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Addressing Antibiotic Resistance: Local Leadership Opportunities

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Page 1: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

Addressing Antibiotic Resistance:Local Leadership Opportunities

Page 2: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

Antibiotic Resistance is a Problem

“Antibiotic resistance is one of the top five threats to public health.”

Page 3: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

Antibiotic Resistance is a Problem

Page 4: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

Antibiotic Resistance is a Problem

Page 5: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

Antibiotic Resistance is a Problem

Page 6: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

Few New Antibiotics Being Developed

1614

12

7

42

1983-1987 1988-1992 1993-1997 1998-2002 2003-2007 2008-2012

Source: Infectious Diseases Society of America (IDSA) Clin Infect Dis. 2011;52:S397-S428, http://www.tufts.edu/med/apua/news/news-newsletter-vol-30-no-1-2.shtml

Page 7: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

80% of Antibiotics Sold for Livestock Use

sold for meat & poultry production

sold to treat sick people

Graphic published by Pew Charitable Trusts, February 2013

Page 8: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

Antibiotic Use Increases Per Kg Meat

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

g ab

xsa

les/

kg (s

laug

hter

wei

ght)

Time (Year)

Increasing in the U.S.

Page 9: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

Antibiotic Uses

Treat disease Control disease outbreak

Page 10: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

Antibiotic Uses

Treat disease Control disease outbreak Prevent disease XPromote growth X

Page 11: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

How Resistant Bacteria Develop & Migrate

Source: GAO Antibiotic Resistance

Page 12: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

How Resistant Bacteria Develop & Migrate

Page 13: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

How Resistant Bacteria Develop & Migrate

Page 14: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

Resistance Happens!

MCR-1 – easily transferable colistin resistance likely from animal to humans

Page 15: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

Resistance Happens!

MCR-1 – easily transferable colistin resistance likely from animal to humans

Page 16: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

Superbugs On Retail Meat & Poultry

Resistant Bacterium % chicken samples positive

Campylobacter jejuni 2%

Enterococci 47%

E. coli 24%

Salmonella 6%FDA, National Antimicrobial Resistance Monitoring System, Retail Meat Annual Report, 2012

Frequency of bacteria resistant to three or more classes of antibiotics on retail chicken (2012)

Page 17: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

Progress in Federal Law

FDA Guidance #213 No antibiotic use for

growth promotion Veterinary oversight of

antibiotics use

Page 18: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

Gaps in Federal Law

FDA Guidance #213 No antibiotic use for

growth promotion Veterinary oversight of

antibiotics useX Use still allowed for

disease preventionX Voluntary complianceX No tracking or reduction

targets

Page 19: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

Ending Growth Promotion Not Enough

Cordova, C. et al. NRDC Fact Sheet: FDA’s Efforts Fail to End Misuse of Livestock Antibiotics, 2015.

Netherlands

Page 20: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

New California Law is An Important Step

SB-27• Prohibits growth promotion and “regular pattern”

of use for disease prevention

Page 21: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

New California Law is An Important Step

SB-27• Prohibits growth promotion and “regular pattern”

of use for disease prevention

• Requires veterinary oversight

Page 22: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

New California Law is An Important Step

SB 27• Prohibits growth promotion and “regular pattern”

of use for disease prevention

• Requires veterinary oversight

• Requires CDFA to collect information about use and antimicrobial

resistance in CA

Page 23: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

New California Law is An Important Step

SB 27• Prohibits growth promotion and “regular pattern”

of use for disease prevention

• Requires veterinary oversight

• Requires CDFA to collect information about use and antimicrobial

resistance in CA

• Applies only to animals raised in CA

Page 24: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

Local leadership opportunities

Page 25: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

Local leadership opportunities

City Procurement

Page 26: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

Local leadership opportunities

City Procurement

Consumer Information

Page 27: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

City Procurement

• Require City Departments purchasing raw meat to provide information to SFE on:

Suppliers and antibiotic use practices Proposed timeline for antibiotic-free

purchasing Estimated cost of purchasing antibiotic-free

raw meat

• SFE review information, develop procurement regulation

Page 28: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

Consumer Information

• Right-to-Know Legislation

Retailers of raw meat to disclose to SFE suppliers’ practices

SFE to share information on public website

Page 29: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

Affected Parties

Large stores selling raw meat with more than 25outlets are required to comply with the proposedordinance. Voluntary for small businesses.

• Safeway • Whole Foods • Costco• Lucky Supermarket• Trader Joe’s • Walgreens

• Target• Grocery Outlet• Bristol Farms• Cash & Carry• Foods Co• CVS

Page 30: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

Market Shift

Page 31: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

Market Shift

Page 32: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

Market Shift

Page 33: Addressing Antibiotic Resistance · Addressing Antibiotic Resistance: Local Leadership Opportunities. Antibiotic Resistance is a Problem “Antibiotic resistance is one of the top

Likely Supporters

• NRDC• SF Marin Medical Society• Prevention Institute• Clean Water Action• Physicians for Social Responsibility• CALPIRG• Healthcare Without Harm• Environmental Working Group• Food Chain Workers Alliance• Keep Antibiotics Working Coalition• Roots of Change• The Antibiotic Resistance Action Center, Milken Institute

School of Public Health, The George Washington University• Numerous Individual Doctors and Scientists