A recent report from the Johns Hopkins University Center for a Livable Future on public health, environmental, and animal welfare concerns in the large-scale livestock industry (sometimes called 'industrial food animal production') provides a distressing picture of the limited progress made in addressing a key public health concern – the use of antibiotics for nontherapeutic uses such as speeding up growth, bulking up livestock weight, or preventing disease (rather than treating disease) in overcrowded large-scale animal production facilities. While the overuse of antibiotics to treat human illness is generally accepted as the primary cause of the increasing problem of multidrug-resistant germs, there is substantial scientific consensus that the extensive use of antibiotics in food animal production has also contributed to the increase in antibiotic-resistant diseases.

Antibiotic-resistant infections reduce the effectiveness of medical treatment, resulting in increased sickness and death, as well as longer and costlier hospital stays. A recent Centers for Disease Control and Prevention report estimated that more than 2 million cases of antibiotic-resistant infections occur each year, resulting in more than 23,000 deaths. The Hopkins report, an update to a 2008 report from the Pew Commission on Industrial Farm Animal Production, highlights frustrated federal legislative initiatives and limited, relatively ineffectual efforts by the Food and Drug Administration (FDA) as contributing to this lack of progress.

Many of the antibiotics used for nontherapeutic livestock production purposes are the same drugs used by humans to treat diseases. According to a recent FDA report, almost 30 million pounds of antibiotics were sold for use in meat and poultry production in 2011. This represents about 80 percent of the antibiotics sold for all purposes (including for treatment of human disease).

People can be exposed to antibiotic-resistant bacteria in livestock through environmental exposures and food consumption, including direct contact with animals; contact with soil, air, or water contaminated with animal waste; and consumption or handling of contaminated food.  Workers in large industrial livestock production facilities have been found to carry livestock-related antibiotic-resistant bacteria, as have people living in the rural communities surrounding them, leading to increased risk of livestock-related antibiotic-resistant infections. 

Recognition of this concern and legislative efforts to address the problem date back more than a decade. Beginning in 1999, Rep. Louise Slaughter (D-NY) has sponsored legislation to address this issue, most recently with H.R. 1150, the Preservation of Antibiotics for Medical Treatment Act of 2013, and a companion bill, the Preventing Antibiotic Resistance Act of 2013, has been sponsored by Sen. Dianne Feinstein (D-CA). Both bills would require the FDA to withdraw approvals of nontherapeutic uses of medically important antibiotics in food animals, except where a company with a currently approved drug can demonstrate with reasonable certainty that the nontherapeutic use of the drug will not harm human health by promoting the development of antibiotic resistance. Because most approvals of nontherapeutic uses are unlikely to meet this standard, passage of this legislation would probably result in the withdrawal of most FDA approvals and stop the nontherapeutic use of antibiotics in livestock production. However, extensive opposition from the food animal industry has stymied adoption of this legislation.

Federal efforts to monitor and regulate the use of antibiotics in livestock production have likewise been relatively ineffectual. The FDA has pursued a voluntary and partial approach to restricting nontherapeutic antibiotic use. In April 2012, the agency issued a guidance document and published a draft second guidance document that together urge drug companies to voluntarily withdraw approvals to market antibiotics for certain nontherapeutic uses (i.e., growth promotion) while maintaining approvals to market these drugs for other nontherapeutic uses such as disease prevention. While three arsenic-based antimicrobial drug have recently been banned by the FDA after the agency found inorganic arsenic (a toxic compound) in the livers of chickens that had been treated with these drugs, one arsenic-based drug is still used in food production.  In addition, U.S. Department of Agriculture and FDA efforts to collect data on antibiotic use and resistance have been criticized as flawed by the Government Accountability Office.

Given the food production industry’s ability to frustrate legislative efforts and to water down federal regulatory initiatives, ultimately successful outcomes in several pending public interest lawsuits against the FDA may be the only avenue left to finally address this significant public health concern.