Antibiotic Resistance: Progress and Peril with Lance Price
One of the most gratifying things about a conversation with Lance Price, aside from his kindness and easy manner, is his optimism. On the issue of misuse of antibiotics in livestock, he believes we’re making progress. He does not necessarily think we’re doomed, and he offers full-hearted praise for certain players in the animal agriculture industry.
Price is a professor at the George Washington University’s Milken Institute School of Public Health and founding director of the Antibiotic Resistance Action Center. He is also a Center for a Livable Future-Lerner Fellow, having earned his doctorate in Environmental Health Sciences from Johns Hopkins University.
Along with the Center for a Livable Future (CLF) and advocacy organizations such as Keep Antibiotics Working and Food and Water Watch, Price has been a harsh critic of the use of antibiotics to promote growth in food animals. It’s fairly standard practice for livestock producers to routinely administer antibiotics to healthy animals, instead of reserving them to treat sick animals. He notes that while antimicrobial growth promotion is no legal in the US, it probably still happens under the guise of “disease prevention.” In using the drugs so liberally, the producers provide an opportunity for the evolution of “super bugs,” or pathogens that have developed resistance to the antibiotics used. When these super-charged pathogens infect humans or animals, the antibiotics that formerly were successful at fighting the infections are no longer as successful.
Tetracyclines are a class of antibiotics that provides of good example of what happens when a drug is overused. For decades, tetracyclines were administered with little restraint not only to healthy livestock, but they were also added to many products used by humans. Price says that they’re no longer an effective drug for humans or animals.
“Today, the antibiotics most being used by animal agriculture are tetracyclines, and we’ve ruined them,” says Price. “We blew out much of their life-saving capacity for humans a long time ago. They used to be an amazing drug, super broad spectrum, very safe. But then they were overused, and when you overuse antibiotics, they quickly lose their effectiveness.”
In the international public health community, the fear is that we will eventually lose even more antibiotics for human medicine. The phenomenon of drug resistance extends beyond bacteria to microbes such as parasites, viruses, and fungi. The Centers for Disease Control and Prevention classifies antimicrobial resistance as a public health priority, and the World Health Organization treats it as a top global public health threat.
Lance believes that what’s happening with drug resistance globally is “scary,” but he says that organizations such as CLF and others are making progress in the United States.
“It’s important to look at specific classes of antibiotics,” he says. “When you do that, it doesn’t look so bad.”
Although he’s been a harsh critic of the Food and Drug Administration’s reluctance to ban the use of certain classes of antibiotics, he wants to give them credit for thoughtful approaches to addressing the issue. In 2003, the Center for Veterinary Medicine (CVM), a branch of the FDA, issued Guidance 152. Officially, it was a “guidance for industry,” and it set a high bar for what drugs could be introduced into animal agriculture. Price describes it as “a first real shot across the bow from FDA to industry to rein in their drug use. … We said this is good but, you need to address other drugs, too.”
In 2013, the FDA issued Guidance 213, which CLF found disappointing at the time. While Price had a similar reaction, he now feels that with this guidance, the FDA and Center for Veterinary Medicine took a thoughtful, nuanced approach to rein in the use of some of the most important drugs.
“It’s not all rainbows and glitter, but I think we have to give them some credit for that guidance,” he says. “We see the results reflected in the food supply. We see multidrug resistant strains, but they’re not the raging superbugs that we fear when we go into a hospital. I feel like we have made progress.”
The FDA acknowledged the need to investigate classes of drugs known as fluoroquinolones and cephalosporins, two of the most important drug classes for humans, and Price feels this is important progress.
But the FDA guidances provide a generous loophole for producers. As long as producers are officially purchasing the drugs for the use of “disease prevention,” instead of for “growth promotion,” they’re in the clear. There was a significant reduction in drug purchasing, says Price, but it should have been greater. There have been no new guidances since 2017.
“We were hoping for follow up,” to that guidance says Price. “The idea was to chase down the loophole in the next administration, anticipating a Clinton victory, but there was no continuation in the Trump office, and no visible progress since.”
But if creating positive change through legislation seems like a bad bet right now, Price is finding hope in collaborations with industry partners. Over the last 20 to 30 years, researchers and advocates have generated evidence about how urgently we need to avert a public health crisis around antibiotic misuse in animal agriculture.
“Our public health messaging got through to the industry leaders, and it’s having an impact,” says Price. “Some companies are actually doing the right thing.”
Starting in the mid-2010s, some of the biggest poultry producers jumped on the antibiotic stewardship bandwagon. By 2022, 60 percent of broilers raised and sold in the US were labeled as “No Antibiotics Ever,” or NAE. Recently, however, in July, 2023, Tyson ended its commitment to NAE, replacing it with a “no antibiotics important to human medicine” or NAIHM label. The class of drugs that Tyson will resume using is ionophores, which are considered non-medically important to humans.
In contrast, Perdue is doubling down, according to Price. “Perdue is one of the good guys now,” he says. He attended an animal welfare summit by Perdue, in which animal welfare advocates were invited and asked for feedback. The company is experimenting with slower growing breeds, which should lead to fewer pathogens, and Price detects a genuine commitment to both animal welfare and public health from them. So far, Perdue has acquired Niman Ranch and Coleman Natural Foods, and maintains their commitments to raising animals humanely.
How did it happen that Perdue changed course so dramatically? Price, in part, credits research in 2007 by CLF, Jay Graham (another CLF-Lerner Fellow) and Bloomberg School professor Ellen Silbergeld. Their secondary analysis of Perdue-compiled data showed that adding antibiotics for growth promotion was not cost-effective. Shortly afterwards, Perdue began phasing out its use of antibiotics in feed and hatcheries.
There has been some progress in pork, beef, and turkey production, but the progress is slow. Producers raising these species without antibiotics still make up a minority of the market.
As Price says, though, it’s not an entirely rosy picture. He believes the US livestock industry deserves blame for creating a standard practice of misusing antibiotics for growth promotion, and for industrializing food animal production with little regard for the welfare of the animals. In the last 20 years, the US has been carefully dialing back antibiotic use, with researchers and advocates effectively putting pressure on FDA the change the way the picture looks. But unfortunately, we’ve exported the industrial food animal production model to places such as Cambodia, Ecuador, Brazil, Southeast Asia, and South America, and there are not necessarily robust FDA-type agencies taking nuanced approaches to antibiotic use in those places. In fact, says Price, it’s no holds barred in terms of drug classes. When compared to countries in Europe, the US looks bad because of the sheer volume of drugs (including antibiotics) used in production, but Price again points out that most of the drugs used in the US are tetracylines, which we no longer rely on in human medicine. “In reality, most of it is tetracycline, and it doesn’t pose a huge threat.”
To preserve progress made here in the US and prevent antibiotic-resistance disasters globally, there are many angles that need to be worked.
“In the US, policymaking is completely broken, and it’s so slow, whereas with enough pressure, the industry can respond very quickly,” says Price. “We saw it with Perdue, and we were starting to see it with Tyson.” When Tyson ended its commitment to NAE in July, 2023, though, they gave some reasons to worry. Price says, “We’re concerned about how far back they will slide.”
Part of the progress puzzle is that the CVM and FDA need to close the loophole in Guidance 213, and we should look at the 2017 “Keep Antibiotics Effective Act” in Maryland, which has a fairly strong prohibition against the misuse of antibiotics in animal agriculture. The law includes a detailed reporting requirement. (Forthcoming research from CLF will address the laws in California and Maryland.) We still need to apply pressure on producers of turkey, cattle, and swine; penicillins, a very important class of drugs for human medicine, are used liberally in turkey production.
Meanwhile, Price is working with his center, as well as in collaboration with Kaiser Permanente and with CLF, to develop tools that can measure the transfer of pathogens from animals to people. This tool can help put risk in context, potentially allowing scientists to specify the percentage of drug-resistant infections that come directly from animals to people.
He feels that regulatory changes will take much longer to be effected—whereas industry will feel pressured by consumers and the scientific community at a much faster rate.
“The fastest progress will probably be on the industry side,” says Price.
For more insights and opinions, check out CLF Perspectives on Food Animal Production.