REPORT: Roadmap for a Future Where Antibiotics Still Work

David Wallinga, MD NRDC Senior Health Officer, Health Program

davidwallinga_sf_450.jpg

As the national (and global) crisis of antibiotic resistance worsens, it garners more attention. Deservedly so. "We are running out of antibiotics fast“ is how the “Stopping Superbugs" series PBS NewsHour began earlier this month. Without stronger, swifter action – my friends who are infectious disease docs warn – we’ll find ourselves living in a world where once routine infections are no longer treatable. All of us share the sense that more could be done, and must be done to avoid this catastrophe. But what’s required, and by whom? 

Today a new report, Combating Antibiotic Resistance: A Policy Roadmap to Reduce Use of Medically Important Antibiotics in Livestock, answers both questions. Released by a commission of independent experts, it offers 11 core recommendations for action by everyone, from policymakers to food companies, medical professionals to hospitals. The full report can be found here

The Roadmap focuses on livestock because the resistance crisis amounts to a ‘numbers game,’ where risks mount with each person or animal given to antibiotics, and the duration and frequency of that usage.  And yet, 70% of medically important antibiotics sold in the U.S. are for use in food animals, not people. Moreover, those sales continue to rise, to more than 21.3 million pounds of antibiotics in 2015 – 26 percent more than in 2009. We can't solve the bigger resistance problem without tackling the overuse of medically important antibiotics in livestock, in other words. 

Unfortunately, existing federal policies are not adequate to reverse the unnecessary uses of these drugs. One massive FDA loophole, for example, is that it still allows such antibiotics to be fed routinely to flocks or herds of healthy animals, under the guise of preventing disease.

The Commission’s twelve experts, including five veterinarians, created a roadmap for a different path forward. Its core recommendations are both commonsense, and easily implemented at many levels. For example, they include: 

  • Creating hard targets and timelines for reducing livestock antibiotic use.
  • Ending the practice of routinely feeding medically important antibiotics to flocks or herds of food animals that are not sick.
  • Reducing the need for antibiotics in the first place, by adopting new technologies (e.g. vaccines) and the best non-antibiotic herd management practices to improve animal health and prevent disease.

Sadly, prospects are dim that federal agencies will close loopholes and take stronger actions anytime soon to avoid or reduce unnecessary antibiotic use. But cities, states, medical organizations, hospitals and food companies, as the Commission suggests, can and must lead.

The good news is that many have been doing so. California and Maryland recently passed new laws ensuring that antibiotics will only be used in food animals that aren’t sick. And 12 of the nation’s top 15 fast food restaurants have made some commitment to curb unnecessary antibiotics used by their chicken suppliers. Still the spread of antibiotic resistance marches on. As the story said, ‘we are running out of antibiotics fast’.  And we all face the consequences together.

To save our miracle drugs, we need more bold state action, and continuing change in the marketplace. But it can’t stop there. Pork and beef producers should take a page from chicken industry leaders, step up and embrace reductions in their antibiotic use – and so should the USDA, FDA and the White House.  

For the sake of our patients, and our kids, I hope that leadership comes sooner than later.