There are two great existential threats faced by humanity today. Climate change and antibiotic resistance. Both are man-made and could destroy humanity as we know it. In this post I will talk about the latter, how it links to food production, and how we can tackle it by changing the way we produce and consume food.
The Miracle of Antibiotics
Since the discovery of penicillin in 1928, antibiotics ingrained themselves in every corner of medicine (one exception being psychiatry). We have a huge array of antibiotics for all bacteria, we give them preventatively to make possible surgery which we couldn’t have dreamed of 50 years ago. At the start of the 20th century life expectancy was about 50 and the main killers were infectious diseases by a huge margin. We now expect to live to about 80 and most people will die from degenerative diseases. Pneumonia does still kill but normally with an underlying condition. In short, thanks to antibiotics we live longer and we live healthier, they are the backbone of modern healthcare.
Visualisations of Male and Female causes of death.
The Threat
The World Health Organisation stated, this year, that we are heading towards “a post-antibiotic era, in which common infections and minor injuries can once again kill.” We face sending ourselves back into a world where a small cut on your finger while gardening could kill a healthy young person within months and where we have no way of treating the numerous infections that jeopardise the lives of newborns.
A strain of the bacteria Klebsiella Pneumoniae which is resistant to all available antibiotics has already been discovered, in China in 2015. The same resistance genes were found in bacteria which killed a woman in Nevada just over a year later. Bacterial resistance is already taking lives and quickly spreads worldwide.
It’s no surprise that this particular strain apparently originated in China, given that it developed in livestock and China uses about a quarter of the worlds antibiotics for livestock.
Farming
In the US, an estimated 70% of all antibiotics produced are used in farming. These antibiotics are used for various reasons, almost entirely for livestock (0.36% is used for crops, with no measurable impact on resistance). The uses for livestock are to treat and prevent disease as well as to promote livestock growth.
The impact of antibiotic use is compounded by the fact that antibiotics then leach into water supplies and soil, so resistance will develop in bacteria outside of agriculture. Antibiotics are passed up the food chain into human digestive systems, creating further opportunities for resistance to develop.
While it’s true that many of the bacteria found among animals do not present a big threat to human health, bacteria are capable of horizontal transmission. This is when bacteria share genes, which can happen across species, meaning that a resistance gene which develops in a relatively harmless species of bacteria might spread to species that are dangerous to humans.
Pharmaceutical companies
It’s reasonable to assume that this situation leaves an open goal for pharmaceutical companies to develop new antibiotic drugs, and that filling a gap in the market would make plenty of return on investment. This has not happened. Antibiotics are only given for a short period of time. Compared to drugs which are taken for life (e.g. blood pressure medication) there can only be a small amount of drugs sold per patient.
Since new antibiotics have no resistance working against them yet, they are reserved for the most extreme cases where other options have been exhausted. This slows the rate at which resistance develops, but it reduces the sales of new antibiotics even further, which deters pharmaceutical companies from developing them.
In 2011 the WHO believed there were only five companies in the world developing new antibiotics. Pharmaceutical companies are often very secretive about their research activities and the number may now be as low as three.
This shows how profit seeking organisations are not incentivised because the market has failed to create demand, therefore economic incentives need to be created.
Solutions
Given how important China is in relation to antibiotic resistance, it is important to look at efforts it is making to fight resistance. China recently signed up to the WHO’s Global Action Plan on Antimicrobial Resistance and is a signatory to the UN’s ‘One Health’ agenda. China’s ministry of agriculture recommended phasing out some types of antibiotics critical for humans, making some drugs legal only with prescription and improved monitoring of drug usage. However, they have been criticised by groups such as Greenpeace, who believe this response is too slow and not far-reaching enough.
Denmark and The Netherlands are two countries widely considered to be leading the way on antibiotic resistance. They both banned antibiotic growth promoters and set up surveillance systems for antibiotic resistance. The Dutch government even enforced halving antibiotic use. Neither of these countries saw reductions in production or profit despite drastic reductions in antibiotic use, showing that is possible for governments to successfully implement regulation.
On an individual level, one way to help reduce antibiotic use is to eat less meat. As stated earlier, a tiny amount of antibiotics are used in farming crops, with no measurable effect on resistance. Going vegetarian or vegan will hugely decrease the amount of antibiotics used to produce your food – even reducing the amount of meat you eat will have a significant contribution.
Summary
The danger of antibiotic resistance is huge and coming quickly, but solutions are within reach. Governments and multilateral organisations are waking up to resistance and in some case even making huge strides in fighting it. Market failures mean that we need to create incentives for pharmaceutical companies to develop new drugs to replace the quickly dissolving last lines of defence. At the same time we must regulate to make sure these new drugs are reserved for medical uses, not used for livestock. Additionally, links between meat consumption and antibiotic resistance create a good case for reducing meat in our diets.