On Wednesday last week, the nonprofit Natural Resources Defense Council revealed that pig herds in the United States receive almost as many antibiotics as people in this country do. That’s bad news, especially since most of the pigs receiving antibiotics aren’t sick, but instead are getting the drugs to prevent infections in intensive farming. Those drugs don’t keep the US pig herd healthy—major diseases have increased year over year since 2000—and all those antibiotics are increasing the amount of drug-resistant bacteria that arise on pig farms and that are routinely found on meat.
None of that is good news. But there’s a second story hidden in the NRDC report that is worse: The advocacy organization had to jump over hurdles to get the data to explain the effects of that drug use. Even in the era of Big Data, the information we‘re allowed to have about how antibiotics are used in US animals is limited, incomplete, and hostage to commercial interests—all of which keeps Americans from fully understanding how bad raising practices put our health at risk.
It doesn’t have to be that way. Other nations track and report agricultural antibiotic use, livestock diseases and human health impacts—not only in granular detail, but in unified data sets that make it easy to see how what’s happening on farms affects the wider world.
In the Netherlands, for instance, paired sets of data—Nethmap for human antibiotic use and resistance, MARAN for livestock (it stands for Monitoring of Antimicrobial Resistance and Antibiotic Usage in Animals in the Netherlands) are released in a single document every year by the Ministries of Health, Welfare and Sport, and Economic Affairs, Agriculture and Innovation. (Those are the equivalent, allowing for differences in government structure, of the US Department of Health and Human Services and the USDA.)
The Dutch data sets are assembled with the participation of physicians, pharmacists, and veterinarians, and they are a marvel of completeness. They are remarkably real-time, fine-grained, and coherent across categories—so much that, in the wake of a 2005 European Union ban on one type of farm antibiotic use, the Dutch data could show that drug-resistant infections linked to food didn’t drop as expected. That gave the government the proof it needed to recruit farmers into voluntary cuts in farm drug use. Antibiotic use dropped 60 percent in three years—and that time, they saw a drop in human infections.
Contrast that to the United States, where human prescription statistics are compiled and sold by a private company, Quintiles IMS, formerly IMS Health. (NRDC couldn’t afford to buy this data for its report; the group had to beg help from a deeper-pocketed think tank.) Animal-drug sales, but not usage, are tendered by veterinary-drug manufacturers to the FDA. Documenting where resistance is occurring is even more complicated: That is a joint project of the USDA, FDA, and CDC—but the agencies don’t report all their results in a single document or at the same time.
In the current political moment, perhaps it’s no surprise that the companies that make and sell antibiotics play a much larger role in the US surveillance system than they do in the Netherlands or across the European Union. For a glimpse of how uninformative American antibiotic surveillance is, look at how animal-antibiotic data comes to be.
Compiling and releasing those stats is governed by a law called the Animal Drug User Fee Act (ADUFA). The law’s origin was a slightly shady deal done between the FDA and pharma companies back in 2003: The companies were so impatient with the slow pace of new-drug approvals that they volunteered to pay a “user fee” that would allow the agency to hire more staff and process paperwork faster.
In ADUFA’s first years, drug companies paid the FDA $43 million, practically guaranteeing the act’s re-approval when it came up for a 5-year re-authorization. Sensing some leverage, members of Congress who wanted more transparency around farm antibiotic use shoehorned into the law a requirement that any antibiotics manufacturer that wanted new drugs approved would have to give up some agricultural sales data in exchange. That led to the first “ADUFA Report” (technically the “Summary Report on Antimicrobials Sold or Distributed for Use in Food-Producing Animals”) in 2009. It has been published every year, more or less, ever since.
But the statistics included in the report have been incomplete at best. The first ADUFA report, which recorded 28.8 million pounds of antibiotics sold for farm use, was only four pages long and contained just a single table. (It’s up to 67 pages and 28 tables and figures now.) The ways that drugs are dispensed on farms only began to be described a few years ago, and the descriptions don’t exactly match scientific understanding of how resistance emerges from farms. As Wallinga points out, the breakdown of how the drugs are used in different livestock species was only divulged in last year’s report, which covered 2016.
The biggest problem, though, is that ADUFA isn’t considered an obligation owed to public health, as antibiotic data is in Europe. Instead, it’s a political football. The law is up for reauthorization again this year, and since March, versions have been bouncing between the House of Representatives and the Senate. Some have been what legislative wonks call a “clean bill,” a strict reproduction of the text from the last round. But others have been lavishly tinkered with: one provision allowed the use of animal drugs, for up to five years, under “conditional approvals”—that is, without companies having to reveal any data showing their drugs are effective.
The newest version of ADUFA isn’t final yet; versions that separately passed the House and Senate will have to be reconciled and then voted on again. Advocacy organizations who have been monitoring the maneuvers contained in the various amendments are already exhausted—not just by the argumentation, but by the persistent sense that farm antibiotic misuse isn’t anyone’s priority other than theirs.
“The lack of data is a problem because we know that antibiotics are vastly misused in agriculture, but we need more information on exactly how they are used to put in place the best stewardship practices possible,” says Matthew Wellington, antibiotics program director for the organization US PIRG.“The less clear that data is, the harder time public health advocates and elected officials will have in creating best practices.”
If American farm and human antibiotic data were complete, up to date, and open-access, we’d be able to easily draw the kinds of comparisons that the NRDC authors needed and that Europe takes for granted. Robust public health ought to be the entitlement of every American. It’s incongruous that the data that could help achieve it isn’t free to all.