Authored by Venkat Rao
Are the nation’s largest grocery chains stocked with food products at-risk of exposure to superbugs? A new report just published by a public interest research group concludes that most of the largest grocery chains in the United States received a failing grade on policies to eliminate routine antibiotic use in store-brand meat and poultry products.
In 2021, private label meat products represented 25% of total meat products on shelves across the grocery chains in the United States. According to this report released last week, the nation’s top 12 grocery chains, which includes Walmart, Kroger, Costco, Aldi, Trader Joe’s, and Publix received a “F” grade, meaning that the corporate antibiotic policies and meat sourcing practices does not exist for meat and poultry sold under their private labels. The survey study awarded only a single “C” grade, and no grocery chain received a “B” or “A” grades. The survey used publicly available information on the meat and poultry products sold in major grocery stores where a vast majority of American household buy meat and poultry food products.
The grades were assigned based on whether established policies are in place that prohibits reckless use of medically important antibiotics for growth promotion or disease prevention in livestock animals and these policies applied for all meat groups (beef, turkey, chicken, and pork). Other survey questions covered the veracity of policy implementation. Grocery chain would receive grade “A” if they have animal welfare policy and requires all suppliers of private-label meat and poultry to have clear policy to eliminate reckless use of antibiotics and humane conditions for animals, validated by third-party verification. None of the major grocery chains in the US received grade “A” or “B.” The highest grade received by a grocery chain was grade “C” by Target which has a time-bound antibiotic use policy for all meat groups. . Ahold Delhaize—the parent company of Stop and Shop, Food Lion, and other grocery chains—received a "C-" for a policy that applies across animal species.
Among the other chains reviewed in the study, Costco and Meijer received a "D," and eight others—including Kroger, Aldi, Walmart, and Trader Joe's—received an "F." The report found that these companies, some of which are among the top five in the country based on annual revenue—had no publicly available policy on antibiotic use in meat products.
According to the report, vast majority of the top 12 grocery chains in the United States are failing to address the rampant use of antibiotics in meat and poultry products, vastly contributing to the growing threat of antibiotic-resistant infections.
The alarming health security implication of the abysmal score card is that large grocery chains are failing to protect human and animal health allowing suppliers misuse antibiotics in the meat and poultry production. The current meat and poultry production practices in the US meat and poultry industries have taken limited or no meaningful measure to mitigate the spread of antibiotic-resistant pathogens, which the scientific community aptly refers to as slow-moving pandemic.
Why Antibiotic Resistance is a Slow-Moving Pandemic?
Antibiotic resistance is a public health crisis right at our door steps. One of my previous posts on Superbugs, provided an overview of antibiotic-resistant infection as the number-one long term global health security threat and a slow-moving pandemic right under the radar of public health surveillance.
COVID-19 global pandemic may have increased public health community vigilance on emerging infections in the short-term, while glossing over the silent pandemic of antimicrobial resistance, brewing in the background, moving slowly but steadily in the past few decades through the human health and animal health ecosystems. Not in the so-distant future we are likely to witness a full-blown antimicrobial resistance diseases pandemic, to which we do not have strong countermeasures. Developing countermeasures to combat antimicrobial resistance requires decades of investments in research and development of new countermeasures, and best practices implementation globally.
According to the 2019 US Centers for Disease Control and Prevention (CDC) report on antimicrobial resistance, more than 2.8 million antimicrobial-resistant infections occur in the US each year with more than 35,000 fatalities as a result.
Compare the 2019 statistics to the 2013 CDC report revealing more than 2 million antimicrobial-resistant infections reported annually and 23,000 die from such infections. Evidently, the number of antimicrobial resistant infections and associated fatalities are on the rise from 2013 to 2019 and the trend is likely to accentuate in the coming years and decades.
Why are Antibiotics Used By the Meat and Poultry Industries?
Antibiotics are primarily used in the meat and poultry industry sector in food consumed by the animals, towards treatment and prevention of diseases, and to enhance animal growth. Different types of antibiotics are used with food, or to treat a disease, and vary depending on the type of livestock population. For example, only lactating dairy cows in the US are administered annually with antibiotic for clinical mastitis, but all dairy cows receive intra-mammary infusion of prophylactic doses of penicillins or cephalosporins as a preventive measure against mastitis. Mastitis in cows is the inflammation of udder due to microbial infection, a common disease in dairy cows in the United States.
According to US Department of Agriculture, 42% of beef calves in feedlots are fed tylosin, a veterinary macrolide antibiotic, to prevent liver abscesses and promote growth, and nearly 88% of growing swine in the US receive antibiotics, most often tetracyclines or tylosin, in the feed for disease prevention and promotion of growth. Notably, antibiotic use in livestock requires a prescription from a veterinary doctor. According to the US Food and Drug Administration’s Veterinary Food Directive, Final Rule, all veterinary prescriptions for medically important antimicrobials for use in feed require authorization by veterinarians.
However, treatment decisions are often made by lay farm workers, including the decision on the type of antimicrobial used and the mode of administration. The floor practices generally follow a standard operating procedure based on guidelines provided by a veterinarian, but there is limited or no oversight from an animal health practitioner for routine use of antimicrobials in the feed and for prophylactic uses. According to a survey study on antibiotic usage of 113 dairy herds from 13 counties in Pennsylvania, 70% of the farms were found to feed calves and dairy herds with milk replacers containing oxytetracycline and neomycin. This study concluded that beta-lactam and tetracycline antibiotics were most widely used on dairy herds for both prophylactic and therapeutic purposes, although there were considerable variations among the dairy farms on the scope and scale of antimicrobial use on dairy farms. There was no inter-dairy validated best practices, aimed at minimizing routine use of antimicrobials in dairy farms.
Meat and Poultry Industry Defends Current use of Antimicrobials
North American Meat Institute (NAMI), the trade association representing 95% of the beef, pork, veal and 70% of turkey products in the United States and their suppliers, published a brief report titled, “The Facts about Antibiotics in Livestock and Poultry Production”, providing the industry position and rationale for the use of antimicrobials in meat and poultry production.
Essentially, the report, while admitting wide-spread use of antimicrobials, makes a couple of key technical points that merit further consideration. First, the type antibiotics used in the meat and poultry industry are different from those used to treat human infectious diseases. To further illustrate this point, the report cites whereas, Penicillin is used to treat 44% of human cases, but only 6% to treat animals; Cephalosporins are used in 15% of human cases and less than 1% in animals. In contract, tetracyclines are used only in 4% of human cases but up to 44% in animals; and Ionophores are used in 30% of animals and never to treat human diseases. The underlying rationale is that antimicrobial resistance, if it emerges in the livestock population, should still retain susceptibility when treated in humans with a different type of antibiotics. Second, the report implies contagious diseases and larger herds and flocks as the reasons for increased use of antibiotics, but without providing any supportive data to back up the claim.
Although it may be accurate to state that vast majority of antibiotics are used to either treat humans or animals, but not both, it does not justify the widespread use of antimicrobial in the meat and poultry industry. Also, only 4% of tetracycline in treatment of human diseases appears a low estimate, although its use up to 44% to treat animals is consistent with published FDA reports.
If NAMI study summary is the defense of the current antimicrobial uses in meat and poultry industries, then the facts presented in the report to justify current practices are inadequate and does not address the central issue of antibiotic resistance that spans both human and animal health. Diseases appearing in animals jump to humans, which is referred to as zoonosis. Humans coming into contact with food, water and environment inevitably come in contact with pathogens from livestock animals, among others. Emergence of drug-resistant disease in animals also cause disruptions in the production and trade of livestock food products, issues not addressed in the NAMI report, nor does the report provide guidelines for establishing prudent practices in safe and limited uses of antimicrobials in the livestock industry.
It does not matter whether the widespread and often needless use of this powerful category of drugs to treat human or animal diseases. The health security crisis originating from the reckless use of antibiotics for human and animal health conditions is first and foremost a clear and present threat to global health. Antimicrobial-resistant pathogens originating either in humans or animals are inter-connected in the multi-sectoral, transdisciplinary One-Health framework, where the mission is to recognize the interconnected environment of humans, animals and plants and the goal to achieve optimal health outcomes. Current practices in the use of antimicrobials in meat and poultry industries not only pose a serious health security challenge and is not aligned to achieving the One-Health goal.