Chicken or Egg: Drivers for Antimicrobial Resistance in Poultry in India (DARPI)

Lead Research Organisation: University of Liverpool
Department Name: Institute of Infection and Global Health

Abstract

The aim of this study is to first to map antimicrobial use (AMU) and the antimicrobial resistance (AMR) that is driven by inappropriate use, across the entire poultry meat supply chain from farm to table in India. The study provides [1] a unique opportunity to map AMU, [2] to understand entry points for development of AMR and [3] the contribution by inappropriate AMU in poultry, and [4] suggests potential solutions to address the huge AMR burden in India.
AMR is a major global health risk, particularly in developing countries, threatening human and animal health. Contributing to this problem is the inappropriate use of antimicrobials in people and livestock production. India has a high burden of infectious disease, and bacteria from human clinical infections are becoming increasingly difficult to treat, with fewer treatment options available. Studies suggest that livestock may commonly carry resistant bacteria in their gut, with poultry and poultry meat also identified as a source of such bacteria. However, there is a complete lack of data on the scale of the problem, or on what antimicrobials are being used in poultry meat production, how they are used, and how this contributes to the carriage of AMR bacteria that may be a threat to human and animal health.
Poultry meat is one of the main protein sources in Indian and is the fastest growing livestock sector. Increasingly, poultry meat in India is produced through more intensive integrated or semi-integrated farming systems where antimicrobials are used for various purposes, including for growth promotion, to prevent and treat disease. To date there have been no comprehensive studies on AMU or AMR through the poultry meat supply chain. Our interdisciplinary project aims to address these data gaps by studying the poultry meat food supply in its entirety to determine: behaviours that drive AMU and how these contribute to the selection and transmission of AMR, to inform better use; to design with farmers and other stakeholders interventions to reduce AMU/AMR, which are cost-effective and easy to implement; determine the economic impact from changing AMU practices, or using alternatives. The project will involve working closely with the poultry industry, policy makers and other stakeholders throughout to ensure the findings have impact.
This project is timely in providing crucial data to inform antimicrobial stewardship: the trajectory of the Indian poultry industry is shifting towards intensive farming and AMU is predicted to rise substantially. Therefore, this is an opportunity to intervene through working closely with stakeholders to provide alternative strategies for sustainable AMU. The project also offers other benefits, with a strong social science component providing unique insights into behaviours driving AMU, as well as service design enabling visualization of AMU and AMR, and co-design strategies. Indian researchers will be trained in these methods, building capacity for social science in Indian agricultural and veterinary research that will have value long after the conclusion of this project.
The study will be the first to map AMU and AMR in the entire poultry meat supply chain from farm to table in India. The study provides a unique opportunity to map AMU, understand entry points for development of AMR and the contribution by inappropriate AMU in poultry, and suggest potential solutions to address the huge AMR burden in India.

Planned Impact

DARPI is a strong interdisciplinary team using a systems approach to tackle the important issue of AMR in the Indian poultry meat industry. Communicating with the Indian poultry industry and other stakeholders, through partnerships, workshops, industry events, social media, newsletters and publications is central to our ambitious research programme. Ultimately we aim to identify drivers of AMU and AMR to facilitate rationale prescribing, through education, training and alternative strategies, to reduce the burden of AMR in the poultry food production chain, to the benefit of both animal and public health.
Social and economic
The project will enhance understanding of the business practices and processes that underpin the current flow of antimicrobials through the poultry supply chain in India and how this is changing with increasing intensification, in line with predicted future trajectories. The current flow of antimicrobials will be characterised by drivers and inhibitors of use, including awareness and understanding of antimicrobials and AMR amongst poultry workers; level of education and training around prescribing; and risk perceptions around potential or perceived changes to current AMU.
Beneficiaries:
Indian research institutes by introducing and training in, social science and design research methodologies to enable a cross-disciplinary approach to the challenges of AMR, in particular by building a better understanding of everyday AMU that is essential for implementing more rational stewardship of antibiotics through the poultry supply chain.
Indian poultry farms by creating a clear mapping of the flow of antimicrobials into the poultry supply chain, to visualise and identify where drivers of AMR are strongest and what processes may lead to more rational AMU at key points along the supply chain. In addition, applying a bottom up approach, through co-design with end users to articulate and communicate good practice to farmers.
The Indian poultry industry: by enhancing understanding of drivers and motivations; and the processes and procedures that enhance or inhibit more rational use of antimicrobials at key points along the poultry supply chain by farm workers and animal health workers. Such data will inform guidelines and training across the industry to improve practices and communicate best practice for AMR minimization. The co-design of interventions with industry will ensure that such interventions are feasible, acceptable and cost-effective. Furthermore, these tools will be developed with consideration of the future industry trajectory, so that approaches are scalable and sustainable and able to react to accommodate anticipated trajectory development.
The Indian veterinary industry by mapping how AMU along the poultry supply chain is understood and initiated by farm workers, managers and animal health workers and whether current usage patterns may drive AMR in poultry and humans. In addition, this work will highlight where further education and training is required on antimicrobial prescribing, with a MOOC will be developed to cover such gaps.
The Indian pharmaceutical industry by improving understanding of how inappropriate use of antimicrobials in the poultry supply chain may drive AMR, so that promotion of antimicrobials, information and guidelines for use can be rationalised to minimise the emergence and spread of resistance.
The Indian media by enhancing understanding of AMU in the poultry industry its contribution to the emergence and spread of resistance will support more scientifically accurate and appropriate solutions to highlight and tackle the existing problem.
The Indian policy community to will inform clear briefing papers on the link between poultry industry practices and the emergence and spread of AMR, with economic comparisons of alternatives. Our findings will inform the Indian NAP on AMR, highlighting pathways to behaviour change and where regulatory/policy frameworks are inadequate.

Publications

10 25 50
 
Description "Drivers of antimicrobial resistance in poultry in India: chicken or egg?" (oral presentation at a veterinary conference). 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Invited speaker at the 7th Pan-Commonwealth Veterinary Conference, Bangalore, India, 2019 (oral presentation) by Dr Nag Hegde, Indian PI. Introduced the audience to the project and interdisciplinary approach and challenges around AMR.
Year(s) Of Engagement Activity 2019
 
Description "Incorporation of social science to AMR projects - value added, any lessons learnt." short presentation. 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact India-UK Antimicrobial Resistance Workshop, Delhi, India, 2019. Presentation given by the Indian PI to a AMR workshop consisting of Indian and UK academic delegates.
Year(s) Of Engagement Activity 2019
 
Description 4. NR Hegde. Oral presentation on "Antimicrobial resistance: chicken or egg?" at a conference. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Presentation at the Annual Conference of the Association of Microbiologists of India, and International Symposium on Host-Pathogen Interactions, Hyderabad, India, 2018.
Year(s) Of Engagement Activity 2019
 
Description AMR masterclass in Nairobi, Kenya. 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact Professor Williams taught on a AMR masterclass around diagnostics of AMR which included a practical class and DARPI presented as a case study around methodology to delegates (~27) from Kenya, Ethiopia, Eritrea, Somaliland and Somalia. The attendees included junior and more senior academics and both undergraduate and postgraduate students who attended this two day masterclass as part of the One Health in the Horn of Africa GCRF project. Attendees have since contacted Professor Williams who is advising on protocols for research and diagnostics by some of the delegates and who wish to collaborate.
Year(s) Of Engagement Activity 2019
 
Description Causing a Flap: chicken-based research to inform industry, education & human well-being engagement day, 28th August, Woburn House London. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact Invited speaker at this interdisciplinary event to talk about the challenge of controlling antimicrobial use and antimicrobial resistance in the poultry industry in the UK and India.
~50 people were present from diverse disciplines, including the history, archeology and the arts. This was a really useful event to attend and speak at in terms of the different methods used in the Causing a Flap project for public engagement in the UK and overseas, as well as bringing biological context to modern issues in intensive poultry production, which sparked lots of debate.
Year(s) Of Engagement Activity 2019
URL https://www.eventbrite.co.uk/e/causing-a-flap-chickens-in-industry-education-human-well-being-ticket...
 
Description ISID/ProMED conference Invited Talk 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Dr Jenni Cole (RHUL) was Invited to talk at a international conference (ISID/PROMED) on the integration of social science in AMR research with DARPI used as the exemplar.
Consisted of a multi-disciplinary audience of academics and others.
Year(s) Of Engagement Activity 2018
 
Description International Society for Infectious Disease 18th Annual Conference, 2018, Vienna 9-11 November 2018 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact Invited speaker at a conference on Infectious Disease.

Abstract for ISID/ProMED conference

Jennifer Cole, PhD
Royal Holloway, University of London
jennifer.cole@rhul.ac.uk

With 1.3 billion inhabitants, India is the world's second most populated country and the third largest emerging market. It is also the 4th largest global user of antibiotics in livestock, with little regulation or control on their use . Rising income levels and aspirational living standards are seeing increasing demands for food products from animal sources, in particular poultry, and it is predicted that antimicrobial input to manage animal disease will double in India by 2030 as the country moves to more intensive livestock systems. As data suggest that the same or similar antimicrobials are used in human medicine and livestock production, this poses a particular challenge to human health.
Poultry and poultry meat can carry resistant bacteria, but there is a complete lack of data on the scale of the problem in India, including on what antimicrobials are being used in poultry meat production, how they are used, and how this contributes to the carriage of AMR bacteria that may be a threat to human and animal health.
In July 2018, a cross-disciplinary team of researchers from the UK and India began a series of four projects, funded jointly by the UK'S Economic and Social Research Council and the Indian Government Department of Biotechnology to better understand and counter the threat from AMR in India. Two of these projects will map and quantify antimicrobial use (AMU) and antimicrobial resistance (AMR) across the entire Indian poultry meat supply chain, from farm to fork: one project focussing on intensive production methods, the other on more traditional farming systems.

The full integration of social science methodology with microbiology, veterinary science, animal welfare and agricultural economics on these projects will ensure they deliver a full understanding of the socioeconomics pressures that drive AMU. This will highlight workable solutions to reducing the quantities used by identifying economically viable alternatives, as well as surveying the scale of the problem and promoting better antimicrobial stewardship.
Year(s) Of Engagement Activity 2018
URL https://isid.org/imed-2018/
 
Description Invited speaker at OIE 2nd AMR Meeting in Marrakech, Morocco. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Professor Jonathan Rushton was invited to speak at the OIE 2nd AMR Meeting in Marrakech, October 2019.
The presentation was on the use of economics for selection interventions and policies, with particular reference to tackling AMR through reduced antimicrobial use.
It was attended by Government veterinary services, private sector (Pharmaceutical companies, livestock companies, food system representatives) and international organisations plus some University academics.
Year(s) Of Engagement Activity 2018
URL http://www.oie.int/amr2018/en/
 
Description Poster presented at the India International Science Festival, Lucknow, India, 2018. 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Schools
Results and Impact Poster presentation at public science festival and work on the project discussed with attendees.
Year(s) Of Engagement Activity 2019
 
Description Presentation about Campylobacter control at the 7th Pan Commonwealth Veterinary Conference, Bangalore March 2019 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Invited talk on the infection biology and control of Campylobacter in broilers and the broiler meat chain.
~70 people attended from India and other commonwealth countries
Year(s) Of Engagement Activity 2019
 
Description Social Science for Scientists Summer School 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact 30 researchers, postgraduate students, PhD students and research assistants, most of whom were microbiologists, veterinary scientists, animal nutrition specialists and from other scientific disciplines, attended a five day summer school where they learned basic social science field techniques including interview skills, observational skills, transect walks, mapping, service design, participatory rural action (PRA) and ethics. The week included one day's practical training in the field.

The training provided the scientists with basic skills that will enable them to collect some social science data alongside microbiological sampling on farms, thus increasingly the social science capacity of the project.
Year(s) Of Engagement Activity 2019
 
Description Stand at Poultry India, November 2018. 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Industry/Business
Results and Impact We hosted a stand at Poultry India which is attended by industry from India and neighbouring countries, as well as global industry players.
We used the stand to promote the project and interact with stakeholders, and make them aware of the project and discuss the issues they have around AMR.
We were informed about issues that vets are facing in treating infections due to AMR and we had requests from farmers (including those based outside of India) to engage them in our research.
Year(s) Of Engagement Activity 2018
 
Description Stand at Poultry India, November 2019. 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Industry/Business
Results and Impact We held a stand at Poultry India to interact with the poultry industry and other stakeholders, and used a number of methods to obtain the views and priorities of those attending this industry fair. We were able to talk to farmers who work in different regions who have different issues and are managing a range of different types of farms, or are supplying products to the industry. The stand generated a lot of interest in AMR, not just from a disease perspective and managing this on poultry farms but individuals indicated they were concerned about the risk of AMR to their own and their families health, which is something we had not encountered before from those working in the industry and which can be explored more. We also made a number of contacts who are interested in being involved in our research.
Year(s) Of Engagement Activity 2019