more commercially productive European countries.
Highest priority critically important antibiotic (HP-CIA) sales for UK food producing animals have also fallen 75% since 2014, and sales of colistin are virtually nil (Veterinary Medicines Directorate, 2019). Less than 30% of the UK's antibiotics are used to treat disease in food producing animals, despite over a billion farm animals being reared and managed in the UK every year. Levels of antibiotic resistance found through Government monitoring and surveillance are also stabilising and falling in response to reductions in use (Veterinary Medicines Directorate, 2019).
The importance of data
What has become clear since the inception of the TTF infrastructure, is the crucial role that data play in shaping the targets and tactics in the journey towards achieving them. High levels of data capture clearly correlate with positive progress on reductions. Data help everyone understand where sectors are right now, usage levels, hotspots, tracking progress towards targets and help drive informed decisions and engagement. All sectors work incredibly hard to gather data, but there are many constraints and limiting factors that mean this will take more time in some sectors than in others. For example, where industries are bigger, more extensive and complex such as ruminant sectors, data gathering is naturally a bigger challenge and building the right data capture mechanisms is more demanding. Whereas, in other sectors with fewer limiting factors, such as pig and poultry, comprehensive data gathering has had a real and tangible beneficial impact on progress and engagement.
A key component on data gathering and recording has been embedding building blocks that provide a unified approach and a common language across all sectors. Rules have been developed for each sector to enable consistent data recording methodologies; this ensures that data are comparable across sectors using a consistent language through which antimicrobial usage can be recorded, used, and shared across the diverse stakeholder groups.
Targets Task Force 2 — applying learnings
In 2019 work began on the next phase of targets by the Targets Task Force 2 (TTF2), building on the lessons learned from phase 1. The first 3 years of the TTF saw technical developments, the capture of data and microbiological research which has changed the understanding of antibiotic use and resistance. These findings informed new targets launched in November 2020 and which run from 2021 to 2024. This second phase looks to further enhance and strengthen the response of agriculture to the AMR challenge. There has been a general shift of focus from national numerical targets to ‘on-farm’ health and welfare, data and engagement targets, especially in ruminants. This ensures that metrics are more relevant to individual farms and farmers. Where targets exist, they now act as more of a guide and indicator to progress.
Feedback showed that national targets are understood, but relaying messages and insight using individual farm data is also important. Industry level data and figures are still essential to illustrate the general direction and provide focus for sector activities, but farm level data are vital and give farmers the autonomy to set their own goals and targets to achieve realistic and sustainable levels of responsible use.
The targets are not about driving towards zero antibiotic use. It is important to acknowledge that antibiotics are there as a tool to treat sick animals and to improve and maintain animal welfare. Each sector will ultimately reach a sustainable level below which further reductions could create issues of animal welfare. For now, reductions continue across most sectors but in others, usage is beginning to level out or even bounce back a small amount where sustainable use has been achieved. Seasonal weather or disease challenges also result in targeted increased use of medicines.
The new sector targets fall into three groups in terms of focus:
- Ruminant sectors of beef, dairy, calves and sheep, for which usage remains largely unknown or unproven because of unavailability of data. The focus in these sectors going forward is on understanding and benchmarking use on-farm; engagement between farmer and veterinary surgeon; development of health plans
- Pigs and gamebirds are still on their downward trajectory and are making strong progress on reducing use. The new targets plan to reduce use by a further 30% and 40% respectively
- Those that have already achieved low levels of use, and whose target is to maintain them in the face of biosecurity or disease control challenges amid shifting external environmental and market forces. This group includes salmon, trout, laying hens and poultry meat sectors.
Driving ongoing support
As well as the ongoing work of the TTF and the support in place across the sectors, providing more support to mixed veterinary practices regarding the many intricacies that exist across the sectors was identified as a key factor. This has led to the development of a collaborative project called the ‘Farm Vet Champions’ initiative, whereby veterinary professionals within practices can become AMR champions, becoming practice advocates for sharing insights and best practice guidance with colleagues (RCVS Knowledge, n.d.). They have online access to all the latest best practice guidance, training and tools covering all the sectors, which can then be shared within each practice to drive ongoing awareness, support and outcomes regarding AMR.
The journey ahead — conclusions and summary
What has been achieved to date has been incredible and has been done so completely voluntarily without regulation — testament to the commitment right across the British live-stock industry in delivering the highest standards of food safety, animal health and animal welfare.
The key learnings from the first set of targets, most notably the importance of data which remains a critical component moving forwards, have helped shape the creation of the second set of targets. Learnings will continue to be applied moving forwards to ensure informed, evidence-based decision-making is applied across all aspects of TTF activity.
Of particular note moving forwards, is acknowledgement that achieving zero use of anti-biotics is neither possible nor appropriate across any sector, so there will come a tipping point where the journey of reduction changes and becomes focused on maintaining responsible levels of use rather than pushing antibiotic use so low that the repercussions would actually be detrimental.