Interviews with the experts: Erik Ruiz, Health Care Without Harm (HCWH) Europe


Welcome to our new and updated interview series for 2022:

Interviews with the Experts

In this series we continue to ask some of the leading experts in the field of antimicrobial resistance (AMR) and One Health for their take on progress, leadership and challenges. 

Our latest interviewee is Erik Ruiz, Safer Pharma Project Officer at Health Care Without Harm (HCWH) Europe. Erik's role is to coordinate the implementation of the Health For Food project, which raises awareness amongst European healthcare professionals about antimicrobials used in food production and their effect on the development of antimicrobial resistance.

Hi Erik, what have you been doing on AMR in the last few years?

Last year I led an EU-wide campaign mobilising health professionals to call on the European Commission to include colistin in the list of antimicrobials reserved for human use. I have also coordinated a group of procurement, animal health and human health experts drafting a set of procurement criteria for European hospitals to reduce the use of antibiotics in animal production. Right now I am working on the revision of the animal welfare legislation to ensure that this legislation prevents overuse and misuse of antibiotics in food-producing animals to sustain intensive farming


Antibiotic resistance is increasingly referred to as the next global pandemic. A recent study published in The Lancet has estimated that 4.95 million people died of an antibiotic-resistant infection in 2019, and for 1.27 million of these people their deaths were attributable to the antibiotic resistance of the infection. Do you think current global actions will be sufficient to tackle a problem of this scale?

Current global actions are a step in the right direction, however I am afraid they are not strong enough. AMR is referred to as the next global pandemic, but this issue is already here, it’s not even our children or grandchildren who will see the surge of AMR, it’s us. I think we need to follow an approach based on two pillars. Firstly, raising awareness among health professionals and patients on the importance of a responsible prescription and consumption of antibiotics. Secondly, we need to transform our food supply chains and the way we produce food to reduce the structural need of antimicrobials. In this sense, improving animal welfare is a crucial step.


Do you think the global growth in intensive livestock farming is contributing to higher levels of farm antibiotic use?  

Of course it is. Intensive farmers need to understand that their business model is harming both human health and animal welfare. It’s not sustainable and will soon stop being profitable too. Plant-based affordable options are arising and I am sure they will replace cheap meat from feedlots in our diets. Organic farming will grow to offer those who still want to eat meat a sustainable option.


Would you recommend any systemic changes to the way we raise livestock in order to preserve the efficacy of antibiotics?

Some widely used farming practices, such as early weaning or tail-docking, among many others, are simply not acceptable. These practices in combination with high stocking densities and poor hygiene in the farms are making animals sick, therefore increasing the need for antibiotics. Improving animal welfare would greatly reduce their use and would help to transform this model into a more sustainable one. Farmers need to do this for the sake of their own survival.


New EU legislation that came into force in the 28th of January 2022 bans routine farm antibiotic use and restricts prophylactic use to exceptional cases and for individual animals only. It also prohibits using antibiotics to compensate for inadequate husbandry and poor hygiene. The legislation limits metaphylaxis to cases when the risk of disease spread is high. Do you think these new rules are a step forward for responsible antibiotic use in farming?

These new EU rules have set a new framework that will certainly reduce the sales of antimicrobials for veterinary use. However, there are many blind spots that make me question its ambition. For example, all the antibiotics that are proposed to be been banned in animal use were already not authorised in food production in the EU. Also, many crucial antimicrobials such as colistin are missing from the draft list.

In this sense I feel that the Commission has not listened to the concerns of health professionals and the advice of global health organisations. So, even if this legislation will improve and reduce antimicrobial use in animals, it is a missed opportunity that we might regret in the near future.


Do you anticipate that these rules will deliver responsible farm antibiotic use or is further action likely to be required?

I think the Commission needs to refine some aspects such as the reporting mechanisms for member states. We need these mechanisms to show disaggregated data with a species by species approach, and we need also to be able to compare the use of antimicrobials in intensive and organic production.

Setting clear targets would have been ideal, but we have seen that this measure has not been very effectively implemented in the past. In 2016 the European Medicines Agency set a target for member states to reduce their use of colistin in husbandry. Many countries did not reach those targets, and some of them increased (even doubled!) their use of colistin. The biggest reductions in the use of colistin were due to voluntary commitment in the member states, and not promoted by the legislation in place. The Spanish government did a great job with its ‘Reduce Antibióticos en Porcino’ programme reducing almost completely the use of colistin in pigs. But again, the EU rules were not enough and these reductions relied on the voluntary commitment of a member state.


The world has been shaken by the impact of covid, what advice would you give to world leaders about their response to AMR?

If COVID has taught us something is that a global approach is needed to tackle global health issues. National governments must follow the guidelines of global health organisations, such as the WHO, to pull in the same direction.

On the other hand, institutions have to set clear targets and constantly measure both antibiotic use and antimicrobial resistance. Only by doing so will we be able to know with certainty the incidence of antimicrobial resistance and will enable us to act accordingly.


What is the single most important thing to achieve if we are to win the fight against rising AMR?

Visibility and awareness will be key to fight AMR in the years to come. Patients need to know that antibiotics are a precious tool that should only be used in exceptional situations and under the guidance of a health professional. Consumers need to understand that their choices can help to shape the food supply chains and make them more responsible in terms of antimicrobial use. Farmers need to understand that misuse of antimicrobials will lead to a major health issue. And last, but not least, governments need to take on the responsibility of setting clear limitations to the overuse of antimicrobials. If we all get to understand our role in this fight instead of blaming each other, we might be able to tackle this challenge before it’s too late.


Thank you for your time Erik, and for giving us an insight into your work. 

If you’d like to know more, you can follow the links for further information about Health Care Without Harmand follow Erik @erikruizmar and HCWH on Twitter @HCWHeurope