With few new antibiotics in the pipeline and bacterial resistance to existing products spreading, the World Health Organization, the Obama administration, and other governments around the world are looking for ways to stem the tide. As the recent Ebola outbreak made clear, pathogens do not respect borders, so keeping antibiotics effective for as long as possible is a global issue requiring global cooperation. While it is something that matters to all of us, it is particularly critical for the poorest countries, where infectious disease remains the leading cause of death (see figure 2 of this article). Just last month, The New York Times brought us the heart-rending story of 58,000 babies dying in India from a multi-drug resistant bacterial infection.
Some hopeful news
But there has been some good news too. Earlier this month, researchers announced the discovery of a new, potentially more powerful antibiotic that could replace some of those losing the resistance battle. And, last fall, President Obama issued an executive order outlining a national strategy to attack the problem of antibiotic resistance. The President also appointed a taskforce to develop an action plan to implement the strategy. I’m looking forward to seeing what the taskforce recommends when it reports out next month.
Some remaining worries
At the same time, I remain worried the agricultural and pharmaceutical lobbies could succeed in watering down parts of the strategy they fear will affect their bottom lines. In this country, as in many others, livestock producers use antibiotics in subtherapeutic doses for long periods to promote growth and prevent disease among their animals. That is a recipe for resistance and addressing it has to be a part of the solution. A bit more than a year ago, the US Food and Drug Administration (FDA) issued a voluntary guidance document that encouraged but did not require drug companies to remove growth promotion as an approved use from their veterinary drug labels. Then, last March, the FDA announced 25 companies, responsible for virtually all veterinary drug sales, had agreed to follow the guidance. Notably, the guidance still allows the use of drugs to prevent disease in livestock, which could be a major loophole.
To try and prevent the loophole from becoming too gaping, the guidance also asks drug companies to mandate that medically important antibiotics are subject to veterinary oversight and are no longer available over the counter. Prior to the FDA guidance, many antibiotics had labels authorizing their use for disease prevention as well as growth promotion, often with similar dosage recommendations. The FDA hopes that veterinary oversight will ensure that farmers are using these drugs only when there is a genuine need to protect animal health.
And a big question: how will veterinarians use their new power?
Giving veterinarians a larger role could be akin to putting the fox in charge of the henhouse. Some vets make a profit from reselling antibiotics. And, as a recent Reuters investigation found, “Veterinary medicine is a little-regulated corner of the medical profession, more dependent on [pharmaceutical] industry funding than its human counterparts….” Unlike doctors in human health, according to Reuters, veterinarians have no legal obligation to reveal financial ties to drug companies.
When Denmark became concerned about links between antibiotic use in farm animals and drug resistance in humans, one of the first things the government did was prohibit veterinarians from profiting from antibiotic sales to farmers. Therapeutic uses of antibiotics in swine dropped by nearly half the next year. Moreover, research found little impact on productivity a decade after Denmark banned the use of antimicrobial growth promoters in swine.
I am sure that the vast majority of veterinarians are dedicated professionals. But if they are going to be given a larger role in policing antibiotic use that also has implications for human health, the public deserves to know more about their links to pharmaceutical companies.