Earlier this month, evidence emerged that a Nevada woman who died last September had contracted a superbug resistant to all 26 available antibiotics, including colistin, the drug of last resort. If left unchecked, antimicrobial resistance (AMR) could cause up to 10 million deaths a year by 2050 with a cumulative loss of $100 trillion to the global economy. The misuse of antibiotics in human medicine allows bacteria to evolve resistance to many life-saving drugs. But their excessive and inappropriate use in farm animals—which consume 70-80 percent of antibiotics sold in the United States—is another key factor accelerating drug resistance globally.
In a new CGD policy paper, we argue that a global treaty to reduce antibiotic use in animals could help make inroads into that problem. Such a treaty could be modeled on lessons learned from the 1987 Montreal Protocol on Substances that Deplete the Ozone Layer—a milestone in international cooperation often considered one of the most successful global treaties of all time. Researchers project the protocol will prevent over six million deaths from skin cancer in the US alone between 1990 and 2165. We have previously discussed similarities between the AMR threat and the challenge posed by ozone-depleting substances. Here, we outline three core components of a global treaty to curb antimicrobial use in animals:
1. Flexible provisions to reduce use
Governments often use taxes to discourage consumption of ‘global public bads.’ But setting a global tax rate for antimicrobials would be a complex undertaking, and enforcing it in practice would be even more challenging. Instead, we propose setting country-level targets for use, giving countries flexibility about how to meet those targets. As part of national strategies to meet the targets, governments might well decide to tax antibiotic use in animals.
We suggest three complementary approaches for setting targets: banning the use of antimicrobials for growth promotion in livestock; banning or restricting the use of specific drugs that are critically important for human use; and sharply reducing overall use.
The most important consideration in setting targets will be to incorporate flexibility in the treaty structure so they can be revised as more evidence and additional alternatives become available—a key feature in the Montreal Protocol’s success. Flexibility is important given the extent of the knowledge gaps in how, where, and why farmers around the world give antibiotics to their animals, uncertainty around the extent of livestock’s contribution to the overall AMR threat, and specifically how often resistant bacteria from farm animals cause infections in humans.
2. Incentives for countries to participate
Modeled on the Montreal Protocol example, we recommend three ways to incentivize countries, especially low- and middle-income countries, to participate in a global treaty:
Restrictions on meat imports from countries that refuse to join the treaty will encourage universal adoption and help prevent nonparticipants from offsetting progress made elsewhere.
Granting low- and middle-income countries a grace period before they are required to reduce or phase out antibiotics on their farms should lower the costs of implementation.
A fund providing financial and technical support, like the Montreal Protocol’s Multilateral Fund, would help developing countries implement treaty commitments. Support might include advanced market commitments and/or subsidies for vaccines for livestock or agricultural extension programs to help farmers transition to alternatives and improve livestock management practices.
3.Requirements around reporting, monitoring, and enforcement
Directly measuring and monitoring the use of antimicrobials on millions of farms worldwide would be challenging. We propose following the Montreal Protocol model once again and monitoring “apparent consumption”: production plus imports minus exports of antimicrobials for use in agriculture, disaggregated by drug class. To facilitate the ultimate goal of improving data on antimicrobial use on farms worldwide, technical and financial support for developing countries, discussed above, should be used to bolster data collection and surveillance systems. And after initial rounds of support, future assistance could be made conditional on fulfilling basic reporting requirements.
To get the ball rolling, treaty negotiations could begin with the 20 countries that account for 75 percent of global antimicrobial use in animals. Given the urgency of the AMR threat, initial steps toward treaty-making should begin as early as possible.
It is true that the uncertain political climate in the United States (and across much of Europe) could make this a challenging time for international treaty-making. But going back to the Montreal Protocol example, Ronald Reagan signed on to the treaty in 1988 with unanimous Senate approval, marking what he himself described as “a monumental achievement.” As much as protecting the ozone layer prevents millions of US cancer deaths, negotiating a global treaty to help avoid millions of US deaths from drug-resistant microbes is in the clear self-interest of the United States. It would be a proud legacy for any president.