Hi, my name is Nicholas Fortane. I'm a researcher in sociology at the French Research Institute for Food, Agriculture and the Environment. My research for few some topic of animal health, especially looking at how public policies, markets, professions and other instruments to impact the way we deal with the risks associated to animal diseases. My talk today is entitled reducing antimicrobial use, so what? Controversies and resilience in our antibiotic infrastructures? There are a couple of questions that I would like to address today. For example, what it means to try to reduce antimicrobial use? Or how the controversies in narratives of antimicrobial resistance or AMR have shaped the way we are trying to reduce antimicrobial use? Again, what is changing or not in the way we use antimicrobials. AMR could be perceived as a one global health issues, which means that on the one side, there are three sectors involved in the fight against the AMR, human, animal, and the environment, and on the other side, it is also a worldwide issue, because antibiotics and resistant bacteria do circulate all over the world. I would like today to interrogate what Claire Chandler has called antibiotic infrastructures. By that term, she designates the health and food systems that have developed from the second half of the 20th century onwards, and that relies so much on massive production and consumption of antimicrobials in order to support the objectives of productivity and profitability. Instead of sustainability. There's contradiction between those objectives of productivity and objectives of sustainability, could be seen in the way we have built the narratives of the AMR crisis. Yes. This topic representation of a world without antibiotics or with antibiotics that don't work anymore. It's spreading around and urging us to reduce antimicrobial use. However, this crisis is not necessary, a catastrophe for everyone. In fact, despite this topic narrative that usually spread, AMR is a very convenient crisis for the dominant infrastructures and stakeholder in place. For example, it has professional that have managed to gain control over the prescription of antibiotics or the international organization that have increased their power over international health governance. Again, the format critical industries that are trying to secure the patterns and market, or medicines, or the food industry that maintain the process of industrialization of livestock from. A social scientists, these narrative must question us, how is it possible that we can blame our antibiotic infrastructure for relying so much on antibiotics, and in the meantime, keeping reinforcing them, or even considering that they can save us from this topic future. This is probably related to what we can call the resilience of capitalism, which means the ability of our health and food system to neutralize the critics we are addressing to them by pretending to be able to carry the transitions to what prudent use of antibiotics. In other words, when we reduce our antibiotic consumption without reducing our need of antibiotics like we do at the moment, are we making changes that help us not to change? I will mostly focus on the veterinary side of the story. Because most of the work I have done with my colleagues, tackled with the use of antibiotics in livestock farming. But this is exactly the question I was just raising. We observe in certain region of the world, an important decrease of antibiotic use in veterinary medicine, whereas it will still probably increase at a global level. What does it mean? Did something change, how has it been possible? In veterinary medicine in Western countries? The current decrease of antimicrobial use is highly correlated with the development of new approaches to animal health, namely preventive veterinarian medicine. Preventive veterinarian medicine is related to the development of new techniques, tools, and knowledge for Animal Health. Veterinarians have enlarged their domain of expertise, which is historically limited to veterinary clinics. Towards technical aspects of animal farming, such as nutrition, hygiene, breeding, housing. This means that veterinarians have substituted antibiotics with older pharmaceutical inputs, such as vaccines, but also alternative medicines. In doing so, they have changed their role on farms and they have built a new professional legitimacy and authority over the domain of animal health. But they also have developed new business models for the practices. In many countries veterinary businesses was highly relying on the sale of drugs, which was certainly limiting the change in the practice. Led to debates regarding whether or not we should separate prescription in delivery of antibiotics. In many countries, including France, the specific way of regulating the veterinary drug market was nonetheless preserved. Thanks to the development of the preventive approaches to animal health, which enabled this, to create new business models for the professional activity based on the sale of diverse services, as much as pharmaceutical prescription it sells. This trend is a result of the transformation of veterinary practices, in particular, the development of large corporate groups, that have been able to invest in all the domain, I mentioned earlier, such as hygiene and nutrition products or technical advice and alternative medicines, for example. But these large photonic corporate groups are also related to the continuous industrialization of livestock farming. Which is not surprising, because you observed that the massive decrease of antimicrobial use in animal farming is mostly the result of conventional farms. I'm not saying that organic farming or sustainable agriculture is not a solution, but they didn't contribute so much to the decrease of antimicrobial use. Therefore, we must wonder how this reduction has been obtained. How did farming practice in conventional agriculture changed, but not. What we observed in analyzing the development of antibiotic free labels, is that it is correlated with a continuous intensification of farming practices, such as high medicalization of animals in particular, the vaccinations or important confinement of animals and buildings that are always larger and more productive. On the other hand, those labels have reinforced the vertical integration of the food-supply chain, which means that upstream stakeholders, such as retailers or the food industry, have gained power over farmers and independent cooperatives by controlling the way they produce food. There's dynamics, intensification and integration, what we call industrialization of livestock farming, and it shows how resilient agricultural capitalism proves to be. The AMR crisis has been an opportunity to strengthen the system that was criticized on the firsthand for the overuse of antimicrobials. Even if, of course, the issues is nowadays decreasing. Similar conclusions can be made from the research that colleagues did about human health. In market-driven hospitals that are more and more ran through the principles of capitalists health policies based on cost reduction, patient trios and efficiency. The prescription of antibiotics has reduced at the price of an impoverishment of care and cure practices. Management practices in market-driven hospitals rely on massive labor division that doesn't allow holistic approaches of patients and antimicrobials to watch this programs, face contradiction with the objectives of cost reduction and efficiency. They are not supported, but it required resources and time and space that patients would need for their antibiotic for recovery. Similar dynamic can be observed in community medicine that is having great difficulties to develop preventive approaches that could help to move from cure to care and to establish new roles for doctors, that will try to approach health from a more holistic where they're medical centered perspective. Basically, health and food systems are facing similar challenges regarding the transformation that they should carry to tackle the burden of AMR, but which they don't really do. This leads me to my last point. We need to rebuild our aim or narratives if we really want to support changes that would really transform our food and health systems, rather than maintaining them on just renewed shapes. We certainly should build on utopia rather than dystopia, when we're thinking of AMR, and consider the problem not necessarily as one of excess of antibiotics, but one of access to antibiotics. We should focus less on reducing antibiotic use and more on our dependence to antibiotic infrastructures. What matters here is health and well-being of human and animal population. Yes, it should rely less on antibiotics, but if reducing antibiotics contribute to an impoverishment of health condition, the situation might become worse than when we start to implement those AMR policies. Perhaps we need to rethink what an antibiotic free world means. It's certainly not a world without antibiotics, which would be the dystopia, but to a world freed from the dependence to antibiotics, which would be the utopia. Responsible use of antibiotics shouldn't only be assessed from a medical perspective, but from a much larger socially ecological one, where care and health rights for every beings matter more than the productivity and efficiency of food and health systems. More largely, we need to assess which more accurately, what is change and what is resilience in this time where capitalist structures are shaping the care practices of humans, animals, and the environment. I think this reflection is an important contribution of what social sciences of AMR could bring. Among many other research groups all over the world, this is what we are trying to do with my colleagues of the AMAGRI research group based in Paris-Dauphine University in Paris, France. Thank you very much for your attention.
