Successful Prevention of Antimicrobial Resistance in Animals—A Retrospective Country Case Study of Sweden

Abstract

The misuse and overuse of antibiotics have resulted in an alarmingly high prevalence of antimicrobial resistance (AMR) in human and animal bacteria. European monitoring programmes show that AMR occurrence in food animals is lower in Sweden than in most other EU Member States and that the use of antibiotics for animals is among the lowest in Europe. In this retrospective country case study, we analysed published documents to identify factors contributing to this favourable situation. A fundamental factor identified was early insight into and sustained awareness of the risks of AMR and the need for the prudent use of antibiotics. Early and continuous access to data on antibiotic use and AMR made it possible to focus activities on areas of concern. Another factor identified was the long-term control and eradication of infectious animal diseases, including coordinated activities against endemic diseases, which reduced the need to use antibiotics. Structures and strategies for that purpose established at the national level have since proven useful in counteracting AMR as an integral part of disease prevention and control, guided by a “prevention is better than cure” approach. A third factor identified was consensus among stakeholders on the need to address AMR and their cooperation in the design and implementation of measures.

Exploring the One Health Perspective in Sweden’s Policies for Containing Antibiotic Resistance

“…Structural factors in the Swedish healthcare system as early as 1959 have played an important role in Sweden’s work against antimicrobial resistance, driven by events such as the large Salmonella outbreak in 1953. Thousands of human cases and 90 deaths were recorded and the outbreak could be traced to infected meat from a slaughterhouse in Alvesta [ 26 ]. In the early 1990s, there was a rapid increase in pneumococcal strains resistant to penicillin in southern Sweden.…”

“…A challenge with policies is achieving the wanted effects when implementing them in practice. Evaluating the effect of the policies is not the scope of this paper, but data show that Sweden has low and decreasing consumption of antibiotics for both human and veterinary use in an international comparison [18][19][20]26]. Qualitative studies conducted as part of the ABR CARRO project by our research team have shown that actors both in the human, veterinary, and environmental sectors perceive the Swedish work on AMR to be well known and established among most stakeholders in the various sectors [35][36][37].…”

Governing Antimicrobial Resistance (AMR) in a Changing Climate: A Participatory Scenario Planning Approach Applied to Sweden in 2050

“…Given the identified need to continue to protect the efficacy of antimicrobials, for AMR and climate change to be addressed as interlinked issues, for the SDGs to be achieved, and for societal norms to change, future research is needed to elicit different stakeholder perspectives including from pharmaceutical, climate change and environment, energy and information technology, economic and insurance, tourism, immigration, and food and farming sectors, as well as social policy actors, advocacy groups (e.g., consumer), and the public. Since our study's focus on Sweden reflects a social welfare state with high levels of confidence in core national institutions and political trust ( 43 ) and where awareness about AMR is high among the general population and government and industry actions have reduced AMR ( 44 ), engaging stakeholders from countries with different contexts will be important, such as South East Asia where AMR emergence and spread is a growing problem ( 45 ). Our scenario planning approach and tools (newsletter, video, and narrative of alternative future scenarios) can be used to engage such stakeholders to assess scenario quality and apply them in planning and decision-making processes by testing how potential actions might hold up under each scenario and identify additional potential risks and mitigation actions to address AMR under a changing climate.…”

The rise of antibiotic resistance in Campylobacter

“…An important reason for the emergence and spread of drug-resistant bacteria is the use of antibiotics as growth promoters. From an international perspective, the incidence of antibiotic resistance in Sweden is low, most likely due in part to the relatively low use of antibiotics in animals and the prohibition of the use of antibiotics as growth promoters since 1986 [55]. However, the prohibition of fluoroquinolones in food animals could not completely eliminate the emergence of Campylobacter drug-resistant strains [56].…”