Long Overused, High-Level Livestock Antibiotic Sales Persist

Despite a decade of claimed progress, sales of medically important drugs remain stubbornly high, underscoring what increasingly appears to be the FDA's failed approach.

According to newly-released FDA data, annual U.S. sales of medically important antibiotics for food-producing animals were 8 percent higher in 2020 than in 2017, when a de facto FDA ban on antibiotics for growth promotion finally took effect. It is one more piece of evidence that federal action has stalled to curb the spread of drug-resistant superbugs, and the antibiotic overuse that fuels it.

Unfortunately, the FDA’s reporting obscures a key part of the story. The FDA points out that sales fell from 2016 to 2020, but in the years since growth promotion ended, the trend has mostly been upward. 2020 sales are higher than they were in 2017, for livestock production overall and for every major sector, apart from chicken. The rise in overall sales from 2017 is mostly explained by higher sales for pigs, which rose from 2.02 million kilograms in 2017 to 2.45 million kilograms in 2020.

My colleague, Avinash Kar, began warning about an enormous loophole that FDA left in place almost as soon as the 2017 growth promotion ban took effect. That loophole allows many drugs previously used as growth promoters to continue being added to animal feed at similar levels and for similar durations of time under the guise of “disease prevention”. In 2020, 92 percent of all medically important livestock antibiotics sold for food-producing animals were given to entire entire flocks or herds in their feed or drinking water. The use of preventive antibiotics in flocks or herds where no animals are sick is strongly discouraged by the World Health Organization, and will largely be illegal across Europe starting next month.

Implications for U.S. Federal Policy

Globally, antibiotic overuse in medicine and in livestock production are the two major drivers of spreading antibiotic resistance. Resistance makes treatment of even common pneumonias, UTIs, and other bacterial infections more likely to fail, which in turn means sicker patients and more deaths. 

A decade ago, the FDA acknowledged the public health imperative to curb antibiotic overuse in livestock production, and mounted a campaign to encourage “judicious” use of these precious medicines. This effort did lead to the ban on growth promotion, but has not catalyzed other much-needed and more comprehensive reforms around antibiotic use on farms. The FDA continues to hide behind faux signs of progress without implementing more concrete and urgent measures to actually curb antibiotic overuse. No concrete limits have been set on how long these precious medicines can be used in livestock, for example. And for decades, FDA has failed to create a system to collect antibiotic use data at the farm level, which is essential for verifying whether that use is “judicious”, or not. Finally, as already noted, the FDA never closed the enormous loophole that allows antibiotics to be routinely used in animal herds for disease prevention when no disease has been diagnosed.

FDA’s efforts pale in comparison to work done over the last decade or more by its counterpart in the European Union, the European Medicines Agency (EMA). In November, the EMA published livestock antibiotic sales data for 2019 and 2020. EMA showed those sales were 43% lower in 2020 than in 2011, adjusting for the calculated weight of the animal population to which those drugs were likely administered. By that weight-adjusted measure, the decline in European sales has been far more impressive than the 27% decline in U.S. sales (not weight adjusted) over the same period (from 8.26M kilograms to 6.00M kilograms).

In 2017, the FDA said it was moving toward weight-adjusted reporting of U.S. sales, but then never followed through. Absent FDA leadership, we have made those calculations, using the EMA methodology. Next month, we plan to issue a new issue brief that compares in more detail weight-adjusted sales data for both the U.S. and Europe.

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