Antibiotic resistance is a growing threat to public health, and doctors – whether ones who treat people or animals – must do their part to help address the problem. But most media stories and advocacy groups only focus on animal agriculture, usually claiming that on farms antibiotics are being abused or that there’s some failure to regulate their use. But neither is true.
In pointing the finger of blame at farmers, some salient facts tend to be (purposefully?) omitted, including that more than a third of the antibiotics used in food animals are in classes that are not used in human medicine and that another third are in classes that are not considered highly or critically important to human medicine.
And while it’s true that about “three-quarters” of all antibiotics are used in animals, including pets, it stands to reason that that’s the case given there are at least 10 times more animals than people. In 2011, for example, 30 million pounds of antibiotics were sold for use in more than 3 billion livestock and poultry, compared with 7 million pounds for 311 million people, meaning each person used nearly five times more antibiotics than were used in each food animal.
The most-important rarely mentioned fact: Numerous risk assessments, including one from the U.S. Food and Drug Administration, have demonstrated a negligible risk to public health from antibiotics used in food animals.
Despite those truths, over the last 15 years, there have been several regulatory actions taken related to the use of antibiotics in food animals. In 2003, FDA initiated a risk assessment requirement for approval of all new animal drugs, focusing on the potential threat to public health from antibiotics used in food animals. If the risk of using a particular antibiotic was found unacceptable, the drug either was not approved or approved with significant marketing limitations. Since then, FDA has acted on two antibiotics used in food-animal production that are critically important in human medicine. Based on antibiotic-resistance surveillance data, the agency withdrew approval of fluoroquinolones for use in poultry and banned the extra-label use of cephalosporins.
In 2013, FDA published Guidance for Industry 213, requiring pharmaceutical manufacturers to stop selling antibiotics important in human medicine labeled only for promoting growth and to put all other therapeutic uses under veterinary oversight. In fact, animal health companies have done that, and it now is illegal for farmers and their veterinarians to use those antibiotics to promote growth. (Claims that they’re still using those antibiotics at growth promotion levels but calling it prevention are unfounded and, quite frankly, offensive to farmers and veterinarians.)
Farmers and their veterinarians use antibiotics when clinical evidence and diagnostic testing has proved they are needed and will be beneficial, and they use scientific data and knowledge of herd health to support their selection of antibiotics and when best to use them. The bottom line is antibiotics use in food-animal medicine is highly regulated and restricted to uses FDA considers to be judicious.
The pork industry, however, hasn’t focused only on complying with regulatory actions. Not only were swine veterinarians the first to develop species-specific guidelines for the judicious use of antibiotics, the Pork Checkoff developed similar guidelines for hog farmers. The guidelines have been updated several times and now are included in the industry’s Pork Quality Assurance Plus Program. Nearly all major pork packers require their farmer-suppliers to be certified in the program, which has evolved from education-only to include an on-farm assessment and is consistent with the Common Swine Industry Audit.
Additionally, hog farmers and veterinarians do everything they can to take the best possible care of their animals to reduce the need for antibiotics. This includes such things as paying careful attention to cleaning and disinfecting barns, employing timely vaccination of piglets susceptible to illness and making sure animals are kept warm and dry while preventing potential exposures to diseases.
While food-animal farmers struggle to improve their uses of antibiotics so they can produce the safest food possible, there are also challenges with antibiotics use in human medicine. Medical practitioners and the Centers for Disease Control and Prevention (CDC) realize that inappropriate prescribing, such as for certain ear or respiratory infections, contributes to antibiotic resistance and less-than-optimal outcomes. Poor patient compliance, including utilizing old antibiotics from an unfinished course or flushing unused antibiotics down the toilet, also can contribute to resistant bacteria in people and the environment.
In fact, the CDC’s report “Antibiotic Resistance Threats in the United States, 2013” identified 18 bacteria-specific resistance threats that, collectively, comprise the public health problem known as antibiotic resistance, but only two of those had food from animals as a potential source. Similarly, the World Health Organization’s “Antibiotic resistance: global report on surveillance 2014” focused on pathogens not related to foodborne infections from food animals.
The issue of antibiotic resistance isn’t as simplistic as some would have us believe; it’s certainly complicated enough that responsibility for the development of resistance can’t be placed only – or even mostly – on animal agriculture.
We suggest a One Health approach to addressing the resistance issue. Those in the medical community need to work cooperatively to conserve antibiotics through their careful use in animal and human health to minimize the risk of antibiotic resistance to humans, animals and the environment. Pork producers are committed to doing just that.
Livestock and poultry farmers long ago accepted that they must do their part to address the threat of antibiotic resistance, but there are two things they won’t do: take all the blame or abandon their moral responsibility to treat sick animals and produce safe food.
Banner image credit: Wikipedia.
Dr. Liz Wagstrom is the chief veterinarian for the National Pork Producers Council. Liz was featured in our “Stopping Superbugs” partner series with Paul Solman for the PBS NewsHour. Views expressed are her own.