May 26, 2022<\/p>\r\n
Chris Kempczinski<\/p>\r\n
McDonald's Corporation, CEO<\/p>\r\n
Dear Mr. Kempczinski,<\/p>\r\n
We write to you as health care professionals to express our ongoing concerns about the overuse of antibiotics in livestock production. We see the devastating consequences of antibiotic resistance first-hand in the medical field, and we're urging you to take action now to reduce antibiotic use and help keep these life-saving medicines effective. McDonald's position as a global leader in the fast food industry is vital in this effort.<\/p>\r\n
When McDonald's stopped serving chicken raised with medically important antibiotics in 2016, we welcomed the change. After your 2018 commitment to set targets for reducing medically important antibiotics in beef production by the end of 2020, we considered McDonald's a true leader in efforts to preserve these drugs. That's why we're disappointed that it seems McDonald's has not not followed through on that commitment.<\/p>\r\n
Antibiotic resistance is often considered a silent and slow burning pandemic, but the World Health Organization and the Centers for Disease Control and Prevention (CDC) consider antibiotic-resistant bacteria among the top threats to global public health. Millions of Americans get sick each year from drug-resistant infections. One estimate suggests drug-resistant infections account for up to 160,000 annual deaths [1].<\/p>\r\n
Overusing antibiotics in any setting can spur resistance, but it's critical we work to reduce use in the livestock sector, where nearly two-thirds of medically important antibiotics sold in the U.S. are used each year [2]. Meat producers overuse these antibiotics, routinely giving them to animals that are not sick to prevent diseases caused by unsanitary, overcrowded, and stressful conditions. That practice spurs the growth of antibiotic-resistant bacteria, which can then spread from farms and ultimately infect people and cause dangerous illnesses [3].<\/p>\r\n
<\/em><\/p>\r\n While we believe that antibiotics should be used to treat sick animals-just as we treat sick people-they should not be used to compensate for industrial farming conditions.<\/em><\/p>\r\n McDonald's commitment to reduce antibiotic use in beef is crucial because this sector accounts for 41 percent of the medically important antibiotics sold to the meat industry in the U.S. [4]. Your 2018 commitment would restrict use and set reduction targets for medically important antibiotics across 85 percent of McDonald's global beef supply chain by the end of 2020. Your policy also included a commitment to phase out routine use of medically important antibiotics for prevention of disease. These commitments rightly were based on the 2017 World Health Organization \"Guidelines on Use of Medically Important Antimicrobials in Food-Producing Animals\" as clearly indicated in the 2018 announcement [5].<\/p>\r\n As far as we can tell, McDonald's missed its own 2020 deadline for setting reduction targets, and has not publicly reported any progress toward phasing out the routine use of the drugs.<\/p>\r\n We are calling on McDonald's to fulfill its previous commitments and continue to lead on this issue by:<\/p>\r\n\r\n Sameer J. Patel, MD, MPH<\/p>\r\n Medical Director, Antimicrobial Stewardship Program<\/p>\r\n Attending Physician, Division of Infectious Diseases<\/p>\r\n Payal K. Patel, MD, MPH<\/p>\r\n Division of Infectious Diseases<\/p>\r\n Assistant Professor, University of Michigan Health System<\/p>\r\n Scott Weissman, MD<\/p>\r\n Pediatric Infectious Disease specialist<\/p>\r\n Talene A. Metjian, Pharm.D.<\/p>\r\n Clinical Pharmacy Specialist in Infectious Diseases<\/p>\r\n <\/strong>\r\n Sujit Suchindran, MD, MPH<\/p>\r\n Assistant Professor of Medicine<\/p>\r\n Division of Infectious Diseases, Emory University School of Medicine<\/p>\r\n <\/strong>\r\n John Pauk<\/p>\r\n Medical Director of Antimicrobial Stewardship and Infectious Diseases<\/p>\r\n Swedish Medical Center<\/p>\r\n <\/strong>\r\n Brian Werth<\/p>\r\n Associate Professor of Pharmacy<\/p>\r\n University of Washington School of Pharmacy<\/p>\r\n <\/strong>\r\n Liza Vaezi<\/p>\r\n Infectious Diseases Pharmacist<\/p>\r\n Virginia Mason Medical Center<\/p>\r\n <\/strong>\r\n Andrew Goldstein, MD<\/p>\r\n Progressive Doctors<\/p>\r\n <\/strong>\r\n David Rosen, MD, PhD<\/p>\r\n Washington University School of Medicine<\/p>\r\n <\/strong>\r\n Jonathan D. Moreno<\/p>\r\n David and Lyn Silfen University Professor<\/p>\r\n University of Pennsylvania<\/p>\r\n <\/strong>\r\n Jon S. Jacobson, MD<\/p>\r\n Ophthalmologist<\/p>\r\n Gillie Ram?rez, RN<\/p>\r\n NYC Department of Education<\/p>\r\n <\/strong>\r\n Kristina Beglarian, FNP<\/p>\r\n Oxford health network<\/p>\r\n <\/strong>\r\n Allison Mullarney<\/p>\r\n Internal Medicine Hospitalist<\/p>\r\n <\/strong>\r\n Mithya Lewis-Newby, MD MPH<\/p>\r\n Pediatric Cardiac Critical Care Physician and Bioethicist<\/p>\r\n Seattle Children's Hospital and University of Washington<\/p>\r\n <\/strong>\r\n Richard E. Kanner, MD<\/p>\r\n Professor of Medicine<\/p>\r\n University of Utah School of Medicine<\/p>\r\n <\/strong>\r\n John H. Holmes, PhD, FACE, FACMI<\/p>\r\n Professor of Medical Informatics in Epidemiology<\/p>\r\n University of Pennsylvania Perelman School of Medicine<\/p>\r\n <\/strong>\r\n Kimberly Brouwer<\/p>\r\n Professor & Infectious Disease Epidemiologist<\/p>\r\n University of California San Diego, H.W. School of Public Health<\/p>\r\n <\/strong>\r\n William Parks, MD<\/p>\r\n Retired Emergency Physician<\/p>\r\n <\/strong>\r\n Kevin Foskett<\/p>\r\n Chair, Department of Physiology<\/p>\r\n University of Pennsylvania School of Medicine<\/p>\r\n <\/strong>\r\n Joanna Benavidex<\/p>\r\n Psychologist<\/p>\r\n Private Practice<\/p>\r\n <\/strong>\r\n Steffanie Strathdee, PhD<\/p>\r\n Associate Dean, Global Health Sciences, Co-Director of IPATH<\/p>\r\n University of California San Diego<\/p>\r\n <\/strong>\r\n Dona Kim Murphey, MD PhD<\/p>\r\n Neurologist Neuroscientist<\/p>\r\n In Phase Neuro, LLC<\/p>\r\n <\/strong>\r\n Janet Perlman, MD, MPH<\/p>\r\n UCSF<\/p>\r\n <\/strong>\r\n Richard M. Baldo, Ph.D.<\/p>\r\n Clinical Psychologist<\/p>\r\n Richard M. Baldo, Ph.D., Inc.<\/p>\r\n <\/strong>\r\n Andrea Schindler, DO<\/p>\r\n Retired Family Physician<\/p>\r\n <\/strong>\r\n Ilene Tannenbaum<\/p>\r\n NP\/Director<\/p>\r\n Brooklyn College Health Clinic<\/p>\r\n <\/strong>\r\n Erin Schauer, MOT, OTR\/L<\/p>\r\n Emory University Hospital<\/p>\r\n <\/strong>\r\n Martin Gelman, MD<\/p>\r\n Radiologist<\/p>\r\n <\/strong>\r\n Jennifer Cecilia Fish, MD<\/p>\r\n Family Medicine Physician<\/p>\r\n Sutter Santa Rosa Family Medicine Residency Program<\/p>\r\n <\/strong>\r\n Jessica Stanton, MD<\/p>\r\n West County Health Centers<\/p>\r\n <\/strong>\r\n Wendy Kohatsu, MD \/ Chef<\/p>\r\n Associate Clinical Professor, Family & Community Medicine<\/p>\r\n University of California, San Francisco<\/p>\r\n <\/strong>\r\n Panna Lossy, MD<\/p>\r\n Sutter Santa Rosa Family Medicine Residency<\/p>\r\n <\/strong>\r\n Kambria Beck Holder, MD<\/p>\r\n Family Physician<\/p>\r\n <\/strong>\r\n Leilani Zimmerman<\/p>\r\n Community Health Family Nurse Practitioner<\/p>\r\n Santa Rosa Community Health<\/p>\r\n <\/strong>\r\n Jared Garrison-Jakel, MD MPH<\/p>\r\n West County Health Centers<\/p>\r\n <\/strong>\r\n Emily Shaw, MD<\/p>\r\n Family Physician<\/p>\r\n Sutter Medical Group of the Redwoods<\/p>\r\n <\/strong>\r\n David Schneider, MD<\/p>\r\n Clinical Professor of Family & Community Medicine, UC San Francisco School of Medicine\/Clinical Professor of Pharmacy, UC San Francisco School of Pharmacy<\/p>\r\n <\/strong>\r\n Audra Lehman, MD<\/p>\r\n Family Physician<\/p>\r\n Kaiser Permanente<\/p>\r\n <\/strong>\r\n Terry Isaacson, PhD<\/p>\r\n Stadium Park Student Housing<\/p>\r\n <\/strong>\r\n Tony H Tran, MD<\/p>\r\n Gastroenterologist<\/p>\r\n Mercy OKC<\/p>\r\n <\/strong>\r\n Ashley Jones<\/p>\r\n Pharmacist<\/p>\r\n Emory healthcare<\/p>\r\n <\/strong>\r\n Kinna Thakarar, DO MPH<\/p>\r\n Assistant professor of medicine<\/p>\r\n Maine medical center\/Tufts university school of medicine<\/p>\r\n <\/strong>\r\n Irana Hawkins, PhD, MPH, RDN<\/p>\r\n Public Health Doctoral Faculty<\/p>\r\n Walden University<\/p>\r\n <\/strong>\r\n Jeremy Rossman, PhD<\/p>\r\n Virologist<\/p>\r\n University of Kent<\/p>\r\n <\/strong>\r\n Ahmed Abdul Azim, MD<\/p>\r\n Assistant Professor of Medicine<\/p>\r\n Division of Infectious Diseases, Rutgers Robert Wood Johnson Medical School<\/p>\r\n <\/strong>\r\n Laila Woc-Colburn<\/p>\r\n Associate Professor<\/p>\r\n Emory University School Of Medicine<\/p>\r\n <\/strong>\r\n Danny Toub<\/p>\r\n Clinician Lead for Antimicrobial Stewardship<\/p>\r\n Santa Rosa Community Health<\/p>\r\n <\/strong>\r\n Alan Peterson, MD<\/p>\r\n Emeritus Director of Environmental and Community Medicine<\/p>\r\n Lancaster General Hospital<\/p>\r\n <\/strong>\r\n Rosie Amini, PharmD. BCPS<\/p>\r\n Senior Clinical Pharmacy Advisor<\/p>\r\n Premier, Inc.<\/p>\r\n <\/strong>\r\n Taylor Heald-Sargent<\/p>\r\n Assistant Professor<\/p>\r\n Northwestern University<\/p>\r\n <\/strong>\r\n Tara Vijayan<\/p>\r\n Medical Director, Adult Antimicrobial Stewardship<\/p>\r\n University of California, Los Angeles<\/p>\r\n <\/strong>\r\n Julianna Van Enk, PharmD<\/p>\r\n Antimicrobial Stewardship Pharmacist<\/p>\r\n MultiCare Tacoma General Hospital<\/p>\r\n <\/strong>\r\n Elisa Glubok Gonzalez<\/p>\r\n Family Physician<\/p>\r\n Santa Rosa Family Medicine Residency<\/p>\r\n <\/strong>\r\n Michael Diamond<\/p>\r\n Executive Director<\/p>\r\n The Infection Prevention Strategy<\/p>\r\n <\/strong>\r\n Richard E. Kanner, MD<\/p>\r\n Professor of Medicine<\/p>\r\n University of Utah School of Medicine<\/p>\r\n <\/strong>\r\n Paul H. Axelsen MD<\/p>\r\n Professor of Pharmacology and Infectious Diseases<\/p>\r\n University of Pennsylvania<\/p>\r\n <\/strong>\r\n Bill Sullivan, PhD<\/p>\r\n Professor<\/p>\r\n Indiana University School of Medicine<\/p>\r\n <\/strong>\r\n Lipi Roy, MD, MPH<\/p>\r\n Medical Director<\/p>\r\n Housing Works<\/p>\r\n <\/strong>\r\n Andrew M. Morris<\/p>\r\n Professor, Infectious Diseases<\/p>\r\n Sinai Health, University Health Network and University of Toronto<\/p>\r\n <\/strong>\r\n Kevin Outterson<\/p>\r\n Professor<\/p>\r\n Boston University School of Law<\/p>\r\n <\/strong>\r\n Anna Valdez, PhD, RN<\/p>\r\n Professor and Chair of Nursing<\/p>\r\n Sonoma State University<\/p>\r\n <\/strong>\r\n Murtaza Akhter, MD<\/p>\r\n University of Arizona College of Medicine-Phoenix<\/p>\r\n <\/strong>\r\n Lori Burrows PhD, FAAM, FCAHS<\/p>\r\n Interim Director<\/p>\r\n MDG Institute for Infectious Disease Research, McMaster University<\/p>\r\n <\/strong>\r\n Suzanne Stensaas<\/p>\r\n Professor of Neurobiology, Emerita<\/p>\r\n <\/strong>\r\n Steven J Zelman, MD<\/p>\r\n Nephrologist<\/p>\r\n Southern Illinois Consultants for Kidney Disease<\/p>\r\n <\/strong>\r\n Rachael Stalker, MSN, FNP-BC, RN<\/p>\r\n Nurse Practitioner<\/p>\r\n <\/strong>\r\n Robin Taylor Wilson<\/p>\r\n Associate Professor of Epidemiology & Biostatistics<\/p>\r\n Temple University<\/p>\r\n <\/strong>\r\n Betelihem Tobo<\/p>\r\n Assistant Professor<\/p>\r\n Temple University College of Public Health<\/p>\r\n <\/strong>\r\n Jesse Karagianes<\/p>\r\n SVP Revenue and Groeth<\/p>\r\n CV Sciences, Inc.<\/p>\r\n <\/strong>\r\n Susan Spanos<\/p>\r\n Microbiology Supervisor<\/p>\r\n The Everett Clinic, Everett, WA.<\/p>\r\n <\/strong>\r\n Daniel Pak, PharmD<\/p>\r\n Antimicrobial Stewardship Pharmacist<\/p>\r\n Seattle Children's Hospital<\/p>\r\n <\/strong>\r\n Catherine Liu, MD<\/p>\r\n Professor & Director of Antimicrobial Stewardship<\/p>\r\n Fred Hutchinson Cancer Research Center<\/p>\r\n <\/strong>\r\n Beverly Leite MD<\/p>\r\n Infectious Disease Specialist<\/p>\r\n <\/strong>\r\n Rosie Amini<\/p>\r\n Senior Clinical Pharmacy Advisor<\/p>\r\n Premier, Inc.<\/p>\r\n <\/strong>\r\n Molly Hayes, PharmD<\/p>\r\n Clinical Pharmacist, Infectious Diseases<\/p>\r\n The Children's Hospital of Philadelphia<\/p>\r\n <\/strong>\r\n Jacqueleen Wise<\/p>\r\n Infectious Disease Nurse Practitioner<\/p>\r\n <\/strong>\r\n Rachael Pines, CRNP<\/p>\r\n The Children's Hospital of Philadelphia<\/p>\r\n <\/strong>\r\n Louis M. Bell, MD<\/p>\r\n Associate Chair of Clinical Programs,<\/p>\r\n The Children's Hospital of Philadelphia<\/p>\r\n <\/strong>\r\n Maria Mascarenhas<\/p>\r\n Medical Director, Integrative Health Program<\/p>\r\n Children's Hospital of Philadelphia<\/p>\r\n <\/strong>\r\n Lindsey Albenberg, DO<\/p>\r\n Pediatric Gastroenterologist<\/p>\r\n Children's Hospital of Philadelphia<\/p>\r\n <\/strong>\r\n Katie Chiotos, MD<\/p>\r\n Pediatric Infectious Diseases Specialist<\/p>\r\n <\/strong>\r\n Winona Chua, MD<\/p>\r\n Clinical Associate Professor of Pediatrics<\/p>\r\n Perelman School of Medicine, University of Pennsylvania<\/p>\r\n <\/strong>\r\n Susan E. Martin<\/p>\r\n CRNP-PC\/AC<\/p>\r\n Children's Hospital of Philadelphia<\/p>\r\n <\/strong>\r\n Carsten Krueger, MD, FRCP(C)<\/p>\r\n Clinical Infectious Diseases Fellow<\/p>\r\n Children's Hospital of Eastern Ontario<\/p>\r\n <\/strong>\r\n Michael E. Russo<\/p>\r\n Pediatric Infectious Diseases Physician<\/p>\r\n <\/strong>\r\n Kristin H. Wheatley, PharmD<\/p>\r\n Clinical Pharmacy Specialist, Pediatric Infectious Diseases<\/p>\r\n <\/strong>\r\n Katherine Dobbs, MD<\/p>\r\n Pediatric Infectious Diseases specialist<\/p>\r\n <\/strong>\r\n Sandra Arnold, MD, MSc<\/p>\r\n Professor of Pediatrics and Chief, Division of Infectious Diseases<\/p>\r\n University of Tennessee Health Science Center<\/p>\r\n <\/strong>\r\n Shivang Shah, MD, DPhil<\/p>\r\n Assistant Professor of Pediatrics, Division of Infectious Diseases<\/p>\r\n Columbia University<\/p>\r\n <\/strong>\r\n Mayssa Abuali, MD<\/p>\r\n Pediatric Infectious Diseases Specialist<\/p>\r\n Einstein Medical Center Philadelphia<\/p>\r\n <\/strong>\r\n Patricia Pichilingue-Reto, MD, FAAP, AAHIVS<\/p>\r\n Assistant Professor of Pediatrics, Infectious Diseases<\/p>\r\n Louisiana State University Health System - Shreveport<\/p>\r\n <\/strong>\r\n Kelley Lee, Pharm.D., BCPS AQ-ID<\/p>\r\n Clinical Pharmacist - Antimicrobial Stewardship<\/p>\r\n Le Bonheur Children's Hospital, Memphis, TN<\/p>\r\n <\/strong>\r\n Jason G Newland<\/p>\r\n Pediatric Infectious Diseases<\/p>\r\n Washington University in St. Louis<\/p>\r\n <\/strong>\r\n Trahern W. Jones, MD, MMC, FAAP<\/p>\r\n Assistant Professor of Pediatric Infectious Diseases<\/p>\r\n University of Utah School of Medicine<\/p>\r\n <\/strong>\r\n Annabelle de St. Maurice<\/p>\r\n Assistant Professor Pediatric Infectious Diseases<\/p>\r\n UCLA<\/p>\r\n <\/strong>\r\n Ankita Desai, MD<\/p>\r\n Pediatric Infectious Diseases, Medical Director of Antimicrobial Stewardship<\/p>\r\n UH Rainbow Babies and Children's Hospital<\/p>\r\n <\/strong>\r\n Michael L. Chang, MD<\/p>\r\n Director of Pediatric Antimicrobial Stewardship<\/p>\r\n UTHealth Houston McGovern Medical School<\/p>\r\n <\/strong>\r\n Emily Keller, MD<\/p>\r\n Attending, Pediatric Infectious Diseases<\/p>\r\n Advocate Children's Hospital<\/p>\r\n <\/strong>\r\n Karen Davidge, PharmD<\/p>\r\n Clinical Pharmacist Specialist - Pediatric Infectious Diseases<\/p>\r\n Michigan Medicine<\/p>\r\n <\/strong>\r\n Amisha Malhotra, MD<\/p>\r\n Associate Professor, Pediatric Infectious Disease<\/p>\r\n Rutgers- Robert Wood Johnson Medical School<\/p>\r\n <\/strong>\r\n Peter Cooch<\/p>\r\n Infectious Diseases Pediatrician, Director of Pediatric Antimicrobial Stewardship<\/p>\r\n Kaiser Oakland<\/p>\r\n <\/strong>\r\n Gary Preston, MA, PhD, CIC, FSHEA<\/p>\r\n Epidemiologist<\/p>\r\n Healthcare Management Alternatives, Inc.<\/p>\r\n <\/strong>\r\n Hayden Schwenk, MD, MPH<\/p>\r\n Clinical Associate Professor<\/p>\r\n Stanford University School of Medicine<\/p>\r\n <\/strong>\r\n Kevin Meesters, MD, MPH, PhD<\/p>\r\n Pediatric Infectious Diseases Fellow<\/p>\r\n <\/strong>\r\n David Zhang<\/p>\r\n Assistant Professor of Pediatric Infectious Disease<\/p>\r\n University Hospitals<\/p>\r\n <\/strong>\r\n Federico Laham, MD<\/p>\r\n Pediatric Infectious Diseases<\/p>\r\n Arnold Palmer Hospital for Children at Orlando Health<\/p>\r\n <\/strong>\r\n Julie Martin, MD<\/p>\r\n Children's Hospital of Georgia<\/p>\r\n <\/strong>\r\n Joshua Wolf<\/p>\r\n Medical Director of Antimicrobial Stewardship<\/p>\r\n St. Jude Children's Research Hospital<\/p>\r\n <\/strong>\r\n Kailynn DeRonde<\/p>\r\n Pediatric Infectious Disease Pharmacist<\/p>\r\n Jackson Medical Center<\/p>\r\n <\/strong>\r\n Jessica Tansmore, PharmD, BCIDP<\/p>\r\n Advanced Patient Care Pharmacist- Antimicrobial Stewardship<\/p>\r\n Nationwide Children's Hospital<\/p>\r\n <\/strong>\r\n Paul K. Sue, MD, CM<\/p>\r\n Pediatric Infectious Diseases<\/p>\r\n UT Southwestern Medical Center<\/p>\r\n <\/strong>\r\n Stefania Vergnano, Dr<\/p>\r\n Bristol Royal Hospital for Children,UK<\/p>\r\n <\/strong>\r\n Preeti Jaggi<\/p>\r\n Medical Director of Antimicrobial Stewardship<\/p>\r\n Children's Healthcare of Atlanta<\/p>\r\n <\/strong>\r\n Rosemary Olivero<\/p>\r\n Director of Antimicrobial Stewardship<\/p>\r\n Helen DeVos Children's Hospital of Spectrum Health<\/p>\r\n <\/strong>\r\n Reshma Ramachandran, MD, MPP<\/p>\r\n Physician Fellow<\/p>\r\n Yale National Clinician Scholars Program<\/p>\r\n <\/strong>\r\n Pavel Prusakov, PharmD<\/p>\r\n Antimicrobial Stewardship Pharmacist<\/p>\r\n Nationwide Children's Hospital<\/p>\r\n <\/strong>\r\n\r\nBenjamin S. Avner, MD, PhD\r\n\r\nWestern Michigan University Homer Stryker MD School of Medicine\r\n\r\n <\/strong>\r\n\r\nBryan Meyers, MD MPH\r\n\r\nWashington University School of Medicine\r\n\r\nMarc H. Scheetz, PharmD, MSc\r\n\r\nMidwestern University\r\n\r\nJim Rhodes, PharmD\r\n\r\nMidwestern University, Northwestern Memorial Hospital\r\n Debbie Pelkey, RN<\/p>\r\n <\/strong>\r\n Rosemary Diamant, CRNP<\/p>\r\n <\/strong>\r\n Robert Martinez, MD<\/p>\r\n <\/strong>\r\n Brandon Cortez, MD<\/p>\r\n <\/strong>\r\n Terry Winter, RN, MPH<\/p>\r\n <\/strong>\r\n Anna Frattolillo, MA, LMFT<\/p>\r\n <\/strong>\r\n Toni Winter MSN, RN<\/p>\r\n <\/strong>\r\n Dominique Motta, RN, BSN, CCM<\/p>\r\n 1Journal of Infection Control and Hospital Epidemiology, New Estimate of Annual Deaths Caused by Treatment Resistant Infections Highlights Gaps in Research, Stewardship, Surveillance3 December 2018,https:\/\/www.idsociety.org\/es\/news-publications-new\/articles\/2018\/new-estimate-of-annual-deaths-caused-by-treatment-resistant-infections-highlights-gaps-in-research-stewardship-surveillance\/<\/a><\/p>\r\n 2U.S. Food and Drug Administration (hereinafter FDA), Center for Veterinary Medicine, 2016 Summary Report on Antimicrobials Sold or Distributed for Use in Food-Producing Animals, December 2017,https:\/\/www.fda.gov\/AnimalVeterinary\/NewsEvents\/CVMUpdates\/ucm588086.htm<\/a>. Data on 2015 sales of antibiotics for human medicine in the United States were obtained from Eili Klein of the Center for Disease Dynamics, Economics & Policy (CCDEP). Klein also provided data for years prior to 2015 in Kar, A., and Klein, E. \"Animal Antibiotic Sales Finally Drop, but Much Work Remains,\" Natural Resources Defense Council (hereinafter NRDC), December 2017,https:\/\/www.nrdc.org\/experts\/avinash-kar\/animal-antibiotic-sales-finally-drop-much-work-remains<\/a>. CDDEP also provided those figures for years preceding 2015; 2016 data are not yet available.<\/p>\r\n [5] Natural Resources Defense Council, Livestock Antibiotic Sales See Big Drop, but Remain High, 18 December 2018,\r\n \t