One Health in reality - The Dutch experience
In 2007, the Netherlands started to detect cases of Q-fever in humans. Q-fever, caused by Coxiella bunetii bacteria, can trigger abortions in sheep, goats or cows, but can lead to pneumonia in humans. After over 2000 confirmed human cases of Q-fever, the Dutch authorities took the rather controversial decision to cull over 50 000 dairy goats identified as the source of the infection.
The Netherlands’ Chief Veterinary Officer, Dr. Christianne Bruschke, has on many occasions explained why this tough decision was necessary. Dr. Bruschke is one of the keynote speakers at Uppsala Health Summit in October, where she will share the Dutch experiences on how to meet an outbreak of a zoonosis in one of the world’s most densely populated countries, and also the world’s second largest exporter of dairy products.
The livestock industry in the Netherlands is intense, and very important to the country’s economy. With 17 million inhabitants on a surface of 41 543 km², this is also one of the world’s most densely populated countries. Add to this 125 million livestock animals.
- I think that we today have a good understanding of the need to think and work along the principles of a One Health perspective, says Dr Bruschke, at least a better than in many other countries. And even if we can always wish for improved general understanding of the interdependencies, we are satisfied with collaborations on ministerial level. We at the Ministry of Economic Affairs have regular contacts with our colleagues at the Ministry of Health. Together, we are working on the control of other zoonotic diseases and we have implemented a new structure for their surveillance.
The Netherlands is also known for its successful fight against overuse of antibiotics in animal production. Between 2009 and 2015, antibiotic use in the livestock industry fell by 58,4 %. As in the case of Q-fever, the much-needed reduction in the use of antibiotics was related to the dangers to human health.
- The Dutch experience is that to reach a sustainable change, we must work with bottom-up approaches. In this case, the Dutch government set the target for the reduction we wanted to achieve, and we have the responsibility for the enforcement, but we asked the livestock sector to make the plans for how this reduction should become reality and take the responsibility for its implementation, says Christianne Bruschke.
But the livestock sector’s plans for how to reduce the use of antibiotics had to be supported by other measures.
- We saw that the veterinarians’ position in relation to farmers needed to be strengthened. Veterinarians are dependent on the farmers for their income, which sometimes made it difficult for them to handle the new situation. The Dutch government therefore adopted new legislations, including a rule saying that antibiotics could be prescribed and administered only by veterinarians, except when the farmer complies with a list of conditions. In addition, if one veterinarian has decided not to prescribe antibiotics to a farm’s livestock, this decision cannot be overruled by another veterinarian since there is a one to one relationship between farmer and veterinarian.
Finally, the government set up restrictions for which antibiotics to use. Antibiotics of critical need to human health, like the fluoroquinolone as well as the 3rd and 4th generation of cephalosporin, are only allowed as third line treatment, and its usage for livestock is today almost nil.
- The usage fell dramatically until 2015, but then flattened out before we had reached our target. So we have turned to the sectors again and asked them to update their plans. And this last year, we could see intensified reductions in the use of antibiotics for livestock, which once more confirms the value of a bottom-up approach.
- But we need to continue, Dr Bruschke underlines, both implementing a One Health approach in other countries and to convey a general understanding of the risks involved when humans handle livestock.
- I hope that Uppsala Health Summit will bring different groups together, and that we can have a concrete discussion on how keep the vigilance alive. A One Health approach necessarily means working across sectors and with different professional groups. We must constantly increase the easiness by which we understand each other, and never forget that we have a task in common.