Antibiotic resistance is the number 1 looming health crisis that barely anyone has heard of. Picture this: you get an infection, go to the best-stocked and best-staffed hospital and are given medicine after medicine, with no effect whatsoever. So you die, despite access to the best medical care available. According to the WHO, this is not completely dystopian:
“Without urgent, coordinated action, the world is heading towards a post-antibiotic era, in which common infections and minor injuries, which have been treatable for decades, can once again kill.”
The main culprit that may cause this dystopian scenario is the overuse of antimicrobials in animal farming.
80% of the antibiotics in the US and Canada and 45% in the UK are for animal use. They are mostly sold over the counter, without oversight, and self-administrated through feed or water, which makes it hard to control doses. At low doses, it is easy for resistant bacteria to emerge through genetic selection. Similar to the concept of vaccination, the low dose does not kill all bacteria at once, but rather allows the micro-biome to adapt to the new reality. The more animals are exposed to this medicine, the more likely resistance: each animal basically constitutes its own petri dish of Darwinian selection.
There are plenty of ways such resistant bacteria then cross over into the human world: through contact by farm workers or their families, through residues on the food itself, or through the environment, as most antibiotics and bacteria are expelled through manure which is then sprayed on fields and enters the soil and waterways. These new bacteria hubs are still understudied, but bear considerable risk. In particular, we know that bacteria can exchange genes while staying the same otherwise. Thus, bacteria that only affect animals might share their resistance with new pathogens that can be passed between humans.
It is therefore of supreme importance that we do not use the same antibiotics in humans and animals. Yet, that is exactly what happens: a global review found that of the 51 antimicrobials most used in aquaculture and agriculture, 72% were ranked as ‘highly’ or ‘critically’ important by the WHO.
Legislation on this issue has been rather teethless in most regions of the world. In 2014, the WHO conducted a global survey and found that out of 133 countries, only 34 had a comprehensive strategy to preserve antibiotic effectiveness. Even less specifically mention regulating animal agriculture use in them.
There have been some advances: growth-promoting antibiotics have been banned in the EU since 2006, Brazil and India require veterinarians’ prescriptions for the use of such drugs, and China and Russia only allow the use of antibiotics that are not used in humans. However, in the latter cases, enforcement has been lax.
The EU experiment in turn has shown that bans after years of considerable use may be too little too late, as resistant strains have continued to survive in the environment.
Yet, the US takes the cake when talking about insufficient regulation: a highly publicized reform effort (the US FDA’s Guidance for Industry #213) only produced a non-binding and nonenforceable recommendation that pharmaceutic companies should revise their labels and that veterinarians should oversee the use mainly for disease prevention purposes. Still, in many cases the growth-promoting and disease-preventing doses overlap, giving farmers considerable leeway to continue their current practices even while following the recommendation to the letter. Meanwhile, a much more effective regulation, PAMTA (the Preservation of Antibiotics for Medical Treatment Act), has languished in Congress. Rep. Louise Slaughter, the only microbiologist on the Hill, has introduced the bill 5 times so far (in 2007, 2009, 2011, 2013, and 2015). Industry opposition has never even allowed its consideration on the floor.
Maybe the tides have started to change, however. Two days ago, an influential group of London-based investors published an open letter urging fast food companies to desist from using meat that was produced with antibiotic use. Calling it a threat to firms’ reputations considering increased public awareness, they forced immediate and defensive responses from companies such as McDonalds, Burger King, and Domino’s Pizza. Many of them said they were already reviewing their supply chain policies regarding the use of antibiotics. We might be able to watch industry change in real time as people start waking up to the possibility of the ‘apocalyptic scenario’ of antibiotic resistance, to use the words of Great Britain’s chief medical officer.
Did you know about the extensive use of antibiotics in livestock farming? Are you worried about the risk of antibiotic resistance?
Quick note: I am back after quite the hiatus! Work has kept me pretty busy, but also given me a wealth of topics to write about, including this post – hopefully I will be able to update more frequently these coming months. Thanks for continuing to read!