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The growth and global spread of infections resistant to almost all known antibiotics is a huge looming threat. A recent study estimates up to 10 million lives could be lost each year by 2050, with enormous economic impact. Antimicrobial resistance could reverse progress made against big global killers such as HIV, malaria and tuberculosis. Even common surgery could carry a lethal risk of infection. CGD work examines the incentives, innovation, and impetus needed to ensure collective action to produce a new generation of antibiotics, and encourage their widespread development and use.
Since Charles, Janeen, and I last wrote about the links between drug-resistant superbugs and antibiotic use in livestock, there has been a slew of new interesting, terrifying, and informative things to read on the topic. And they all underscore the need for a global approach to reduce agricultural use of antibiotics to promote animal growth and prevent disease in large, concentrated feeding operations. We offered initial ideas on the essential elements of a global treaty here. You can also read more about the problem, and the steps taken thus far to address it, in my new CGD book, Global Agriculture and the American Farmer: Opportunities for US Leadership.
In a recent blog post on the topic, my colleagues and I applauded McDonald's decision to (gradually) extend its US-only policy of eliminating the use of medically important antibiotics among its chicken suppliers in countries around the world. That was not enough, however, to raise its grade from a C+ for the coalition of consumer, health, and environmental groups that just put out its third report card on antibiotic policies at the 25 largest US fast food chains. Since this is a global problem, McDonald's should have received a bit more credit for going global with its policy, even if it is lagging (like most other chains) on reducing antibiotic use among its beef and pork suppliers. You can find out how your favorite chain does here.
Also out recently is Maryn McKenna's new book, Big Chicken: The Incredible Story of How Antibiotics Created Modern Agriculture and Changed the Way the World Eats. She explores the history of feeding antibiotics to chickens (and other livestock) to promote faster growth—a practice that paved the way for the industrial agricultural production model prevalent in much of the world today. You can read an excerpt of the book on the NPR website.
What's even scarier is how intensive livestock operations are spreading around the world, alongside rising demand for meat in the rapidly growing emerging markets of Brazil, India, and, especially, China. In a new article in Science magazine, Thomas Van Boeckel and colleagues estimate the consumption of antimicrobial drugs by food animals around the world—this involves statistical modeling because few countries collect this type of data. The authors also project that antibiotic use in livestock production will grow by some 50 percent by 2030, to more than 200,000 metric tons, if nothing is done. Finally, they explore how various policies, or combinations of policies, could constrain this growth by as much as 80 percent. The policies they examine include a cap on the permissible amount of antibiotics that could be used (per animal), a tax on veterinary drugs of concern, and reductions in meat consumption.
Each of these policy options for reducing antibiotic use in livestock has pros and cons in terms of how easily it could be implemented, what the distributional effects among rich and poor countries would be, and how effective it would be. As a first step, international cooperation would be necessary to effectively implement any of these policies, and our proposal for a global treaty provides a useful framework for how to do that.
McDonald's has just gone global with its commitment to serve chicken free from antibiotics that are critically important to human health. Building on a similar phase-out in its US chicken supply in 2016, the company will ban critical antibiotic use from sourced chicken in a handful of high-income countries and Brazil in 2018, expanding to a longer list of “designated markets” by 2027. That's evidence of both the potential to reduce global antibiotic use in livestock and the vital role consumers can play in speeding progress.
Widespread antimicrobial use accelerates the development of resistance, and the vast majority of current antibiotic use worldwide is in livestock—primarily to promote growth and prevent disease. Overall, antimicrobial resistance could be responsible for 10 million deaths a year by 2050. That’s why we're pushing for a global treaty to reduce antibiotic use in livestock. Our proposal is based on the successful model of the Vienna Convention and Montreal Protocol governing the use of chlorofluorocarbons—which helped dramatically slash their use and protect the ozone layer.
Two vital elements behind the ozone agreements were consumer pressure alongside industry leadership. In response to consumer demand, industry replaced ozone-depleting aerosol spray cans with pump spray containers. This proved to be relatively inexpensive and showed that change was possible. As pressures to do more mounted, industry invested in new technologies and approaches that replaced chlorofluorocarbon use in refrigerators, car air conditioners, and elsewhere. The equivalent of the aerosol can in the case of livestock antibiotic use is poultry. It turns out that feeding antibiotics to chickens doesn’t improve productivity as much as it used to. Some studies suggest that farmers can even save money by foregoing feed laced with antibiotics.
Enter McDonald's, with 36,900 restaurants spread across 120 countries. The restaurant chain is famously concerned with prices—it practices “cost leadership” in management-guru-speak. That means it wouldn’t take on the challenge of reducing antibiotic use in its poultry supply unless the company was convinced both that it wouldn’t significantly raise the price of a McNugget and that it would be valued by customers. With this latest move, senior management at the fast food chain think that’s likely to apply across its operations worldwide.
And as the world’s second largest purchaser of chicken (after KFC), its buying power has significant potential to transform markets globally. The new company policy will take effect in countries like China and Brazil whose livestock sectors are among the top three consumers of antibiotics in the world. (We did notice, however, that others like India and Mexico—where use is currently high and projected to increase further—didn’t make McDonald's list.)
McDonald's is not the only one taking action. As of June 2017, 11 of the 15 top US fast food chains had committed to phasing out routine antibiotic use in their chicken supplies. And the six largest US school districts—Chicago, Dallas, Los Angeles, Miami-Dade, New York City, and Orlando County—announced that they would demand antibiotic-free chicken when they next renew contracts with food vendors. In turn, poultry producers such as Perdue are reducing or eliminating antibiotic use in their flocks. This is only the start—and beef and pork both present larger challenges—but the move to antibiotic-free sourcing could have far-reaching global implications.
Customers are pushing the food industry to act based on a range of motivations beyond concerns with global antimicrobial resistance, including fear of consuming antibiotic residues and awareness of animal welfare issues. But whatever their reasons, they are making a difference. And if more companies follow in McDonald’s footsteps that would help set the stage for worldwide cooperation against a major health threat. So, this really is a case where it makes sense to think local about a global issue. Next time, before you order, ask ‘is it antibiotic-free?’
Each of the G20 summits of the past seven years has suffered in comparison with the London and Pittsburgh Summits of 2009, when the imperative of crisis response motivated leaders, finance ministers, and central bankers to coordinate effectively with each other. Subsequent summits have lacked the same sense of urgency and have failed to deliver any kind of agenda that can be pinpointed as clearly as “saving the global economy.” This week’s summit in Hamburg, Germany promises more of the same, with the real possibility that the G20’s stock could fall even further at the hands of a non-cooperative US delegation.
Given this peril, it’s important to recognize that the G20 has had some successes since the global financial crisis. First and foremost, a global commit to address climate change has depended on important groundwork and commitments made within the G20. Second, even as conflict and failures continued to define key elements of the trade and macroeconomic agenda, steady adherence to core principles within the G20 arguably played a salutary role in the face of difficult national politics. And finally, the G20’s clear prioritization of infrastructure investment, initially as a developing country issue and then as a universal agenda item, has no doubt motivated much of the recent work in institutions like the multilateral development banks (MDBs).
And so last fall, as we looked forward to Germany’s G20 leadership for 2017, we might have expected more of the same—an ever-expanding and diluted agenda, punctuated by moments of low-key progress on some issues. But after the election of Donald Trump in the United States, what the Germans and other G20 countries are now discovering by its absence is the degree to which the United States itself has long been the primary motivator behind a globally-oriented G20 agenda. No longer is there a US-backed G20 agenda that seeks to combat climate change, coordinate on macroeconomic policy, avoid trade protectionism, or elevate support for initiatives in developing countries.
If a shift in orientation in Washington is clear, what remains less clear is just how far the White House will go to disavow the sprawling G20 agenda of the past seven years or how much (and how well) the rest of the G20 might seek to counter the Trump administration’s more damaging tendencies. On the latter, Chancellor Merkel has vowed to make a strong push at this week’s summit in favor of a robust climate agenda. And on the former, the White House itself is showing signs of adopting the playbook of the last seven years, using the G20 to roll out a new initiative on women’s entrepreneurship in developing countries.
Taking these two data points as some grounds for hope, here at CGD we have thoughts on various elements of the G20 agenda and how they might see progress at this week’s summit.
Take serious action on displacement and migration – Jeremy Konyndyk
The G20 Summit could be an important opportunity to advance a constructive agenda on displacement and migration—but don’t hold your breath. The G20 has had migration and refugee challenges on the agenda for several years running now but delivered little real change. And the global politics of this issue are, if anything, even more problematic this year. Last year’s G20 took place a few weeks before President Obama’s summit on refugee issues at the UN General Assembly—a perfect moment to demonstrate the G20’s relevance and resolve on the issue. Instead, the summit did little to advance the agenda apart from some general (and target-free) language on burden sharing in the summit communique, while the summit annex documents (where the real commitments reside) didn’t touch on these issues at all.
As for this year’s summit, it is hard to be optimistic. President Trump is showing that he sees refugee and migration policy mainly as a law enforcement issue. Rather than sharing the burden of global displacement, his plans to cut refugee resettlement in the United States mean the US will be putting more of the global burden on frontline states that are already overwhelmed. The UK looks ill-suited to lead on this issue as well, with migration policy politicized by Brexit, and Prime Minister May’s government hobbled by the recent election. If there is any hope for a good outcome, it rests with Germany and France, whose leaders have actively pushed back on the sort of isolationist rhetoric that has characterized US and UK migration politics for the past year. But even the EU’s policy has been focused on minimizing migration into the Union while refugee drown by the thousands in the Mediterranean. I would love to see a G20 agreement that takes serious action on the deadly migration routes through the Mediterranean by developing safer legal options, and proposes a real framework for global burden sharing on refugee resettlement. But it’s hard to hold out much hope.
Support private investment in Africa – Scott Morris
This week’s summit will officially launch the G20’s Compact with Africa Initiative, which aims to support private investment in Africa. The compacts will seek to improve the conditions for private investment through comprehensive, coordinated, country-specific investment compacts between select African countries and multi- and bilateral development partners. Arguably, the G20’s political support will lend the compacts credibility, visibility and scale. From this standpoint, not all G20 countries are equal, and perhaps more than any of the others, China could make or break this initiative given the scale of its bilateral investments in Africa.
Keep up the good work on digital financial inclusion – Liliana Rojas-Suarez
I have high expectations for the upcoming G20 Summit. The G20 has made commendable progress in assessing and promoting digital financial inclusion initiatives through its Global Partnership for Financial Inclusion (GPFI), building on the work of the previous Summit in Hangzhou, where the G20 leaders endorsed the High-Level Principles for Digital Financial Inclusion. The G20 recognizes that inclusive digital payment systems are fundamental to providing basic financial services to excluded populations
More recently, the G20 has taken an active role in reviewing improvements in the provision of digital finance. By presenting different approaches, the G20 is highlighting various paths countries have taken, or can take, to achieve greater financial inclusion. In a recent publication, Digital Financial Inclusion: Emerging Policy Approaches, the G20 highlights a sample of national initiatives, focusing on its High-Level Principles.
As I have reported before, Principles 2, 3, and 7, in particular, are very much aligned with the 2016 CGD Task Force Report, Financial Regulations for Improving Financial Inclusion. For example, Principle 2, “Balance innovation and risk to achieve financial inclusion,” encapsulates the analytical backdrop which frames the CGD report; whereas, Principle 3, “Provide an enabling and proportionate legal and regulatory framework,” describes the core aims of the CGD report and underlines the necessity of proper financial regulation. Principle 7, “Facilitate customer identification for digital financial services,” emphasizes how strong national identification ID systems can improve Know-Your-Costumer (KYC) compliance—one of the key focuses of the CGD Report. Both the G20 and the CGD reports underscore multiple innovations that are fostering digital financial inclusion. Beyond the well-known case of Kenya’s mobile money transfer services (M-Pesa), Peru and Tanzania’s digital payments ecosystems are also discussed (Billetera Móvil and Tigo Pesa respectively). And India’s unique biometric ID system (Aadhaar) is inspiring similar initiatives in other developing countries.
But of course, much remains to be done. I hope that the upcoming G20 Summit catalyzes further action towards achieving more accessible and digitally supportive financial systems, and also, that the G20 reports on more successful experiences in future publications.
Move the AMR response from “concern” to concrete commitments – Rachel Silverman
Once esoteric, the challenge of antimicrobial resistance (AMR) has received increasing global attention in recent years, including a landmark UNGA resolution last September and inclusion on this year’s list of G20 priorities. But as I’ve previously discussed, it’s relatively easy (though important) for the global community to express concern; the hard part is identifying and agreeing to concrete measures to address the problem. The scope and scale of the AMR crisis may be daunting, but the G20 has an opportunity to get the ball rolling, potentially by honing in on one or two manageable pieces of the puzzle where concrete action is possible. In particular, policy change to tackle inappropriate antimicrobial use is politically sensitive, but enormously important and thus far largely neglected. G20 leaders could start by tackling antimicrobial use for growth promotion in agriculture; for inspiration, I suggest they read my colleagues’ proposal for an international treaty to reduce antimicrobial use in livestock. And as always, additional funding commitments would certainly be welcome; the World Bank estimates that an effective AMR response would come at a $9 billion per year price tag relative to the 2016 baseline—and there’s still a long way to go.
Empower all women entrepreneurs – Tanvi Jaluka and Mayra Buvinic
However, in order for the fund to deliver on its promise of empowering women entrepreneurs, it must incorporate three considerations. Firstly, the fund’s governance structure must be inclusive. The fund would benefit most from diversity in leadership—including representatives from developing countries, grassroots organizations, and the private sector—rather than prioritizing donors. Secondly, the fund’s approach must be holistic. While access to capital is a significant barrier for women entrepreneurs, most women also face a range of socio-cultural challenges. Tackling these barriers requires the creation of an environment enabling of business, which means that the fund should address the lack of family planning, healthcare, child care, education, and capabilities available to women in addition to financial constraints. Lastly, it is key to recognize that SMEs do not encompass the poorest of women entrepreneurs, whose businesses operate at the micro-level. Indeed, as it stands, only one-third of SMEs are owned by women; most women’s work is represented in the informal sector. While the fund has the potential to remove some barriers for SMEs, it will not be a “silver bullet” to promote economic empowerment for all women.
The US agricultural sector is critical to global food security. American farmers account for 25 percent of all corn and wheat exported globally, and the US is the largest foreign aid donor providing assistance to, among other things, improve food production in many developing countries.
Yet, at the same time, many of the US’s agricultural policies can negatively impact people in the rest of the world. In a new book entitled Global Agriculture and the American Farmer: Opportunities for US Leadership, CGD visiting fellow Kim Elliott argues for practical policy reforms in three areas that are particularly damaging to developing countries: food aid, biofuel subsidies, and antibiotic resistance in livestock.
As the US Congress works through a major new farm bill, Elliott joins the CGD Podcast to discuss how the US can reform agricultural policy to achieve better outcomes.
“The Trump budget actually zeroes out the main food aid program,” Elliott tells me in the podcast. “So that seems to me to open up a space for Congress to say, ‘Well, we recognize there are some inefficiencies. But let’s fix it, not end it.”
Click below to hear some of Elliott’s recommendations, and check out the full podcast at the top of this page.
Given the hurricane of news around immediate crises in the past few months, it’s not surprising that warnings about antimicrobial resistance (AMR)—often called a slow moving tsunami—are getting lost. Without global action, by 2050 there could be as many as 10 million AMR-related deaths each year, which would entail a high cost for the global economy as well. An important—and often overlooked—part of the problem is the overuse of antibiotics in farm animals. (For more on how antibiotic use in livestock is contributing to the spread of antibiotic-resistant superbugs, be sure to check out Kim Elliott's new book Global Agriculture and the American Farmer.) Without action, antibiotic use will grow rapidly in middle-income countries where meat consumption and the intensification of livestock industries are expanding. CGD recently convened a roundtable discussion with technical experts to discuss possible ways to strengthen global cooperation to address livestock’s contribution to AMR. Drawing on that productive discussion, we outline steps that could help make inroads into the problem.
Earlier this year we outlined key elements of a global treaty to reduce antibiotic use in farm animals in this CGD policy paper. This (admittedly ambitious) global treaty—modelled on the Montreal Protocol on Substances that Deplete the Ozone Layer—would support much-needed research, surveillance, and data collection; establish a framework for binding commitments and targets that would evolve over time; and create a mechanism to encourage participation from low- and middle-income countries. A couple of weeks ago, we convened a roundtable discussion with technical experts to build on this idea and assess how a treaty could contribute to global efforts to address AMR. Here’s a rundown of what we learned (without any attribution since the discussion took place under Chatham House rules).
The time is right
There was unanimous agreement that global momentum around the AMR issue is building. The issue was in the spotlight at last September’s United Nations General Assembly, which culminated in a landmark resolution calling for national action with international oversight. The recent creation of a UN Interagency Coordination Group (as set forth in the resolution) is a sign of initial progress toward this effort. Moreover, 90 percent of the world’s population now lives in a country that has developed or is of developing a multi-sectoral national action plan to tackle AMR. Efforts are also ongoing to establish a global database on antibiotic use in farm animals at the World Organization for Animal Health (OIE). Against this background, a global treaty could help fill an existing gap by providing the legal framework to consider important policy and trade issues related to antimicrobial use in farm animals as countries roll-out their national action plans.
Setting up a flexible framework is key
A key question in our discussion was whether such a treaty should focus on livestock, or be comprehensive and consider antimicrobial use in humans as well. Everyone agreed that any treaty should be in the context of the overall One Health approach led by the tripartite collaboration between the World Health Organization (WHO), Food and Agriculture Organization (FAO), and OIE. But many felt a treaty focused on antibiotic use in livestock would be more feasible and realistic. To us, this debate underscored the importance of designing a mechanism for addressing the livestock problem that could stand on its own, or could be slotted into a broader global treaty on AMR.
The need for flexibility was also relevant to the discussion on possible targets for “prudent use.” A treaty framework could include targets focused on multiple dimensions—i.e., for certain animal species (with poultry producers perhaps leading the way); for specific drug classes (per WHO’s list of Critically Important Antimicrobials); or for different practices (growth promotion, prevention, etc.). But considering the extent of knowledge and data gaps in this space, participants argued against setting targets for use in livestock before more information is available. Thus, flexibility would need to be a key feature of the treaty framework so that targets and commitments could be adapted as additional evidence becomes available.
What about a global voluntary industry partnership?
Increased consumer awareness and concerns about food safety and quality are already driving change on the supply-side of the market. In the United States, for example, many fast-food chains are committing to serve meat raised without antibiotics and large meat producers are following suit by voluntarily phasing out antibiotics on the farm. A June 2016 study reported that one-third of the US poultry industry had eliminated or pledged to eliminate routine use of medically-important antibiotics. For example, Perdue—the fourth largest US poultry producer—now uses natural herbs like oregano and thyme, in addition to vaccines and probiotics to keep their chickens healthy. Reflecting on these positive developments, we discussed the potential role industry could play in paving the way forward, especially in light of the current political climate. A global treaty could therefore serve as the stick—spurring industry to keep making progress in anticipation of regulations coming down the pike. The carrot would come in the form of business opportunities for developing antibiotic alternatives. An industry-led partnership could have powerful reinforcing impacts.
As we at CGD continue to chip away at the problem, we’ll seek to broaden our engagement with key stakeholders: researchers and policymakers in low- and middle-income countries; the livestock and pharmaceutical industries; international organizations such as WHO, FAO, and OIE; the wider global health community; and financial industry experts.
Watch this space as we continue to rethink, refine, and adapt our policy proposals. And we’d love to hear additional ideas and feedback in the comments section below.
The United States is a major player in global agricultural markets. American farmers account for around 25 percent of world exports of wheat and corn, and are also among the largest producers and exporters of beef, pork, and poultry. This success is partly the result of those farmers having access to abundant land, deep financial markets, and modern technologies. But as I explore in my new book, Global Agriculture and the American Farmer: Opportunities for U.S. Leadership, it is also the result of government policies that distort markets and undermine the provision of global public goods. The poor in developing countries are particularly vulnerable to the negative spillovers of these policies.
Congress has already begun deliberations on next year’s farm bill, which provides an array of subsidies that form the core of US agricultural policy. In recent years, premium subsidies to encourage farmers to buy crop insurance has been one of the most costly. Producers of sugar, peanuts, and some other crops also receive protection from import competition. Both kinds of policies support higher domestic prices, but they suppress prices for farmers elsewhere. And many developing country governments cannot afford their own subsidies to offset the effects on their farmers. More disturbingly, the aid that the United States provides to help the hungry in overseas crises is far more costly and slower to arrive than it should be, thanks to the farm bill. This is due to obsolete provisions originating in a 1950s farm bill that require food aid to be purchased in the United States, and transported on US-flagged ships.
Other policies that are not always as visible as the farm bill support farm incomes by bolstering demand for their crops, or reducing their production costs. Two that I focus on in the book are the mandate to blend biofuels—made mainly from corn and soybeans—in gasoline and diesel, and the failure to effectively regulate the widespread use of antibiotics in livestock. The biofuels mandate contributed to the 2007-08 food price spikes and is more likely to contribute to climate change than mitigate it as intended. In the latter case, livestock producers have been using antibiotics to promote growth and prevent, rather than treat, disease and these practices are contributing to the global spread of antibiotic resistant superbugs.
In the book, I analyze these policies in detail with particular attention to the deleterious effects for the poor and vulnerable in developing countries. While an overhaul of US agricultural policy to make it less trade-distorting and more focused on providing public goods—such as research and development, environmental amenities, and infrastructure—is desirable, it does not seem likely in the short run. Thus, in the book I recommend more limited steps that still provide important benefits for American taxpayers and consumers, as well as developing countries.
In next year’s farm bill, I recommend that Congress:
Reduce the amount of the subsidy that farmers receive for buying crop insurance (now more than 60 percent of the value of the average premium).
Reform the complicated and increasingly expensive program protecting domestic sugar producers and remove the tight restrictions on imports.
Remove the requirements to purchase food aid in the United States and transport it long distances on US-flagged ships.
In addition, I recommend that Congress eliminate the mandate to blend biofuels in gasoline and diesel, or at least make the mandate more flexible and reduce the amount of biofuel that is derived from food crops. Finally, the executive branch should negotiate global targets to reduce the use of antibiotics in livestock and ensure that veterinarians who oversee such use do not have financial incentives to prescribe antibiotics. In a policy brief accompanying the launch of the book, I focus on food aid reform and more modest steps that Congress could take in the farm bill to lessen the distortions associated with the biofuels mandate and antibiotic use in livestock.
Farmers face numerous risks that markets alone cannot address, so there is a role for government assistance. But the US government supports the agriculture sector at levels far beyond what is socially optimal, or what other sectors receive. Unbeknownst to many, these subsidies go disproportionately to larger, richer farmers and only a few crops receive the bulk of the support—mainly grains, oilseeds, sugar, and dairy, rather than fruits and vegetables. This is not a set of policies that serves most Americans well, much less poor and vulnerable people around the world.
The US agricultural sector is critical to global food security, but many of the policies that currently govern it negatively impact people around the world. In a new book, CGD visiting fellow Kim Elliott argues for practical policy reforms in three areas that are particularly damaging to developing countries: food aid, biofuel subsidies, and antibiotic resistance in livestock. As the US Congress works through a major new farm bill, Elliott joins the CGD Podcast to discuss how the US can reform agricultural policy to achieve better outcomes.