Created from the leadership and vision of the Responsible use of Medicines in Agriculture (RUMA) Alliance, which has helped to halve the use of antibiotics to treat UK farm animals and has seen the use of highest priority critically important antibiotics in animals reduce by 79% since 2014, the RUMA Companion Animal & Equine (RUMA CA&E) Alliance has been established to define the principles of responsible use of medicines in the companion animal and equine sectors, with a view to contributing positively to the One Health agenda.
This new collaboration covers the responsible use of medicines in dogs, cats, rabbits, small mammals, exotic animals kept as pets, and equids. The aim is for the UK to lead the way in these sectors through evidence-based and measurable activities that will promote and enhance stewardship. RUMA CA&E will focus initially on the responsible use of antibiotics.
The alliance has appointed a Chair, Gwyn Jones, who brings previous experience from The Responsible Use of Medicines in Agriculture (RUMA) Alliance, and includes important representation and support from the British Veterinary Association, British Small Animal Veterinary Association, British Equine Veterinary Assocation, British Veterinary Zoological Society and other veterinary professional associations, regulators, academia, industries and many of the leading stakeholders from these sectors.
The alliance will agree and define, through effective consultation with stakeholders, areas to establish specifically targeted activities and research that will form the basis of agreed sector specific key performance indicator (KPI) development and monitoring. These KPIs will ensure that specific goals are set, and efforts are focused in the appropriate areas to demonstrate progress:
- Strategic KPIs for industry level reporting
- Practical KPIs relevant to practitioners that will inform organisation or practice-wide activities
- Assist stakeholders, associations and organisations across the sector to develop, endorse, implement and raise awareness of guidance and protocols on the stewardship and responsible use of medicines within the companion animal and equine sectors. The protocols and guidance will be practical, drive positive behaviour change, align with KPI progression, and will protect patients and practitioners alike
- Provide evidence of progress from the companion animal and equine sectors towards achieving the government 20-year vision and 5-year national action plan for how the UK will contribute to containing and controlling antimicrobial resistance.
As the Chair of RUMA CA&E, Gwyn Jones commented that there are lessons and learnings we can take from the farm animal sectors, but we do need to recognise that the companion animal and equine sectors are very different. Pets are seen as family members, so there is a very different dynamic at play compared to agriculture. Looking at dogs specifically, over the years they have moved from the kennel into the house and even into the bedroom in some households, so sharing of the same home and spaces means a higher propensity for the sharing of the same bugs.
Steve Howard, RUMA CA&E Secretary General contributed that the PDSA Animal Wellbeing (PAW) Report tells us that 51% of UK adults own a pet and they live in close proximity day in and day out. So, although antibiotic use in the pet and equine sectors are much less than in agriculture, that very close proximity and the potential for the sharing of microorganisms and bacteria means even low use of antimicrobials in these sectors could result in resistance to key medicines and passing of microbes between owners and pets or horses through the close interactions they have.
In the interests of One Health, this is why the CA&E sectors are a very important consideration when thinking about antimicrobial stewardship and anti-microbial resistance.
With regards to the different considerations at play in the companion animal and equine sectors, in the agriculture section herd level decisions on antimicrobial usage can have quite a large impact on many animals from a few key decision points, in terms of whether to use anti-biotics in the first place, and which ones to use, whereas in the CA&E sectors, there has to be consideration at every interaction between clients and their pets as to which antibiotic to use, if appropriate, duration and what dose, and this has to happen in consulting rooms and stable yards every single day, for every single interaction that takes place.
This means that the concept of antimicrobial stewardship and antibiotic resistance has to be at the forefront of the mind for every decision made in every consultation. RUMA CA&E are therefore looking to promote a culture where that approach is the default in consulting rooms, stable yards and operating theatres and are working closely with key stakeholders to drive this forward.
RUMA CA&E are aware that there will be a lot of work to do to manage client expectations. Just like in the human medical world, patients often ‘expect’ to be given antibiotics and there has been much work underway to address this. It is not a dissimilar challenge in the veterinary consulting room, where clients often expect that if their pet is ill, they will be prescribed antibiotics or tablets to take home immediately; so client education and support will form a key part of RUMA CA&E activity in the future.
Other considerations in the companion animal and equine sectors include:
- Affordability: a vet may have made a decision about the right treatment, but they may have to adapt their approach depending on whether an owner can afford certain treatments or not
- Owner compliance: the success of treatments is often dependent on owners being able to successfully administer medication in the right way for the right amount of time back at home, or in the stable yard
- Market influences: the marketplace can be affected at times by product availability issues, which can result in limited availability or in some cases, products may be withdrawn. There are also price differentials to consider that can impact client affordability.
Work is also underway to define practice and service level measures. Once all measures are in place, realistic benchmarks or targets can be set that will acknowledge the complexity of this area and the numerous factors at play, including social demographics, economic demographics, licensed products availability, and species-specific considerations.
RUMA CA&E is already making great progress towards agreeing and defining, through effective consultation with stakeholders, the areas to establish specific activities and research, which will form the basis of agreed sector targets. These targets will ensure specific goals are set and efforts focused in the appropriate areas to demonstrate success.
Achieving change requires great collaboration and we only have to look to the farming industry to know that with the right evidence and insights in place, realistic targets can be developed and achieved. RUMA CA&E want to become a hub for antimicrobial stewardship and be the place where all the research and guidance exists in one place.
As well as looking at practice and individual level insights on prescribing habits, RUMA CA&E will also look at guidance, protocols and audits, as evidence-based protocols are very valuable when they are used in practice.
The protocols and guidance RUMA C&E share will be practical, will drive positive behaviours, align with KPI progression and will protect pets, owners and practitioners alike. These important building blocks will provide benchmarks and baselines and, in time, evidence of progress towards achieving the government's 20-year vision and 5-year national plan for how the UK will contribute to containing and controlling antimicrobial resistance.
RUMA C&E will seize the present opportunity to make a positive impact on antimicrobial resistance and protect the role of antibiotics in both human and animal health for the future.