Antibiotic-resistant bacteria have become a massive health problem worldwide, killing thousands of people every year and prompting calls to phase out the unnecessary use of antibiotics on farm animals and in people. After all, the more often these drugs are used, the more quickly bugs outsmart them — rendering them useless.
Now Tyson Foods — the biggest chicken seller in the US — is trying to tackle the problem of antibiotic resistance, announcing today that it plans to eliminate the use of human antibiotics in its flocks by 2017. The pledge comes nearly two months after McDonald's announced that within two years it will stop buying chicken that has been reared on antibiotics meant for humans.
Given that these are some of the largest food companies in America, the moves could have a major impact on how animals are reared, and on consumer expectations.
But they're still only small steps in addressing a big problem. Despite dire warnings about the health impact of antibiotic-resistant bacteria, the issue is mostly abstract for many, industry has blocked efforts by governments to tackle it, and related legislation has repeatedly flopped. We continue to abuse and squander one of the greatest and most life-saving gifts science has bestowed on us. The lack of action is baffling and only makes the problem of antibiotic resistance more terrifying.
1) Superbugs could soon kill more people than cancer
There are billions of bacteria that live in and around us, most of which help us survive and thrive. But sometimes we are exposed to bacteria that can make us sick. Antibiotics are chemicals from organisms in the world around us that can kill off these harmful microbes. In addition to curing us when we're ill, these wonder drugs revolutionized medicine and changed the scale of modern food production.
But the use of antibiotics has a major downside: the more we consume them, the more quickly they stop working. Since Alexander Fleming discovered the first antibiotic (penicillin, in 1928), he and many other scientists, public health officials, and doctors have been sounding alarm bells over "antibiotic resistance."
Antibiotic resistance refers to a natural phenomenon that happens in response to the medicine. Bacteria multiply by the billions, and typically a few will randomly develop a mutation in their DNA to outsmart the pharmaceuticals designed to kill them. This situation is magnified by the fact that we overuse antibiotics and often take them in incorrect doses. When we don't finish a course or when we give them to animals in very low doses to fatten them up, we create environments in which the weakest bugs are killed off but the strongest "superbugs" survive.
In recent years, this misuse has sped up the natural process of resistance, rendering some antibiotics useless and causing experts to warn that we are at the "dawn of a post-antibiotic era" that amounts to a health "nightmare" and "catastrophic threat" on par with terrorism.
In the US alone, antibiotic-resistant infections are associated with 23,000 deaths and 2 million illnesses every year. We’ve already seen a number of bacterial infections — gonorrhea, carbapenem-resistant enterobacteriaceae (or CREs), strains of tuberculosis — that no longer respond to any of the drugs we have.
Overusing antibiotics also kills off the good bacteria in people’s bodies, potentially wreaking havoc on our microbiomes and weakening our immune systems. This means more people get sick, stay sick for longer, and die from resistant infections that we have no cure for — while the costs of treatment of antibiotic resistance go up.
A recent report commissioned by the UK government contains an alarming prediction: by 2050, antimicrobial-resistant infections will kill 10 million people across the world — more than the current toll from cancer.
This nightmare scenario isn't that far-fetched for one simple reason: we keep failing to muster the action needed to stave it off. There has been an incredible amount of inertia in medicine, and the agricultural sector has for years denied the science for economic and political reasons.
2) Medicine would be undone without antibiotics
It's not an overstatement to say that most of modern medicine hinges on the effectiveness of antibiotics. Whenever you go to the hospital for an operation — a hip replacement, an ACL repair, heart surgery — almost without exception, doctors will give you a dose of antibiotics to prevent infection. Antibiotics also make the cesarean section, one of the single most life-saving procedures on the planet, possible.
Without antibiotics that work, common medical procedures like hip operations, C-sections, or chemotherapy will become more dangerous, and some medical interventions — organ transplants, chemotherapy — will be impossible to survive. In one piece, science writer Maryn McKenna describes a world before antibiotics and what we'll face again when the ones we have fail:
Before antibiotics, five women died out of every 1,000 who gave birth. One out of nine people who got a skin infection died, even from something as simple as a scrape or an insect bite. Three out of ten people who contracted pneumonia died from it. Ear infections caused deafness; sore throats were followed by heart failure.
"It’s almost unimaginable," said professor Kevin Outterson of Boston University School of Law, "how going back to a pre-antibiotic era would affect US health care." Jirka Taylor, an analyst at Rand Corporation, said, "If you had a 5 percent chance of contracting an infection that had a 40 percent case fatality rate, would you still be interested in submitting to a relatively mundane procedure such as hip replacement, when your survival did not depend on it?"
3) We’re making the problem worse by misusing antibiotics
More often than not, we use antibiotics incorrectly and unnecessarily. In agriculture, farmers use small doses on animals to promote growth and to prevent infections (not treat them); in hospitals and clinics, doctors administer the drugs when they’re not sure of a diagnosis or to satisfy patient demand for a treatment — despite the fact that patients may be suffering from viral (and not bacterial) sickness.
As Sarah Kliff pointed out recently, while doctors have long known that antibiotics can't treat bronchitis, a staggering 71 percent of bronchitis cases continue to be treated with antibiotics. According to the journal Nature, the average American child has been given 10 to 20 courses of antibiotics by the time he or she reaches adulthood. That's one dose every one or two years. The best estimates suggest that fully half of antibiotic prescriptions may be unnecessary.
Most of our antibiotics, however, are used on farms. Of the approximately 100,000 to 200,000 tons of the antibiotics made each year, about 80 percent are used on animals.
This happens for two main reasons: farmers discovered that continually giving low doses of the drugs to their animals causes them to grow more quickly, and using them for prevention allows animals to live in squalid conditions. While these practices have underpinned our cheap food supply, they also exacerbate the resistance problem.
The confined and dirty conditions in which antibiotic-stuffed animals live create a perfect scenario for resistance: the low doses kill off the weakest bugs, while the strongest survive.
4) We’re not making new, better antibiotics to treat superbugs
One of the scariest features of the antibiotic-resistance crisis is that pharmaceutical companies aren't creating new drugs to address it.
Antibiotics just aren't a great investment for drugmakers; they don't offer great financial returns. Unlike treatments for chronic diseases, people only use antibiotics for short periods of time. And we now know we need to use them even more judiciously than we ever have, which is not exactly an appealing business proposition for large pharmaceutical companies.
For this reason, many lament the fact that the "drug pipeline is dry." Only a handful of new antibiotics have come on the market in the last decade, and health organizations such as the Infectious Diseases Society of America worry that progress on new drugs is "alarmingly elusive."
5) Big Food companies like Tyson and McDonald’s are stepping in — but with some loopholes
Food companies like Chipotle, Panera Bread, Applegate, McDonald's, and, most recently, Tyson Foods have stepped in where governments have failed, taking stands on antibiotic overuse with various policies limiting the kinds of drugs their suppliers can use and when.
But these policies don’t always go far enough. McDonald's, for example, announced it will stop buying chicken that has been reared on human antibiotics within two years. But the chain will continue to allow chicken suppliers to use ionophores, an animal antibiotic. While it's not used in people, overuse could potentially have an impact on human health, since we know resistance can cut across species and classes of drugs.
Also the policy only applies to US restaurants, not the tens of thousands of global locations the company owns, and only to chicken — not beef, a staple of the McDonald's menu. So it’s a step in the right direction, but given that foodmakers are more concerned about their bottom line than about public health, it’s not entirely surprising that McDonald's may cut corners.
Even so, these foodmakers all say they were responding to consumer demand. Advocates like Congresswoman Rep. Louise Slaughter argue that consumers ought to continue pressuring Big Food by voting with their dollars: "We need to engage the American people to demand that they are not going to buy a steak soaked in antibiotics; that they don’t want their chicken dipped in Clorox; that they want wholesome food for themselves and their children; that they want to save antibiotics for animals and people that are ill."
6) The agricultural industry is dead-set against reform — which has left the US lagging in its policies
In addition to the dry drug pipeline, we're failing to enact policies to conserve the drugs we have. Lawmakers in the US have repeatedly put forward bills to reduce antibiotic overuse. But industry has repeatedly blocked these efforts, which, so far, have yet to make it through Congress.
For example, Rep. Louise Slaughter — the only microbiologist in Congress — has been leading the push to stop the overuse of antibiotics on farms through the Preservation of Antibiotics for Medical Treatment Act (PAMTA). PAMTA has been reintroduced four times since Slaughter took it over in 2007, and it has died every time on the House floor.
According to Slaughter, "We have 450 outside groups — every consumer group, scientific group, and medical group you can think of — supporting our bill. But 88 percent of the money spent lobbying on this issue lobbies against us."
At the federal level, there have been other efforts to address the problem on farms, and the Food and Drug Administration has acknowledged since the 1970s that the way the drugs are used for food production is problematic. But these efforts have also been shaped and watered down by the agriculture industry, animal pharmaceutical companies, and Big Food businesses that want cheap product.
Last December, for example, the FDA released guidance encouraging the judicious use of the drugs for growth promotion on farms— but the guidance is voluntary. "Over the years I worked on this," said Rep. Slaughter, "I determined that the FDA will not protect us. Neither will the Agriculture Department, and neither will the White House."
Researchers and lawmakers who worry about the growing problem of drug resistance have been trying to get the US agricultural sector to go the way of Denmark and other European countries, where farmers now only use the drugs to treat sick animals.
7) We know what we need to do to solve the antibiotic resistance crisis. We’re just not doing it.
To truly address antibiotic resistance, we need a global plan. Superbugs travel as easily as people can hop on planes. Acting globally will not only keep us all safe, but will also help minimize the cost of action by ensuring that restrictions on antibiotic use in animals affect all farmers equally around the world.
As an editorial in the most recent issue of the Bulletin of the World Health Organization argues: "There is a clear role for a binding international legal framework to encompass the issues of access, conservation and innovation. When paired with strong implementation mechanisms, international law represents the strongest possible way in which countries can commit themselves to act."
To tackle the problem, we need to conserve the current stock of antibiotics and create new ones.
But while we have known this for more than a century, we have done terrifyingly little to curb the resistance crisis. We continue to abuse them in medicine, inject them into our food supply, and use them liberally in everything from yoga mats to sanitation products.
Still, it’s not all bad news. Last year seemed to mark a turning point, with a number of governments and global bodies promising to take action against superbugs. One researcher writing in the New England Journal of Medicine summed up some of those efforts:
In April, the WHO declared that the problem "threatens the achievements of modern medicine. A post-antibiotic era — in which common infections and minor injuries can kill — is a very real possibility for the 21st century." In May, the World Health Assembly commissioned the WHO to deliver a global action plan on antimicrobial resistance. In June, the British public voted to dedicate a government-sponsored £10 million Longitude Prize to the best solution to the resistance problem. And in September, the U.S. President's Council of Advisors on Science and Technology released a report on antibiotic resistance linked to an executive order from President Barack Obama, who directed the National Security Council to work with a governmental task force and a nongovernmental advisory council to develop a national action plan by February 2015.
The Obama administration also launched a $20 million prize for the creation of a new point-of-care diagnostic test, and requested a doubling in federal funding for research on drug resistance.
There hasn't been similarly clear action here on the conservation side, even though other governments have already been conserving their antibiotics for decades. In 1971, for example, the UK banned the use in agriculture of several antibiotics for growth promotion. Following its lead, Denmark phased out growth promoters, and Norway and Sweden followed. By 2006, the European Union had abandoned the use of antibiotics for growth promotion.
Amazingly, these efforts did not impact production. According to one study in Denmark, while the agricultural sector there reduced antibiotic consumption in pigs by 50 percent between 1992 and 2008, it managed to improve productivity and sustain zero or minor increases in production costs. These lessons haven't been applied in America, where politics and economics continue to trump science. Only time will tell whether we do too little, too late.