COPENHAGAN, Denmark — Michael Nielsen unlocks the door to his pig factory. He doffs his jacket, pants and muddy boots and zips on white coveralls. Then he steps into the maze-like complex housing several thousand pigs.
From the birthing room — where one enormous sow has just delivered 22 squirming piglets — to the insemination stalls where the next generation is in the works, Nielsen prides himself on smart, efficient farming.
Here in Denmark that means recording every single dose of antibiotic farmers use.
Unlike Canadian farmers who can import antibiotics by the truckload, Nielsen can only obtain them by prescription at a pharmacy. Use too many antibiotics and Nielsen would get a dreaded “yellow card” from the Danish government that has the world’s most comprehensive surveillance system for tracking and targeting overuse of antibiotics.
Nielsen isn’t complaining. “It’s a very good system,” says the affable 50-year-old who raises more than 20,000 pigs a year at his farm north of Copenhagen.
While Canada is seen as a laggard, Denmark and its farmers are seen as a model in a world increasingly threatened by bacteria growing resistant to antibiotics.
Health authorities around the world are sounding the alarm over the superbugs showing up in not only in hospitals but also at farms, slaughterhouses and supermarket meat counters. Antibiotics must be used more judiciously, they say, because the drugs help create resistant bacteria that are increasingly difficult — sometimes impossible — to kill.
Canadian officials share the concern.
“We are extremely worried about the rise of the all the antibiotic resistant organisms,” Dr. Gregory Taylor, the deputy chief Public Health Officer of Canada, told Postmedia News in an interview. He describes it as “one of top priorities for the agency and for the government.”
Canada has, however, dawdled over improving antibiotics stewardship. Or, as Calgary infectious disease specialist Dr. John Conly said this spring, “Canada is an international embarrassment” having failed to come up with an action plan to better monitor and control the thousands of tonnes of antibiotics used in Canada each year.
More than three-quarters of the antibiotics used in Canada are given to cows, chickens, pigs and other animals, according to a recent report from the Public Health Agency of Canada that questions the way most of the drugs are used for “mass medication” to boost growth and prevent infections.
Taylor says he and his colleagues are working to improve antimicrobial stewardship and deal with problems — or “black holes” as some call them — like importation of massive amounts of antibiotics by Canadian farmers. And Health Canada is being applauded for informing “stakeholders” last week that it is planning a three-year phase out use of “medically-important” antibiotic growth promoters that are used to spike the feed and water of animals to speed their growth.
The move, which mirrors proposed changes in the U.S., is seen as a step in the right direction. But it pales compared to what has been accomplished in Denmark, which has a thriving farming industry but uses a fraction of the antibiotics used to medicate animals in North America.
As Dr. Margaret Chan, director general of the World Health Organization has put it, Denmark has tackled the problem in a “pioneering way.” The country remains one of the world’s top pork exporters with production climbing more than 50 per cent as it cut antibiotic use — per kilogram of meat and eggs produced — more than 50 per cent in the last 20 years.
The Danes banned growth promoters more than a decade ago. They also passed legislation that put an end to the way veterinarians were profiting from the sale of antibiotics to farmers.
“It removed the incentive for prescribing too much,” says veterinarian Jan Dahl, at the Danish Agriculture and Food Council, noting how antibiotics sales took a dive when veterinary sales were abolished.
The Danes also created VETSTAT, a national system that tracks antibiotic use down to individual farm and herd.
And in 2010 Denmark started a “yellow card” system that singles out farmers using high levels of antibiotics. They get nine months to reduce their drug use. If they don’t succeed the government can order them to reduce the size of their herds.
“You can only get so far by asking people to behave nicely,” says Dahl, noting how government and producers worked together to create the system. Antibiotics use by Danish farmers — which was already low — has dropped more than 10 per cent since the yellow cards appeared.
Add it all up and Danish’s livestock got less than 50 milligrams of antibiotics per kilogram of “animal production” in 2011, according to the most recent European data. That compares to more than 200 milligrams in Germany and more than 100 milligrams and France and the Netherlands. Authorities say U.S. farmers use even has more — almost 300 milligrams of antibiotics for every kilogram of meat and eggs — and Canadian farmers are believed to using as much, though no really knows.
The Danish program keeps Nielsen and his staff of five alerts to every cough and sneeze in their herd.
“It makes us sharp,” says Nielsen, who has raising pigs down to a science.
“It’s like kids in kindergarten, when one gets sick, they all get sick.”
His 650 sows give birth to — on average — 31.1 piglets a year. Pregnancies last three months, three weeks and three days. The piglets stay with their mothers five weeks. Then the cycle starts again, with sows artificially inseminated just days after their last piglets are weaned.
“It is a factory farm,” Nielsen says.
Inside the 5,000-square-metre complex, Nielsen stops at the farrowing or birthing room where several enormous, grunting sows have just, or are about to give birth. Stroking the silky ear of a day-old piglet, he explains how they are protected from infection by their mother’s milk.
In a room down the hall, a small herd of five-week-olds are getting their first taste of a powdery mixture of milk powder, fishmeal and grain that helps ease the transition to solid food. It reduces the incidence of diarrhea in the piglets, which was initially a problem for Danish farmers who increased use of medically valuable antibiotics when they first eliminated growth promoters.
They reduced that problem with better feed — and government monitoring. But infections still do occur when you have thousands of animals living in such close quarters. “It’s like kids in kindergarten, when one gets sick, they all get sick,” says Nielsen, standing in a sea of tiny pigs scooting around his feet and playing with toys dangling over the stall.
He has a small stash of antibiotics that been prescribed by his veterinarian. Nielsen and his staff try catch and treat infections early, injecting a dose of antibiotic into affected animals. But if more than 25 percent of animals in one room get sick, antibiotics are added to the group’s drinking water.
“It could be for one day or for five days, it depends on how severe it is,” says Nielsen. “We use as little as possible but as much as necessary.”
Every use of antibiotics is recorded in a yellow binder. Nielsen’s vet makes monthly visits, assessing the herd and adjusting and renewing prescriptions that are tracked on VETSTAT.
To date, there has been no yellow card for Nielsen. His piglets get about 10 percent less antibiotics than the Danish average, and his sows even less.
Nielsen, like many here, suggests North American farmers could learn much from the way Danish farmers control, monitor and report their antibiotic use. “If I can, they can do it too,” says Nielsen as he leans over, returning a small bottle of streptocillin to a small fridge where he keeps his antibiotics.
Danish farmers have also reduced use of important human antibiotics such as cephalosporins and fluoroquinolones in a bid to prevent emergence and spread of bacteria resistant to the drugs used to treat infections in people. The pig farmers used just 1.3 kg of the cephalosporins in 2011, a tiny amount compared to other countries, says Dahl, pointing to the kind of detailed data that does not exist in Canada, though many doctors and veterinary researchers would like to get their hands on it.
Drug companies report that they sell about 1,600 tonnes of antibiotics a year to Canadian farmers. But farmers are also known to be importing what officials believe are massive quantities of antibiotics for their own use. “There is approximately 30 percent that may be not accounted for,” says Rebecca Irwin, director of the Canadian Integrated Program for Antimicrobial Resistance Surveillance, which tracks resistant microbes emerging across Canada.
John Prescott, a veterinarian at the University of Guelph, and his colleagues have been urging the government for years to deal with what he describes as the “black hole” in federal and provincial regulations that enables farmers to import and use antimicrobials, some of them “not evaluated and registered by Health Canada.”
Prescott sees no reason Canada could not follow Denmark’s lead and set up a system like VETSTAT to monitor and track drug use.
He’d also like Canada’s veterinarians to stop profiting from the sale of antibiotics. The income generated varies but is said to be substantial for some vets. “It is a conflict,” says Prescott, who co-chaired a committee of leading Canadian veterinarians and agricultural experts that issued a scathing report in March on Canada’s antimicrobial stewardship.
Taylor in Ottawa says antibiotics and antimicrobial resistance present a “wicked problem” because it involves so many players in the health and agriculture sectors and the federal and provincial and territorial governments.
“It is important to remember that Canada is a federated model,” says Taylor. “So the kind of approach that Denmark would have is different than the kind of approach in Canada.”
Frank Aarestrup, a veterinarian and microbe tracker at the Technical University in Denmark helped propel the Danish government into action in the mid-1990s, when he and his colleagues found resistant bacteria in chickens and pigs being fed antibiotic growth promoters. The find generated headlines in Denmark where antibiotics use in livestock remains almost as a hot a topic as the oilsands are in Canada.
Over the years Aarestrup has heard of plenty of arguments and reasons, from drug companies, agricultural groups and bureaucrats, why Denmark’s experience can’t or shouldn’t be repeated in other countries.
Some say the Danes have been successful at curbing antibiotics because the country of 5.6 million people is so small. Others maintain Danish farmers are more centrally organized and amenable to government control.
But Aarestrup says the farmers were no pushover. “It’s been an uphill battle, some of it certainly,” he says.
He said better monitoring and control of antibiotics boils down to making decisions and implementing them. “It’s basically as simple as that.”
“If you can do it in one country, of course you can do it all countries,” says Aarestrup. “It’s a question of will.”
(Research for this story was funded in part by a journalism award from the Canadian Institutes of Health Research.)
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