Antibioresistance in France

by Claire Richaud
A therapeutic deadlock within 2050 ? How antibioresistance is becoming one of the greatest health challenges France is currently facing.

A therapeutic deadlock within 2050 ? How antibioresistance is becoming one of the greatest health challenges France is currently facing. Our Consultant Claire Richaud, wrote an Overview.

Following the discovery in 1928 of the antibacterial properties of penicillin, the medical uses of this first antibiotic was developed between the two world wars. First cause of death in 1940, infectious diseases are today responsible for only 2% of the causes of death in France. However, the massive and repeated use of antibiotics in human and animal health generates over time an increase in bacterial resistance. Indeed, antibiotics not only act on the bacterium responsible for the infection to be treated, but also, for the majority of them, on the useful and non-pathogenic bacteria of our organism and the environment. 

All bacteria are thus likely to acquire new mechanisms of resistance to antibiotics, in addition to those that some of them naturally possess. Each new generation of antibiotics has seen the appearance of resistance mechanisms corresponding to it. 

Thus, the antibiotic, repeated or punctual, can lead to the emergence of resistant bacteria that will make subsequent antibiotic treatments less effective, for the patient in whom they appear, but also for the community when they diffuse in the environment and are passed on to other patients. Unfortunately, the uncontrolled use of antibiotics contributes to the spread of resistant bacteria and is now a major public health issue. In France, 158,000 infections from resistant bacteria occur each year and are the direct cause of 13,000 deaths, which represents four times the number of killed ones on the roads in 2016. 

A true therapeutic deadlock is currently ongoing, with the risk to see infectious diseases becoming once again the first cause of death in the world by 2050. 

France is leading an ambitious public policy to raise awareness and concrete action on this topic since 2001 at the occasion of the launch of multi-year action plan on controlling and rationalising the prescription of antibiotics for human health. The creation of an cross-ministry committee on this topic led then to a transversal plan entitled EcoAntibio from 2011 to 2016, aiming to reduce by 25% the consumption of antibiotics in animal health within 5 years. 

The decision to extend the public policy from human to animal health lies within the fact that the resistance of bacteria and microbes to antibiotics is largely due to unlimited use of antibiotics in both human and animal health. Indeed, the health of humans, animals and ecosystems are interconnected; the One Health concept. This involves applying a coordinated, collaborative, multidisciplinary and cross-sectoral approach to address potential or existing risks that originate at the animal-human-ecosystems interface. This conception is at stake since, according to the World Health Organization, half of the world's antibiotics are intended for animals, which favors resistance to antibacterials and antibiotics for the animals and the humans.  

France’s efforts to rationalise the consumption of antibiotics in animal health was a success. On 6 October, the Ministers of Health and Agriculture welcomed the progress of the EcoAntibio plan, following the publication of a report by the Agency for Food, Environmental and Occupational Health & Safety (ANSES) showing that over the last 5 years, the global exposure of animals from antibiotics decreased by 36.6%. 

Furthermore, France is clearly intending to position itself as a European leader on the fight against antibioresistance. The French Agency for Food, Environmental and Occupational Health & Safety was selected to become general coordinator of the European Joint Program (EJP) on "One Health”, to start on 1st January 2018, and France is participating to the European Surveillance of Veterinary Antimicrobial Consumption since 2010, under the supervision of the European Medicines Agency. 

In spite of these clear efforts, the current question which was perceived during the debates of the General States of Food, launched by the newly elected Minister of Agriculture Stéphane Travert in October 2017, to find solutions to the French agriculture and countryside crisis, is the implicit challenge of antibioresistance in France and agricultural countries. The efforts led are only poorly taking into account the issue of meat consumption as the real problem of antibioresistance. However, the major vector of resistances crossing is meat consumption, since in animal health in France, 96% of antibiotics are consumed by animals intended for human consumption and only 4% by domestic animals. A report published by the think-tank Terra Nova on 23rd November highlights the fact that epidemiologists warn of increased systemic risks of development of viruses in intensive rearing, due to promiscuity, confinement, antibiotics, and genetic standardization which are promoted through industrial farming. 

France being the 3rd European producer of meat, behind Germany and Spain, and the recent milk and meat-producing crisis remaining sensitive, we may doubt that the root of antibioresistance will truly be addressed in public policy in France over the next years.