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Data released Monday by the U.S. Food and Drug Administration (FDA) reveal a significant increase in the sales of medically important antibiotics for use in the production of chicken, beef and pork for human consumption.
The revelation comes seven years after the U.S. Department of Health and Human Services released its National Action Plan for combating antimicrobial resistance, and two years after the plan was updated.
The FDA report also follows the release of a joint investigation by The Bureau of Investigative Journalism (TBIJ) and The Guardian revealing that several major retailers and restaurant chains — including McDonald’s, Taco Bell and Walmart — are sourcing beef that originates from farms using a specific category of antibiotics linked to impacts on human health and the spread of “superbugs.”
TBIJ’s investigation, published Nov. 21, drew from “unpublished U.S. government records,” revealing that beef produced for meat packing firms such as Cargill, Green Bay and JBS came from industrial farms using antibiotics categorized as the “highest-priority critically important” (HP-CIA) to human health.
The FDA report revealed that, despite an overall 1% decrease in antibiotic sales to the livestock industry in 2021 as compared to 2020, there were increases in antibiotic sales for use in the production of chicken (12%), pork (3%) and beef (1%).
Coupled with data showing that in 2021, chicken and pork production actually decreased compared to 2020, the results show “more antibiotics were sold for use in fewer animals,” according to Civil Eats and data from the Natural Resources Defense Council (NRDC) and the U.S. Department of Agriculture (USDA).
“The reckless overuse of medically important antibiotics on factory farms is a major contributor to this deadly public health threat,” said U.S. Sen. Cory Booker (D-N.J.) who has advocated for stricter controls on how antibiotics can be used in food production, according to The Guardian.
“Giant agribusinesses have built a system that is dependent on this misuse of antibiotics to maximise their profits, with no regard to the serious harm they are causing.”
In interviews with The Defender, a number of scientists, doctors and nonprofit advocacy groups that monitor the use of antibiotics in cattle and livestock commented on the FDA and TBIJ reports and the implications for human health of allowing the widespread use of antibiotics in animal agriculture.
CDC: 35,000 deaths annually in U.S. caused by antibiotic resistance
According to TBIJ’s report, the spread of drug-resistant bacteria in the environment represents a “huge public health challenge,” yet “many U.S. cattle farmers still routinely use antibiotics” on their food animals, “often for months on end.”
TBIJ’s report states:
“The drugs have historically been used in industrial farming to prevent diseases from spreading. But their use — and overuse — enables bacteria to develop resistance, meaning the drugs stop working.”
TBIJ referenced statistics from the Centers for Disease Control and Prevention (CDC) showing antibiotic resistance causes more than 2.8 million infections and 35,000 deaths annually in the U.S., and 1.3 million deaths worldwide.
According to TBIJ, the World Health Organization (WHO) has proposed that the use of HP-CIA in cattle and livestock be stopped. The WHO describes HP-CIAs as often being the “last line treatments available for serious bacterial infections in humans.”
Katie Amos, director of communications and outreach with A Greener World, said the routine overuse of antibiotics provides the ideal conditions for bacteria to mutate and become resistant to their effects.
“The threat to human health that we are facing is the rise of bacteria that have survived this constant exposure and are now resistant to antibiotics, leading to a situation where we can no longer treat many common diseases,” Amos said.
“The link between antibiotic abuse in intensive livestock farming to the dramatic rise in life-threatening antibiotic-resistant bacteria is a global health threat that demands our immediate attention,” Amos added.
Cóilín Nunan, scientific adviser for the Alliance to Save Our Antibiotics, made the distinction between antibiotic residues in meat itself, as compared to the spread of antibiotic-resistant bacteria on, or in, meat and dairy.
Nunan told The Defender:
“Antibiotic residues in meat … are not the main way that farm antibiotic use contributes to resistance in human infections. The spread of antibiotic-resistant bacteria on, or in, meat or dairy contributes a lot more.
“There is no reliable estimate of how much farm antibiotic use contributes to the resistance problem in human medicine, as the problem of tracing the resistance is very complicated since bacteria can pass resistance genes between each other through a mechanism called horizontal gene transfer.”
HP-CIAs ‘widespread’ in U.S. beef supply chains, according to TBIJ investigation
TBIJ’s investigation found that “residues of numerous HP-CIAs and other antibiotics were present in many of the US’s beef supply chains between 2017 and 2022,” according to tests by the USDA’s Food Safety and Inspection Service.
According to TBIJ, among 10 of the biggest meat packers:
“All had at least one HP-CIA in use on farms supplying their abattoirs. Several were found to have as many as seven separate HP-CIAs in use.
“Cattle farms selling to JBS, which has sold beef to Wendy’s, Walmart and Taco Bell, were found to have used seven HP-CIAs. Farms serving Green Bay Dressed Beef, which has supplied the Kroger supermarket chain, also had seven in use.
“Cattle suppliers to Cargill, which sells beef to McDonald’s, were found to have at least five HP-CIAs in use.”
Richard Young, chief scientific advisor for the U.K.’s Sustainable Food Trust, told The Defender there are two reasons HP-CIAs are so popular in the animal agriculture industry.
“These are generally the most modern antibiotics available, as such they are currently highly effective against many infections in farm animals,” Young said. “But some of the antibiotics, for example, ceftiofur … have very short withdrawal periods, zero days in milk. As a result, the cow can be treated while the milk all still goes for human consumption.”
Dr. Dimitri Drekonja, an infectious disease specialist at the University of Minnesota Medical School, highlighted their effectiveness, ease of use and other ancillary benefits of HP-CIAs. “The high-priority antibiotics are generally more active against a broad range of bacteria, so if you want to kill bacteria, whether for disease prevention because of an exposure, or treating a sick animal, they are appealing.”
“And for reasons we never have really understood, receipt of antibiotics in farm animals results in more weight gain. If your business is raising as many pounds of meat as possible for your input, giving antibiotics is attractive. Use of antibiotics to ‘prevent’ disease allows more crowded conditions and other cheaper ways to farm.”
Amos told The Defender that the “routine antibiotic use in industrial farming systems — often to animals who are not sick — maximizes production of meat, milk or eggs by improving feed efficiency and suppressing diseases that would otherwise spread like wildfire in the confined, unsanitary, and stressful conditions typical of intensive livestock operations.”
The greatest volume of HP-CIAs, like most medically important antibiotics, are used in cattle and pigs,” according to Steven Roach, head of Keep Antibiotics Working.
“Much of the use in cattle is to prevent liver abscesses in feedlot cattle caused by inappropriate high energy diets,” he said, adding:
“Most of the [usage] in cattle is to prevent respiratory disease caused by moving calves off pasture and shipping them to feedlots, which makes them susceptible to respiratory disease. In pigs, a lot of the use is to prevent diarrhea and respiratory disease caused by unhealthy conditions in pig farms.”
TBIJ’s investigation noted, however, that other categories of antibiotics aside from HP-CIAs are used and have been found in beef products. Young provided background into some of these antibiotics — some of which are harmful to human health — telling The Defender:
“One antibiotic used in intensive pork production in the U.S. is a suspected carcinogen at the levels sometimes found in pork. It is called ‘carbadox’ [and] sold as Mecadox. This was banned in Europe in 1999. Consumers should demand that the industry stops using it and refuse to buy pork or bacon or ham until it does.
“Carbadox is a suspected carcinogen which is why it was banned throughout the EU in 1999. Tetracycline, on the other hand, an antibiotic widely used on U.S. farms has very low toxicity. Even if you had a thousand times the recommended safe amount, it would not have any toxic effects.”
Cargill, Taco Bell, McDonald’s defend use of antibiotics
Companies identified in TBIJ’s report defended their practices. Cargill stated:
“Judicious use of antibiotics prevents sick animals from entering the food supply, and ensures that animals do not unnecessarily suffer from disease.
“While we support the responsible use of human antibiotics in food production, we are committed not to use antibiotics that are critically important for human medicines as defined by the World Health Organization.”
Taco Bell claimed that it updated its fresh beef standards in 2019 “to require its US and Canada suppliers to restrict antibiotics important to human health in [the] beef supply chain by 25% by 2025.”
McDonald’s referred to its online statement on antibiotics, claiming the company will “establish market-appropriate targets for use of medically important antibiotics — as defined by the WHO.”
But Laura Rogers, deputy director of the Antibiotic Resistance Action Center at George Washington University’s Milken Institute School of Public Health, told The Defender that while “McDonald’s had made an announcement that it would be reducing antibiotics in its beef supply,” it “has not yet followed through with any meaningful action.”
In fact, many companies have not fulfilled similar pledges, said Gail Hansen, a veterinarian and public health consultant.
“The companies pledged to purchase more meat from animals that were given fewer, or no, antibiotics. The timing and amount varies by company, but several companies have let those pledges lapse without implementation.”
Most corporate pledges have come from chicken producers, Roach said.
“This has led to much of the chicken raised for meat in the U.S. not receiving antibiotics. Subway, Taco Bell and McDonald’s have made commitments on other meats but have not made progress on implementing them.”
“McDonald’s this year walked back a commitment made in 2018 to reduce use of antibiotics in its global meat supply. McDonald’s has changed its commitment to reduce use [and] to use antibiotics responsibly, which is much more difficult to measure and will not reduce resistance if it does not lead to reductions in use.”
Hansen highlighted “real progress” that has been made in the chicken industry, due to public demand: “There has been real progress in the chicken industry over the past 10 years to decrease the antibiotic use in that industry, partly as a result of consumer demand.”
“Raising cattle and the beef industry have a different set of issues to work through,” she added, “but I am convinced that significantly decreasing antibiotic use in beef cattle without sacrificing animal welfare — and without significantly raising costs to producers and consumers — can be accomplished if there is the political will and economic incentive to do so.”
‘Drug-resistant salmonella rise dramatically when poultry farmers use antibiotics to raise their flocks’
There are many examples of “pathogenic resistant bacteria infecting humans that have acquired at least some of their resistance from farm antibiotic use,” Nunan told The Defender.
These include campylobacter, salmonella, E. coli, methicillin-resistant Staphylococcus aureus, or MRSA, enterococci and Clostridioides difficile.
“The extent to which farm antibiotic use has contributed to resistance in these pathogens,” said Nunan, “depends on the bacteria in question. It has contributed a lot in the case of campylobacter and salmonella, but less in the case of the other pathogens.”
Roach highlighted salmonella and campylobacter as particular threats. He said:
“CDC considers resistant salmonella and campylobacter as serious public health threats. Multidrug-resistant E. coli and MRSA are other examples of superbugs that threaten lives.
“A recent paper found that bacterial infections globally cause 7.7 million deaths annually. Effective antibiotics could save many of these lives.”
Young told The Defender that while extended spectrum beta-lactamase E. coli live harmlessly in the human gut, other strains of E. coli can transfer resistance genes to them.
“Community-acquired MRSA appears to come from farm animals, especially pigs via pork,” Young said, while “antibiotic resistance in campylobacter, salmonella and E. coli food poisoning can come from the use of antibiotics on farms.”
Other experts identified additional types of bacteria that can evolve into superbugs.
“Methicillin-resistant staph aureus strains resistant to tetracyclines have been linked to farms using tetracycline to raise swine,” Drekonja said, while “drug-resistant salmonella rise dramatically when poultry farmers use antibiotics to raise their flocks, and fall when antibiotics are removed.”
Jan Kluytmans, Ph.D, professor of medical microbiology at University Medical Center Utrecht in the Netherlands, described carbapenemase-producing bacteria as those that are “most feared,” noting they are included on the WHO priority list of resistant bugs.
Even if foods contain no antibiotic residues, the bacteria they naturally contain can still pass resistance on to humans, Young said.
“Essentially, the antibiotics kill off the bacteria that are sensitive to it, but because bacteria multiply so rapidly — E. coli can double in number every 20 minutes, salmonella every 30 minutes — a few of them can be naturally resistant to it.”
“Once the opposition has been killed off,” Young added, “the resistant ones soon create a population where they are all resistant.”
Peter Collignon, Ph.D., an infectious disease physician and microbiologist at Canberra Hospital in Australia, explained that it is such resistance, along with poor farming practices, that can give rise to superbugs.
“It is clear that ‘superbugs,’ or resistant bacteria, can spread to people from food animals … and from water contaminated with these resistant bacteria. Examples include bacteria such as campylobacter, salmonellae, Staphylococcus aureus, E. coli and enterococcus,” Collignon said.
‘Final nail in the coffin’ of FDA’s failure to regulate
David Wallinga, senior health officer with the NRDC, told Civil Eats the latest data are “just another nail in the coffin of a failed FDA approach to stewardship of antibiotics in the livestock sector.”
According to TBIJ, “Until 2017, antibiotics were added to animal feed to fatten up livestock. After the FDA announced a ban on the practice, the sale of antibiotics for use in agriculture dropped by a third.”
However, sales have since “leveled off,” as “farmers can still routinely use antibiotics to prevent disease, so long as they have a prescription from a vet.”
According to Roach, FDA regulations are insufficient and fall short of WHO recommendations. In reference to the FDA, he told The Defender:
“In 2003, they began requiring antibiotics to be reviewed prior to approval to determine if they are safe with respect to resistance. What they did not do was require antibiotics that were already approved to go under review and the bulk of the drugs now marketed were first approved before 2003.
“In addition, FDA rules are much less restrictive than what is recommended by the World Health Organization allowing almost any drug to be used in individual animals by injection.”
According to Hansen, for most farmers, obtaining antibiotics is as simple as getting a prescription from a veterinarian:
“As long as the antibiotics are used as directed on the label, there are no other regulations. Usually that means a veterinarian has prescribed the antibiotic.
“There are a few antibiotics that are not allowed to be used in animals raised for food, and veterinarians cannot prescribe antibiotics to be used ‘off label’ in animals raised for food — ‘off label; means that FDA has not approved the specific use for an antibiotic.”
“In many countries where antibiotic growth promotion is banned and antibiotic use is under veterinary prescription, antibiotics can still be added to animal feed or drinking water for disease prevention. This is the case for the U.S. and the U.K. In those countries it is legal for a vet to prescribe antibiotics for groups of animals preventatively, under certain conditions.
“Sometimes this differs very little from growth promotion as some of the same antibiotics that were licensed for growth promotion are permitted for preventative group treatments.”
Unlike the U.S., Nunan said, “Any form of routine antibiotic use is no longer legal in the EU since 28 January 2022, nor is using antibiotics to compensate for poor hygiene, inadequate animal husbandry or lack of care or poor farm management.”
“Antibiotics can still be used to treat groups of animals,” he added, “but a vet must diagnose disease within the animals and the disease must be sufficiently serious to justify antibiotic use.”
NRDC’s data on antibiotic use found that in 2020, the rate of antibiotic use in the U.S. was nearly double the overall rate in the EU.
While TBIJ’s investigative piece noted that antibiotics can no longer be added to cattle feed in the U.S., this is not fully accurate, according to Nunan. “Antibiotics can still be added to cattle feed. … It is just that they are no longer permitted for growth promotion in some countries like the U.K., U.S. and EU.”
“Antibiotics are still added to cattle feed through a mechanism known as the ‘Veterinary Feed Directive’ (VFD). The veterinarian writes a ‘prescription’ for antibiotics to be added to the feed of several animals for a specific amount of time to prevent, control or treat disease.”
TBIJ investigation findings ‘alarming but not surprising’
Experts told The Defender they weren’t surprised by TBIJ’s findings.
“When the FDA disallowed the usage of antibiotics for growth promotion, we all expected to see a reduction in use,” Drekonja said. “But we also knew that lots of ‘preventative’ use could be done that looked very similar in terms of drugs used [and] doses used for growth promotion.”
So, the leveling off after the initial drop is “not too surprising,” Drekonja said.
The “preventative” use described by Drekonja refers to the common practice of preemptively administering antibiotics to cattle and livestock to prevent illness in the animals and the potential outbreaks of diseases on the farms.
“Responsible companies should only be allowing their suppliers to use antibiotics exceptionally, and not for routine disease prevention,” Nunan said, adding:
“Using antibiotics preventatively for groups of animals should not be called therapeutic use, since it is only done for productivity purposes and to compensate for poor husbandry and hygiene. It should not be allowed by these companies or by governments.”
Young connected the “preventative” use of antibiotics in food animals to the unsanitary conditions on industrial factory farms.
Young told The Defender:
“The fundamental problem is that the way most animals are raised in the U.S. and many other countries, means that they can only be prevented from becoming sick by daily doses of antibiotics.
“It’s no good telling farmers they have to use less antibiotics. There is a vicious circle here that involves everyone: consumers, multiple retailers, vets and farmers.
“The only way to break this cycle is for us to eat less meat overall, better quality meat, meat produced in less intensive and more natural ways, and yes that does mean more expensive meat. But if we factor in the negative impacts on human health and the environment this is by far the cheaper option overall.”