Unreal Truths

Antimicrobial-resistant bacteria are everywhere. The World Health Organization says we are in a global crisis because of this resistance. It’s a message constantly making its way across the globe in tweets and clever headlines, influencing the way people live, what they buy and even where they shop. The narrative is also behind a premium market niche continuing to shape animal agriculture.

A pivotal point in the shift took place in 2014, when Chick-fil-A announced that by December 2019, all of the chicken it sells will carry a “No Antibiotics Ever” (NAE) promise. The popular fast-food chain has converted more than 80% of its chicken supply to NAE product and says it will meet its end-of-year goal. Other food companies following suit include Panera, Jason’s Deli, Carl’s Jr., Hardee’s, Subway and Papa John’s.

Chicken suppliers began to shift production to meet these markets and, in the process, took their own NAE promotions retail hoping to influence grocery shoppers to spend more for a package of chicken raised without antibiotics. The fact that antibiotic withdrawal times meant chickens already didn’t have antibiotics in them when they left the farm was overlooked in the race to stand out at the meat counter.

Taking a position opposite these prevailing marketing winds, Mike Cockrell, chief financial officer at Sanderson Farms, notes: “We decided not to sacrifice our environmental goals, our animal-welfare goals or our food-safety goals for marketing purposes.”

Rather, Sanderson Farms, the third-largest poultry producer in the U.S., pulled back its corporate curtain, telling consumers the truth about antibiotic use in chickens. They did it with Bob and Dale, a fictional blue-collar duo who first appeared in 2017, reassuring consumers there was no reason to pay more for labels that said “No Antibiotics” because chickens don’t have antibiotics in them. They poked fun at a Madison Avenue marketing guru and farmer “Old MacGimmick.”

The response to the campaign was overwhelmingly positive. Brand recognition reached nearly 80% for the Laurel, Mississippi, producer. Facebook followers more than doubled.

INFLUENCE OF THE VFD

At the same time Sanderson Farms’ advertising campaign was educating consumers, the FDA was implementing new rules regarding antimicrobial use in animal agriculture. The Veterinary Feed Directive (VFD), launched in January 2017, moved antimicrobials from over-the-counter sales to prescription or VFD status. It was all in an effort to reduce unnecessary use, especially of products important for human health. That meant all production claims for antimicrobial uses as growth agents were removed from labels.

A recent summary from the FDA looked at the amount of antimicrobials sold or distributed for use in food-production animals before and after implementation of the VFD. It is the industry’s first report card since the change, showing double-digit shifts between 2016 and 2017 in domestic sales and distribution of medically important antimicrobials approved for use in food-producing animals.

Overall, levels decreased 33%. Tetracycline, which represented the largest volume in the report, decreased 40%. The highest reductions were reported in antimicrobials in feed, followed by water. The chicken industry led with a 47% decrease. Cattle and swine were each 35% lower.

AN EVOLVING ISSUE

The VFD is only the first step in a changing pattern of antimicrobial use. Not content to maintain the status quo, Sanderson Farms has continued to evaluate its stance on antimicrobial use. It recently announced a shift largely in response to an eight-month study it commissioned, which was led by a research team made up of medical doctors, veterinarians and researchers who specialized in antimicrobial-resistant bacteria, members of academia and members of the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria.

“We made all of our data and feed formulas, and medications used available to this group of experts,” Cockrell says. “The conclusion they came to was that everything we were doing was considered judicious use of antibiotics. They said … a reasonable compromise would be if we no longer used medically important antibiotics to prevent disease, even though these products are approved.”

The antimicrobials impacted are gentamicin and virginiamycin, used to keep chicks healthy in hatcheries and in feed. Both are on the FDA’s “Medically Important” list for use in human medical therapy. Cockrell stresses Sanderson Farms’ decision to eliminate their use earlier this year had nothing to do with marketing.

“This was about science and about being deliberate,” Cockrell says of the changes. “Animal welfare is top of mind. We will not take that next step, which is ‘no antibiotics ever,’ because it’s inconsistent with our principles for animal welfare. We will continue to treat sick chickens. And, we will continue to use ionophores.”

In the study Sanderson Farms commissioned, Cockrell notes that higher rates of chicken deaths are seen in NAE systems. In addition, chickens in those systems were found more likely to shed salmonella or campylobacter.

“Birds that aren’t treated when they become ill die at a higher rate. That is particularly true in the first seven days of life. Those birds don’t die a pretty death. Their lungs fill with fluid. It is a fact, also, that a sick flock not treated brings a higher bacteria load to the plant. Whether that impacts consumers depends on what they do at the plant.”

VIEW FROM THE FEEDLOT

Tera Barnhardt is a Kansas feedyard veterinarian and a strong proponent of a team approach to animal health care. She believes the VFD underscores the importance of those relationships.

“I’m all for the idea that any medication that will be used in production agriculture goes through a veterinarian to be sure it’s an appropriate use,” she says. “I honestly do not think the VFD had the negative impact producers expected. The benefits have yet to be measured accurately in my opinion.”

Barnhardt is on the front lines of the segment of the cattle industry many criticize for a lack of antimicrobial stewardship. She works with Cattle Empire, a family-owned and operated feedyard with a one-time capacity of just more than 50,000 head. Her views on antimicrobial resistance are bold, and she doesn’t hold back opinions on ways she believes the industry could improve.

“In the feeder sector, there is a lot of pressure to be good stewards of antimicrobials,” she says. “But, there is a disconnect when it comes to what happens before animals get to the feeder. We don’t always get a good history. We don’t know if they’ve been managed well. Sometimes, there are transportation issues or weather problems. It can be hard to know when it’s appropriate to use an antimicrobial or which ones will be most effective if they’ve been treated before they arrive. Based on what I’ve seen, there is often a management issue prior to the feeder receiving a group of cattle that will show up in a disease outbreak.”

Noting a reluctance in the beef industry for mandatory traceability, Barnhardt says implementation of such a system would definitely help the industry improve antimicrobial use.

“We’d know what kind of management an animal was under prior to their arrival at the feeder, and that would help us,” she says. “When the industry figures out traceability, we will be able to figure out how to be the best stewards possible.”

Joan Ruskamp is part of a family beef operation and feedlot in Nebraska. She says they’ve relied on three main antibiotics for years and have not seen a loss of effectiveness unless an animal has a chronic history they don’t know about. “That’s where we will see an issue, and it’s not very common,” she notes.

Primarily, she says, they use Excede, Nuflor and Draxxin. The health issues they most often deal with are hoof rot and bovine respiratory disease. Their health protocols were developed with their veterinarians, where they discuss things like where they buy cattle from, weights on those cattle and time of the year they buy.

“Every feedyard is not the same. There are similarities but no exact replicas. How you use bedding, how your pens lay … there are a lot of factors that go into developing the right health program for the cattle you raise,” she explains.

“At the end of the day, I think the industry needs to work as one. It’s ethically right to work together as a team in what we produce. Send us a healthy calf; we’ll keep him healthy all the way through. Then, as an industry, we can have a product we’re all proud of.”

Ruskamp adds she has a lot of empathy for consumers who receive information that’s often hard to decipher. A common statistic she is faced with is that a majority of antimicrobials sold go to the beef industry. If a person just looks at kilograms of antimicrobials sold, it’s easy to get the wrong message.

“You have to consider what is being used, how it’s used and the size of the animal. There’s a big difference in the amount of antimicrobial you’d use to treat a 150-pound person versus a 1,200-pound steer. When we look at something on social media, it can be so sensationalized. Sadly, the average consumer doesn’t get the real story.

“People in this industry, in all of animal ag, work so hard, and they really do care,” she adds. “We are out there on holidays, Sundays, in blizzards, hurricanes and fires. People have lost their lives trying to save and care for their livestock. The dedication is out there. We just need to find a way to communicate that to those outside of agriculture. We need them to know they can count on us to do the right thing.”

RESISTANCE IN CONTEXT:

Studies on antimicrobial resistance in livestock often reach the layperson as a headline without a lot of underlying context. To understand the issue, that context is critical. Food-safety microbiologist Terry Arthur says to start with the idea that antimicrobial resistance is “essentially everywhere.”

Based at the U.S. Meat Animal Research Center (USMARC), in Clay Center, Nebraska, Arthur says antimicrobial resistance is what allows bacteria to grow in the presence of the antimicrobial, commonly called an antibiotic. In human health, this resistance would mean an infection spreads despite treatment. He stresses there are few new drugs in the pipeline, underscoring the importance of judicious use of products available today. But, true judicious use has to be fact-driven.

THE ANTIMICROBIAL LINK

“What’s often forgotten is where antimicrobials come from,” he says. “We got our antibiotics from soil bacteria. That’s where they started. Resistance comes with those. As long as there have been soil bacteria, there has been resistance in those environments to go along with it. It’s ancient. Ice core samples thousands of years old identified resistant bacteria. It’s been found in remote, uncontacted tribes and in caves isolated for 4 million years. Resistance existed prior to human use of antibiotics.”

As to the role animal agriculture plays in antimicrobial resistance in humans, Arthur’s answer would surprise many: “There is simply no data to show a connection,” he states, explaining it is more likely environment is at the root of much of the antimicrobial resistance seen around the world today, not animal production.

COMPARING ANIMAL PRODUCTION SYSTEMS

A 12-month study led by Arthur’s USMARC colleague, John Schmidt, looked at differences in levels of resistant bacteria in beef cattle raised conventionally and without antimicrobials.

“This study should have shown the maximum reduction in antimicrobial resistance (if there was one), because you had cattle that never received any antimicrobials compared to cattle raised under conventional management practices,” Arthur explains. “I think many people assume if you do not treat animals with antimicrobials, there won’t be any antimicrobial-resistant bacteria associated with those animals or their environments. That simply isn’t the case. We determined that factors other than antimicrobial use play a large role in the occurrence of resistance.”

TIMING MATTERS MORE THAN TREATMENT

The 2017 report, published by the American Society for Microbiology, notes multiple instances where antimicrobial-resistant E. coli levels differed less between animal production systems than with the time of year cattle were harvested, being higher in the summer and fall.

Antimicrobial-resistant generic salmonella did not differ between production systems, but prevalence varied with harvest season, with the highest levels in the summer.

He adds studies have consistently shown antimicrobial-resistant-bacteria populations increase when nutrients are applied to soil regardless of antimicrobial use. These nutrients could be in the form of manure from livestock or human biosolids from a municipal wastewater-treatment plant.

n conclusion,” Arthur says, “when an environment is nutrient-rich for bacteria to grow, it likely will increase the number of antimicrobial-resistant bacteria as the overall population grows. Examples of this could include a feedlot or a watershed, or sediment at the bottom of a river.”

NEXT STEPS IN RESISTANCE MANAGEMENT:Described as a “One Health” approach to address antimicrobial stewardship, the FDA Center for Veterinary Medicine (CVM) set three goals for the next five years to manage the issue of resistance.

> GOAL 1. Align antimicrobial drug product use with the principles of antimicrobial stewardship. Specifically, the agency wants to see labels with “appropriately targeted duration of use” and, for those remaining over-the-counter, medically important antimicrobials to be brought under veterinary oversight.

> GOAL 2. Foster antimicrobial stewardship in veterinary settings. Objectives include more outreach and education on the subject of stewardship, strengthening compliance programs and international outreach and collaboration.

> GOAL 3. Enhance monitoring of antimicrobial resistance and antimicrobial drug use in animals. The CVM reports it will work closely with the USDA Animal and Plant Health Inspection Service and stresses there is a “data gap” on use of antimicrobials in veterinary settings. There are pilot data programs underway to gain a better view of on-farm antimicrobial use in poultry, swine, dairy and feedlot cattle.

Tiffany Lee, veterinarian and director of scientific and regulatory affairs at the North American Meat Institute, says while initial reactions to government agency goals may be negative, outcomes are
often positive.

“When we talk about regulations, especially pending ones, many people put their guards up. I think the FDA has tried to work with veterinarians going back to the publication of the VFD and its implementation to really help foster a good relationship. It laid a groundwork for both the agency and veterinarians to be more comfortable in that working relationship. The door is open to continue these collaborations.”

For more information

> FDA 2017 Summary Report on Antimicrobials Sold or Distributed for Use in Food-Producing Animals

> FDA Goals: Supporting Antimicrobial Stewardship in Veterinary Settings

Editor’s Note: In researching this story, one particular report was referred to frequently by general interest media and special interest groups. That report, by The National Antimicrobial Resistance Monitoring System (NARMS), was part of our background for this story. We chose not to use the data, because it is 4 years old and not reflective of changes in the industry under the Veterinary Feed Directive, which began January 2017.

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