Addressing Antibiotic Resistance: Local Leadership Opportunities

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

Antibiotic Resistance is a Problem

Few New Antibiotics Being Developed 16 14 12 7 4 2 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

Graphic published by Pew Charitable Trusts, February 2013 80% of Antibiotics Sold for Livestock Use sold for meat & poultry production sold to treat sick people

Antibiotic Use Increases Per Kg Meat 0.35 Increasing in the U.S. 0.3 g abx sales/ kg (slaughter weight) 0.25 0.2 0.15 0.1 0.05 0 Time (Year)

Antibiotic Uses Treat disease Control disease outbreak

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

How Resistant Bacteria Develop & Migrate Source: GAO Antibiotic Resistance

How Resistant Bacteria Develop & Migrate

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

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

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

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

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

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

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

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

Local leadership opportunities

Local leadership opportunities City Procurement

Local leadership opportunities City Procurement Consumer Information

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

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

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

Market Shift

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