The One Health practice in Sweden that has been adopted in the United States is the highly restrictive policy governing the use of antibiotics in animal agriculture. This practice specifically involves banning the use of medically important antibiotics for promoting animal growth and mandating veterinary oversight for all remaining therapeutic applications. Adopting this approach is a direct response to the global threat posed by antimicrobial resistance, where drug-resistant bacteria can pass from livestock to people. This Swedish model provided an early, real-world example proving that a major agricultural sector could successfully reduce its reliance on these medicines.
Pioneer Approach to Antibiotic Use in Livestock
Sweden’s journey toward antibiotic stewardship began decades before most of the world recognized the problem of antimicrobial resistance (AMR). In 1986, Sweden became the first country globally to institute a ban on the use of antibiotics for growth promotion in food-producing animals. Before this landmark decision, antibiotics were routinely mixed into animal feed at low, sub-therapeutic doses. The ban immediately ended this practice, forcing the agricultural sector to prioritize animal health and hygiene over routine medication.
The immediate aftermath of the 1986 ban was not without difficulty, particularly in the production of young pigs and broiler chickens. Farmers reported clinical problems like increased post-weaning mortality in piglets and outbreaks of necrotic enteritis in poultry, which the low-dose antibiotics had unintentionally been preventing. This demonstrated that the drugs were compensating for suboptimal animal management and housing conditions. The response involved significant industry-wide efforts to improve housing, hygiene, and overall herd management practices.
After the initial adjustment period, the comprehensive strategy led to a dramatic reduction in overall antibiotic consumption. By 2001, the total use of antibiotics in Swedish animals had decreased to about 34% of the level recorded in 1984. This reduction was achieved through a dual approach: eliminating non-therapeutic use and establishing a strict system where all remaining antibiotic use—for treating sick animals—required a veterinary prescription. The result has been one of the lowest sales of veterinary antimicrobials in Europe and a comparatively low prevalence of antimicrobial resistance in Swedish livestock.
The One Health Framework for Managing Drug Resistance
The Swedish model’s success is a practical demonstration of the One Health framework in action, specifically targeting the spread of AMR. Antimicrobial resistance arises when bacteria evolve to resist the drugs designed to kill them, accelerated by the overuse or misuse of antibiotics across all sectors. When antibiotics are used to promote growth or to prevent disease in healthy animals, they create an environment that selects for resistant bacteria within the animal population.
Resistant bacteria or the genes that confer resistance can move from the farm environment to affect human health through multiple pathways. One common route is through the food supply chain, where resistant pathogens contaminate meat or other animal products. Environmental transmission also occurs when animal waste is used as fertilizer or runs off into water sources and soil. This multisectoral spread means that action in one area, such as animal agriculture, has measurable benefits for human and environmental health.
The One Health approach advocates for a coordinated, cross-sectoral effort, recognizing that human medicine alone cannot solve the AMR crisis. The Swedish experience provided concrete evidence that reducing antibiotic use in livestock successfully limited the opportunity for resistance to emerge and spread. This success protected the efficacy of human medicines and provided justification for other nations, including the United States, to pursue similar regulatory changes.
Regulatory Transfer and Implementation in the US
The United States adopted the core principle of the Swedish model—ending the non-therapeutic use of medically important antibiotics—through the Food and Drug Administration’s (FDA) implementation of the Veterinary Feed Directive (VFD) rule. The VFD became fully effective in January 2017, fundamentally changing how antibiotics could be used in US food-producing animals. It specifically targeted antibiotics that are also important for treating human infections, classifying their use for growth promotion as an injudicious practice.
The new regulation effectively eliminated the use of medically important antibiotics for enhancing production in livestock, mirroring the 1986 ban in Sweden. Furthermore, all remaining therapeutic uses of these drugs when administered through feed or water were placed under the mandatory supervision of a licensed veterinarian. This requirement established a formal Veterinary-Client-Patient Relationship (VCPR), ensuring that antibiotics were only used when an animal was genuinely sick or at risk of disease.
Unlike Sweden’s immediate ban, the US approach involved a voluntary compliance framework with the pharmaceutical industry to phase out the growth promotion indications on drug labels. Despite this difference in implementation, the VFD achieved its goal of promoting judicious use. In the year following the VFD’s full implementation, sales and distribution of medically important antibiotics for use in US livestock saw a significant decline, falling by 33% between 2016 and 2017.