(Beyond Pesticides, October 16, 2020) The Lancet has published an article that identifies several of the multiple and interacting crises the U.S. and world face, with a focus on another “looming potential pandemic . . . [a] rise in multidrug-resistant bacterial infections that are undetected, undiagnosed, and increasingly untreatable, [whose rise] threatens the health of people in the USA and globally.” It calls on leaders in the U.S. and beyond, asking that even as they address the current coronavirus pandemic, they also attend to the antimicrobial resistance (AMR) problem, which is a growing threat to public health. The co-authors outline a number of strategies for progress on AMR, including banning of medically important antibiotics in agribusiness, and promoting consumer, and supplier and private sector, awareness and action on food choices. Beyond Pesticides endorses these strategies, but insists that a genuine solution would include the transition to organic agriculture, not least for the health benefits it would provide.
The introduction to the article adds another crisis layer — the climate emergency — and asserts that any resolutions of these crises will, or will not, unfold in a political context: “The outcome of the U.S. election will have far-reaching consequences for planetary health.” Beyond Pesicides monitors and writes about all these issues: how agricultural uses of antibiotics fuel antimicrobial resistance; the contributions of chemical- intensive farming to the climate emergency; factors that exacerbate risks of COVID-19; and the record of the Trump administration that makes the coming election one with very high stakes for human and environmental health. (See more examples here, here, here, and here.)
The growing threat of antibiotic resistance is a major healthcare issue. Beyond Pesticides has written, “Many bacterial infections are becoming resistant to the most commonly prescribed antibiotics, resulting in longer-lasting infections, higher medical expenses, the need for more costly or hazardous medications, and the inability to treat life-threatening infections. The development and spread of antibiotic resistance is the inevitable effect of antibiotic use. Bacteria evolve quickly, and antibiotics provide strong selection pressure for those strains with genes for resistance.”
The significant role of antibiotic use — in crop, livestock, and even aquaculture production — in the development of antimicrobial resistance has been demonstrated repeatedly. In addition, some pesticides may induce antibiotic resistance in particular pathogens, as dicamba and glyphosate do in certain strains of E. coli and Salmonella eterica. Further, antibiotics used on livestock, which through their waste get broadcast into the environment and onto crops via use of manure as fertilizer, reach consumers in food products. These antimicrobials disrupt gut microbiota that play a role in mediating immune response to pathogens; thus, they may represent an additional risk in the coronavirus pandemic.
Multi-drug-resistant bacterial infections currently claim 700,000 lives annually across the world; such deaths are projected, by 2050, to reach approximately 10 million people per year and cost $100 trillion to the global economy, primarily through loss of those people’s productivity. The U.S. sees 35,000 deaths each year among 2.8 million such infections across the population; this level of morbidity tallies to $20 million in healthcare costs.
The co-authors also discuss how the antimicrobial resistance (AMR) phenomenon that underlies this rise can exacerbate COVID-19 risks. They observe that, across five countries, COVID-19 diagnoses are associated with bacterial infections (with 3.5% diagnosed concurrently and 14.3% post-COVID-19); the prevalence is higher in patients who require intensive care. A cited study from summer 2020 shows that a shocking 72% of COVID patients received antibiotics even when they were not clinically indicated. This misuse of antibiotics absent clinical need is a phenomenon understood to contribute to the problem of AMR. The authors note: “AMR might worsen under COVID-19 due to the overuse of antibiotics in humans, continuing misuse in agriculture, and the dearth of antimicrobials in the development pipeline.”
Those misuses in agriculture include antibiotics used to control certain bacterial diseases in plant agriculture (dominantly, oxytetracycline and streptomycin), but plant uses are vanishingly small compared to those in animal operations. In conventional livestock farming, antibiotics are not used primarily to treat bacterial infections, although that does happen (and products from those animals can go to market). In such operations, antibiotics are misused largely as additives to animal feed to ward off any potential infections and to promote unnaturally rapid growth (the latter of which translates to higher profits). Both of these objectives function as compensation for the overcrowded and unsanitary conditions of concentrated animal feeding operations (CAFOs), which scientists believe will contribute to the next pandemic. Use of antibiotics is prohibited in all certified organic production; though the standards of the National Organic Program require that sick animals be treated, meat and other products from such animals cannot be sold with the imprimatur of the Certified Organic designation.
In 2019, the CDC (Centers for Disease Control and Prevention) did an AMR threat assessment that showed fewer deaths attributable to AMR compared with 2013, but also, wild increases in several specific, severe, multi-drug-resistant bacterial infections. Examples include a 315% increase in erythromycin-resistant group A. Streptococcus, a 124% increase in drug-resistant Neisseria gonorrhoeae, and a 50% increase in extended-spectrum β-lactamase-producing Enterobacteriaceae. (Translation: a 50% rise in the presence of an enzyme that confers resistance to common antibiotics such as penicillins and cephalosporins; infections with these enterobacteria often have poor prognoses.)
Unfortunately, the political landscape has a huge impact on these emerging risks. The forward-thinking planning of federal agencies under previous administrations has been walloped by the Trump administration’s devotion to agrochemical and pharmaceutical (and other) industrial interests. As the subject paper lays out, the Obama administration issued a comprehensive plan, in 2015, establishing milestones to reduce antibiotic misuse and accelerate research and development of antimicrobials and vaccines.
Yet those goals have suffered during the past three-plus years. An FDA (Food and Drug Administration) ban on the use of antibiotics as growth promoters in livestock, which went into effect on January 1, 2017 (just before the inauguration), was confounded later that year by USDA’s (U.S. Department of Agriculture’s) rejection of the World Health Organization’s guidance on limiting antibiotic use in animal feed. USDA asserted that treating, controlling, and preventing” [emphasis by Beyond Pesticides] disease under veterinary supervision constitutes “appropriate use” — undercutting the ban on antibiotics for growth promotion because, when used in feed for disease prevention, antibiotics also promote growth.
The federal government then went on to slash budgets for hospital-based AMR programs; USDA removed federal oversight of meat inspection at pork processing plants; and EPA (the Environmental Protection Agency) “condoned expansion of medically important antibiotics such as streptomycin and oxytetracycline as pesticides to maximize crop yields.” Every one of these actions mitigates against solving the AMR problem, to the detriment of public health.
There are additional examples of the Trump administration working against the health of the population. Beyond Pesticides wrote, earlier this year, that the “Trump Administration worked [in 2018] on behalf of a chemical industry trade group [CropLife America] to weaken international guidelines aimed at slowing the crisis. Emails obtained by the Center for Biological Diversity through the Freedom of Information Act show that officials at . . . USDA worked to downplay the role of industrial agriculture and pesticide use in drug-resistant infections.”
Further, the Daily News Blog entry explained, “Many of the same antibiotics and fungicides used to manage infections on crops are the same used for human medicine. While overuse in the medical field remains a concern, agricultural applications, which likely occur more frequently and on a larger scale, are major contributors to the crisis. . . . A 2018 study published in Nature Sustainability found that Earth has surpassed ‘planetary boundaries’ for pesticide and antimicrobial resistance. ‘Without new approaches, going to hospital in the future will increasingly become a gamble. More patients will get unlucky, and become infected with untreatable or hard to treat bacteria. This is an urgent risk to human society,’ study coauthor Søgaard Jørgensen, PhD, said.”
Among this paper’s recommendations are that the U.S. revive its 2015 AMR National Action Plan by: (1) permanently banning the use of medically important antibiotics in agribusiness; (2) supporting antibiotic stewardship programs; (3) encouraging the development of new antibiotics through bipartisan initiatives (e.g., the DISARM Act and the PASTEUR Act); and (4) investing in innovation to identify and evaluate other anti-infectives. The National Action Plan, which has been updated for the 2020–2025 period, adds to the original, and takes a One Health approach (as adopted by the UN Interagency Coordination Group on AMR), which recognizes that the health of humans, animals, plants, and the environment are all interrelated.
The researchers conclude that progress on AMR should be framed in the context of pandemic preparedness, and guided, in part, by lessons from COVID-19, to wit: healthcare infrastructure and incidence surveillance must be strengthened, and policies put in place that ensure equitable access, nationally and globally, to diagnostics, antimicrobials, and vaccines. The authors’ perspective is that the U.S. cannot tackle this problem unilaterally, but ought to participate actively in international efforts to coalesce around a set of global solutions and to speed up action on AMR.
They recommend that the U.S. support the “multilateral global architecture” needed, which includes WHO, the UN Food and Agriculture Organization, and the World Organization for Animal Health. Failure to do so, they assert, would undermine decades of medical and public health advances, adding that “The COVID-19 pandemic is a wake-up call that global collaboration is the most effective way to tackle global health threats.” Seen through the lens of the coming U.S. Presidential election, the possibility of progress on these would appear possible with one outcome, and at grave risk with the other.
Beyond Pesticides endorses a ban on the use of antibiotics in agriculture of all kinds. Medical and veterinary overuse and misuse contribute to the AMR problem, certainly, but agricultural uses play a disturbing part in this unfolding crisis, which will get worse until it is more effectively addressed. The public must create upward pressure on legislators to become active on this issue; please consider advocating with them, at both federal and state levels, on this issue. If anything has been learned through the experience of the COVID-19 pandemic, it might be that action deferred increases the magnitude of the calamity.
All unattributed positions and opinions in this piece are those of Beyond Pesticides.