Yes I think including them in the local activities is the optimal start - just harder remotely and especially now during the pandemic. Thanks for the GWWC-suggestion, that could be a great remote alternative!
Thank you, that's great!
Good point. I'm unsure what the best practise in editing previous comments is - I don't want to change it so much that the subsequent comments don't make sense to another reader. Clarified now by leaving in the original number that fits with the reasoning around it while keeping the correction in brackets.
That was sloppy of me, thanks a lot for the correction! Edited in the comment.
Edit: I originally made mistakes in the calculation below, have edited to correct this. See comment below by willbradshaw for details of the calculation.
Thanks! I completely agree there are other strong reasons to reduce (or eliminate) factory farming.
About your other comment – I also don’t think the situation is reassuring at all. I think it’s very plausible that the antibiotic use in agriculture could be an important driver of antibiotic resistance.
I think that we need more research on both the jumping of species barriers and on horizontal gene transfer. This paper could be interesting if you want to read more on how common horizontal gene transfer is, but I haven’t been able to find anything that gives a good assessment on how important this is for resistance (I will be very grateful for suggestions if you or someone else know good research on this!).
I know an analogous problem is that human patients often develop resistant bacteria in the normal gut microbiota when they take antibiotics, and this could also be transferred to pathogens through horizontal gene transfer – again, we don’t know how much it happens. Another thing is that some bacteria can both be living in the environment or on animals or in the normal bacterial flora, and then act as pathogens when they end op in the “wrong” place – for example bacteria that is harmless in the gut flora could cause urinary tract infection. If these develop resistance, they don’t need to do any gene transfer but simply change location to cause problems.
Personally, if I try to speculate, I would reason that it’s very unlikely that antibiotic use on animals drives resistance in human infections as much per kg used as antibiotic use on humans. So if we assume that 75% of the kg of antibiotics is used on animals, I would say that it’s unlikely to drive as much as 75% of the resistance burden on humans. It could be that it is 10% as efficient in driving resistance on humans because of the “transfer barriers”, that would mean that 7.5% (CORRECTION: should be 23%, see comments below) of the resistance burden on humans would go away if we eliminated antibiotic use in agriculture. That would still be very significant and worth pursuing. Of course, I don’t know at all if the number should be 10% or 50% or 1%, and I could also not answer if that makes it a more significant driver than for example the misuse of antibiotics for viral infections.
Apart from speculative, this reasoning is also very simplified, since there are many different classes of antibiotics that target different bacteria. It is unclear which would be the best way to measure “resistance burden”. If we would mean it as QALYs lost, it will make a big difference which bacteria is resistant and to which antibiotic(s). In some cases resistance would just mean switching over the patient to another drug and the patient recovers a couple of days later. In some cases, such as with tuberculosis, resistance could mean the alternative treatment is prolonged by years, has serious side-effects and is also much more expensive. In some cases, the patient would die. Resistance to so-called last-line antibiotics is much more severe than others. This report lists the WHO priority pathogens, I think it’s quite good in how it gives an understanding of how much worse the treatment for resistant tuberculosis is compared to “regular” tuberculosis, for example (p 21).
Even if I think we need more research to understand this better (and thereby how to design interventions and allocate resources), I don’t think that should be taken as a reason to wait with reforming agriculture to eliminate (non-therapeutic) antibiotic use. We know the mechanisms are there, and we also know that it’s possible to remove the antibiotics from production, and I don’t think we can afford to wait and see. This urgency to achieve change is also why I think it unwise to tie this cause too closely to elimination of factory farming, for example – even if that would be good, I think it would take too long time, and I think it’s possible to eliminate the antibiotic use much faster if we keep that as a (relatively) separate issue. In context where one can be nuanced I don't think it's wrong to bring up antibiotic use and resistance as a negative effect of factory farming, but I think as you say that there are stronger arguments to front to end factory farming.
Thanks a lot!!
Thanks a lot for your comments! I don’t have a strong view on what is the best way to reduce the use of antibiotics in agriculture, but it seems important to adapt to the specific context. I live in Sweden where it’s forbidden to use antibiotics for prophylactic or growth-purposes in agriculture, and that works well here, but in some countries a ban might be hard to enforce, or lead to corruption and unmonitored use, or else have very negative consequences for financially vulnerable farmers. I remember reading somewhere about some kind of insurance/compensation program for poor farmers that reduce or quit use of antibiotics, but I couldn’t find it right now – will look and see if I can and add a link.
When it comes to the adaptations in farming that could reduce risk (apart from reducing meat production), I would think it’s likely they would be related to improved animal welfare since you need to keep the animals in better conditions to prevent infections if you don’t want to prevent or treat them with antibiotics. To lessen the risk of transmission would be a matter of improved hygiene, which I don’t see as having obvious negative consequences.
In general I would think (without having thought a lot about possible scenarios) that higher meat prices should be a good thing, as long as there are other good alternatives for nutritious and affordable food that people choose instead. But I don’t know what the actual effects of such price changes are.
Thanks a lot for this post!
Hi, since half a year back I am running a foundation focusing on prevention of antibiotic resistance and am working very actively with mapping up the area: parfoundation.org Feel free to reach out if you’d like to have a chat about it! I could also write up a forum post on the subject soon-ish!