White House Report on Antibiotic Resistance Disappoints

Health Care Without Harm

September 18, 2014

No Recommendation that FDA Act Immediately to Collect Critical Data on Antibiotics Overused in Livestock, Or To Curb Overuse

[A joint release with Healthy Food Action]

Washington, DC – Top advisors to the White House released a long-anticipated report on how the nation should respond to the current crisis in bacterial infections that resist treatment with antibiotics. The President’s Council of Advisors on Science and Technology (PCAST) warned that antibiotic resistance already costs the U.S. economy up to $70 billion annually, and that “ the Nation risks losing the tremendous public health progress made over the last century from the discovery and development of antibiotic drugs, thereby threatening patient care, economic growth, public health, agriculture, economic security, and national security.”

The report reiterates the basic principle of microbiology that resistance occurs largely because of the use of antibiotics, which drives natural selection for resistance among bacteria that are exposed to them.

"Antibiotics are the foundation of our health care system. And yet, the vast majority of antimicrobials sold in the United States are for use in livestock and poultry -- around four times the amount sold for use in patients," said Gary Cohen, president and founder of Health Care Without Harm. “It is irresponsible that the PCAST recommendations fall short in addressing the critical need to reduce antibiotic use, especially in livestock.”

Last year, the Centers for Disease Control and Prevention (CDC) estimated half of human use and possibly much more of agricultural use is unnecessary; recent aggressive action by central governments in Denmark, the Netherlands and elsewhere in Europe are succeeding in reducing agricultural antibiotic use by at least 50 percent.  While PCAST endorses better “stewardship” of antibiotics, it fails to recommend the U.S. set national targets on antibiotic use reduction, including in agriculture, despite their success in Europe.

The PCAST report also errs in stating that antibiotics in livestock are typically used to treat sick animals. Industry sales data (2010) recently collected by the Food and Drug Administration (FDA) indicate around 90% of all agricultural drugs are sold as additives to animal feed or drinking water. These antibiotic used are not for treating infections, typically, but instead are FDA-approved for growth promotion, feed efficiency and disease prevention. They often are employed in place of changing the farming practices that create the need for them. In other words, much of this use is unnecessary.

The PCAST report, instead of recommending strong FDA action to address the overuse of antibiotics for disease prevention in livestock, promotes an approach of waiting to see whether current FDA voluntary requests of the pharmaceutical industry will be effective in reducing antibiotics sales for animals.

“For the White House to punt leadership on this critical medical and national security issue to the FDA would be a tragic mistake,” said David Wallinga, MD. “For four decades, the FDA has failed to take action to reduce antibiotics used in livestock feed. It’s failed to take even modest steps, like collecting important information on how these precious drugs are used in animals and on farms.” Wallinga is Director of Healthy Food Action, and serves on the steering committee of Keep Antibiotics Working: the Campaign to End Antibiotic Overuse.

The White House also releases a Presidential Executive Order on Antibiotic Resistance today.  Preliminary statements by officials raise questions on what real action will result in the short-term. A ‘new’ interagency task force will be established on antibiotic resistance, co-chaired by the Secretaries of Defense, Agriculture and Health and Human Services. Fifteen years ago, a similarInteragency Task Force on Antimicrobial Resistance was formed under direction by Congress, co-chaired by the CDC, the FDA and National Institutes of Health. It is not regarded as having succeeded in blunting the overuse of antibiotics, or the march of the resistance epidemic.

“To avoid a medical ‘dark age’ where antibiotics no longer work as needed, more than yet another task force is needed,” said Dr. Wallinga. “The White House must deliver on reducing our nation’s overuse of precious antibiotics where they are not absolutely necessary.”

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Healthy Food Action is a national network of physicians, nurses, dieticians and other health professionals who work to create a food system that promotes and supports the nation’s health.

Health Care Without Harm is an international coalition of organizations working to transform the health sector worldwide, without compromising patient safety or care, so that it becomes ecologically sustainable and a leading advocate for environmental health and justice. Health Care Without Harm’s national Healthy Food in Health Care program works with hospitals across the country on sustainable meat procurement.