Today’s Washington Post story about superbugs spreading through chicken should give us all pause. The backdrop to the story is a high level UN meeting to address antibiotic resistance. This is only the fourth time the UN has addressed a health issue, underlining the gravity of the antibiotic-resistance threat.
Dr. Margaret Chan, director general of the World Health Organization, called antimicrobial resistance “a serious threat to human health, development and security.”
Chan said the commitment countries are making needs to be turned into rapid and effective action. “Hurry up,” she said.
STATNews, September 21, 2016
Disappointingly however, as noted by my colleague, David Wallinga, the meeting emerged with anemic recommendations, particularly on the use of antibiotics in raising poultry and livestock. Closer to home, the US regulatory backdrop to that story has also been one of anemic action. California has the potential to change the US story, but the realization of that potential will depend on the implementation of its US-leading new law on livestock antibiotics.
Why does all this matter?
As we have now heard from numerous experts and medical and health authorities, the overuse and misuse of antibiotics in both human and animal medicine is putting the continued effectiveness of these life-saving medicines at risk. The Centers for Disease Control and Prevention (CDC) conservatively estimates 2 millions illnesses and 23,000 deaths associated with antibiotic resistant infections, and has affirmed that animal use of antibiotics is contributing to the spread of resistance and harm to human health. Many other groups including the American Academy of Pediatrics and the World Health Organization have called for action to eliminate the routine use of antibiotics on animals that are not sick, in part because livestock sales constitute over 70% of sales of antibiotics that are important for human medicine.
In practice, more antibiotic resistance means that it’s more likely that essential medicine won’t work when we need them. It means longer illnesses, more hospitalizations, and more deaths. It means higher costs (estimates put the cost to the US economy over $55 billion annually). It means a lot more pain and suffering.
The science shows that resistant bacteria spread from farms to people in multiple ways: through air, water, soil, workers, transfer of genetic material between different bacteria, and meat. The story in the Washington Post today is about a new study that indicates that antibiotic-resistant bacteria, specifically MRSA (methicillin resistant staphylococcus aureus), likely spreads via the handling and consumption of contaminated chicken. This study adds to many others which collectively show that many different kinds of bacteria can travel from farms to communities via poultry and cause illness in people. Routine use of antibiotics on farms exacerbates the problem because it promotes the proliferation of more antibiotic resistant forms of these bacteria, which can lead to infections that are more difficult to treat.
What needs to be done and what is being done?
Addressing the problem requires action to reduce the human overuse of antibiotics, of course. And it’s heartening to see the President’s National Action Plan set concrete quantitative goals for the reduction of antibiotic overuse in medical settings and for the collection of better data.
No such specifics have emerged, however, for addressing the livestock use of antibiotics, which constitutes more than 70% of the sale of medically important antibiotics. This is in spite of the fact that we have great working examples in Denmark and Netherlands, which have reduced antibiotic use by huge percentages without ill effect. Instead, the National Action Plan relies on a voluntary and ineffective FDA approach that cannot succeed in significantly reducing livestock antibiotic use because it fails to grapple with the overwhelming majority of livestock use, as my colleague Jonathan Kaplan notes. This is why NRDC and several other groups recently petitioned FDA to act on the science and move to stop the routine addition of antibiotics to the feed and water of animals that are not sick.
There have been a number of good commitments in the chicken industry and fast-food chains serving chicken (come on, KFC!), but there is still a long way to go, especially with other meats, and we still need meaningful and effective government action.
In California, the story has the potential to be brighter. Last year, the Governor signed into law a strong new approach that prohibits the regular use of antibiotics on animals that are not sick starting in 2018. The law also directed the state’s Department of Food and Agriculture to monitor the use of antibiotics in livestock. The Department says action is forthcoming soon. Much depends on a good plan to collect the data necessary to better characterize livestock antibiotic use and target improvements where they are most needed. We await the details.