July 1, 2016

Connecting the Dots from Stockholm to New York…from Food Systems to Antimicrobial Resistance

Anthony So

Anthony So


Johns Hopkins Center for a Livable Future

ASo-Stordalen-2016Even in the land of the midnight sun, the days with the coming summer solstice were not long enough to resolve the issues before the EAT Stockholm Food Forum. This remarkable global gathering of food system thought leaders, celebrity chefs and entrepreneurs to academics and government officials is the inspiration of Gunhild Stordalen, a Norwegian physician who co-founded both the Stordalen Foundation and its EAT Initiative. The Forum hosted voices from Jamie Oliver and Michael Pollan to Kimbal Musk and Sam Kass—all of whom took turn in leading sobering conversations about an ailing food system. This year, connecting the dots between the food system and antimicrobial resistance received important attention on both days in the plenary sessions and in a special breakout track.

Coming on the heels of COP 21 climate change talks in Paris, several speakers suggested that the momentum to address climate change must include the food system. Climate change clearly affects yields from food production, and food production contributes significantly to climate change. Livestock production accounts for roughly 15% of greenhouse gas emissions, and a major driver of this relationship is a global increase in meat consumption. Accompanying this increase in consumption is an expansion of food animal production.

Consider how these factors are coming together in a country like China. Already the world’s largest producer and consumer of pork, the world’s second largest producer of poultry and the world’s largest importer of soybeans for animal feed, China will see meat consumption rise at a much faster pace than the United States. To meet this growing demand for meat, the country has become increasingly reliant on grain imports, much of it for animal feed. Chinese-owned concerns have moved to acquire global agribusiness firms, like Smithfield Foods and now Syngenta. China is moving towards a model of industrial food production. In step with these changes, China will account for 30 percent of global antimicrobial consumption in food animal production by 2030. Between now and 2030, two-thirds of the projected global increase in antibiotics in food animals will be because we are consuming more meat, and a third because of the shift to this more intensive form of production.

Recently though, China’s Ministry of Health announced dietary guidelines that recommend people to cut their read meat intake by half. This recommendation alone—if implemented in China—could go a long way to lowering greenhouse gas emissions in the country. Will the normative sway of Ministry of Health dietary guidelines be a game-changer to move China towards a more sustainable path of food production, more so than the influence of providers and patients? Or will concerns over food safety prove to be the game-changer? Or will national security concerns over the increasing dependence on grain imports to feed livestock be the impetus?

This past November, investigators in China discovered MCR-1, the first ever-documented finding of plasmid-mediated resistance to the antibiotic colistin—where resistance spreads from one bacterial species to another—a finding that sent shock waves through the global health community. Because of its known toxicity, colistin is seldom used in humans—it is used only as a drug of last resort. By contrast, it is widely used in treating food animals. Could MCR-1—and the loss of our last-resort antibiotic—serve as a wake-up call for policymakers to take a deeper look at the system of industrial food animal production?

We are only beginning to appreciate how our dietary choices are so deeply interconnected with planetary health and the sustainability of the food system. Biocides like glyphosate, also known as the herbicide Round-up, can significantly amplify drug resistance in bacteria, like E. coli and Salmonella, potential pathogens in the human gut. The use of antibiotics in food animals could also have unintended consequences. Coming full circle, a recent study suggests antibiotics given to cattle can alter not only the microbes found in the gut of livestock, but also the manure of antibiotic-treated cows, such that it produces nearly twice as much methane—a potent greenhouse gas—compared to manure from non-treated cows.

Giving antibiotics for growth promotion or prophylaxis to animals—when they have no disease—is no way to spend a life-saving resource. Yet as CLF first documented from FDA data in 2010, nearly 80% of antibiotics sold, by weight, goes towards food animal usage as opposed to human use. Most of the leading trade partners to the United States have more restrictive policies on antimicrobial use in food animal production, and given how U.S. policies have lagged behind Europe’s, the Congressional Research Service sought to size up the potential trade implications on U.S. export markets for livestock and poultry in 2011. In the interval, civil society groups working on human and animal use of antibiotics have come together to lay out a multisectoral, One Health approach to addressing this challenge, and the World Health Assembly has adopted a Global Plan of Action that calls for “phasing out of use of antibiotics for animal growth promotion and crop protection in the absent of risk analysis” and “reduction in nontherapeutic use of antimicrobial medicines in animal health.” While calling for curbing the use of critically important antimicrobials and ten-year targets for reducing unnecessary use of antibiotics in agriculture, the UK Commission on Antimicrobial Resistance pointed to the need for collecting data on antibiotic use in the sector. Alongside these recommendations, CLF and ReAct—Action on Antibiotic Resistance contributed a commissioned paper that provided a framework for examining the economic costs of lowering use of antimicrobials in food animal production. The need for an international framework agreement to ensure global coordination of these efforts has never been clearer.

From KFC to Subway, U.S. consumer groups have called upon major food retail chains to source products that do not involve the routine use of medically important antibiotics. However, the early successes of these campaigns need to be deepened, with clear timetables, independent third-party verification, and a global commitment beyond U.S. franchise operations.

With the upcoming High-Level Meeting on Antimicrobial Resistance this September at the time of the UN General Assembly, there may be added impetus to tackling the overuse of antibiotics in the system of industrial food animal production. Just a week prior to the EAT Food Forum, a broad swath of stakeholders from country missions and intergovernmental agencies to the private sector and civil society gathered in New York for a UN briefing on “Meeting the Multisectoral Challenge of Antimicrobial Resistance” in New York. Here we had an opportunity to bring issues around antimicrobial resistance in food animal production to the forefront of policymaker discussions by co-organizing and moderating a panel that included case studies from the Netherlands, the world’s second largest agricultural exporter, and the Republic of Korea, as well as civil society. CLF and ReAct—Action on Antibiotic Resistance also provided a background fact sheet on “Curbing Antimicrobial Use in Food Animal Production.” From Stockholm to New York, perhaps antimicrobial resistance will serve as an important policy trigger to shaping a healthier, more sustainable food system.

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