Antimicrobial Resistance

“If you drive a car, I’ll tax the street; if you try to eat, I’ll tax your meat…” Apologies to The Beatles for flagrant misuse of “The Taxman” lyrics, yet as reported in The Conversation based on this study, taxing conventionally-produced meat* is the newest solution proposed to tackle antibiotic resistance.

At first glance, the premise seems like a logical solution. If somebody’s individual choice confers a societal cost, e.g. person A’s decision to eat meat raised in a system where antibiotics are used increases the risk that person B will incur negative health consequences because drugs do not effectively treat bacterial infection, then it is logical to suggest that person A should be morally responsible for that economic cost. Taxing conventionally-produced meat and using the tax to fund research into alternative treatments therefore appears to make sense.

However, the first and most obvious issue arising from this premise is that we have not yet been able to accurately quantify the comparative impacts of humans, companion animals and livestock on antibiotic resistance. Indeed, a recent paper in Royal Society Open Science concluded that curtailing antibiotic use in livestock would have little impact on the level of resistance in humans. Therefore, although there is consensus that shared-class antibiotics (those used in both human and animal medicine) should be phased out of livestock production and that any reduction in antibiotic use can potentially have mitigating effects, we cannot state with any degree of certainty the relative impacts of completing (or, more seriously, not completing) one course of human antibiotics, compared to treating a bacterial infection in a cat or using antibiotics to treat a lame cow.

The study authors suggest that people who buy conventionally-raised meat are morally responsible for antibiotic resistance. This is rather a stretch, especially given the knowledge gaps around human/companion animal/livestock impacts described above. Does this mean that children treated for throat or ear infections are morally responsible for cases of antibiotic-resistant Staphylococcus aureus in elderly people? Tax those toddlers immediately!

The tax mechanism has not been implemented elsewhere, at least not in the UK under the National Health Service. For example, patients who are morbidly obese or contract lifestyle-related diseases (e.g. smokers with lung cancer) do not pay a greater economic cost towards healthcare than those who have breast cancer or require a hip transplant. Without a precedent for this type of action, the hypothesis remains entirely theoretical.

Although dairy consumption is relatively inflexible with regards to economic cost, taxing meat has been shown to cut consumption. Placing a tax upon conventionally-produced meat would therefore not necessarily generate the billions of pounds required to develop new drugs or treatments. Cutting consumption might reduce antibiotic use simply as a consequence of fewer animals being raised, but also penalises those people who have lower incomes – should they be forced to forgo meat simply because they cannot afford it? If ethical and moral responsibilities are the major issue, how do we justify removing high-quality protein that demonstrably improves cognitive development and scholastic achievement from the diets of growing children, particularly those in developing countries where animal protein consumption is already significantly below nutritional targets?

There is no realistic all-or-nothing solution to antibiotic resistance. Demanding that all antibiotics used in livestock production are banned instantly is not a viable solution on a national nor a global basis, nor is continuing with present levels of antibiotic use. However, the paper’s authors underestimate the potential for improvements in disease surveillance and livestock management to cut antibiotic use, without incurring additional costs to the producer. Building upon existing initiatives by groups including RUMA, NOAH, academics at the University of Bristol, and animal health companies; and working with farmers to discover, disseminate and adopt practices that allow antibiotic use to be reduced or eliminated while maintaining and improving livestock health and welfare is essential for ensuring human, animal and food safety, and can be achieved without putting food security at risk.

*The Conversation refers to “meat that contains antibiotics” several times. This is a misnomer that really needs to be addressed as strict withdrawal periods exist for antibiotics used in livestock production to ensure that residues are not present in either milk or meat.

Resistance After some excellent commentaries on future food production and Brexit on Farming Today last week, it seems that, not content with domestic violence, miscarriage and admitting women to the Ambridge cricket team (the horror of it!) on The Archers, BBC Radio 4 has dived into modern agricultural issues with a vengeance. However, their latest venture has all the balance and perspective of Nigel Farage faced with a chicken vindaloo and a team of migrant NHS workers.

Developed through the Wellcome Trust Experimental Stories Unit and written by Val McDermid, well-known for her crime novels, “Resistance” describes the impact of an outbreak of antibiotic-resistant swine erysipelas, which passes swiftly from contaminated sausages at a music festival to the general public exhibiting dreaded “purple spots” and collapsing at the supermarket checkout.

Alas, having listened to the first two episodes with more than a passing interest (after all, antibiotic resistance is a huge issue for our industry, both from an animal and human health perspective), it’s clear that an aluminium helmet and a “meat is murder” sign may be required listening accessories. The main protagonist is a slightly holier-than-thou vegetarian who was turned away from meat by the animal rights activists with whom she worked on a story and is currently scratching around to find freelance work after her editors became afraid of “real investigative journalism.”

Cue a cliched storyline, lined up in true pantomime fashion with neon signs alerting the listener to every plot development. The contaminated meat is traced back to a “factory” farm in an urban location, with pigs kept in “tiny pens with no room to lie down or turn around.” A specialist (non-local) vet throws antibiotics at the animals and a surly, secretive, Eastern-European-accented farm manager doesn’t seem keen on a journalist sniffing around.

The racial stereotyping is unfortunate given how much UK agriculture relies on workers from Europe and beyond, and the farm portrayed as secretive, polluting water and soil, and utterly lacking transparency. By contrast, organic systems with “humanely-farmed” animals, and “well-scrubbed, rare breed pigs” are the dramatic ideal. Yet in real life, farm assurance schemes such as Red Tractor (which covers >80% of UK pork) ensure that pigs are kept in environments that provide sufficient space; are given suitable, healthy feed; and that waste is managed to prevent water or soil contamination. Does that mean that every pig farm is perfect? No. So does it mean that poor husbandry, environmental pollution and rampant overuse of pharmaceutical drugs is the norm? Absolutely not.

The casual listener might be horrified by the implications of antibiotic resistance for human health, but never fear, the drama suggests all will be well as long as your sausage comes from an organic Berkshire pig hand-raised on acorns. However, bacterial resistance to antibiotics occurs naturally and can be maintained or increased by any antibiotic use – in people, livestock or companion animals – not simply by use on conventional farms. Indeed, it’s vital to remember that organic operations are permitted to use antibiotics (as per the Soil Association organic standards), especially if they are the “best way to reduce suffering, save life or restore your animal’s health.” There is no blanket antibiotic prohibition on organic operations, as is often assumed.

Still more rhetoric invades the human health side of the drama – doctors try to dismiss and cover-up the public health implications, antibiotic researchers are hampered by lack of funds (possibly the most crucial but least discussed issue of the entire drama) and “big pharma” is lambasted for being more interested in developing drugs that generate long-term profit (e.g. diabetes or high blood pressure medication) than antibiotics that only need to be used once.

There is an immediate and definite need to develop new antibiotics both for animal and human health, yet if effective new drugs are found they’re unlikely to be distributed widely, but stored in case of an epidemic. Livestock farmers and vets have a huge responsibility in protecting both animal and human health, but so do doctors, food processors and ultimately all of us – simple hygiene measures, including effective hand-washing, are key to preventing the spread of disease.

Both national and global programs have been implemented to quantify, assess and reduce antimicrobial use; veterinary scientists are actively involved in on-farm research and interventions to reduce both antimicrobial use and resistance; and animal health companies (so-called”big pharma”) have joined with food processors, retailers, charitable foundations and human/veterinary medicine associations in taking a One Health approach (incorporating the health of people, animals and their environments) to making sure that antibiotics that are critically important for human medicine are withdrawn from animal use, and that the speed and spread of antibiotic resistance is reduced. Unless the rabid journalist has a serious epiphany in the third episode (to which I have not yet listened) it seems that facts are going to be overwhelmed by fiction as the efforts and advances made by global livestock producers are ignored.

I’m not suggesting that all drama should be absolutely true to life, but when real-life, topical, scientific issues are discussed, surely broadcasting agencies have a responsibility to be factual rather than alarmist? It’s unfortunate that this drama, written by a famous author and advised by a Professor of Microbiology at the University of Warwick, seems to have been developed without input from experts in veterinary science, animal production or on-farm antibiotic use. Furthermore, given the Wellcome Trust’s role as a global medical charity, one would assume that they have a responsibility to provide factual information, especially when their sponsorship must ultimately have been publicly funded. Instead, as with so many sensationalist dramas, it seems the world is going to end and we are the innocent victims of others greed for profit. Better switch to the organic sausage, or better still, the tofu surprise.