Congressional hearing highlights need to reduce antibiotic overuse in meat production

Preliminary data from an upcoming World Health Organization (WHO) report paint a concerning picture of the international antibiotic development pipeline. While 27 antibiotics targeting WHO-priority pathogens are in clinical trials, just two are aimed at “highly drug-resistant” superbugs. Given that at least 35,000 Americans die from antibiotic-resistant infections every year, it’s all the more important to preserve the effectiveness of current drugs to protect public health. That’s why we’re working to reduce antibiotic overuse in meat production, where nearly two-thirds of the medically important antibiotics are sold in the United States each year. 

Antibiotic resistance received much-needed attention at a congressional hearing last week on the upcoming reauthorization of the Animal Drug User Fee Act (ADUFA). ADUFA has allowed the Food and Drug Administration (FDA) to collect fees from the animal drug industry to fund and help expedite the agency’s animal drug review process since 2003. The federal government and animal drug industry consider ADUFA a “win-win” and thus must-pass legislation before the program expires at the end of September. The real win during the hearing was Rep. Anna Eshoo (CA-16) and Rep. Kim Schrier (WA-08) holding Tracey Forfa, the Director of the FDA’s Center for Veterinary Medicine (CVM) accountable for the center’s role in overseeing antibiotic use in meat production. 

Ranking Member Rep. Eshoo was the first member of the Health Subcommittee of the House Energy and Commerce Committee to ask a question about the issue. “Overuse of antibiotics in animals can contribute to the emergence of antimicrobial resistance,” Eshoo said, before emphasizing that the CVM is responsible for monitoring that overuse. Eshoo also mentioned the “stunning numbers” associated with antibiotic resistance: 2.8 million drug-resistant infections in the United States each year, causing at least 35,000 deaths. After that introduction, Eshoo asked Forfa to detail what the CVM has done to enhance and measure veterinary antibiotic stewardship over the last five years and how the center plans to move forward. 

Forfa referred to antimicrobial resistance as a “huge priority” but didn’t provide details on how the center will improve stewardship. When pressed by Eshoo for “new steps to address these numbers,” Forfa was vague: “So not in the proposal specifically, but this work is continuing…to going on in the center. It’s part of our priorities and our strategies for – our key strategies for – the year, each year. And we devote a significant number of resources to that particular work.”

Throughout the hearing, Forfa fell back on a familiar response from CVM of “continuing” its work, but that hasn’t translated into concrete results. Take antibiotic duration limits as an example. A human antibiotic prescription nearly always includes a limit on how long to take the drug. However, one in three medically important antibiotics approved for use in veterinary settings has no clearly defined duration limit. That means the drugs can be fed to animals nearly continuously absent signs of infection, which is a perfect recipe for drug-resistant bacteria that can spread from farms and make people sick. The FDA made establishing duration limits for veterinary antibiotics a priority in 2016, but we are still waiting for the agency to release even a draft guidance seven years later despite the ongoing risk to public health.

Rep. Schrier asked about the CVM’s current five-year plan, “Supporting Antimicrobial Stewardship in Veterinary Settings”, which will expire at the end of 2023:

“In September of 2018, the FDA’s Center for Veterinary Medicine issued a five-year stewardship action plan intended to combat antibiotic resistance and preserve the future effectiveness of these medications. I was wondering if you could describe some of the goals of that action plan, the progress FDA has made and maybe some of the challenges that you have found along the way.”

In her response, Forfa mentioned the FDA’s upcoming guidance bringing antibiotics previously available over-the-counter under veterinary oversight. That’s a step in the right direction, but since 96% of veterinary antibiotics are already under veterinary oversight, it likely won’t make a significant difference in curbing antibiotic overuse. What Forfa didn’t say is that there aren’t any indicators in the five-year plan to measure whether antibiotic stewardship is improving. Based on antibiotics sales data, which should be an appropriate benchmark despite FDA’s reluctance to say so, efforts to reduce antibiotic use appear stagnant. From 2018, when the plan was released, to 2021, the most recent year for which we have data, antibiotic sales to meat producers decreased by just 0.7%. That isn’t enough to move the needle on antibiotic resistance. 

Forfa made a bigger acknowledgment at the end of her response: “We’re also continuing to work with a wide variety of stakeholders on next steps and our next five-year plan.”

It’s good news that the CVM confirmed a new five-year plan for 2024-2028 is in the works, but the plan needs to have teeth. It should include a primary goal of reducing the use of medically important antibiotics in food animal production to protect public health. It should also include quantitative indicators so the CVM can measure whether veterinary antibiotic stewardship is improving. And finally, the agency needs to deliver on putting time limits for all medically important antibiotics used in food animal production. 

Rep. Eshoo and Rep. Schrier deserve credit for using this hearing to hold the CVM accountable for keeping antibiotics effective. Because of their leadership, the CVM has committed publicly to a new five-year plan to improve veterinary antibiotic stewardship. Will the center’s words translate into timely action? Only time will tell.