Angry veterinarians

General Council of Veterinary Colleges of Spain photo

Thousands of veterinarians demonstrated in Madrid on March 5 outside the headquarters of Spain's Ministry of Agriculture, Fisheries and Food to protest a new law that limits their use of antimicrobial drugs.

Veterinarians across Spain plan to walk off the job Wednesday to protest a new national law that limits their use of antibiotics, in a sign that global efforts to tackle antimicrobial resistance — while broadly supported by the veterinary community — can face pushback if considered overly restrictive.

The two-hour demonstration comes at an already challenging time for Spain's veterinary profession, which is grappling with a separate animal welfare law that, among other things, appears to prohibit practitioners from euthanizing animals when owners can't afford treatment.

"Our life is very complicated right now," lamented Dr. Veronica Salazar, an anesthesia specialist in Madrid.

Overuse of antimicrobial drugs (which include antibiotics) can contribute to antimicrobial resistance, or AMR, which occurs when microbes evolve to withstand treatments meant to kill them.

In recent years, governments worldwide have stepped up efforts to combat AMR with education campaigns and stricter rules. In the United States, for example, the use of antimicrobials in food animals has fallen sharply since 2017, when the country's Food and Drug Administration banned using antibiotics to promote growth in livestock — a quirk of the drugs that led to excessive use by some food producers.

Spain's new law, which came into force on Jan. 2, is based on a European Union directive that compels the bloc's 27 member states to report all of their antimicrobial usage by 2030. The Spanish law's critics contend that it interprets the EU directive too harshly and was adopted too hastily, without proper consultation with the veterinary community.

Thousands of veterinarians across Spain stopped work on Feb. 11 for varying lengths of time as part of a coordinated national day of action. A second day of national demonstrations was held March 5. Separate events also have been staged in individual regions. For instance, more than 1,000 veterinarians protested on the streets of Valencia on Feb. 21.

A third day of national demonstrations is planned for Wednesday, during which veterinarians will strike between 10 a.m. and noon, according to a press release issued by the General Council of Veterinary Colleges of Spain, which represents the country's regional veterinary regulators.

Under the new law, every time a veterinarian prescribes an antimicrobial drug, they must log into a national database called PresVet to make a detailed record. They no longer can sell antimicrobials at their practices (for discharged patients) and are compelled to prescribe only such drugs that are labeled exclusively for veterinary use.

Oftentimes, a veterinary version of an antibiotic isn't readily available in pharmacies or available at all, according to practitioners who spoke to the VIN News Service.

"The pharmacies don't necessarily stock, for example, an amoxicillin that is from a veterinarian brand, and their provider doesn't stock it, either," said Salazar. "Maybe, if they contact a provider they don't usually work with, their answer will be, 'Maybe I can get it to you by next week.' But I need the antibiotic now. Not next week."

Salazar said patchy availability is making for angry pet owners. "They come back to you and say 'What kind of prescription did you give me? Nobody carries this. I'll have lost my whole evening walking around different pharmacies. Can you just make a normal prescription?' And the answer is: 'No, I can't, or I can be fined.' "

Fines for disobeying the law range from €600 (US$648) for minor infringements to €1.2 million (US$1.3 million) for the most serious breaches — amounts many veterinarians consider draconian.

Veterinary versions of many types of medicine don't even exist in Spain, according to Dr. Gonzalo Moreno del Val, president of the Alicante College of Veterinarians. He offered the example of allopurinol, widely regarded as the go-to treatment for canine leishmaniasis, a parasitic disease. "In Spain, we do not have authorized veterinary drugs with allopurinol as an active ingredient, and therefore, a priori, we could not use this product for the treatment of the disease," he said. "This is primarily an animal health problem but, as it is a zoonotic disease, it is also a public health problem."

Del Val maintains that the new law is so rigid that, in some instances, it goes against the spirit of what it's trying to achieve. For instance, he noted that antimicrobials have been divided into four categories: A, B, C and D — the last category being the least restrictive.

"If there is no veterinary medicine authorized in Spain for group D, instead of being able to use the equivalent in human medicine, which would generate fewer problems in terms of resistance, we are forced to go up a step and prescribe veterinary antibiotics from more restricted groups, such as C or B," he said.

Medicines in groups B can be administered only after the patient's pathogen is confirmed by a culture and found to be sensitive to the desired antibiotic. Medicines in group A are "not permitted" for use in food animals, and permitted only "exceptionally" for use in companion animals, the law states.

Del Val and Salazar also decried the time they must spend logging each prescription into the national database. "That can mean up to 10 additional minutes for each consultation," del Val said.

Both said they respected the intent of the new rules. "It is a noble cause, and we all root for it," Salazar said. "On paper, it does make sense. But in reality, its application does not make sense."

Another Spanish veterinarian contacted by VIN News was more sanguine and contended that some of the concern about the law is misguided.

"I think it makes sense to regulate antibiotics in veterinary medicine, as they have been misused for a very long time in our profession," said Dr. Patricia Ibarrola, a practitioner at an emergency hospital in Madrid. "Vets are becoming scared of using antibiotics through lack of knowledge about antibiotic use and not reading the regulations. The other day, somebody told me that they would not give antibiotics for a dog bite because they had to wait for the culture results. This is not the case, and they are misinformed."

Still, Ibarrola, too, says there's room for improvement. "The problem with this law is that veterinarians have been threatened with unrealistic fines," she said. "Also, the week when it became compulsory to report antibiotic usage, the system was not functional, and people could not register. Overall, I think the intention behind regulating antibiotics is sound, but the execution has been problematic."

For its part, the government is standing firm. When challenged on March 18 in Spanish parliament by opposition lawmakers, the agriculture minister Luis Planas, insisted that veterinarians can still administer antibiotics adequately.

"All pet owners and all citizens should be rest assured: Obviously, the law protects veterinarians and supports them in prescribing whatever our pets need," he said (in Spanish).

All of Spain's regional colleges of veterinarians are united in opposing the new law. They reiterated at a press conference on March 19 that they have requested a moratorium to allow more time to study its viability.

Circus animals out; bullfighting still in

The dispute over antibiotics comes after Spain, in September 2023, instituted sweeping animal welfare legislation.

Among the notable changes is a ban on animals performing in circuses (though bullfighting is still allowed). Dogs and cats no longer can be sold in pet stores, and all dog owners in Spain must purchase liability insurance to provide coverage should their dog injure a human or other animal. In addition, all dog owners are required to take an ownership training course.

Spanish citizens are becoming increasingly aware of a need to "guarantee the protection of animals," particularly those "living in the human environment," the law states (in Spanish), adding that "these animals are sentient beings."

Some aspects of the law had immediate effect — dogs and cats fast disappeared from pet stores, and circuses started relying more on human performers like clowns — but others can't be obeyed or enforced, according to veterinarians contacted by VIN News.

For one, the dog ownership training course, which was meant to be offered for free online through a government website, hasn't yet materialized.

"There still is no course, as far as I know," Salazar said. "Not much thought was put into who's actually going to pay for it. Who's going to pay for the professionals that create the course? Who's going to run it?"

Ibarrola, the small animal practitioner in Madrid, said that while she agrees with some of the changes, she and many people she's talked to think others are too intrusive — and hypocritical.

"For example, you get reported to the police for leaving a dog in a car for five minutes at 10 p.m. — my own experience when I had to collect a prescription from a hospital — but it is OK for drunken people to run behind terrified bulls in different festivities or stab them repeatedly until they die in a bullfighting ring," she said.

Ibarrola supports the requirement for dog owners to have liability insurance, which she says costs about €30 to €40 (US$32 to $43) a year in Spain. (Many insurance companies have wrapped such coverage into home insurance policies, Salazar noted).

Another of the changes, one perhaps most relevant to veterinarians, is allowing euthanasia only when an animal is suffering from an untreatable condition.

"This law wasn't made with any technical advice, and we're afraid that we're going to get in trouble where the situation isn't clear cut," Salazar said, offering the example of an owner who might not be able to afford treatment.  "Sometimes we get emergency cases from lower income owners that come to us, and when they ask for euthanasia just for economic reasons, we have to send them away."

Salazar said she knows of many colleagues who have ended up adopting pets from owners who couldn't afford care.

Ibarrola said if the apparent restriction on economic euthanasia isn't lifted, the law needs to be amended to address the ethical quandaries it creates.

"For example, they could make pet insurance compulsory so that everybody is able to access veterinary care — and people may think twice about having a pet if they cannot afford it," she said. "Alternatively, there should be government schemes that support veterinary practices in these type of situations."

The government department that oversees the animal welfare law, the Ministry of Social Affairs, did not respond to requests for comment.