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

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.

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.