McDonald’s recently announced it will begin phasing out the use of medically important antibiotics in its global beef supply chain, building on its experience phasing out such antibiotics from its chicken supply. Other retail food chains have also made progress. Now it’s time to take aim at pork.
McDonald’s promise is a commendable step in addressing antimicrobial resistance, one of our most pressing global health challenges. It’s also an important signal that consumers hold power to shift food industry practices toward sustainability.
Nearly a century ago, Alexander Fleming’s discovery of penicillin launched modern medical practice into the antibiotic era. His discovery, and those that followed, are credited with saving untold millions of lives and enabling landmark medical breakthroughs. Yet decades of inattentive use — for purposes as different as treating viral infections, for which antibiotics are ineffective, to the industrial production of beef, chicken, pork, and seafood — now risks throwing away the gift of these precious medicines.
Drug-resistant infections are now challenging our best medical care. And multidrug-resistant bacteria, against which even our last-resort antibiotics aren’t effective, are accelerating the prospect of a post-antibiotic world, one in which modern medicine may have little to offer people with infections.
Unless we shift to careful custodianship of the antibiotics we have now, deaths from drug-resistant pathogens will soar from a current rate of 700,000 a year globally to more than 10 million by 2050 — more deaths than caused by cancer and diabetes combined. That catastrophic human toll is matched by a substantial economic burden: resistance-linked losses exceeding a cumulative $100 trillion by 2050. That’s more than $3 trillion each year — nearly 4 percent of gross world product — every year through 2050 and beyond unless we rein in this threat.
While drug-resistant bacteria won’t likely rip through communities the way viruses such as those responsible for severe acute respiratory syndrome (SARS), Ebola, or influenza might, by every measure — lives lost, dollars, fear — the impact of antimicrobial resistance will be arguably more devastating. When a viral pandemic is extinguished, communities rebuild and health systems recalibrate. But antimicrobial resistance is an ever-present threat. The marauders have not come and gone, off to a distant hideout — they are behind every door.
Resistance to antibiotics and other antimicrobial agents isn’t new. It is the ancient defensive strategy of microbes to naturally occurring chemical assault deployed by other microbes — an inherent element of an ever-evolving microbial arms race.
What is new is the industrial scale use of antibiotics in human medicine and animal production, and in unprecedented amounts of antimicrobial compounds contaminating the environment.
This is attributable in part to our insatiable demand for animal protein. Every year, global livestock agribusinesses mobilize more than 131,000 tons of antimicrobial agents to produce our poultry, eggs, dairy, and meat (and this estimate did not include fish farming). That volume is expected to surge 52 percent globally by 2030, and to double in the fast-growing economies of Brazil, Russia, India, China, and South Africa as demand for animal protein grows along with the size of the middle class.
Global pork production from swine represents one of the largest consumers of antibiotics per unit of live animal weight. In the course of its four-month journey from piglet to slaughter, every hog on this planet — and there are nearly a billion of them — will consume three times the amount of antibiotics by animal weight as cattle, and 2.5 times the amount of antibiotics as the average European citizen.
The use of antimicrobials, either by a veterinarian or under the direct supervision of one, should always be available for the humane treatment of diseased animals. Yet, the majority of antibiotics used in food production aren’t targeted to animals with disease. Instead they are used to prevent infection in high-density production systems with inadequate disease control practices, or to stimulate weight gain and productivity. With good husbandry practices, adequate nutrition, vaccination, and proper veterinary care, though, the weight gain effect is negligible and preventive use recedes as systems cultivate healthier, more resilient animals.
As it turns out, these antimicrobials aren’t being used to treat animal diseases as much as they’re treating a diseased animal production system.
The development of antimicrobial resistance is evolution by natural selection at work. Indiscriminate use of antimicrobials favors the survival and proliferation of communities of bacteria that have naturally developed or acquired the genetic determinants to resist these drugs. In essence, we are inadvertently promoting the dissemination of antimicrobial resistance genes — the advanced arms that are fueling a global microbial insurgency to evade and avoid our most potent medical interventions.
Producers and retailers of chicken, beef, pork, and dairy products, like McDonald’s, hold substantial power to transform and scale healthier animal production around the world, especially in low- and middle-income countries where a constellation of factors — from increasing intensity of production to cheap, easily accessible antibiotics, inconsistent regulatory structures, and anemic enforcement capacities — are the pushing development of antibiotic resistance.
Ongoing work conducted by the U.S. Agency for International Development, the organization I work for, has shown that sound antimicrobial use practices cannot be achieved by the public sector in isolation. Commitment and leadership of the private sector — from farm to fork — is essential.
As a high-volume business, the retail food industry is in a unique position of influence, capable of driving change through the promise of market access, and providing incentives for improved animal production practices, rigorously measuring their impact, and taking proven antibiotic stewardship approaches to scale. In Thailand, for example, a new partnership between the government, pork producers, and retail food outlets is demonstrating that under the right animal husbandry conditions, NSF certified “raised without antibiotics” pork is economically viable for the domestic market.
Plant-based and cell-cultured meat products could someday reduce or even do away with the need for traditional live animal production and slaughter, bypassing the complex ethical, environmental, and health challenges these systems can pose. But the current cost of these products remains a barrier and presents a longer runway to adoption at scale in low- and middle-income countries. In the interim, animal production industries must establish quantitative benchmarks for antimicrobial use across their supply chains, and commit to supporting and implementing production best practices and meeting measurable, time-bound targets for reduction in the use of antimicrobials.
Antimicrobial resistance is a textbook slow-burn pandemic. It is, and will be, global in scale, and will touch each of us — industrialized and developing nations, wealthy and impoverished individuals — in immeasurable ways.
Recall how often in the last year your family filled an antibiotic prescription. Now imagine these seemingly simple scenarios in a post-antibiotic era: Knee replacement? Nixed. Root canal? High risk. Pneumonia, blood stream infection, or infected, indolent wound? Prognosis: grave.
This threat is also a development challenge. The World Bank estimates that drug-resistant infections will push 28 million people into extreme poverty by 2050, over 90 percent of them from lower-income countries. That threatens to erode hard-fought progress toward eliminating the global scourge of malnutrition, hunger, and poverty.
We cannot seal off the threat of contact with antibiotic resistant bacteria. Human mobility and an annual $1.5 trillion international food trade preclude it. We are in this together. Whether 50 years from now we reflect upon this as a tragedy of the commons or as an example of our unified commitment to meet a global public health challenge depends on the actions we take now.
At next year’s United Nations General Assembly, member nations will convene to hear the report from the Interagency Coordination Group on Antimicrobial Resistance. The path back from the precipice of a post-antibiotic era is largely known, and must involve multiple concurrent approaches enumerated in the group’s global action plan that provides a blueprint for sound antibiotic stewardship. What we are compelled to muster is the resolve to action, a resolve that starts with our individual choices: how we manage our health, what foods we demand, and our commitment to preserve the precious gift of these medicines.
The end of the antibiotic era will not be a sudden, cataclysmic event. Instead, its insidious arrival is already being marked by the increasingly common report of “superbugs” that are resistant to all but a handful of antimicrobials of last resort, most of them too toxic to be of widespread value. We will turn to the medicine cabinet, only to find it stocked with an ever-dwindling number of effective options until, finally, there are none.
Fleming understood penicillin’s transformative potential. What he could not have envisioned was the explosive growth in use of these drugs. Failing to be good stewards of their use, we risk shortening the antibiotic era to little more than a footnote — an aberration — in the long arc of humanity’s quest for wellness and health.
Daniel Schar, V.M.D., is the senior regional emerging infectious diseases advisor at the United States Agency for International Development’s regional mission in Bangkok. The views expressed here are his and do not necessarily reflect those of USAID or the U.S. government.