Move over H5N1: The next pandemic is already here
Scientists have sounded the alarm on antibiotic resistance for more than 50 years. Yet, because of government inaction, more than 35,000 Americans will die this year from a preventable pandemic.
Antibiotics are one of the single most important discoveries in modern medicine: Since their first use in 1910, antibiotics have extended the average human lifespan by 23 years. But when bacteria are routinely exposed to low doses of antibiotics, they quickly evolve resistance to the drugs. As explained by Michael Lewis, “the expression ‘what doesn’t kill you makes you stronger’ actually isn’t usually true for human beings. It is for bacteria, however.”
Chronic exposure to low doses of antibiotics is pervasive in industrial animal agriculture, the system in which more than 99 percent of animals are reared in the U.S.
American farmers administer at least 6,834 tons of medically important antibiotics to animals each year — more than twice what is prescribed to humans in the U.S. — to maintain livestock in crowded, sordid conditions. Antibiotic-resistant bacteria from farm animals can, in turn, be transmitted to humans through consumption of contaminated animal products or contact with polluted water sources.
And animal agriculture is not discriminating in its use of antibiotics. Many antibiotics of “last resort” that medical professionals rely on to treat multidrug-resistant bacterial infections are fed to animals on a daily basis. Over the last year, hypervirulent superbugs — resistant to several of these last-resort medications — have emerged across the U.S.
The Food and Drug Administration recognized animal agriculture as a leading source of antibiotic resistance 15 years ago and attempted to promulgate regulations to curb excessive usage. Their approach ultimately failed, stymied by two key problems.
First, the FDA does not regulate a key source of antibiotic overuse. While antibiotics are used chiefly to treat active infections in humans, antibiotics are routinely given to livestock for three purposes: to treat infections, to prevent disease, to increase animal growth rates and reduce time to slaughter. The FDA’s rulemaking only proscribed the use of antibiotics used for growth promotion, not disease prevention.
The result is that farmers are given carte blanche to administer antibiotics for disease prevention on a “routine, untargeted basis” even in the absence of a confirmed or suspected disease. This practice would be indefensible in humans: it is the functional equivalent of giving every classroom of first-graders strep antibiotics each season, just in case. And because the line between using antibiotics for “growth promotion” and “disease prevention” is blurry at best, drugs intended for growth promotion can easily masquerade as “disease prevention” agents.
Second, federal agencies are not authorized to collect the data necessary to detect changes in antibiotic use over time. So, even if the agency’s regulations were effective — a far cry from reality — it would be impossible to know.
The lack of reporting requirements for livestock producers is in stark contrast to the rigorous rules governing the use of antibiotics in humans. The CDC requires hospitals to electronically submit antibiotic use data to the National Healthcare Safety Network to improve patient care and to “help combat antimicrobial resistance.” It is perhaps unsurprising, then, that antibiotic use in livestock is rising amidst a decline in the use of antibiotics in medical settings.
Combating antibiotic resistance poses a significant challenge, but there are clear steps that may be taken to reduce the risk of another devastating pandemic. The federal government needs to close the preventive use loophole and implement data collection measures to confirm that the loophole is, in fact, closed.
Fortunately, regulators need not start from scratch — Maryland has already implemented legislation that can serve as a model for the federal government. While Maryland’s statute still awaits further assessment, the language of the “Keep Antibiotics Effective Act” more tightly regulates the use of antibiotics for prophylactic purposes and implements a reporting infrastructure that provides for the creation of annual reports.
In light of Maryland’s headway, some might argue that states should take the lead on addressing antibiotic resistance. This argument is misguided for at least two reasons. Most obviously, antibiotic-resistant strains of bacteria do not respect state borders. Industrial animal agriculture is an inherently national system, involving the transportation of tens of millions of animals across state lines each year.
More importantly, individual states may not have the necessary incentives to act unilaterally in a way that could place their agricultural sector at a disadvantage relative to other states. Take California, for example. Although it was the first state in the nation to build upon the FDA’s disappointing regulation, California’s attempt to close the preventive use loophole was undermined by legislative negotiations that over-prioritized livestock producer privacy and flexibility. Despite the state law going into effect in 2015, over 90 percent of dairies surveyed in 2018 still reported administering antibiotics to cows that lack any indication of disease.
Antibiotic resistance is an urgent national problem that requires an urgent national solution. The FDA needs to act, and Congress has to empower the agency to take the action necessary to forestall a “post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill.” Millions of lives hang in the balance.
Zoe Robertson is a J.D. candidate at Stanford Law School. Kit Rodolfa is research director at the Regulation, Evaluation, and Governance Lab at Stanford, where Christine Tsang is executive director.
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