Evidence-based policy for controlling antimicrobial resistance in the food chain in Denmark

Emergence of antimicrobial resistance (AMR) in the animal reservoir forms a risk for human health. The use of antimicrobials in animals is the major cause of development of AMR in bacteria in animals. In the 1990s, the use of antimicrobials in animals, particularly as a growth promoter, led to alarming levels of AMR in many countries. This paper analyses the emergence of AMR in Denmark in terms of contributing factors that formed fertile ground from which AMR could develop. New technologies in combination with scientific unknowns led to the unexpected development of cross-resistance and an uncertainty about transmission to and risk for humans. Conflict of interests and varying susceptibility to risk between agriculture, health and commercial stakeholders complicated intervention. In addition, unintended economic incentives from old legislation resulted in a situation where the use of antimicrobials in general was stimulated. Complications of alarming high levels of AMR in animals, and a general discontent about this situation (including with farmers and vets) demanded a solution. National surveillance in DANMAP involving all stakeholders from the farm-to-fork food chain was setup to counteract scientific unknowns and conflicts of interest; new legislation was developed; and unintended economic incentives reduced. The current analysis may help to better understand the AMR problem in general and what may be done to counteract it.