To Protect the Future, Protect Antibiotics

For good reason, the COVID19 pandemic has been dominating headlines and our psyches these past few months, as people worry about their families, health and livelihoods.

This pandemic has exposed very big cracks in our nation’s preparedness for and response to health crises, both present and future. However, this lack of forethought is not specific to the novel coronavirus. The United States has steadfastly declined to meaningfully address another critical global health threat slowly unfolding for decades: bacterial resistance to antibiotic medicines.

We rely on antibiotics to cure common infections like strep throat or gonorrhea, but also the pneumonias and other secondary bacterial infections that take hold in people whose immune systems have been depleted in trying to fight off a virus like the flu or COVID-19. In fact, recent studies in the Lancet show that antibiotics were used in all or nearly all patients hospitalized in Wuhan, China with COVID-19; up to half of those who died had secondary bacterial pneumonia, common for patients on ventilators. In 2009’s global influenza A (H1N1) pandemic, the CDC estimates 29% to 55% of all 300,000 deaths were due to secondary pneumonias caused by bacteria. The National Institutes of Health are now undertaking a study evaluating the use of an antibiotic called azithromycin as a therapy for COVID-19, in combination with hydroxychloroquine.

Antibiotics underpin nearly all of modern medicine. Doctors can’t or won’t perform invasive surgeries, like joint replacements or organ transplants, or critical procedures such as dialysis or chemotherapy, if they lack antibiotics to treat the inevitable infections that often complicate them.

We also need effective antibiotics to protect us from rising infections caused by multidrug resistant “superbug” bacteria, spurred by the continued misuse and overuse of these medicines. Some experts believe as many as 162,000 people in the United States die each year from drug resistant infections. That is nearly twice the number of U.S. fatalities to date involving COVID19. Globally, the death toll drug-resistant infections may rise to 10 million deaths each year by 2050, if urgent action is not taken.

Despite a half-century of warnings about the rise in antibiotic resistant infections, there is a frightening shortage of novel antibiotics being developed or put on the market. Meanwhile, our arsenal of effective antibiotic medicines is under threat, and constantly eroded by the rampant overuse of the same drug classes in many U.S. livestock operations. As an example, azithromycin, mentioned above, is a macrolide antibiotic related to tylosin—a commonly used drug in beef production. 

Overuse of these precious medicines drives the rise and spread of bacterial resistance. Nearly two-thirds of drugs important to human medicine in the U.S. are sold for food animal use. The vast majority of these medicines are routinely and intensively fed to herds of pigs and cows—often not to treat diagnosed illness, but ostensibly to ward off future problems that may be created by the crowded, unsanitary conditions in which those animals are being raised. In 2017, the World Health Organization (WHO) released guidelines calling for the elimination of all routine use of medically important antibiotics in food-producing animals, including for disease prevention purposes. Just as with the COVID crisis, the Trump Administration turned a blind eye to these recommendations and instead publicly undermined them.

So far, the federal government has failed to take decisive action in the livestock sector to protect our antibiotics toolkit (We do have a national reduction target for use in the health care sector, which is an important step). Yet our current health crisis is a stark reminder that these drugs are a doctor’s first tool. Urgent policy action is needed to protect antibiotics and sustain their effectiveness as long as possible, while new alternatives are developed. We urge Congressional leadership to ensure:

1. Investment in infrastructure necessary to track and integrate antibiotic use data, including in medicine and on farms, and to monitor antibiotic resistance in bacteria off and on farms.
2. Development of a national policy that aligns with World Health Organization Guidelines and prohibits the routine use of medically important antibiotics on animals. (A ban on such uses goes into effect in the 27 countries of the European Union in 2022.) 
3. Setting of ambitious national targets for reducing antibiotic use in livestock, especially for the pork, beef and dairy industries.
4. Ensure that producers provide data about on-farm antibiotic use and report it annually.

We can’t predict the next pandemic, of course. Yet whether the cause will be a deadly new virus or a novel strain of bacteria, we know it will be vital for us to have a stockpile of antibiotics that work, reliably and effectively.

These interventions will benefit Americans on any given day, by protecting the drugs they rely on every day to stay healthy.