In December, as COVID-19 cases were spiking again, the U.S. Food and Drug Administration (FDA) released its annual report on the volume of “medically important” antibiotics sold for use in animal agriculture. Despite the distraction of a pandemic, experts and advocates who track a different public health threat—antibiotic resistance—took note. Although ag sales of antibiotics had been steadily dropping since a peak in 2015, the report showed that for the second year in a row, the trend had reversed. Overall sales were ticking up, driven by the pork and beef industries.
“I wasn’t surprised, but I was disappointed,” said Lena Brook, the director of food campaigns at the Natural Resources Defense Council (NRDC). “The beef and pork sectors have been the highest users since the FDA started releasing species-level data . . . and we haven’t seen any new commitments [to reducing use] from producers in either of those sectors.”
In response, in January, a coalition of organizations including the NRDC issued a call for “urgent action” from the incoming Biden administration, “to act on the antibiotic resistance crisis as swiftly as it will surely act on the COVID-19 crisis” by setting a national target to reduce medically important antibiotic use in livestock and establishing a system to track it.
The call turns up the flame on an issue that’s been simmering for years, with health experts and agencies warning that the overuse of antibiotics in agriculture is a leading cause of resistant bacteria. (For the purposes of this story, all references to “antibiotics” are to “medically important antibiotics” only.)
The danger is obvious: If antibiotic-resistant bacteria infects humans more often, once-minor health issues could become life-threatening. The World Health Organization (WHO) identifies antibiotic resistance as “one of the biggest threats to global health” today, and a 2019 Centers for Disease Control (CDC) report found antibiotic-resistant bacteria cause 2.8 million infections and 35,000 deaths annually in the U.S. The CDC’s numbers did show an 18 percent decrease in deaths over the six years since its initial 2013 report, as a result of actions that have been taken to curb overuse in both healthcare and agriculture. But other estimates of deaths attributable to antibiotic-resistant bacteria are much higher.
A 2015 National Action Plan to combat antibiotic resistance produced by the Obama White House identified curbing “misuse and overuse” of antibiotics in food production as a primary goal, and policies since have strengthened veterinary oversight and outlawed the use of antibiotics strictly for growth promotion. But agencies have not banned their use for disease prevention, so the majority of pork and beef producers continue to administer them to all of their animals regularly in food and water. “It just so happened that many of the medically important antibiotics that were approved for growth promotion are still approved for prevention in very much the same way, on a routine basis,” said Matthew Wellington, public health campaigns director for U.S. PIRG, a public interest advocacy group. “It’s basically like plugging one leak in a very leaky tub.”
To be clear, the FDA’s data shows sales of medically important antibiotics for use in animal agriculture have dropped 25 percent overall since 2010. But NRDC calculates that 65 percent of the antibiotics sold in the U.S. are still for use in animal agriculture. And while tracking has been vastly improved in healthcare, data on how livestock producers are using antibiotics is spotty and incomplete.
Industry representatives say meat producers only use antibiotics strategically for animal health and that overuse is a problem manufactured by anti-meat advocates. But the slight uptick in the last two years mirrors trends seen in European countries that banned growth promotion earlier, and other data clearly shows routine use in feed and water is still the norm in pork and beef production. According to public health experts, any widespread, routine antibiotic use presents a public health threat, and current levels are not sustainable. “The pace of change is too slow given how scary the antibiotic resistance health threat is,” Brook said. “It’s another global health pandemic that we’re living through . . . it’s just unfolding at a much slower pace than the tsunami that hit us with COVID.”
Antibiotic Use in Pork and Beef Production
Accurate, consistent data on medically important antibiotic use in animal agriculture does not exist, so the only option is to piece together numbers that add up to a partial picture. The FDA tracks sales data, and what we know is that overall sales rose between 2010 and 2015 and then dropped considerably in 2016 and 2017. Experts attribute that change to a confluence of two factors: a massive reduction in antibiotic use in poultry and the FDA’s prohibition of antibiotics used solely for growth promotion overall, which was in the works in collaboration with industry throughout 2016. While numbers did tick up in 2018 and 2019—3 percent compared to 2018 and 11 percent compared to 2017—they are still significantly below 2010 levels.
The sales increases were primarily caused by a 9 percent increase in pork production and a 1 percent increase in beef production. During that time, sales to the poultry industry continued to fall drastically, as companies responded to consumer demand for antibiotic-free chicken. In 2019, industry data showed nearly 60 percent of chickens raised for meat were raised without antibiotics.
And since the FDA started collecting species-specific data in 2016, antibiotic sales for cattle and pigs have dropped by 30 and 18 percent, respectively. In an email response to Civil Eats, Anne Norris, a representative from the FDA’s Center for Veterinary Medicine, said the more recent increase is “not necessarily noteworthy on its own,” in the context of the larger downward trends, and that it’s the third lowest number on record, after 2017 and 2018. “FDA’s actions over the last several years . . . have fundamentally changed the way animal producers obtain and use medically important antimicrobials in food-producing animals,” Norris said.
Lance Price, a professor at George Washington University, has been studying antibiotic resistance since 2003 and co-founded the Antibiotic Resistance Action Center. He said that, over the last several decades, the FDA has “made steady, incremental progress in terms of limiting which drugs can be used in animal production in an attempt to control resistant infections in people,” such as drastically limiting the use of cephalosporins, drugs critical to treating pneumonia, strep throat, and other common infections, in 2012.
On the industry side, Liz Wagstrom, chief veterinarian for the National Pork Producers Council (NPPC) also pointed to the longer-term decreases in pork since the “high point of 2015” and attributed the recent uptick to overall industry growth. “From 2018 to 2019, the number of hogs marketed in the United States grew by 4.5 percent and weights also increased,” Wagstrom said.
Neither the North American Meat Institute nor the National Cattlemen’s Beef Association agreed to comment for this article.
Wagstrom pointed to the fact that the FDA data only shows sales estimates, but producers are not required to track actual use. The FDA has worked with the U.S. Department of Agriculture (USDA) on limited studies using voluntary data. The USDA chose a sampling of cattle feedlots and hog farms and conducted surveys on those operations’ antibiotic use during 2016, and results from these two different projects provide some insights, although they were completed before the rules prohibiting use for growth promotion went into effect.
Overall, the reports show widespread routine antibiotic use in feed and and/or water. In its report on cattle, the agency found 56 percent of feedlots administered medically important antibiotics in feed; among large feedlots, 78 percent did. Drugs were used primarily for growth promotion, respiratory disease, and liver abscesses (which form because cattle are not meant to eat grain). The most commonly used drugs were tetracyclines, characterized as highly important for human medicine by WHO, and tylosin, which is in a class deemed critically important. The USDA also found that 41 percent of the feedlots that reported using antibiotics in feed never recorded the use. In its survey of pork production, the USDA found 94 percent of farms gave their pigs medically important antibiotics in their feed and/or water. Tetracyclines, penicillin, and other drugs were most often administered for growth promotion, respiratory disease, and/or diarrhea. In the pork industry, the agency found record-keeping was much better.
Separate FDA studies, published last year as a package of research looking at antibiotic use in agriculture, looked at 2016 and 2017 records from feedlots and large hog operations and found similar trends. Nearly all of the drugs were given in food and water, suggesting that treating individual sick animals accounts for a tiny fraction of use.
The NPPC disputes that characterization. “Medically important antibiotics are used when animals are sick or known to be at risk of disease outbreaks. This is done under the direction of veterinarians after careful consideration of the clinical history of farms and results of diagnostic workups,” Wagstrom said. “This is not a routine use but rather, when needed, antibiotics are utilized strategically to protect animal health and welfare to allow us to send healthy animals to market.”
Advocates say data like this—together with examples from other countries that have effectively ended routine preventative use in similar industrial systems—shows that producers are using antibiotics to address flaws in the system rather than fixing the system, which would cost more up front. They say that if cattle feed is causing widespread liver abscesses, for example, the feed should be changed rather than adding antibiotics to it. If pigs get infections because of exposure to waste in barns, the management style should be changed (to give animals more space or to add bedding to the barns, for example) rather than putting antibiotics in their water.
Finally, they point to the fact that the numbers show that the ban on antibiotics for growth promotion has not led to more responsible, targeted use of important drugs because of the prevention loophole.
“If your business model is to add low doses of antibiotics to animal feed to increase feed efficiency—and maybe also to fight off infections, but mostly to increase feed efficiency—and the prescriptions on the bag for preventing disease and for promoting growth are exactly the same for a third of the drugs, then you just change what you call it,” Price said.
Why Does Antibiotic Use in Barns and Feedlots Matter?
Like viruses, bacteria have the ability to mutate. As more antibiotics are used, especially for long periods of time in high volumes in animals, they can mutate to resist those antibiotics. That new bacteria, now resistant to the antibiotic, can then be passed to humans—in the meat itself, through workers on farms, or through the environment, when manure is spread on fields or scattered along highways as animals are trucked to slaughter.
Between 2005 and 2008, Bob Martin, the food system policy director at Johns Hopkins Center for a Livable Future, directed the Pew Commission on Industrial Farm Animal Production, a comprehensive, independent assessment of the meat industry’s impacts on the environment, public health, and more. In addition to zoonotic viruses, the top veterinary experts and physicians involved in the commission identified antibiotic resistance as one of the biggest public health threats posed by industrial agriculture.
The commission was not concerned with targeted antibiotics given to sick animals, a practice most experts agree is responsible, just as it is in humans. They were concerned with “subtherapeutic” doses that are given to animals on a regular basis to prevent illness and promote growth. “The logical conclusion we reached was that this low-level daily use [of antibiotics] in farm animal production in these large operations was the main driver of antibiotic resistance in the country, and that there was evidence of it . . . causing resistant infections in people,” Martin said.
Methicillin-resistant staphylococcus aureus (MRSA), for example, can cause staph infections that are difficult to treat and is classified as a “serious threat” to human health by the CDC. In 2017, it caused an estimated 323,700 hospitalizations and 10,600 deaths. Many studies have found that pigs and pig farmers in industrial systems carry MRSA, but the prevalence varies considerably from study to study, and workers often carry the bacteria without falling ill. A 2016 analysis found multidrug-resistant staph bacteria in surface water near fields sprayed with waste from industrial hog farms in North Carolina; a March 2021 study that examined the same region found evidence of multidrug-resistant strains spreading between pigs, farmworkers, and residents there. Another study published in JAMA in 2013 looked at patients in a Pennsylvania health care system and found “proximity to swine manure application to crop fields and livestock operations each was associated with MRSA and skin and soft-tissue infection.”
The bacteria associated with urinary tract infections (UTIs) have also become increasingly resistant to antibiotics, and one 2018 study published by the American Society of Microbiology found that strains of E. coli that were causing UTIs in people matched those found in commercial poultry flocks. Based on the results, the lead researcher said “we can more confidently say that the E. coli went from poultry to people and not vice versa,” as a result of individuals eating contaminated meat.
Regulation and Policy Fixes
The 2017 rule change that ended the routine use of medically important antibiotics exclusively for growth promotion and moved other uses under veterinary oversight was the most significant action the FDA has taken to address animal agriculture’s contribution to antibiotic resistance to date. The issue, Price and others said, is that the rule did not go as far as banning the routine use for prevention (as opposed to treatment) and many of the drugs used in the two cases are the same.
Price pointed to one particular chart in the December FDA report to support the assertion that many producers likely continued using the same antibiotics but began characterizing the use as disease prevention only. In 2017, when the sales of drugs for growth promotion officially disappeared, the sales of drugs for “therapeutic indications only” doubled.
“There is an [overall] decrease, so we’ll give them credit for that,” he said. “But that jump in that purple line is, I think, just a business decision to continue doing what they were doing.” (NPPC interprets the graph as showing the portion of producers that were solely administering for growth promotion ended, but those that were also using antibiotics for both purposes—growth promotion and disease prevention—continued using them for prevention.)
Lena Brook and her NRDC colleague David Wallinga, the author of a 2020 NRDC report on antibiotic use in beef production, said it was telling that countries that had followed an earlier policy arc followed a similar path in terms of sales trends. When the Netherlands banned the use of medically important antibiotics for growth promotion, sales dipped but then slightly increased in subsequent years. But when the government then also banned routine use for disease prevention, sales were cut in half over the next four years.
Because the Netherlands and Denmark both have large industrial pork industries and are now operating with medically important antibiotics approved only for treatment, Wallinga said they provide illustrative examples for what is possible in the U.S.
“There is no reason to think that a lot of the best practices that they have come up with couldn’t be replicated here. The FDA and the U.S. industries like to say differently, but I just don’t think they have a leg to stand on from a scientific standpoint,” said Wallinga. But, he adds, “these enormously powerful companies would have to [stop] raising animals in ways that were designed for maximum economic output and not designed to optimize the health of the animals or to avoid antibiotic use.”
Wallinga and several others said that while there are still many European countries using medically important antibiotics in animal agriculture at high rates, the E.U. has made more progress in reducing use overall. (According to NRDC numbers, for example, beef producers in the Netherlands use an estimated 50 mg of antibiotics per kg of livestock, compared to 162 mg in the U.S. Pork producers in the U.K. use 183 mg per kg of pig vs. 338 kg in the U.S.) And next year, a new E.U. law completely prohibiting the routine use of medically important antibiotics for prevention will go into effect.
Price says a similar ban on preventative use should be top priority in the U.S. too. But that’s unlikely to happen anytime soon. Instead, the Antibiotics Off the Menu Coalition is calling for more modest—but still lofty—goals: the establishment of a true tracking system that accounts for all use at the farm level and a quantitative federal goal to reduce medically important antibiotic use in animal agriculture by 50 percent by the end of 2023.
In the meantime, U.S. PIRG and other groups are also working to push the FDA toward requiring drug companies to reduce the legal window when antibiotics can used in livestock.
“We know that typically, less is better,” Wellington said. Currently, there are 89 approved drugs that can be given to animals continuously, without time limitation. The FDA has started the process of establishing duration limits and is accepting comments on a draft of a potential framework for doing so until June 11. But many of the proposed changes give companies broad discretion and would not go into effect for six years or more. “The concept paper is incredibly disappointing,” he said. “We’re asking for a much quicker timeline and to have it be focused on real duration limits that we know will help curb antibiotic resistance.”
States are also moving forward with enforcing stricter laws within their borders. California’s law that eliminated low-dose use of medically important antibiotics for prevention and required veterinary oversight for all therapeutic uses went into effect in 2017. Maryland passed a similar law in 2017, and it was updated in 2019 to ensure that routine preventative use would be eliminated. Its Department of Agriculture is now collecting and reporting real data on farm-level antibiotic use in an unprecedented way.
In addition to the Netherlands and Denmark, these states could serve as proving grounds for what the next level of reduction would mean for producers and the meat industry. “People are doing it all around the world. The models exist. It’s just that our current model of production is not conducive to it,” Price said. “But if by design your system makes the animals sick, you should probably change the system.”
civileats.com, 27 April 2021