New World Health Organization report says antibiotic resistance getting worse. We need to be doing more.
Posted May 6, 2014
Last week brought yet another urgent warning from the healthcare community. The World Health Organization (WHO) yesterday released a report, noting plainly that antibiotic resistance “is a problem so serious that it threatens the achievements of modern medicine.” The WHO states that “the report makes a clear case that resistance to common bacteria has reached alarming levels in many parts of the world and that in some settings, few, if any, of the available treatments options remain effective for common infections.” Scientists agree that both human and animal misuse of antibiotics is contributing to the spread of antibiotic-resistant bacteria.
It’s clear as day: we need to be doing much more than we are to stop the rise of antibiotic resistance, including in animal agriculture. And the longer we wait to act, the worse off we’ll be.
Our decision makers have known about this escalating crisis for nearly forty years, but have made little meaningful progress. Nearly four decades ago, the US Food and Drug Administration (FDA) first determined that routine misuse of antibiotics in animal agriculture is a threat to people’s health. In the ensuing years, the problem has only worsened to the point where farm animals now account for 80 percent of the antibiotics sold in the U.S. FDA has offered up an inadequate solution unlikely to stop industry’s overuse of our live-saving medicines. Unfortunately, publications like the Los Angeles Times have hailed FDA’s announcement of industry participation in its voluntary plan a success when it is likely to result in little real change.
Yes, 25 of 26 drug manufacturing companies have agreed to participate in FDA’s voluntary program. But you have to ask why? As we have emphasized before, the reality is that drug companies and the meat industry really don’t have to change their practices much at all.
FDA’s policy has a gaping loophole, explicitly allowing the same drugs to be used in pretty much the same way under a different label. Although drug manufacturers have agreed to stop selling antibiotics for growth promotion, they can continue to sell them for a very similar use: to fend off diseases that easily proliferate in the crowded and stressful conditions of many industrial livestock facilities. Not only is the use nearly identical—low doses added to the feed of a large number of animals day after day—many of the antibiotics are approved for both kinds of uses. Pharmaceutical companies can simply continue to sell the drug under a different label, allowing problematic uses to continue.
Don’t just take our word for it. The drug manufacturers themselves have acknowledged that FDA’s program is unlikely to significantly affect levels of antibiotic use in animals. Pharmaceutical industry leaders made the following statements about FDA’s Guidance 213:
- The Animal Health Institute, the animal pharmaceutical trade association, stated: “Growth uses of medically important antibiotics represent only a small percentage of overall use, so even if all other factors are static it’s unlikely overall use would be greatly affected.” (emphasis added)
- The president of Elanco, the animal health division of Eli Lilly, was quoted in a Wall Street Journal article: “We do not see this announcement being a material event.”
- The CEO of Zoetis, another leading animal health pharmaceutical company told the Wall Street Journal that he did not expect the FDA guidance to have an effect on the company’s revenues. The New York Times reported that a spokesperson for the company said that “the new policy was not expected to have a big effect on the revenues of the company because many of its drug products were also approved for therapeutic uses.” FDA includes disease preventive uses in its definition of “therapeutic” uses.
Others have pointed out the loophole. The Economist recently noted the loophole in an article, as have pieces at Forbes.com and in the New York Times. The US Government Accountability Office (GAO) noted the overlap between growth promotion and prevention uses and pointed out how current uses can continue under the guise of prevention, citing an interview with a veterinarian. Here’s the GAO chart noting the overlap between the two kinds of uses for antibiotics that are highly or critically important for human medicine:
As the veterinarian the GAO interviewed pointed out, veterinarians employed by livestock companies can continue to dispense antibiotics for preventive uses even after growth promotion uses are discontinued, and in fact have an incentive to do so. We agree.
As a result, we find that the editorial in the Los Angeles Times was too optimistic in this statement: “In addition, the drugs must be prescribed by a veterinarian rather than sold over the counter; that will end the practice of adding them to feed.”
Unfortunately, FDA’s Guidance 213 allows exactly that: Vets can continue to authorize the administration of antibiotics to livestock on a routine basis in feed for “disease prevention.”
To protect public health, FDA should live up to its mission and limit antibiotic use to compensate for poor conditions. A false sense of success will not help us tackle our antibiotic resistance crisis.
We know solutions exist. Companies like Chipotle, Panera, and Applegate are selling meat raised without antibiotics at mainstream prices. Chick-fil-A recently announced that it is transitioning to meat raised without antibiotics in 5 years. The country of Denmark, which produces as many pigs a year as Iowa, one of the top pork-producing states in the US, has eliminated the use of antibiotics for both growth promotion and prophylactic purposes. It has actually increased production, without negatively affecting the economy, while decreasing the presence of antibiotic-resistant bacteria in animals and meat.
The WHO’s report makes the stakes clear. Stronger action is urgently needed now to preserve the effectiveness of these essential medicines so that they will work when we need them most.