UN makes historic commitment to fight antibiotic resistance

On September 21, the United Nations General Assembly took a historic step: It acted on the danger posed by antibiotic resistance, which is rising around the world, killing an estimated 700,000 people each year.

The U.N. action was only the fourth time that the General Assembly, which usually addresses economic and social issues, had ever considered a health problem. Its all-day “high-level meeting,” in which representatives of 70 governments shared their concerns about controlling resistance, resulted in a commitment by all 193 member nations to begin working on the problem. The first step was to create a “coordination group” to bring all the international efforts in line.

And, unusually for discussions about antibiotic resistance, the role played by agriculture and food production was front and center.

UN Secretary-General Ban Ki-moon opened the meeting by saying: “Antimicrobial resistance poses a fundamental long-term threat to human health, sustainable food production, and development.” He added, “In all parts of the world, in developing and developed countries, in rural and urban areas, in hospitals, on farms, and in communities, we are losing our ability to protect both people and animals from life-threatening infections.”

That was a refreshing foregrounding of the problem posed by the routine use of antibiotics in raising livestock and in fish farming. The question now is, what happens next?

As part of the U.N. action, the member governments agreed to develop individual national strategies, based on the World Health Organization’s year-old Global Action Plan. But the U.N. did not include any usage targets that countries should aim for, as one set of researchers recommended prior to the meeting.

And it did not include any promises of funding from rich nations. Some funding mechanisms were created in the run-up to the meeting, such as the CARB-X program in the U.S. and the Fleming Fund in the UK, but those focus on developing new antibiotics and improving surveillance for resistant organisms.

Yet enormous amounts of antibiotics are used in agriculture: about 33 million pounds in the U.S. in 2014, according to the FDA; and, in what is considered a conservative estimate, 126 million pounds worldwide.

One use of antibiotics in livestock — growth promoters, the very small doses that are given to animals to make them put on weight — was outlawed in the European Union in 2006. Similar though voluntary controls will begin in the United States in 2017. But neither of those programs curb antibiotic dosing that is intended to prevent animals from getting sick in crowded farm conditions. (The equivalent practice in human medicine, giving antibiotics on the off-chance that someone might develop an illness, would be considered medically inappropriate and a waste.)

And almost no controls on antibiotic use exist in most of the developing world. Economists have predicted that, unless control programs are created, the emerging economies of India, China and Brazil, among others, will account for a two-thirds rise in global antibiotic use on farms by the year 2030. At that point, they project, China will be giving its livestock one-third of all the antibiotics produced in the world.

The effect of that uncontrolled drug use has already been spotted, in multi-drug-resistant pathogens that are moving across the world — such as MCR, an acronym for resistance to the last-ditch antibiotic colistin. MCR was identified in pigs, meat and human patients in China in 2015, and now has been found in 30 countries, including in four people in the United States.

In trying to put controls on farm antibiotic use, the United Nations’ program and the governments which supported it face some important challenges. The first is that, as the nonprofit Wellcome Trust identified in a pre-U.N. summit on antibiotic use held last spring, resistant bacteria don’t seem like a priority to nations that are dealing with hunger, diseases of poor sanitation, low life expectancy and women dying in childbirth.

The second is that countries use farm antibiotics for what feel like good reasons — to keep up with the growing demand for meat that is occurring as their populations become more affluent, and also to keep productivity high even on small, low-tech, low-hygiene farms. Rising demand for meat would not be such a problem if meat animals could be raised in a cleaner, more high-tech, low-antibiotics manner, using supplements and vaccines, as farmers in Europe learned to do following antibiotic bans there.

The challenge inherent in that — and where governments may have to focus next — is helping developing nations afford better farming practices that they don’t have the resources to create themselves. In the wake of the U.N. action, researchers have proposed the creation of a “global antimicrobial conservation fund” that would help low-income countries build better labs, surveillance and healthcare. Since international pressure to cut back on farm antibiotic use will only increase, it seems likely that any such spending will need to cover livestock raising, too. 
Maryn McKenna is a National Geographic contributor and the author of Superbug and Beating Back the Devil. She last wrote for FERN about how the Netherlands cut antibiotic use on farms.