Addressing Antibiotic Resistance: Local Leadership Opportunities

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1 Addressing Antibiotic Resistance: Local Leadership Opportunities

2 Antibiotic Resistance is a Problem Antibiotic resistance is one of the top five threats to public health.

3 Antibiotic Resistance is a Problem

4 Antibiotic Resistance is a Problem

5 Antibiotic Resistance is a Problem

6 Few New Antibiotics Being Developed Source: Infectious Diseases Society of America (IDSA) Clin Infect Dis. 2011;52:S397-S428,

7 Graphic published by Pew Charitable Trusts, February % of Antibiotics Sold for Livestock Use sold for meat & poultry production sold to treat sick people

8 Antibiotic Use Increases Per Kg Meat 0.35 Increasing in the U.S. 0.3 g abx sales/ kg (slaughter weight) Time (Year)

9 Antibiotic Uses Treat disease Control disease outbreak

10 Antibiotic Uses Treat disease Control disease outbreak Prevent disease X Promote growth X

11 How Resistant Bacteria Develop & Migrate Source: GAO Antibiotic Resistance

12 How Resistant Bacteria Develop & Migrate

13 How Resistant Bacteria Develop & Migrate

14 Resistance Happens! MCR-1 easily transferable colistin resistance likely from animal to humans

15 Resistance Happens! MCR-1 easily transferable colistin resistance likely from animal to humans

16 Superbugs On Retail Meat & Poultry Frequency of bacteria resistant to three or more classes of antibiotics on retail chicken (2012) 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

17 Progress in Federal Law FDA Guidance #213 No antibiotic use for growth promotion Veterinary oversight of antibiotics use

18 Gaps in Federal Law FDA Guidance #213 No antibiotic use for growth promotion Veterinary oversight of antibiotics use X Use still allowed for disease prevention X Voluntary compliance X No tracking or reduction targets

19 Ending Growth Promotion Not Enough Netherlands Cordova, C. et al. NRDC Fact Sheet: FDA s Efforts Fail to End Misuse of Livestock Antibiotics, 2015.

20 New California Law is An Important Step SB-27 Prohibits growth promotion and regular pattern of use for disease prevention

21 New California Law is An Important Step SB-27 Prohibits growth promotion and regular pattern of use for disease prevention Requires veterinary oversight

22 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

23 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

24 Local leadership opportunities

25 Local leadership opportunities City Procurement

26 Local leadership opportunities City Procurement Consumer Information

27 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

28 Consumer Information Right-to-Know Legislation Retailers of raw meat to disclose to SFE suppliers practices SFE to share information on public website

29 Affected Parties Large stores selling raw meat with more than 25 outlets are required to comply with the proposed ordinance. Voluntary for small businesses. Safeway Whole Foods Costco Lucky Supermarket Trader Joe s Walgreens Target Grocery Outlet Bristol Farms Cash & Carry Foods Co CVS

30 Market Shift

31 Market Shift

32 Market Shift

33 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

Agricultural Antibiotics David Wallinga, MD, MPA Natural Resources Defense Council January 2017

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