The Swedish example of food animal production without extensive use of antibiotics - or \"healthy animals do not need antibiotics\".

ObjectiveTo describe how stakeholders at different levels in food animal production in Sweden work to contain antibiotic resistance, with a special focus on poultry production. The stakeholders perceptions of antibiotic resistance and awareness of the One Health concept were also studied.\n\nMethodsThis is an interview study with thirteen informants. They represent policymakers, trade organisations, and veterinarians and farmers in the poultry industry. Interview transcripts were analysed using content analysis. The analysis continued until a latent theme emerged, and then the content was rearranged in four domains.\n\nFindingsA latent theme \"Working in unison\" emerged, based on the consistency expressed by the informants when they discussed antibiotic resistance, use of antibiotics and food animal production methods. The theme was built on four domains, representing the content of the interviews: Knowledge and engagement; Cooperation; Animal health concept; and Development in balance with economic prerequisites. The work for healthy animals started in Sweden already in the 1920-ies and continued step by step in cooperation and with support from the government. In 1986 Sweden became the first country to ban antibiotics for growth promotion. Veterinarians were considered important drivers of processes by spreading knowledge and working close to the farmers. Farmers felt involved in the development of production methods. The One Health concept was well known among stakeholders working at national level but not among veterinarians in production or farmers.\n\nConclusionsSweden has come far in work to contain antibiotic resistance in the animal sector by practicing restrictive use of antibiotics in food animal production. This practise is based on a long tradition of cooperation among stakeholders, from policymakers to farmers, and with a primary focus on animal health and welfare.