Ticking time bomb. End of modern medicine. Urgent danger. This is how the world sees the problem of antibiotic resistance, but in the United States, in part due to politics of the day, with abundant backing from lobbyists, crucial regulations are missing despite the scientific alarms.
England’s Chief Medical Officer, Sally Davies, referred to the problem of antibiotic resistance as a “ticking time bomb” and one that poses as big of a risk as terrorism. The Director General of the World Health Organization voiced similar concerns last year when she warned that we could be facing “an end to modern medicine as we know it. Things as common as strep throat or a child’s scratched knee could once again kill.” In the United States, however, political pressure from the industry heavily invested in denying the problem produced very different results. “[F]arm and pharmaceutical lobbies have blocked all meaningful efforts to reduce the use of antibiotics in raising livestock in the United States, a practice that contributes to an increasingly urgent public health risk.”
Elsewhere in the world, in countries such as the Netherlands and Denmark, remarkable strides have been made in reducing the use of antibiotics in animal farming. As far back as 1995, Denmark became the first European country to ban all uses of avoparcin because of the concern that it contributed to vancomycin-resistant enterococci. “By 1999, all nontherapeutic use of antibiotics in pigs was outlawed—a huge change in a nation that is the world’s leading exporter of pork,” reports Environmental Health Perspectives. Similarly, the Dutch also decided to wean their animals off unnecessary drugs by implementing a new system:
Because antibiotics can only be obtained by prescription — not, as in the U.S., from a feed mill or a farm-supply store — veterinarians are the gatekeepers. In fact, farmers must register the name of the veterinarian they work with, which prevents them from shopping around. All farm drug prescriptions become part of a national database, and farms raising the same type of animal are ranked against each other to gauge how well they are doing. (This year, veterinarians will be ranked against each other as well, to reveal who is prescribing the most drugs.) Antibiotics are also rated; to prescribe the drugs most likely to stimulate serious resistance, a veterinarian must demonstrate that a susceptibility test has been performed and that no other drug will work.
In both countries, decreasing the non-therapeutic feeding of antibiotics to animals led to a decline in resistance without negative impact on the meat industry. But in the United States political will lags behind science.
Last year the Obama Administration formed a task force for combating resistance, which, while it draws further attention to the problem, is a couple of decades too late. More recently the White House released the National Action Plan to Combat Antibiotic-Resistant Bacteria. The outlined strategy appears to add little to combating the misuse of antibiotics on farms as it continues to advocate the implementation of the Food and Drug Administration’s (FDA) voluntary industry guidelines.
These voluntary industry guidelines were finally recommended by the FDA, the agency responsible for drug approval, in 2012, after nearly four decades of inactivity concerning antibiotic resistance. This FDA “action,” criticized by many, was designed to move the industry toward decreasing or limiting the use of antibiotics on farm animals. As this Pew Charitable Trust article observes, however, it has gaps that “may allow some injudicious practices to persist.” Furthermore, as the name suggests, there is little accountability when voluntary guidelines have no force of law.
Furthermore, last year the agency drew ire from consumer and environmental groups when it appealed a lower court ruling that would have a) required the agency to hold hearings to determine whether to withdraw approval for the use of penicillin and tetracyclines in animal feed, and b) required it to consider two citizen petitions urging the FDA to hold such hearings. The ruling on appeal allowed the FDA to proceed with its preferred path — the voluntary guidelines. In a dissenting opinion, the Chief Judge said the majority’s “decision allows the FDA to openly declare that a particular animal drug is unsafe, but then refuse to withdraw approval of that drug.”
Meanwhile, the stream of new investigations, reports and studies about the overuse of antibiotics, especially on animals, continues (further reports here and here). For example, this past September, a Reuters investigation revealed that “[m]ajor U.S. poultry firms are administering antibiotics to their flocks far more pervasively than regulators realize, posing a potential risk to human health.” Another Reuters investigation found that “the strength of the antibiotic ceftiofur – and the frequency with which it’s being misused on farms across America – has created a threat to human health that may overshadow the drug’s effectiveness.” Similarly, a Consumer Union’s report “concluded that the threat to public health from the overuse of antibiotics in food animals is real and growing. Humans are at risk both due to potential presence of superbugs in meat and poultry, and to the general migration of superbugs into the environment, where they can transmit their genetic immunity to antibiotics to other bacteria, including bacteria that make people sick.”