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Richard Young


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Richard Young

  1. 1. The True Cost of Antibiotic Overuse in Food Production Richard Young
  2. 2. Antibiotic resistance – the problem Last 25 years – • Major new types of antibiotic resistance (about) 10 – with hundreds of variations • New Antibiotic Classes 1 • New Gram-negative classes 0 Last new major class of antibiotics developed in 1986 – next to nothing significant in the pipeline • Becoming very much harder to develop new antibiotics – ‘Peak Antibiotics’ was in the 1950s • Existing antibiotics - ‘the best we will ever have’ • Antibiotic resistance inevitable, but speed of rise linked to overuse and misuse
  3. 3. Consequences of resistance • Prolonged duration of disease • Increased number of infections as bugs which resist antibiotic treatment have more time to spread • Increased severity of infections, e.g. more bloodstream infections • More and longer hospitalisation/ isolation • Increased frequency of treatment failures • Greater mortality • Some pig herds with swine dysentery destroyed because infection resistant to all antibiotics
  4. 4. The true cost of resistance • US – Estimates of $5 bn, $26 and $55 billion pa: increased hospital costs $20 billion pa, other costs to society in lost wages, etc. $35 bn (CDC) • An MRSA outbreak can cost $500,000 • UK estimates - range £3-11 billion a year - EU – only estimate €1.5 billion (ECDC and EMEA), but only includes infections where data available • For surgery resistance increases hospital costs dramatically – median $51,000 per patient, plus extra $1,800 for drugs (Evans et al 2007)
  5. 5. Why such a low priority till now? • Highest US estimate of $55 billion a year (from CDC) –still low c/w other health costs. • Cardiovascular disease $380 billion pa, musculoskeletal conditions $300 billion, • motor vehicle accidents $270 billion, • mental disorders $260 billion, • substance abuse $195 billion, • cancer $185 billion, • diabetes ($145 billion) and alzheimers ($70 billion)
  6. 6. However, all costs in literature are huge underestimates • Most look at impact on medical costs for resistant c/w sensitive infections • As we may never get more really good antibiotics we are moving towards breakdown of current health systems: no safe surgery, cancer chemotherapy and radiotherapy, organ transplantation, treatment of preterm babies, caesarians etc. All this could be threatened. • Also close to untreatable STDs and superbugs
  7. 7. Example: hip replacement • At present, antibiotics are used preventatively and infection rate is 0.5-2% and those who are infected can normally be treated. • Without antibiotics, scientists estimate that infection rate would be 40-50%, and 30% of those infected would die. • Hip replacement rates would therefore fall dramatically, which would result in large costs to society. • This analysis by British scientists Richard Smith and Joanna Coast shows that the rise of resistance will impact on patients who are not even suffering from infectious diseases.
  8. 8. How much due to farm use? • Crude estimates suggest worldwide more than half all antibiotics are used in farming. In US, about 60-80% used in animals, in UK now 45% and 5% companion animals • OIE says that 120 of 178 member countries have no control over farm antibiotic use. Sold like food or any commodity. • About 90% of farm antibiotics are added to the feed or water of groups of intensively farmed animals, particularly pigs and poultry. • 49% of countries allow antibiotics to be used as growth promoters. Those that don’t usually permit routine preventative use. Some countries allow antibiotics to be used to treat plants including organic apples in the US even though antibiotics not allowed to treat all organic animals!
  9. 9. Promotion to farmers
  10. 10. Spread of resistance from farms to humans • Farm antibiotic use doesn’t contribute to resistance for many human infections, but… • Most resistance in human Salmonella and Campylobacter infections is of farm-animal origin. • A large proportion of resistance in human E. coli infections comes from farm animals. • Some resistance in human enterococci and now also MRSA comes from farm animals. • Farm use of critically important antibiotics for human medicine has contributed to resistance in human infections.
  11. 11. Research still needed • Source of AMR – how much hospital, how much GPs, how much farm animals, how much fruit, how much companion animals? • How much will it cost national economies if modern treatments: hip and knee replacements, cancer chemotherapy, organ transplants open heart surgery no longer possible? • Other ways to treat bacterial infections
  12. 12. Research needed • Contribution of food • Contribution of the environment • Link between increasing resistance and increasing levels of infections
  13. 13. Policy instruments • Ban all use for growth promotion worldwide • Ban all preventative use in healthy animals except for surgery • Make low antibiotic use a cross-compliance criteria for subsidies – EU especially • Tax antibiotics • Research and encourage non-antibiotic treatments and systems with low usage
  14. 14. True cost of resistance • Low estimates of costs for resistance have led to political inaction. Awareness needs to be increased to level of climate change. • Resistance is not just an infectious disease issue, it’s a cancer issue, a surgical issue, a health-system issue. • With resistance increasing, we should consider the economic cost of completely losing antibiotics and the impact this would have on modern medicine. • Research is needed to estimate cost of losing antibiotics completely, or nearly completely. • Reducing antibiotic use in humans and animals should be been seen as an insurance policy against this catastrophic scenario.
  15. 15. More resistance more serious infections 35000 25 30000 20 25000 15 20000 15000 10 10000 5 5000 0 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 E. coli bacteraemia in England, Northern Ireland and Wales E. coli bacteraemia in England, Northern Ireland and Wales Fluoroquinolone resistance E. coli bacteraemia in England, Northern Ireland and Wales 3rd generation cephalosporin resistance E. coli bacteraemia in England, Northern Ireland and Wales Gentamicin resistance
  16. 16. References • • • ReAct Facts 2007. Economic Aspects of Antibiotic Resistance Cormican M, Vellinga A. Existing classes of antibiotics are probably the best we will ever have. BMJ 2012;344