A newly revised technical report from the American Academy of Pediatrics (AAP) describes how the use of antibiotics in animal agriculture contributes to development of antibiotic resistance in medical use and can adversely affect child health. The report also discusses the need for U.S. initiatives to curb unnecessary use of antimicrobial agents in agriculture. The technical report Use of Antibiotics in Animal Agriculture: Implications for Pediatrics, from the AAP Committee on Infectious Diseases and the Council on Environmental Health and Climate Change, is available online and is published in the October issue of Pediatrics. Thus, the AAP joins others in urging support for “policies that strengthen oversight of antimicrobial use and require tracking and reporting of antibiotic use and resistance across human, animal, plant and environmental sectors.”
The spread of antibiotic resistance is a healthcare crisis of major proportions and requires a moratorium on the use of antibiotics in agriculture. The Centers for Disease Control and Prevention (CDC) calls antibiotic resistance “an urgent global public health threat, killing at least 1.27 million people worldwide and associated with nearly 5 million deaths in 2019.” Furthermore, according to CDC, “More than 2.8 million antimicrobial-resistant infections occur in the U.S. each year, and more than 35,000 people die as a result. When Clostridioides difficile—a bacterium that is not typically resistant but can cause deadly diarrhea is associated with antibiotic use—is added to these, the U.S. toll of all the threats in the report exceeds 3 million infections and 48,000 deaths.” Many bacterial infections are becoming resistant to the most commonly prescribed antibiotics, resulting in longer-lasting infections, higher medical expenses, and the need for more expensive or hazardous medications. The development and spread of antibiotic resistance are inevitable effects of the use of antibiotics. Bacteria evolve quickly, and antibiotics provide strong selection pressure for those strains with genes for resistance.
Unfortunately, the medical profession lacks complete control over the use of antimicrobials. Many of the same chemicals used in human medicine are also used in agriculture. These may show up in or on treated food, but can also spread antimicrobial resistance through horizontal gene transfer. So, in addition to ingesting antibiotics in food, the movement of resistant bacteria and fungi in the environment contributes to this escalating crisis.
In December 2023, the U.S. Food and Drug Administration (FDA) warned nine manufacturers and distributors to stop selling unapproved and misbranded antimicrobial animal drugs, with the director of FDA's Center for Veterinary Medicine, Tracey Forfa, explaining to the public that “inappropriate use of medically important antimicrobials contributes to the development of antimicrobial resistance, which affects both human and animal health.”
As the American Society for Microbiology (ASM) notes in its December 13, 2023 letter to the EPA, ASM Responds to Environmental Protection Agency on Antimicrobial Resistance Assessment Framework about EPA's proposed Antimicrobial Resistance Assessment Framework, “Antimicrobial resistance (AMR) is a top public health threat and one of our most daunting challenges. AMR is associated with the deaths of 4.95 million people in 2019 and is projected to cause 10 million deaths by 2050. Each use of an antimicrobial drug or agent, whether used to treat disease in humans, animals, or crops, contributes to antimicrobial resistance. As existing antimicrobial agents decline in effectiveness, infections will be more difficult and expensive to treat and epidemics harder to control.”
In addition, fungicide use in agriculture is driving the spread of multi-fungicide resistant human pathogens, finds a 2022 study conducted by scientists at the University of Georgia. While this occurrence has long been an assumption based on the rampant overuse of fungicides in chemical-dependent farming, scientists have now found clear evidence linking the development of widespread fungal resistance to farming practices, rather than healthcare use. Despite strong evidence that commonly used synthetic pesticides in chemical-intensive farming are driving resistance that threatens human health on a global scale, the U.S. government has not only failed to take action, it has fought against international efforts to slow the crisis, at the behest of the agrichemical industry.
According to a 2021 article in Current Research in Microbial Sciences, “Antibiotic resistance in agriculture: Perspectives on upcoming strategies to overcome upsurge in resistance,” the leading consumers of antibiotics in developed countries are U.S. consumers. So, it would appear that the U.S. population may have the most to lose from antibiotic resistance. As Beyond Pesticides has previously covered, a report evaluating 204 countries published by the University of Washington's Institute of Health Metrics and Evaluation, “Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis,” generated the following statistics:
- 13.66 million people who died globally had sepsis as an immediate cause of death or in the chain of events leading to their death (intermediate cause).
- 4.95 million people who died in 2019 suffered from drug-resistant infections, such as lower respiratory, bloodstream, and intra-abdominal infections.
- 1.27 million deaths in 2019 were directly caused by AMR [antimicrobial resistance].
- 1 in 5 people who died from AMR was a child under 5 years old, often from previously treatable infections.
According to the Food and Agriculture Organization of the U.N., the Global Research on Antimicrobial Resistance study found, “If action is not taken, the rise of AMR cumulatively may result in over 3.4 trillion USD loss in the world's annual gross domestic product (GDP) in ten short years.
A 2020 scientific peer-reviewed article in Revista Panamericana de Salud Publica (Pan American Journal of Public Health)—a publication of the Pan American Health Organization, "From environment to clinic: the role of pesticides in antimicrobial resistance," finds the following: “Available evidence suggests that the natural environment may be a key dissemination route for antibiotic-resistant genes. Understanding the interrelationship of soil, water, and pesticides is fundamental to raising awareness of the need for environmental monitoring programs and overcoming the current crisis of AMR.”
ReAct, an independent worldwide network focused on antibiotic resistance founded in 2005, has characterized the problem from perspectives around the world, “[A]ntibiotic resistance is here now and is a global leading cause of suffering and unnecessary loss of lives across the world. The global response must finally start to reflect this fact.”
Not all antimicrobial pesticides are registered for their antimicrobial action. For example, the herbicides glyphosate, 2,4-D, and dicamba are able to create resistance in Salmonella and E. coli. From another health perspective, antimicrobial pesticides may negatively affect the gut microbiome, which is essential for human nutrition and immune system function. Health advocates maintain that EPA must cease registration of pesticides with antimicrobial effects (or potential antimicrobial effects) in human pathogens or beneficial human microbiota.
The researchers and agencies raising the alarm exhibit a higher degree of concern about antimicrobial resistance—understood as a growing worldwide pandemic—than the history and ongoing inaction by EPA—resulting in the allowance of widespread nonmedical uses of antibiotics in agriculture and on synthetic (or artificial) turf. Contrary to broad scientific understanding, EPA told a federal appeals court, “There is no data that antibiotic use in agriculture leads to the presence of antibiotic resistance in bacteria of human health concern,” and that “[a]t the present time, there is little evidence for or against the presence of microbes of human health concern in the plant agricultural environment.”
EPA's inaction, despite the agency's sponsoring of research that confirms the spread of antibiotic resistance to humans from horizontal gene transfer in the environment, only adds to the problem. As drug-resistance has been documented as being on the rise for years, EPA's response, or lack thereof, has been increasingly apparent. In one case, as previously reported by Beyond Pesticides, “The agency failed to assess the efficacy of any pesticides that are not used for public health purposes; EPA only evaluated the efficacy of antimicrobial compounds whose use patterns classify them as human-health-related—thus ignoring the impact of other antimicrobial pesticides on resistance in human pathogens.”
Despite litigation and copious studies, there is a growing crisis in health care due to drastic increases in antibiotic resistance. Nonorganic agricultural practices, which utilize antibiotics in crop and livestock production, exacerbate this major health issue by also applying harmful pesticides that promote antibiotic resistance genes in bacteria. In addition, use of antimicrobial pesticides harms the beneficial microbiota in the soil as well as in humans. Despite resistance on many farms that have led to harm and collapse, there are organic methods that offer a path forward. The foundation of all organic land management systems starts in the soil, which highlights the importance of promoting healthy soil and the microorganisms within it.
>>Tell the U.S. Environmental Protection Agency (EPA) and Congress to save antibiotics for important medical uses and eliminate use as pesticides.
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