IMPACT OF NO ANTIBIOTICS EVER / RAISED WITHOUT ANTIBIOTICS PRODUCTION ON ANIMAL WELFARE

IMPACT OF NO ANTIBIOTICS EVER / RAISED WITHOUT ANTIBIOTICS PRODUCTION ON ANIMAL WELFARE Randall Singer Dan Thomson Jennifer Wishnie Mallory Gage Leah Porter Amanda Beaudoin Mindwalk Consulting Group, LLC and University of Minnesota Thomson Livestock Consulting, LLC and Kansas State University Wishnie Consulting, LLC and California Polytechnic University Gage Group Consulting, LLC Mindwalk Consulting Group, LLC Mindwalk Consulting Group, LLC and University of Minnesota 1

Contents Figures... 4 Tables... 7 Terminology... 8 Summary... 9 Introduction... 10 Methods... 12 Survey Design... 12 Survey Dissemination... 12 Data Analysis... 12 Results... 13 General... 13 Broiler... 14 Characteristics of respondents (Q2.4-2.8)... 14 Disease challenges (Q2.9-2.13)... 16 Impacts on Production (Q2.14-2.15)... 22 Management Strategies (Q2.16-2.17)... 23 Food Safety and Animal Health and Welfare (Q2.18-2.19)... 24 Impacts on Cost and Demand (Q2.20-2.21)... 27 Respondent Views on RWA Label Priority and Auditing Needs (Q2.22-2.23)... 28 Respondent Opinions on Antibiotic Resistance (Q2.24-2.25)... 29 Turkey... 31 Characteristics of respondents (Q3.4-3.8)... 31 Disease challenges (Q3.9-3.13)... 32 Impacts on Production (Q3.14-3.15)... 37 Management Strategies (Q3.16-3.17)... 37 Food Safety and Animal Health and Welfare (Q3.18-3.19)... 38 Impacts on Cost and Demand (Q3.20-3.21)... 39 Respondent Views on RWA Label Priority and Auditing Needs (Q3.22-3.23)... 40 Respondent Opinions on Antibiotic Resistance (Q3.24-3.25)... 41 Swine... 43 Characteristics of respondents (Q4.4-4.8)... 43 Disease challenges (Q4.9-4.13)... 45 Management Strategies (Q4.14-4.15)... 51 Impacts on Production (Q4.16-4.17)... 52 Food Safety and Animal Health and Welfare (Q4.18-4.19)... 54 Impacts on Cost and Demand (Q4.20-4.21)... 56 Respondent Views on RWA Label Priority and Auditing Needs (Q4.22-4.23)... 57 Respondent Opinions on Antibiotic Resistance (Q4.24-3.25)... 58 Beef... 60 Characteristics of respondents (Q5.4-5.8)... 60 Disease and Welfare challenges (Q5.9-5.13)... 62 2

Management and Production Strategies (Q5.14-5.15)... 68 Food Safety and Animal Health and Welfare (Q5.16-5.17)... 70 Impacts on Cost and Demand (Q5.18-5.19)... 72 RWA Label Priority and Auditing (Q5.20-5.21)... 73 Respondent Opinions on Antibiotic Resistance... 74 Dairy... 77 Characteristics of respondents (Q6.4-6.8)... 77 Disease and Welfare challenges (Q6.9-6.13)... 79 Impacts on Production and Management Strategies (Q6.14-6.15)... 85 Food Safety and Animal Health and Welfare (Q6.16-6.17)... 86 Impacts on Cost and Demand (Q6.18-6.19)... 89 RWA Label Priority and Auditing (Q6.20-6.21)... 90 Respondent Opinions on Antibiotic Resistance... 91 Discussion... 94 Future Work... 95 3

Figures Figure 1 Disease Challenges Heat Map.... 17 Figure 2 Disease Challenges by Rank, RWA Respondents.... 18 Figure 3 Disease Challenges by Rank, Conventional Respondents.... 18 Figure 4 Welfare Challenges Heat Map.... 19 Figure 5 Welfare Challenges by Rank, RWA Respondents.... 20 Figure 6 Welfare Challenges by Rank, Conventional Respondents.... 20 Figure 7 Disease Management, All Respondents.... 21 Figure 8 Disease Management, RWA Respondents.... 21 Figure 9 Disease Management, Conventional Respondents.... 22 Figure 10 Impact of RWA - Production, RWA Respondents.... 23 Figure 11 Expected Impact of RWA - Production, Conventional Respondents... 23 Figure 12 Impact of RWA Management, RWA Respondents.... 24 Figure 13 Expected Impact of RWA Management, Conventional Respondents... 24 Figure 14 Food Safety - Respondent Opinion.... 25 Figure 15 Animal Health and Welfare - Respondent Opinion.... 25 Figure 16 Food Safety - Customer Opinion.... 26 Figure 17 Animal Health and Welfare - Customer Opinion.... 26 Figure 18 Production Costs.... 27 Figure 19 Product Demand.... 27 Figure 20 Label Priority.... 28 Figure 21 Auditing.... 28 Figure 22 Antibiotic Resistance Problems in Human Medicine.... 29 Figure 23 Antibiotic Resistance Resistant Bacteria in Broilers.... 29 Figure 24 Antibiotic Resistance Resistant Bacteria in Humans.... 30 Figure 25 Antibiotic Resistance Antibiotic Alternatives.... 30 Figure 26 Disease Challenges Heat Map, RWA Respondents.... 33 Figure 27 Disease Challenges by Rank, RWA Respondents.... 34 Figure 28 Welfare Challenges Heat Map, RWA Respondents.... 35 Figure 29 Welfare Challenges by Rank, RWA Respondents.... 35 Figure 30 Disease Management, RWA Respondents.... 36 Figure 31 Impact of RWA Production, RWA Respondents.... 37 Figure 32 Impact of RWA Management, RWA Respondents.... 38 Figure 33 Food Safety - Respondent Opinion, RWA Respondents.... 38 Figure 34 Animal Health and Welfare - Respondent Opinion, RWA Respondents.... 38 Figure 35 Food Safety - Customer Opinion, RWA Respondents.... 39 Figure 36 Animal Health and Welfare - Customer Opinion, RWA Respondents.... 39 Figure 37 Production Costs, RWA Respondents.... 39 Figure 38 Product Demand, RWA Respondents.... 40 Figure 39 Label Priority, RWA Respondents.... 40 Figure 40 Auditing, RWA Respondents.... 40 Figure 41 Antibiotic Resistance Problems in Human Medicine, RWA Respondents.... 41 4

Figure 42 Antibiotic Resistance Resistant Bacteria in Turkeys, RWA Respondents.... 41 Figure 43 Antibiotic Resistance Resistant Bacteria in Humans, RWA Respondents... 41 Figure 44 Antibiotic Resistance Antibiotic Alternatives, RWA Respondents.... 42 Figure 45 Disease Challenges Heat Map.... 46 Figure 46 Disease Challenges by Rank, RWA Respondents.... 47 Figure 47 Disease Challenges by Rank, Conventional Respondents.... 47 Figure 48 Welfare Challenges Heat Map.... 48 Figure 49 Welfare Challenges by Rank, RWA Respondents.... 49 Figure 50 Welfare Challenges by Rank, Conventional Respondents.... 49 Figure 51 Disease Management, All Respondents.... 50 Figure 52 Disease Management, RWA Respondents.... 50 Figure 53 Disease Management, Conventional Respondents.... 51 Figure 54 Impact of RWA - Management, RWA Respondents.... 52 Figure 55 Expected Impact of RWA Management, Conventional Respondents... 52 Figure 56 Impact of RWA - Production, RWA Respondents.... 53 Figure 57 Expected Impact of RWA Production, Conventional Respondents.... 53 Figure 58 Food Safety - Respondent Opinion.... 54 Figure 59 Animal Health and Welfare - Respondent Opinion.... 54 Figure 60 Food Safety - Customer Opinion.... 55 Figure 61 Animal Health and Welfare - Customer Opinion.... 55 Figure 62 Production Costs.... 56 Figure 63 Product Demand.... 56 Figure 64 Label Priority.... 57 Figure 65 Auditing.... 58 Figure 66 Antibiotic Resistance Problems in Human Medicine.... 58 Figure 67 Antibiotic Resistance Resistant Bacteria in Swine.... 59 Figure 68 Antibiotic Resistance Resistant Bacteria in Humans.... 59 Figure 69 Antibiotic Resistance Antibiotic Alternatives.... 59 Figure 71 Disease Challenges Heat Map.... 63 Figure 72 Disease Challenges by Rank, RWA Respondents.... 64 Figure 73 Disease Challenges by Rank, Conventional Respondents..... 64 Figure 74 Welfare Challenges Heat Map.... 65 Figure 75 Welfare Challenges by Rank, RWA Respondents.... 66 Figure 76 Welfare Challenges by Rank, Conventional Respondents.... 66 Figure 77 Disease Management, All Respondents.... 67 Figure 78 Disease Management, RWA Respondents.... 68 Figure 79 Disease Management, Conventional Respondents.... 68 Figure 80 Impact of RWA Management & Production, RWA Respondents.... 69 Figure 81 Expected Impact of RWA - Management & Production, Conventional Respondents. 70 Figure 82 Food Safety - Respondent Opinion.... 70 Figure 83 Animal Health and Welfare - Respondent Opinion.... 71 Figure 84 Food Safety - Customer Opinion.... 71 Figure 85 Animal Health and Welfare - Customer Opinion.... 72 5

Figure 86 Production Costs.... 72 Figure 87 Product Demand.... 73 Figure 88 Label Priority.... 73 Figure 89 Auditing.... 74 Figure 90 Antibiotic Resistance Problems in Human Medicine.... 75 Figure 91 Antibiotic Resistance Resistant Bacteria in Beef Cattle... 75 Figure 92 Antibiotic Resistance Resistant Bacteria in Humans.... 75 Figure 93 Antibiotic Resistance Antibiotic Alternatives.... 76 Figure 94 Disease Challenges Heat Map.... 80 Figure 95 Disease Challenges by Rank, RWA Respondents.... 81 Figure 96 Disease Challenges by Rank, Conventional Respondents.... 81 Figure 97 Welfare Challenges Heat Map.... 82 Figure 98 Welfare Challenges by Rank, RWA Respondents.... 83 Figure 99 Welfare Challenges by Rank, Conventional Respondents.... 83 Figure 100 Disease Management, All Respondents.... 84 Figure 101 Disease Management, RWA Respondents.... 84 Figure 102 Disease Management, Conventional Respondents.... 85 Figure 103 Impact of RWA Management & Production, RWA Respondents.... 86 Figure 104 Expected Impact of RWA - Management & Production, Conventional Respondents.... 86 Figure 105 Food Safety - Respondent Opinion.... 87 Figure 106 Animal Health and Welfare - Respondent Opinion.... 87 Figure 107 Food Safety - Customer Opinion.... 88 Figure 108 Animal Health and Welfare - Customer Opinion.... 88 Figure 109 Production Costs.... 89 Figure 110 Product Demand.... 90 Figure 111 Label Priority.... 90 Figure 112 Auditing.... 91 Figure 113 Antibiotic Resistance Problems in Human Medicine.... 92 Figure 114 Antibiotic Resistance Resistant Bacteria in Dairy Cattle.... 92 Figure 115 Antibiotic Resistance Resistant Bacteria in Humans.... 92 Figure 116 Antibiotic Resistance Antibiotic Alternatives, RWA Respondents.... 93 Figure 117 Antibiotic Resistance Antibiotic Alternatives, Conventional Respondents.... 93 6

Tables Table 1 Characteristics of Participants n = 565... 13 Table 2 Characteristics of Broiler Participants n = 69... 14 Table 3 Production type decision factors.... 15 Table 4 RWA programs used and considered... 15 Table 5 Current welfare program enrollment.... 16 Table 6 Characteristics of Turkey Participants n = 23... 31 Table 7 Production Type Decision Factors, RWA Respondents.... 31 Table 8 RWA Program Types, RWA Respondents.... 32 Table 9 Welfare Program Enrollment, RWA Respondents.... 32 Table 10 Characteristics of Swine Participants n = 148... 43 Table 11 Production Type Decision Factors.... 44 Table 12 RWA Program Types.... 44 Table 13 Welfare Program Enrollment.... 45 Table 14 Characteristics of Beef Participants n = 244... 60 Table 15 Production Type Decision Factors.... 61 Table 16 RWA Program Types.... 61 Table 17 Welfare Program Enrollment.... 62 Table 18 Characteristics of Dairy Participants n = 81... 77 Table 19 Production Type Decision Factors.... 78 Table 20 RWA Program Types.... 78 Table 21 Welfare Program Enrollment.... 79 7

Terminology Academic veterinarians: Respondents that self-identified in this study as Research/Academic/Government veterinarians will be referred to as Academic veterinarians for the present analysis. Veterinarians: Respondents that self-identified in this study as practicing veterinarians will be referred to as Veterinarians. Producers: Respondents that self-identified in this study as manager/producer/grower/rancher/owner will be referred to as Producers. RWA program: Any program where the food animals were raised without the use of any antibiotics will be referred to as an RWA program. RWA respondents: Respondents that self-identified in this study as having, either currently or in the past, produced/consulted/worked with food animals enrolled in marketing programs where the animals were raised without the use of any antibiotics will be referred to as RWA respondents. Conventional program: Any program where the use of antibiotics was allowed while raising food animals will be referred to as a Conventional program. Conventional respondents: Respondents that self-identified in this study as having never had experience producing/consulting/working with food animals enrolled in programs where the animals were raised without the use of any antibiotics will be referred to as Conventional respondents. Customer: The customer in this study will encompass food service, retailers, and restaurants. 8

Summary A survey was conducted to investigate the impacts of removing antibiotics from the food animal supply chain on key parameters such as animal health and welfare, food safety, consumer demand, and cost of food production. A total of 565 completed responses were received from veterinarians, producers, and other stakeholders involved directly in raising broilers, turkeys, swine, beef cattle or dairy cattle. Across all surveyed commodities, the main reasons for raising animals without antibiotics were market-driven. Concerns for animal health and welfare were the most commonly cited reasons for not participating in a raised without antibiotics (RWA) production system. A majority of veterinary and producer respondents across all animal commodities indicated that RWA leads to decreased production efficiency and worse animal health and welfare. In general, respondents in all commodities indicated that RWA production would have negative impacts on animals, including increased morbidity, mortality and culling rates. Most veterinarians and producers indicated, however, that they think retail, restaurant and food service company leadership believe that animal health and welfare are significantly improved with RWA programs. Respondents indicated that RWA programs would slightly to significantly increase the cost of production. They felt, however, that demand for their commodity s products would only slightly increase or not change at all. Respondents indicated there are times that maintaining the RWA label is prioritized over animal health and welfare. Across all surveyed commodities, respondents generally felt that there was a need for increased auditing/assessment of animal health and welfare if RWA systems are practiced. 9

Introduction Ensuring the safety, health, and overall well-being of animals raised for food is both an ethical obligation and a critical component of providing safe food products. Antibiotics are important for maintaining animal health, but their use has come under scrutiny in recent years due to the rise of antibiotic resistance globally. In the U.S., changes have been made to improve antibiotic stewardship; some producers, especially in the poultry profession, have responded by eliminating their antibiotic use, adopting no antibiotics ever (NAE) or raised without antibiotics (RWA) programs. Restaurants, grocers and other retailers of eggs, poultry, turkey, beef, pork and dairy products have implemented niche programs centered on eliminating antibiotics throughout the life of animals raised in their supply chain. These programs center on the premise that they will improve food safety and decrease antibiotic resistance in animals and humans while providing a more wholesome food product. Several studies have shown that raising chickens without antibiotics can be less efficient than conventional programs, potentially increasing mortality and decreasing growth performance. These effects can lead to economic and environmental strain as RWA programs try to match production output of conventional programs. Demand for RWA products is growing in the U.S., but there are concerns that RWA practices might negatively impact animal health and welfare. The interconnected health of people, animals, and the planet has become a popular and common theme in discussions about animal-derived food products. On their own scientific merit, food safety, food security, animal health and welfare, and environmental stewardship are important and longstanding concerns. All of these concepts are pillars of the sustainable food production movement embraced by restaurants, grocers, packers, veterinarians, and producers. In addition to outcome measures used to quantify success within each of these pillars (e.g., mortality rates, HACCP-based testing), it is also important to understand the broader relationship between production costs, animal health, and food safety and downstream factors like revenue, marketing, and consumer perception. Antibiotics are utilized in food animal production to prevent, control, and treat diseases in animals. Recent Food and Drug Administration rule changes for feed-based antibiotic usage has led to changes in drug labeling and a need for increased veterinary oversight. Parallel with these changes have been attempts to monitor antibiotic usage in food animal production and to conduct research aimed at understanding the impact of food animal antibiotic usage on antibiotic-resistant infections in people. Human healthcare and public health sectors have prioritized the improvement of antibiotic use (referred to as antibiotic stewardship, AS) and the tracking and prevention of antibiotic resistance in pathogens relevant to human health. Veterinarians, too, must monitor antibiotic resistance in animal pathogens and in foodborne bacteria that cause illness in humans. The concept of animal health and welfare has been broadly defined. However, the concept is still poorly understood by the general public, with confusion about the difference between animal welfare and issues of animal cruelty and animal rights. In 1979, the Farm Animal Welfare Council communicated five freedoms for domestic animals, including freedom from thirst and hunger, freedom from discomfort, freedom from pain, injury and disease, freedom to express normal behaviors, and freedom from fear and distress. It is important that the role of antibiotics be taken into account when recognizing and optimizing these freedoms. 10

Over the years we have had individual initiatives focused on individual topics such as food safety, food security, animal welfare, environmental stewardship and many more associated topics in food animal production. While many have defined the discussions on sustainability directly to environmental stewardship, sustainability is actually the sum or balance of each of the individual pillars mentioned above on the whole system. Practices that are good for environmental stewardship might have negative impacts on animal health or practices good for food security might have a negative impact on food safety. Sustainability must also interject economic parameters pertaining to the cost and revenue of producing food which directly relates to the ability of farmers to stay in business and ability of citizens to afford food. More studies are needed to understand the balance of decisions on one pillar of sustainability effects the outcomes of other pillars associated with responsible food animal supply chains. Therefore, the objectives of this survey were to investigate the balance of removing antibiotics from the food animal supply chain on animal health, food safety, consumer demand, cost of food production and more by asking veterinarians and producers involved directly in raising these animals. This report summarizes data gathered from stakeholders in multiple commodities about the impact of RWA production on animal health and welfare as compared to conventional production. We also describe information on economic impacts, environmental impacts, and retailer perceptions of RWA practices. All impacts, positive, neutral, and negative, are summarized. 11

Methods Survey Design The survey tool was developed by study co-authors, who include veterinarians with expertise in antibiotic use and stewardship and the study commodities (beef cattle, dairy cattle, swine, turkey, broilers). The tool was reviewed by a small number of industry experts in each commodity for clarity, completeness, and usability. The study included questions related to RWA program experience, disease and welfare challenges, and beliefs about RWA impacts on animal agriculture industries, antibiotic resistance, and animal welfare. Questions were minimally modified to reflect each of the five commodity types. The survey included no identifying information and was entirely anonymous. An electronic version of the survey was created in Qualtrics for online administration. A complete print-version of the survey is included as an Appendix. Survey Dissemination A hyperlink to the online survey was distributed by various professional organizations and commodity groups such as American Association of Avian Pathologists (AAAP), National Chicken Council (NCC), National Turkey Federation (NTF), U.S. Poultry & Egg Association (USPOULTRY), American Association of Bovine Practitioners (AABP), Academy of Veterinary Consultants (AVC), Animal Agriculture Alliance, National Pork Producers Council (NPPC), National Pork Board (NPB), American Association of Swine Veterinarians (AASV), California Department of Food and Agriculture (CDFA), and PIC. Announcements were also made at various professional and commodity meetings. The survey was open from February 15 through March 23, 2018. Data Analysis A total of 894 responses were received. Surveys were characterized as incomplete (n=329) if the respondent did not formally submit his/her responses. Incomplete surveys were excluded from analysis. Responses from international respondents were also excluded in some situations. Data analysis was conducted by using Stata 15.1 (College Station, TX). Respondent role (e.g., veterinarian, producer) and RWA experiences were compared with two-sample Wilcoxon ranksum (Mann-Whitney) tests. 12

Results General We received 565 completed responses. Q1.3 and Q1.4 identified the role of each respondent in animal agriculture and whether the respondent was located within the U.S. or internationally (Table 1). Twenty-seven international respondents were excluded from this analysis because of small numbers, and the potential for varying regulatory and production systems to influence responses. Most U.S. respondents were practicing veterinarians (n=248, 43.9%), producers (n=214, 37.9%) and technical services professionals (n=44, 7.8%). Producers were self-identified as manager/producer/grower/rancher/owner (See Terminology). Just over half of the respondents currently work with (n=241, 42.7%) or have previously worked with (n=76, 13.5%) animals being raised without antibiotics (RWA respondents). The remaining respondents (n=248, 43.9%) had never worked with animals raised without antibiotics (Conventional respondents). Table 1 Characteristics of Participants n = 565 n % Commodity Broiler 69 12.2 Turkey 23 4.1 Swine 148 26.2 Beef 244 43.2 Dairy 81 14.3 Role Practicing vet 248 43.9 Research/Academic/Government vet 29 5.1 Research/Academic/Government non-vet 6 1.1 Manager/Producer/Grower/Rancher/Owner 214 37.9 Technical services 44 7.8 Other 24 4.3 Country of Experience United States 536 95.2 International 27 4.8 Experience with RWA Current experience 241 42.7 Previous experience 76 13.5 No experience 248 43.9 13

Broiler Characteristics of respondents (Q2.4-2.8) We received 69 completed responses from participants in the broiler industry. Q1.3 and Q1.4 identified the role of each respondent in animal agriculture and whether the respondent was located within the U.S. or internationally (Table 2). Nine international respondents were excluded from this analysis because of small numbers, and the potential for varying regulatory and production systems to influence responses. Most U.S. respondents were practicing veterinarians (n=22, 31.9%), producers (n=18, 26.1%) and technical services professionals (n=20, 29.0%). Producers were self-identified as manager/producer/grower/rancher/owner (See Terminology). According to Q2.2, more than half of the respondents currently work with (n=44, 63.8%) or have previously worked with (n=2, 2.9%) broilers being raised without antibiotics (RWA respondents). The remaining respondents (n=23, 33.3%) had never worked with broilers raised without antibiotics (Conventional respondents). Table 2 Characteristics of Broiler Participants n = 69 n % Role Practicing veterinarian 22 31.9 Research/Academic/Government veterinarian 1 1.5 Research/Academic/Government non-veterinarian 2 2.9 Manager/Producer/Grower/Rancher/Owner 18 26.1 Technical services 20 29.0 Other 6 8.7 Country of Experience United States 59 86.8 International 9 13.2 Experience with RWA Current experience 44 63.8 Previous experience 2 2.9 No experience 23 33.3 In Q2.4, RWA respondents addressed the reasons why they decided to work with broilers where the use of antibiotics was not allowed (Table 3). The most commonly identified reason was to fulfill a client/customer request (n=38, 83.2%). In Q2.5, Conventional respondents addressed reasons why they decided not to work with broilers where the use of antibiotics was not allowed; concerns about negative impacts to animal health and welfare (n=16, 94.1%) and that they were already raising animals in a responsible use program (n=10, 58.8%) were commonly identified reasons (Table 3). 14

Table 3 Production type decision factors. Which of these factors contributed to your decision to work with broilers in an RWA/Conventional production system? n % RWA Respondents 42 To decrease antibiotic resistance 11 26.2 To improve animal health and welfare 15 35.7 To increase sale price of animals/product 11 26.2 To gain market entry into a retail program 13 31.0 To fulfill a client/customer request 35 83.3 To eliminate the use of medically important antibiotics 8 19.1 Conventional Respondents 17 Not profitable 5 29.4 Concerned about negative impacts to animal health and welfare 16 94.1 No market pressure 3 17.7 Not a sustainable consumer trend 7 41.2 Food safety concerns 3 17.7 Already eliminated the use of medically important antibiotics 1 5.9 Already raising animals in a responsible use program 10 58.8 Q2.6 and 2.7 asked respondents about their experience with different types of RWA programs or for Conventional respondents, if they have ever considered enrolling in an RWA program (Table 4). Just over half of RWA respondents have participated in a private/retail/restaurant/food service program (n=27, 64.3%). The majority of Conventional respondents reported they have not considered raising broilers under any of these program types (n=14, 82.4%). Table 4 RWA programs used and considered. Do you have experience in/have you considered working with broilers in any of these RWA program types? RWA Conventional n % n % Program Type 42 17 Industry sponsored program 5 11.9 - - Private/Retail/Restaurant/Food Service program 27 64.3 2 11.8 Packer/Processor program 8 19.1 2 11.8 State/Federal government program 7 16.7 - - No program 2 4.8 14 82.4 Q2.8 addressed whether the respondents were part of an animal welfare program (Table 5). The majority of RWA respondents participated in a private/retail/restaurant/food service program (n=29, 69.1%) with industry sponsored programs a close second (n=21, 50.0%) whereas the Conventional respondents participated in a variety of programs and were significantly more likely to participate in packer/processor programs (p=0.0187) and government programs (p=0.0121). The percentage of respondents who stated that they were not part of any program was low (less than 5% for both RWA and Conventional). 15

Table 5 Current welfare program enrollment. Are the broilers you work with currently part of an animal welfare program? RWA Conventional n % n % Program Type 42 17 Industry sponsored quality assurance program 21 50.0 11 64.7 Private/Retail/Restaurant/Food Service animal welfare 29 69.1 9 52.9 program Packer/Processor animal welfare program 11 26.2 10 58.8 State/Federal government animal welfare program 5 11.9 7 41.2 No program 2 4.8 - - Disease challenges (Q2.9-2.13) Q2.9 and 2.10 asked respondents about the disease challenges that are problematic when raising broilers in their respective production systems. Necrotic enteritis was by far the most problematic disease challenge when raising broilers without antibiotics (RWA respondents) and in conventional systems (Conventional respondents). The RWA respondents also identified bacterial osteomyelitis and airsacculitis as important disease challenges, while Conventional respondents identified airsacculitis as the clear number two disease challenge. There were highly significant differences between RWA and Conventional respondents in their rankings of bacterial osteomyelitis (p=0.0005), kinky back (p=0.0059), and gangrenous dermatitis (p=0.0016). RWA respondents ranked bacterial osteomyelitis and kinky back as more problematic diseases in their system than Conventional respondents while gangrenous dermatitis was ranked as more problematic in conventional production systems. These responses are shown in Figures 1-3 below, where Figure 1 uses a heat map to display the cumulative ranks for each disease, while Figures 2 and 3 show the disease composition within each rank. Ten of the RWA respondents selected the Other category on this question; 6 of the respondents listed coccidiosis as a key disease challenge when raising broilers without antibiotics and 3 listed omphalitits. Of the 4 Conventional respondents who selected the Other category, 3 listed coccidiosis as a key disease challenge. 16

Figure 1 Disease Challenges Heat Map. Rank these disease challenges in order of most to least problematic when raising broilers (without antibiotics). 17

Figure 2 Disease Challenges by Rank, RWA Respondents. Rank these disease challenges in order of most to least problematic when raising broilers without antibiotics. Figure 3 Disease Challenges by Rank, Conventional Respondents. Rank these disease challenges in order of most to least problematic when raising broilers. Q2.11 and 2.12 addressed broad health and welfare challenges that are problematic when raising broilers. Concerns about increased morbidity and mortality was the most common response by RWA respondents, whereas Conventional respondents identified several top challenges, including increased morbidity and mortality, negative impacts on performance, and footpad 18

lesions. There were no significant differences in ranking welfare challenges between RWA and Conventional respondents except for corneal lesions and increase morbidity/mortality. Conventional respondents ranked corneal lesions as being more problematic than RWA respondents did (p=0.0043). RWA Respondents ranked increased morbidity/mortality is being much more problematic than conventional producers did (p=0.049). These responses are shown in Figures 4-6 below, where Figure 4 uses a heat map to display the cumulative ranks for each challenge, while Figures 5 and 6 show the composition within each rank. Figure 4 Welfare Challenges Heat Map. Rank these health and welfare challenges in order of most to least problematic when raising broilers (without antibiotics). 19

Figure 5 Welfare Challenges by Rank, RWA Respondents. Rank these health and welfare challenges in order of most to least problematic when raising broilers without antibiotics. Figure 6 Welfare Challenges by Rank, Conventional Respondents. Rank these health and welfare challenges in order of most to least problematic when raising broilers. 20

Question 2.13 asked respondents if there are effective tools to manage the disease challenges they ranked in Q2.9 and 2.10 without antibiotics (Figures 7-9). Results were heavily mixed, with no clear majority in either direction for any disease when we looked at responses overall (Figure7). When we look at RWA and Conventional responses separately, we found that RWA respondents believed that airsaccullitis could be prevented or managed significantly more than Conventional respondents did (p=0.0026). The majority of Conventional respondents (76.5%) and about half of RWA respondents (51.2%) believed that necrotic enteritis, the most challenging disease in both production types, could not be prevented or managed without antibiotics. Management strategies were most commonly indicated as an effective tool to combat these diseases. Figure 7 Disease Management, All Respondents. Are there effective tools to prevent/manage these disease syndromes without the use of antibiotics? Figure 8 Disease Management, RWA Respondents. Are there effective tools to prevent/manage these disease syndromes without the use of antibiotics? 21

Figure 9 Disease Management, Conventional Respondents. Are there effective tools to prevent/manage these disease syndromes without the use of antibiotics? Impacts on Production (Q2.14-2.15) Q2.14 and 2.15 addressed impacts to the production system when raising broilers without antibiotics. The majority of both RWA and Conventional respondents believed that 7-day mortality and total mortality would increase when raising broilers without antibiotics (Figures 10-11). Both RWA and Conventional respondents believed that feed conversion would increase. Conventional respondents believed that condemnation would increase while RWA respondents were split between increase and no change. It should be noted that, although the majority of respondents from both groups indicated that all of these factors would be negatively impacted by switching to RWA systems, the proportion of Conventional respondents holding this view was significantly greater than the proportion of RWA respondents across all categories except feed conversion (7-day mortality p=0.0116, total mortality p=0.0215, condemnation p=0.0064). RWA veterinarians were more likely than RWA producers to report that 7-day mortality and total mortality was/would be increased when raising broilers without antibiotics (p=0.082 and p=0.02, respectively). They did not differ significantly regarding their opinion of impact on feed conversion or condemnation. Due to the small sample sizes in the Conventional respondents when stratified by Role, we did not conduct statistics. However, most Conventional veterinarians and Producers responded that all four impacts would increase. 22

Figure 10 Impact of RWA - Production, RWA Respondents. How did raising broilers without antibiotics impact your production system? Figure 11 Expected Impact of RWA - Production, Conventional Respondents. How do you think switching to an RWA system would impact your production system? Management Strategies (Q2.16-2.17) Q2.16 and 2.17 addressed changes to management or facilities that would be necessary when raising broilers without antibiotics. Both RWA and Conventional respondents identified several production practices that need to be modified when moving from Conventional to RWA production systems (Figures 11-12). The majority of both groups believed that stocking density would need to decrease and downtime would need to increase, though Conventional respondents were more likely to expect this change in downtime (p=0.0269). RWA respondents were divided regarding whether age at slaughter would change whereas Conventional respondents believed that it would need to increase (p=0.0020). Respondents were split on the impacts on grower pay but RWA respondents leaned towards an increase or no change (p=0.0203). Further stratification of RWA respondents revealed agreement between practicing veterinarians and producers regarding the changes that would need to be made when raising broilers without 23

antibiotics, although producers believed that grower pay would need to increase more frequently than the practicing veterinarians. There were no statistically significant differences in the responses between the veterinarians and producers (all P > 0.1). Figure 12 Impact of RWA Management, RWA Respondents. Does/did raising broilers without antibiotics necessitate changes in any of the following? Figure 13 Expected Impact of RWA Management, Conventional Respondents. Do you think switching your animals to an RWA system would necessitate changes in any of the following? Food Safety and Animal Health and Welfare (Q2.18-2.19) Question 2.18 asked respondents how they thought RWA production impacts food safety and animal health and welfare. Almost half of RWA respondents (n=15, 42.9%) believed that raising broilers without antibiotics would slightly worsen or significantly worsen food safety, whereas the majority of Conventional respondents (n=14, 82.4%) believed that switching to raising broilers without antibiotics would slightly or significantly worsen food safety (Figure 14). The majority of RWA (n=29, 69.0%) and all of the Conventional (n=17, 100%) respondents believed that raising broilers without antibiotics would slightly worsen or significantly worsen animal health and welfare (Figure 15). Though the majority of both RWA and Conventional respondents 24

agreed that RWA production negatively impacts food safety and animal welfare, their responses were highly statistically different (p=0.0006 and p=0.0003 respectively). This highlights the 19.0% and 23.8% of RWA respondents that reported RWA production slightly or significantly improves food safety and animal welfare which was not seen in the conventional responses. When stratified by Role, there was a difference of opinion in the RWA respondent group between veterinarians and producers, with RWA producers believing that there would be less of a negative impact on food safety and animal health and welfare than the veterinarians. Within the Conventional group of respondents, the veterinarians and producers were more in agreement. The food safety and animal health and welfare responses differed significantly between the RWA and Conventional respondents when stratified by role (P < 0.05 for all analyses). Figure 14 Food Safety - Respondent Opinion. How do you think RWA broiler production impacts food safety? Figure 15 Animal Health and Welfare - Respondent Opinion. How do you think RWA broiler production impacts animal health and welfare? 25

Q2.19 asked the respondent to identify how they think retailers/restaurants/food services think raising broilers without antibiotics would impact food safety and animal health and welfare. The majority of RWA (n=31, 73.8%) respondents believed that retailers/restaurants/food services thought that raising broilers without the use of antibiotics would improve food safety (Figure 16); the Conventional respondents were split between improving and no impact to food safety though that difference is not significant. A greater number of conventional respondents reported that customers believe RWA production has no impact on animal welfare than RWA respondents did (p=0.0106) though a large number from both groups indicated it slightly or significantly improve animal welfare (Figure 17). No statistically significant differences were observed between RWA and conventional veterinarians or producers. Figure 16 Food Safety - Customer Opinion. In your opinion, how do you think retailers/restaurants/food services think RWA broiler production impacts food safety? Figure 17 Animal Health and Welfare - Customer Opinion. In your opinion, how do you think retailers/restaurants/food services think RWA broiler production impacts animal health and welfare? 26

Impacts on Cost and Demand (Q2.20-2.21) Respondents were asked how they think RWA production impacts the cost of broiler production. The majority of RWA (n=40, 97.6%) and Conventional (n=17, 100%) respondents believe that raising broilers without the use of antibiotics will increase the cost of production (Figure 18). Conventional respondents indicated more frequently than RWA respondents that it would significantly increase cost (p=0.0351) and one RWA respondent indicated that significantly decreased cost of production. Figure 18 Production Costs. How do you think RWA production impacts the cost of broiler production? Q2.21 asked how respondents thought RWA production impacts the demand for chicken products. All RWA and Conventional respondents believe that raising broilers without the use of antibiotics will either have no impact or will slightly increase or significantly increase overall demand for chicken by consumers (Figure 19). Though only RWA respondents indicated a significant increase in demand, this difference from Conventional responses was not significant. Figure 19 Product Demand. How do you think RWA production impacts the demand for chicken overall by consumers? 27

Respondent Views on RWA Label Priority and Auditing Needs (Q2.22-2.23) Q2.22 addressed whether there are times when maintaining the RWA label on a product takes priority over flock health and welfare. More Conventional respondents (70.6%) than RWA respondents (52.4%) either strongly agree or somewhat agree with the statement that there are times that maintaining a raised without antibiotics label has priority over herd health and welfare (Figure 20), although the difference was not statistically significant (p= 0.09). When stratified by role, there were no significant differences between the RWA and Conventional respondents. Figure 20 Label Priority. There are times that maintaining an RWA label has priority over animal health and welfare. Q2.23 addressed whether more stringent health and welfare auditing is needed when raising broilers without the use of antibiotics. A majority of RWA and Conventional respondents believe more health and welfare auditing is needed for broilers raised without antibiotics (Figure 21). When stratified by Role, a greater percentage of Conventional veterinarians and producers believe that more auditing is needed for broilers raised without antibiotics, although the difference was not statistically significant (p>0.05). Figure 21 Auditing. More stringent health and welfare auditing/assessment is needed for broilers raised without antibiotics. 28

Respondent Opinions on Antibiotic Resistance (Q2.24-2.25) Questions 24 and 25 asked respondents to what degree they agreed or disagreed with several statements regarding antibiotic use and resistance. The first statement related to the impact of antibiotic use in the broiler industry on problems in human medicine; the majority of respondents agreed or strongly agreed that antibiotic use in broilers does not cause problems in human medicine. The second statement related to the impact of antibiotic use in the broiler industry on the ability to treat broiler infections in the future; respondents were mixed in their opinion of this statement. The third statement stated that antibiotic use in the broiler industry would make human infections more difficult to treat; the majority of respondents disagreed or strongly disagreed with the statement. The fourth statement related to the willingness of respondents to use alternatives to antibiotics if they were equally effective; the majority of respondents agreed or strongly agreed with this statement. Figure 22 Antibiotic Resistance Problems in Human Medicine. Antibiotic use in the broiler industry/my broilers does not cause problems in humans. Figure 23 Antibiotic Resistance Resistant Bacteria in Broilers. Antibiotic use in the broiler industry/my broilers will make it harder to treat infections in broilers in the future. 29

Figure 24 Antibiotic Resistance Resistant Bacteria in Humans. Antibiotic use in the broiler industry/my broilers leads to bacterial infections in humans that are more difficult to treat. Figure 25 Antibiotic Resistance Antibiotic Alternatives. I would be willing to treat my broilers with antibiotic alternatives if they were equally effective. 30

Turkey Characteristics of respondents (Q3.4-3.8) We received 23 completed responses from participants in the turkey industry. Q1.3 and Q1.4 identified the role of each respondent in animal agriculture and whether the respondent was located within the U.S. or internationally (Table 6). There were no international respondents within the turkey commodity group. Most respondents were practicing veterinarians (n=12, 52.2%) or producers (n=6, 26.1%). Producers were self-identified as manager/producer/grower/rancher/owner (See Terminology). According to Q3.2, 22 of the 23 respondents are currently working with turkeys being raised without antibiotics (RWA respondents) while only one respondent had no experience with turkeys raised without antibiotics (Conventional respondent). Table 6 Characteristics of Turkey Participants n = 23 n % Role Practicing veterinarian 12 52.2 Research/Academic/Government veterinarian 1 4.4 Research/Academic/Government non-veterinarian 0 0 Manager/Producer/Grower/Rancher/Owner 6 26.1 Technical services 3 13.0 Other 1 4.4 Country of Experience United States 23 95.8 International 1 4.2 Experience with RWA Current experience 22 95.7 Previous experience 0 0 No experience 1 4.4 In Q3.4, RWA respondents addressed the reasons why they decided to work with turkeys where the use of antibiotics was not allowed (Table 7). The most commonly identified reason was to fulfill a client/customer request (n=18, 81.8%). To gain entry in a market retail program was the next most common answer (n=12, 54.6%). Table 7 Production Type Decision Factors, RWA Respondents. Which of these factors contributed to your decision to work with turkeys in an RWA production system? n % RWA Respondents 22 To decrease antibiotic resistance 2 9.1 To improve animal health and welfare 3 13.6 To increase sale price of animals/product 8 36.4 To gain market entry into a retail program 12 54.6 To fulfill a client/customer request 18 81.8 To eliminate the use of medically important antibiotics 1 4.6 31

As indicated by Q3.6, the RWA respondents participated in a variety of programs (Table 8). Q3.8 addressed whether the respondents were part of an animal welfare program (Table 9). The majority of RWA respondents participated in either a private/retail/restaurant/food service program (n=10, 45.4%) or a packer/processor program (n=8, 36.4%). Table 8 RWA Program Types, RWA Respondents. Do you have experience in working with turkeys in any of these RWA program types? RWA n % Program Type 22 Industry sponsored program 1 4.6 Private/Retail/Restaurant/Food Service program 8 36.4 Packer/Processor program 6 27.3 State/Federal government program 5 22.7 No program 8 36.4 Table 9 Welfare Program Enrollment, RWA Respondents. Are the turkeys you work with currently part of an animal welfare program? RWA n % Program Type 22 Industry sponsored quality assurance program 5 22.7 Private/Retail/Restaurant/Food Service animal welfare program 10 45.5 Packer/Processor animal welfare program 8 36.4 State/Federal government animal welfare program 2 9.1 No program 4 18.2 Disease challenges (Q3.9-3.13) Q3.9 and 3.10 asked respondents about the disease challenges that are problematic when raising turkeys in their respective production systems. Coccidiosis, bacterial enteritis, airsacculitis and cellulitis were the most problematic disease challenges when raising turkeys without antibiotics (RWA respondents). These responses are shown in Figures 26-27 below, where Figure 26 uses a heat map to display the cumulative ranks for each disease, while Figure 27 show the disease composition within each rank. No data are shown for the one Conventional respondent. Five of the RWA respondents selected the Other category on this question, colibacillosis and ORT were identified as important by these respondents. 32

Figure 26 Disease Challenges Heat Map, RWA Respondents. Rank these disease challenges in order of most to least problematic when raising turkeys without antibiotics. 33

Figure 27 Disease Challenges by Rank, RWA Respondents. Rank these disease challenges in order of most to least problematic when raising turkeys without antibiotics. 34

Q3.11 and 3.12 addressed broad health and welfare challenges that are problematic when raising turkey. Concerns about Increased Morbidity and Mortality and Negative Impacts on Performance were the most common response by RWA respondents. These responses are shown in Figures 28-29 below, where Figure 28 uses a heat map to display the cumulative ranks for each challenge, while Figure 29 show the composition within each rank. No data are shown for the one Conventional respondent. Figure 28 Welfare Challenges Heat Map, RWA Respondents. Rank these health and welfare challenges in order of most to least problematic when raising turkeys without antibiotics. Figure 29 Welfare Challenges by Rank, RWA Respondents. Rank these health and welfare challenges in order of most to least problematic when raising turkeys without antibiotics. 35

Question 3.13 asked respondents if there are effective tools to manage the disease challenges they ranked in Q3.9 and 3.10 without antibiotics (Figures 26-27). Results were somewhat mixed, with a clear majority of no for all diseases except for coccidiosis and bacterial enterititis (Figure 30). Coccidiosis and bacterial enterititis were identified (Figure 26) as the two most important disease challenges in RWA turkey production and approximately 50% of RWA respondents indicated those diseases would be prevented/managed without the use of antibiotics. Management strategies and vaccines were the two most commonly cited methods to manage coccidiosis. Feed and water additives and management strategies were both cited for manageing bacterial enterititis with no refference to vaccine use. For the next two most important disseases, airsacculitis and cellulitis, the majority of respondents indicated they could not be managed without antibiotics. Overall, management strategies were most commonly indicated as an effective tool to combat these diseases. Figure 30 Disease Management, RWA Respondents. Are there effective tools to prevent/manage these disease syndromes without the use of antibiotics? 36

Impacts on Production (Q3.14-3.15) Q3.14 and 3.15 addressed impacts to the production system when raising turkeys without antibiotics. The majority of RWA respondents believed that 7-day mortality and total mortality would increase when raising turkeys without antibiotics (Figure 31). RWA respondents were divided on the impacts on feed conversion. RWA respondents believed that condemnation would either not change or increase. There were no significant differences in the responses of RWA veterinarians (n=11) and producers (n=6). Figure 31 Impact of RWA Production, RWA Respondents. Does/did raising turkeys without antibiotics impact your production system? Management Strategies (Q3.16-3.17) Q3.16 and 3.17 addressed changes to management or facilities that would be necessary when raising turkeys without antibiotics. RWA respondents identified a broad range of production practices that need to be modified when moving from Conventional to RWA production systems (Figure 32). The majority believed that downtime would need to increase and stocking density would need to decrease. RWA respondents were divided regarding whether age at slaughter would change but generally believed that grower pay would need to increase. Further stratification of RWA respondents revealed agreement between practicing veterinarians and producers regarding the changes that would need to be made when raising turkeys without antibiotics; there were no statistically significant differences in the responses between the veterinarians and producers (all P > 0.1). 37

Figure 32 Impact of RWA Management, RWA Respondents. Does/did raising turkeys without antibiotics necessitate changes in any of the following? Food Safety and Animal Health and Welfare (Q3.18-3.19) More than half of RWA respondents (n=15, 68.2%) believed that raising turkeys without antibiotics would slightly worsen or significantly worsen food safety (Figure 33). The majority of RWA respondents (n=17, 77.3%) believed that raising turkeys without antibiotics would slightly worsen or significantly worsen animal health and welfare. When stratified by Role, there was a difference of opinion in the RWA respondent group between veterinarians and producers, with RWA producers believing that there would be less of a negative impact on food safety and animal health and welfare than the veterinarians (Figure 34). Figure 33 Food Safety - Respondent Opinion, RWA Respondents. How do you think RWA turkey production impacts food safety? Figure 34 Animal Health and Welfare - Respondent Opinion, RWA Respondents. How do you think RWA turkey production impacts animal health and welfare? 38

Q3.19 asked the respondent to identify how retailers/restaurants/food services think raising turkeys without antibiotics would impact food safety and animal health and welfare. The majority of RWA respondents (n=15, 71.4%) believed that retailers/restaurants/food services thought that raising turkeys without the use of antibiotics would improve food safety and animal welfare (Figure 35). Similar results were observed when stratified by Role. Figure 35 Food Safety - Customer Opinion, RWA Respondents. In your opinion, how do you think retailers/restaurants/food services think RWA turkey production impacts food safety? Figure 36 Animal Health and Welfare - Customer Opinion, RWA Respondents. In your opinion, how do you think retailers/restaurants/food services think RWA turkey production impacts animal health and welfare? Impacts on Cost and Demand (Q3.20-3.21) The majority of RWA (n=21, 95.5%) respondents believe that raising turkeys without the use of antibiotics will increase the cost of production (Figure 37). Figure 37 Production Costs, RWA Respondents. How do you think RWA production impacts the cost of turkey production? 39

All RWA respondents believe that raising turkey without the use of antibiotics will either have no impact or will slightly / significantly increase overall demand for chicken by consumers (Figure 38). Figure 38 Product Demand, RWA Respondents. How do you think RWA production impacts the demand for turkey overall by consumers? Respondent Views on RWA Label Priority and Auditing Needs (Q3.22-3.23) Q3.22 addressed whether there are times when maintaining the RWA label on a product takes priority over flock health and welfare. Of the 22 RWA respondents, 17 (77.3%) either strongly agree or somewhat agree with the statement that there are times that maintaining a raised without antibiotics label has priority over herd health and welfare (Figure 39). Figure 39 Label Priority, RWA Respondents. There are times that maintaining an RWA label has priority over animal health and welfare. Q3.23 addressed whether more stringent health and welfare auditing is needed when raising turkeys without the use of antibiotics. A majority of RWA respondents believe more health and welfare auditing is needed for turkeys raised without antibiotics (Figure 40). Figure 40 Auditing, RWA Respondents. More stringent health and welfare auditing/assessment is needed for turkeys raised without antibiotics. 40

Respondent Opinions on Antibiotic Resistance (Q3.24-3.25) Questions 24 and 25 asked respondents to what degree they agreed or disagreed with several statements regarding antibiotic use and resistance. The first statement related to the impact of antibiotic use in the turkey industry on problems in human medicine; the majority of respondents agreed or strongly agreed that antibiotic use in turkeys does not cause problems in human medicine. The second statement related to the impact of antibiotic use in the turkey industry on the ability to treat turkey infections in the future; respondents were mixed in their opinion of this statement. The third statement stated that antibiotic use in the turkey industry would make human infections more difficult to treat; the majority of respondents disagreed or strongly disagreed with the statement. The fourth statement related to the willingness of respondents to use alternatives to antibiotics if they were equally effective; the majority of respondents agreed or strongly agreed with this statement. Figure 41 Antibiotic Resistance Problems in Human Medicine, RWA Respondents. Antibiotic use in the turkey industry/my turkeys does not cause problems in humans. Figure 42 Antibiotic Resistance Resistant Bacteria in Turkeys, RWA Respondents. Antibiotic use in the turkey industry/my turkeys will make it harder to treat infections in turkeys in the future. Figure 43 Antibiotic Resistance Resistant Bacteria in Humans, RWA Respondents. Antibiotic use in the turkey industry/my turkeys leads to bacterial infections in humans that are more difficult to treat. 41

Figure 44 Antibiotic Resistance Antibiotic Alternatives, RWA Respondents. I would be willing to treat my turkeys with antibiotic alternatives if they were equally effective. 42

Swine Characteristics of respondents (Q4.4-4.8) We received 148 completed responses from participants in the swine industry. Q1.3 and Q1.4 identified the role of each respondent in animal agriculture and whether the respondent was located within the U.S. or internationally (Table 10). Six international respondents were excluded from this analysis due to their small number, and the potential for varying regulatory and production systems to influence responses. Most respondents were practicing veterinarians (n=56, 37.6%) and producers (n=70, 47.3%). Producers self-identified as manager/producer/grower/rancher/owner (See Terminology). According to Q4.2, just over half of the respondents are currently working with (n=50, 33.8%) or have previously worked with (n=30, 20.3%) swine being raised without antibiotics (RWA respondents). The remaining respondents (n=68, 46.0%) had never worked with swine raised without antibiotics (Conventional respondents). Thirty of the 80 RWA respondents (37.5%) reported no longer working in RWA systems; many of these cited animal health and welfare challenges as a reason they stopped working with this type of production. About a quarter of the RWA respondents no longer working in RWA systems cited insufficient market support (reasons given included limited market opportunity, infeasible cost structures, and going out of business). Table 10 Characteristics of Swine Participants n = 148 n % Role Practicing veterinarian 56 37.6 Research/Academic/Government veterinarian 7 4.7 Research/Academic/Government non-veterinarian 1 0.7 Manager/Producer/Grower/Rancher/Owner 70 47.3 Technical services 8 5.4 Other 6 4.1 Country of Experience United States 142 96.0 International 6 4.1 Experience with RWA Current experience 50 33.8 Previous experience 30 20.3 No experience 68 46.0 In Q4.4, RWA respondents addressed the reasons why they decided to work with swine where the use of antibiotics was not allowed. The most commonly identified reasons were marketdriven, including the need to fulfill a client/customer request (n=52, 69.3%), to increase sale price of animals/product (n=41, 54.7%) and to gain market entry into a retail program (n=30. 40.0%) (Table 11). In Q4.5 conventional respondents addressed reasons why they decided not to work with swine where the use of antibiotics was not allowed; concerns about negative impacts to animal health and welfare (n=51, 76.1%) and that they were already raising animals in a responsible use program (n=49, 73.1%) were commonly identified reasons (Table 11). 43

Table 11 Production Type Decision Factors. Which of these factors contributed to your decision to work with swine in an RWA/Conventional production system? n % RWA Respondents 75 To decrease antibiotic resistance 10 13.3 To improve animal health and welfare 10 13.3 To increase sale price of animals/product 41 54.7 To gain market entry into a retail program 30 40.0 To fulfill a client/customer request 52 69.3 To eliminate the use of medically important antibiotics 6 8.0 Conventional Respondents 67 Not profitable 19 28.4 Concerned about negative impacts to animal health and welfare 51 76.1 No market pressure 21 31.3 Not a sustainable consumer trend 17 25.4 Food safety concerns 19 28.4 Already eliminated the use of medically important antibiotics 15 22.4 Already raising animals in a responsible use program 49 73.1 Q4.6 and 4.7 asked respondents about their experience with different types of RWA programs or for Conventional respondents, if they have ever considered enrolling in an RWA program (Table 12). The majority of RWA respondents participated in a packer/processor program (n=39, 52.0%) and/or a private/retail/restaurant/food service program (n=34, 45.3%). More than half of Conventional respondents reported they had not considered raising swine under any of these program types (n=46, 68.7%). Table 12 RWA Program Types. Do you have experience in/have you considered working with swine in any of these RWA program types? RWA Conventional n % n % Program Type 75 67 Industry sponsored program 4 5.3 3 4.5 Private/Retail/Restaurant/Food Service program 34 45.3 10 14.9 Packer/Processor program 39 52.0 13 19.4 State/Federal government program 1 1.3 2 3.0 No program 14 18.7 46 68.7 44

Q4.8 addressed whether the respondents were part of an animal welfare program (Table 13). The majority of respondents were part of the PQA Plus/Common Swine Industry Audit (n=59, 79.7% of RWA respondents and n=62, 92.5% of Conventional respondents), while a smaller number (n=17, 23% of RWA respondents and n=17, 25.4% of Conventional respondents) were part of a privately owned/facilitated animal welfare program. RWA respondents were significantly more likely to be enrolled in GAP (p=0.0015) but Conventional respondents were more likely to be rolled in PQA Plus (p=0.0301). Table 13 Welfare Program Enrollment. Are the swine you work with currently part of an animal welfare program? RWA Conventional n % n % Program Type 74 67 PQA Plus/Common Swine Industry Audit 59 79.7 62 92.5 NOS National Organic Standard 3 4.1 - - GAP 13 17.6 1 1.5 Certified Humane (Humane Farm Animal Care) 4 5.4 1 1.5 American Humane Certified 2 2.7 2 3.0 Animal Welfare Approved 6 8.1 3 4.5 Privately owned/facilitated animal welfare program 17 23.0 17 25.4 No program 9 12.2 4 6.0 Disease challenges (Q4.9-4.13) Q4.9 and 4.10 asked respondents about the disease challenges that are problematic when raising swine in their respective production systems. Post weaning hemolytic E. coli and Actinobacillus suis, Haemophilus parasuis and Streptoococcus suis were ranked as the most problematic disease challenges when raising swine without antibiotics (RWA respondents) and in conventional systems (Conventional respondents). Similar disease challenges were observed when stratified by Role (veterinarian and producer). These responses are shown in Figures 45-47 below, where Figure 45 uses a heat map to display the cumulative ranks for each disease, while Figures 46 and 47 show the disease composition within each rank. Fourteen of the RWA respondents selected the Other category on this question; 3 of the respondents listed porcine reproductive and respiratory syndrome (PRRS) and 3 listed influenza. Porcine reproductive, and respiratory syndrome (PRRS) accounted for 10/12 Other responses from Conventional respondents. 45

Figure 45 Disease Challenges Heat Map. Rank these disease challenges in order of most to least problematic when raising swine (without antibiotics). 46

Figure 46 Disease Challenges by Rank, RWA Respondents. Rank these disease challenges in order of most to least problematic when raising swine without antibiotics. Figure 47 Disease Challenges by Rank, Conventional Respondents. Rank these disease challenges in order of most to least problematic when raising swine. 47

Q4.11 and 4.12 addressed broad health and welfare challenges that are problematic when raising swine with and without the use of antibiotics, respectively. Respiratory system disorders were by far the most problematic health and welfare disorder when raising swine in both RWA and conventional programs. Digestive system disorders were ranked second by both groups; although with less frequency. These responses are shown in Figures 48-50 below, where Figure 48 uses a heat map to display the cumulative ranks for each challenge, while Figures 49 and 50 show the composition within each rank. Figure 48 Welfare Challenges Heat Map. Rank these health and welfare challenges in order of most to least problematic when raising swine (without antibiotics). 48

Figure 49 Welfare Challenges by Rank, RWA Respondents. Rank these health and welfare challenges in order of most to least problematic when raising swine without antibiotics. Figure 50 Welfare Challenges by Rank, Conventional Respondents. Rank these health and welfare challenges in order of most to least problematic when raising swine. 49

Q4.13 asked respondents in their respective RWA and Conventioanl systems if there are effective tools to manage the disease challenges they ranked in Q4.9 and 4.10. The majority of respondents in both RWA and Conventional systems believe that there are effective tools (i.e. vaccine, feed/water additive, management) to prevent post weaning hemolytic E. coli, one of the top two most challenging diseases in both production types (Figures 51-53). Conversely, the majority of RWA and Conventional respondents did not believe there were effective tools to manage A. suis, H. parasuis and S. suis, which accounted for the other most challenging set of diseases in both production systems. Figure 51 Disease Management, All Respondents. Are there effective tools to prevent/manage these disease syndromes without the use of antibiotics? Figure 52 Disease Management, RWA Respondents. Are there effective tools to prevent/manage these disease syndromes without the use of antibiotics? 50

Figure 53 Disease Management, Conventional Respondents. Are there effective tools to prevent/manage these disease syndromes without the use of antibiotics? Management Strategies (Q4.14-4.15) Q4.14 and 4.15 addressed changes to management or facilities that would be necessary when raising swine without antibiotics. Both RWA and Conventional respondents identified a broad range of production practices that need to be modified when moving from Conventional to RWA production systems. The majority of both groups of respondents identified weaning age, biosecurity, space and personnel as requiring changes when moving to raising swine without the use of antibiotics (greater than 60% for both groups across all changes) (Figure 54-55). Less than a quarter of respondents from both groups thought that bedding needed to be changed when switching to raising swine without the use of antibiotics. Further stratification of RWA respondents revealed agreement between practicing veterinarians and producers that weaning age, biosecurity, space and personnel were the most common changes needed when switching to RWA production (greater than 60% for both groups across all changes, except for space in RWA producers). There were no statistically significant differences in the responses between the veterinarians and producers (all P > 0.05). The only response that had a borderline statistical significance was in the RWA respondents when addressing the need for a change in space; a greater percentage of veterinarians (n=23, 69.7%) than producers (n=10, 41.7%) within the RWA group thought that a change in space was needed when switching to raising swine without the use of antibiotics, although this difference was not statistically significant (P=0.08). 51

Figure 54 Impact of RWA - Management, RWA Respondents. Does/did raising swine without antibiotics necessitate changes to any of these management strategies or facility designs? Figure 55 Expected Impact of RWA Management, Conventional Respondents. Do you think switching your animals to an RWA system would necessitate changes to any of these management strategies or facility designs? Impacts on Production (Q4.16-4.17) Q4.16 and 4.17 addressed impacts to the production system when raising swine without antibiotics. The majority of both RWA and Conventional respondents believed that feed efficiency (greater than 50% across groups), morbidity and mortality (greater than 70% across groups), and age at slaughter (greater than 60% across groups) was/would be negatively impacted when switching to raising swine without the use of antibiotics (Figure 56-57). The majority of respondents in both RWA and Conventional groups also thought that weight at 52

slaughter would either not change or would be decreased when switching to raising swine without the use of antibiotics. It should be noted that, although the majority of respondents from both groups indicated that all of these factors would be negatively impacted by switching to RWA systems, the proportion of Conventional respondents holding this view was greater than the proportion of RWA respondents across all categories. Both RWA and Conventional veterinarians were more likely than producers to report that feed efficiency was/would be decreased when switching to raising swine without antibiotics (p=0.0005 and p=0.07, respectively). This was the only response for which there was a statistically significant difference between the veterinarians and producers. Figure 56 Impact of RWA - Production, RWA Respondents. Does/did raising swine without antibiotics impact your production system? Figure 57 Expected Impact of RWA Production, Conventional Respondents. How do you think switching to an RWA system would impact your production system? 53

Food Safety and Animal Health and Welfare (Q4.18-4.19) Questions 4.18 and 4.19 addressed the respondents perception of the impacts on food safety and animal health and welfare of raising swine without the use of antibiotics. Almost half of RWA respondents (n=35, 46.7%) believed that raising swine without antibiotics would slightly worsen or significantly worsen food safety, whereas the majority of Conventional respondents (n=38, 56.7%) believed that switching to raising swine without antibiotics would slightly or significantly worsen food safety (Figure 58). Figure 58 Food Safety - Respondent Opinion. How do you think RWA swine production impacts food safety? Most RWA respondents (n=57, 76.0%) and Conventional (n=66, 98.5%) respondents believed that switching to raising swine without antibiotics would slightly or significantly worsen animal health and welfare (Figure 59). However, when stratified by Role, a significantly greater number of Conventional producers (n=25, 56.8%) compared to RWA producers (n=6, 23.1%) believed that raising swine without antibiotics slightly or significantly worsened animal health and welfare (p=0.004). Figure 59 Animal Health and Welfare - Respondent Opinion. How do you think RWA swine production impacts animal health and welfare? 54

Q4.19 asked the respondent to identify how retailers/restaurants/food services think raising swine without antibiotics would impact food safety and animal health and welfare. The majority of RWA (n=66, 82.7%) and Conventional (n=54, 80.6%) respondents believed that retailers/restaurants/food services thought that raising swine without the use of antibiotics would improve food safety (Figure 60). The majority of both RWA (n=56, 74.7%) and Conventional (n=44, 65.7%) respondents believed that retailers/restaurants/food services thought that raising swine without the use of antibiotics would improve animal health and welfare (Figure 61). Similar results were observed when stratified by Role; no statistically significant differences were observed between RWA and conventional veterinarians or producers Figure 60 Food Safety - Customer Opinion. In your opinion, how do you think retailers/restaurants/food services think RWA swine production impacts food safety? Figure 61 Animal Health and Welfare - Customer Opinion. In your opinion, how do you think retailers/restaurants/food services think RWA swine production impacts animal health and welfare? 55

Impacts on Cost and Demand (Q4.20-4.21) Question 4.20 asked respondents how/if they thought RWA production impacts the cost of swine production. The majority of RWA (n=65, 86.7%) and Conventional (n=66, 98.5%) respondents believe that raising swine without the use of antibiotics will slightly or significantly increase the cost of production (Figure 62). While not significantly different, when looking at Producers stratified by RWA experience, results suggest more Conventional producers (n=43, 97.7%) than RWA producers (n=20, 76.9%...) believe that there will be an increased cost associated with raising swine without antibiotics (p=0.0988). Veterinarians from both RWA and Conventional systems generally agree that there will be an increased cost of production. Figure 62 Production Costs. How do you think RWA production impacts the cost of swine production? Question 4.21 asked respondents how/if they thought RWA production impacts demand for pork overall by consumers. The majority of RWA (n=70, 94.6%) and Conventional (n=61, 91.0%) respondents believe that raising swine without the use of antibiotics will either have no impact or will slightly increase overall demand for pork by consumers (Figure 63). However, when stratified by Role, more Conventional producers believed that raising swine without the use of antibiotics will have no benefit on consumer demand for pork overall (P=0.01). Figure 63 Product Demand. How do you think RWA production impacts the demand for pork overall by consumers? 56

Respondent Views on RWA Label Priority and Auditing Needs (Q4.22-4.23) Q4.22 addressed whether there are times when maintaining the RWA label on a product takes priority over herd health and welfare. More RWA veterinarians (n=25, 75.8%) than Conventional veterinarians (n=10, 52.6%) believe that there are times that maintaining a raised without antibiotics label has priority over herd health and welfare (Figure 64), although the difference was not statistically significant (p= 0.08). When stratified by Role, the majority of RWA producers agree (n=19, 52.8%), while Conventional producers disagree (n=25. 56.8%), that there are times when maintaining a raised without antibiotics label has priority of herd health and welfare (P=0.01). When comparing RWA respondents to Conventional respondents, Conventional respondents were more likely to believe that RWA increases the cost of sine production (p=0.0084). Figure 64 Label Priority. There are times that maintaining an RWA label has priority over animal health and welfare. Q4.23 addressed whether more stringent health and welfare auditing is needed when raising swine without the use of antibiotics. A majority of RWA and Conventional respondents believe more auditing is needed for swine raised without antibiotics (Figure 65). When stratified by Role, a greater number of Conventional producers than veterinarians believe that more auditing is needed for swine raised without antibiotics, although the difference was not statistically significant (p=0.06). 57

Figure 65 Auditing. More stringent health and welfare auditing/assessment is needed for swine raised without antibiotics. Respondent Opinions on Antibiotic Resistance (Q4.24-3.25) Questions 24 and 25 asked respondents to what degree they agreed or disagreed with several statements regarding antibiotic use and resistance. The first statement related to the impact of antibiotic use in the swine industry on problems in human medicine; the majority of respondents agreed or strongly agreed that antibiotic use in swine does not cause problems in human medicine. The second statement related to the impact of antibiotic use in the swine industry on the ability to treat swine infections in the future; respondents were mixed in their opinion of this statement. The third statement stated that antibiotic use in the swine industry would make human infections more difficult to treat; the majority of respondents disagreed or strongly disagreed with the statement. The fourth statement related to the willingness of respondents to use alternatives to antibiotics if they were equally effective; the majority of respondents agreed or strongly agreed with this statement. Figure 66 Antibiotic Resistance Problems in Human Medicine. Antibiotic use in the swine industry/my swine does not cause problems in humans. 58

Figure 67 Antibiotic Resistance Resistant Bacteria in Swine. Antibiotic use in the swine industry/my swine will make it harder to treat infections in swine in the future. Figure 68 Antibiotic Resistance Resistant Bacteria in Humans. Antibiotic use in the swine industry/my swine leads to bacterial infections in humans that are more difficult to treat. Figure 69 Antibiotic Resistance Antibiotic Alternatives. I would be willing to treat my swine with antibiotic alternatives if they were equally effective. 59

Beef Characteristics of respondents (Q5.4-5.8) We received 244 completed responses from participants in the beef industry. Q1.3 and Q1.4 identified the role of each respondent in animal agriculture and whether the respondent was located within the U.S. or internationally (Table 14). Six international respondents were excluded from this analysis due to their small number, and the potential for varying regulatory and production systems to influence responses. Most of the U.S. respondents were practicing veterinarians (n=106, 43.4%), producers (n=108, 44.3%) and academic veterinarians (n=10, 4.1%). Producers were self-identified as manager/producer/grower/rancher/owner and academic veterinarians were self-identified as research/academic/government veterinarian (See Terminology). According to Q5.2, half of the respondents are currently working with (n=88, 36.1%) or have previously worked with (n=33, 13.5%) beef cattle being raised without antibiotics (RWA respondents). The remaining respondents (n=123, 50.4%) had never worked with beef cattle raised without antibiotics (Conventional respondents). Table 14 Characteristics of Beef Participants n = 244 Role n % Practicing veterinarian 106 43.4 Research/Academic/Government veterinarian 10 4.1 Research/Academic/Government non-veterinarian 3 1.2 Manager/Producer/Grower/Rancher/Owner 108 44.3 Technical services 7 2.9 Other 10 4.1 Country of Experience United States 237 97.5 International 6 2.5 Experience with RWA Current experience 88 36.1 Previous experience 33 13.5 No experience 123 50.4 In Q5.4, RWA respondents addressed the reasons why they decided to work with beef cattle where the use of antibiotics was not allowed (Table 15). The most commonly identified reason was to fulfill a client/customer request (n=76, 65.5%) followed by to increase the sale price of the animal products (n=45, 38.8%). In Q5.5 Conventional respondents addressed reasons why they decided not to work with beef cattle where the use of antibiotics was not allowed; concerns about negative impacts to animal health and welfare (n=79, 65.3%) and that they were already raising animals in a responsible use program (n=68, 56.2%) were commonly identified reasons (Table 15). 60

Table 15 Production Type Decision Factors. Which of these factors contributed to your decision to work with beef cattle in an RWA/Conventional production system? n % RWA Respondents 116 To decrease antibiotic resistance 23 19.8 To improve animal health and welfare 18 15.5 To increase sale price of animals/product 45 38.8 To gain market entry into a retail program 32 27.6 To fulfill a client/customer request 76 65.5 To eliminate the use of medically important antibiotics 11 9.5 Conventional Respondents 121 Not profitable 25 20.7 Concerned about negative impacts to animal health and welfare 79 65.3 No market pressure 31 25.6 Not a sustainable consumer trend 15 12.4 Food safety concerns 10 8.3 Already eliminated the use of medically important antibiotics 6 5.0 Already raising animals in a responsible use program 68 56.2 Q5.6 and 5.7 asked respondents about their experience with different types of RWA programs or for Conventional respondents, if they have ever considered enrolling in an RWA program (Table 16). RWA respondents reported participating in a variety of programs including approximately one third reporting having no experience participating in any formal RWA program (n=43, 37.1%). The majority of Conventional respondents reported they have not considered raising beef cattle under any of these program types (n=93, 76.9%). Table 16 RWA Program Types. Do you have experience in/have you considered working with beef cattle in any of these RWA program types? RWA Conventional n % n % Program Type 116 121 Industry sponsored program 18 15.5 6 5.0 Private/Retail/Restaurant/Food Service program 40 34.5 16 13.2 Packer/Processor program 37 31.9 11 9.1 State/Federal government program 5 4.3 5 4.1 No program 43 37.1 93 76.9 Q5.8 addressed whether the respondents were part of an animal welfare program (Table 17). Differences in enrollment between RWA and Conventional respondents were not significant for any welfare program type. The majority of RWA and Conventional respondents reported not participating in any program (n=65, 56.0% and n= 75, 62.0% respectively.) Of those who did report participating in a program, an industry sponsored quality assurance program was the most common for both RWA (n=30, 25.9%) and Conventional respondents (n=37, 30.6%). 61

Table 17 Welfare Program Enrollment. Are the beef cattle you work with currently part of an animal welfare program? RWA Conventional n % n % Program Type 116 121 Industry sponsored quality assurance program 30 25.9 37 30.6 Private/Retail/Restaurant/Food Service animal welfare 20 17.2 11 9.1 program Packer/Processor animal welfare program 19 16.4 10 8.3 State/Federal government animal welfare program 6 5.2 4 3.3 No program 65 56.0 75 62.0 Disease and Welfare challenges (Q5.9-5.13) Questions 5.9 and 5.10 asked respondents about the disease challenges that are problematic when raising beef cattle in their respective production systems (RWA or conventional). Bovine respiratory disease, calf scours, and pink eye were ranked as the most problematic disease challenges in both RWA and Conventional production systems. These responses are shown in Figures 71-73 below. A total of 7 RWA respondents and 11 Conventional respondents listed other problematic diseases. Digestive disorders/bloat was listed by 2 of the RWA respondents, and blackleg and coccidiosis were each listed twice by Conventional respondents. 62

Figure 70 Disease Challenges Heat Map. Rank these disease challenges in order of most to least problematic when raising beef cattle (without antibiotics). 63

Figure 71 Disease Challenges by Rank, RWA Respondents. Rank these disease challenges in order of most to least problematic when raising beef cattle without antibiotics. Figure 72 Disease Challenges by Rank, Conventional Respondents. Rank these disease challenges in order of most to least problematic when raising beef cattle. 64

Questions 5.11 and 5.12 addressed broad health and welfare challenges that are problematic when raising beef cattle without antibiotics. Respiratory system disorders were ranked by both RWA and Conventional respondents as the most problematic disease challenge when raising beef cattle without antibiotics. Digestive system disorders were ranked second by both groups; although with less frequency (Figures 74-76). A total of 4 RWA respondents listed other problematic issues, and only 2 Conventional respondents listed other issues. Figure 73 Welfare Challenges Heat Map. Rank these health and welfare challenges in order of most to least problematic when raising beef cattle (without antibiotics). 65

Figure 74 Welfare Challenges by Rank, RWA Respondents. Rank these health and welfare challenges in order of most to least problematic when raising beef cattle without antibiotics. Figure 75 Welfare Challenges by Rank, Conventional Respondents. Rank these health and welfare challenges in order of most to least problematic when raising beef cattle. 66

Q5.13 asked respondents in their respective RWA and Conventioanl systems if there are effective tools to manage the disease challenges they ranked in Q5.9 and 5.10. Bovine respiratory disease and calf scours were the two most problematic diseases identified by both RWA and Conventional respondents (Figure 71). The majority of respondents in both RWA and Conventional systems believe that there are effective tools (i.e. vaccine, feed/water additive, management) to prevent or manage these diseases (Figures 77-79). A small majority of all respondents also believed the next two most important diseases, pink eye and foot rot lameness, could be prevented or managed without antibiotics; though conventional respondents did not thinnk this could be done for foot rot lameness. Figure 76 Disease Management, All Respondents. Are there effective tools to prevent/manage these disease syndromes without the use of antibiotics? 67

Figure 77 Disease Management, RWA Respondents. Are there effective tools to prevent/manage these disease syndromes without the use of antibiotics? Figure 78 Disease Management, Conventional Respondents. Are there effective tools to prevent/manage these disease syndromes without the use of antibiotics? Management and Production Strategies (Q5.14-5.15) Q5.14 and 5.15 addressed impacts to the production system and management facilities when raising beef cattle without antibiotics. RWA respondents gave mixed responses for all outcomes. personnel requirements, cattle mortality, death loss, and age at slaughter were all split with approximately half of the respondents answering no change and the other half answering 68

increase. The majority of RWA and conventional respondents believed that feed efficiency decreased in RWA programs (n=61, 53.0% and n=84, 69.4%). For every other outcome, the majority of Conventional respondents believed RWA caused an increase (Figures 80-81). RWA veterinarians were more likely than RWA producers to report that cattle mortality, death loss, and age at slaughter increases (p=0.0002, p=0.0013, and p>0.00001 respectively) and that feed efficiency decreases (p=0.0002) when raising beef cattle without antibiotics (Figure 80). They did not differ significantly regarding their opinion of impact on personnel requirements. Figure 79 Impact of RWA Management & Production, RWA Respondents. Does/did raising beef cattle without antibiotics necessitate changes to any of these management strategies or facility designs? When comparing Conventional veterinarians and producers, we found that veterinarians were more likely than producers to report that the expect feed efficiency to decrease (p=0.0252) and age at slaughter to increase (p=0.0187) if they switched to raising their beef cattle without antibiotics (Figure 81). They did not differ significantly regarding their opinion of impact on personnel requirements, cattle mortality, or death loss. 69

Figure 80 Expected Impact of RWA - Management & Production, Conventional Respondents. Do you think switching your animals to an RWA system would necessitate changes to any of these management strategies or facility designs? Food Safety and Animal Health and Welfare (Q5.16-5.17) Q5.16 asked respondents how they think raising beef cattle without antibiotics impacts food safety and animal health and welfare. Approximately half of both RWA and conventional respondents (n=60, 51.7% and n=65, 53.7% respectively) believed that raising beef cattle without antibiotics would have no impact on food safety (Figure 82). However, the remaining 50% of RWA and Conventional respondents significantly differed in that RWA respondents were split with a slight majority believing RWA improves food safety, and Conventional respondents more often believed RWA worsens food safety (p<0.0001). When stratified by role, veterinarians were more likely to be critical of RWA s impacts on food safety than producers (p<0.0001). Figure 81 Food Safety - Respondent Opinion. How do you think RWA beef cattle production impacts food safety? 70

In regards to animal health and welfare, the majority of RWA (n=78, 67.8%) and nearly all of the Conventional respondents (n=111, 91.7%) believed that raising beef cattle without antibiotics would slightly or significantly worsen animal health and welfare. This difference was significant (p<0.0001). Figure 82 Animal Health and Welfare - Respondent Opinion. How do you think RWA beef cattle production impacts animal health and welfare? Q5.17 asked the respondent to identify how they think retailers/restaurants/food services think raising beef cattle without antibiotics would impact food safety and animal health and welfare. There were no significant differences in opinion between RWA and Conventional respondents or between veterinarians and producers (all p>0.05). The majority of respondents reported they believed that retailers, restaurants, and food services think that raising beef cattle without antibiotics slightly or significantly improves food safety and animal health and welfare (Food safety: n=105, 91.3% for RWA respondents and n=105, 86.8% for Conventional respondents. Health & welfare: n=83, 70.3% for RWA respondents and n=85, 70.2% for Conventional respondents) (Figures 84-85). Figure 83 Food Safety - Customer Opinion. In your opinion, how do you think retailers/restaurants/food services think RWA beef cattle production impacts food safety? 71

Figure 84 Animal Health and Welfare - Customer Opinion. In your opinion, how do you think retailers/restaurants/food services think RWA beef cattle production impacts animal health and welfare? Impacts on Cost and Demand (Q5.18-5.19) Q5.18 and 5.19 asked respondents how they think raising beef cattle without antibiotic impacts the cost of beef production and the demand by consumers for beef products (Figure 86). Most RWA and Conventional respondents believed that raising beef cattle without antibiotics slightly or significantly increases the cost of beef production (n=99, 85.3% and n=112, 92.6% respectively) with Conventional respondents being significantly more likely to indicate it strongly increases cost (p=0.0079). When stratified by role, veterinarians were more likely than producers to believe it increases cost of beef production (p=0.0061). Figure 85 Production Costs. How do you think RWA production impacts the cost of beef cattle production? In regards to the impact of raising beef cattle without the use of antibiotics on demand for beef products, both RWA and Conventional respondents believed it increases or has no effect on demand. RWA respondents were more likely to believe it increases demand than Conventional respondents (p=0.0268). Again veterinarians and producers had significantly different opinions 72

on demand (Figure 87). Though both veterinarians and producers believed it will increase or have no impact on demand, producers were more likely to believe it will significantly or slightly increase demand (p=0.0279). Figure 86 Product Demand. How do you think RWA production impacts the demand for beef overall by consumers? RWA Label Priority and Auditing (Q5.20-5.21) Q5.20 addressed whether there are times when maintaining the RWA label on a product takes priority over herd health and welfare (Figure 88). Both RWA and Conventional respondents were polarized in their responses. Approximately half of all respondents answered that they strongly or somewhat agree and the other half answered that they strongly or somewhat disagree that the RWA label sometimes takes priority over health and welfare. When stratified by role, producers were significantly more likely (p=0.0036) than veterinarians to strongly disagree that the RWA label ever takes priority over animal health and welfare. Figure 87 Label Priority. There are times that maintaining an RWA label has priority over animal health and welfare. 73

Q5.21 addressed whether more stringent health and welfare auditing is needed when raising beef cattle without the use of antibiotics. A majority of RWA and Conventional respondents (n=78, 67.2% and n=91, 77.1% respectively) believe more health and welfare auditing is needed for beef cattle raised without antibiotics (Figure 89). Conventional respondents were significantly more likely than RWA respondents to strongly agree that more auditing is needed (p=0.0125). When stratified by Role, a significantly greater percentage of veterinarians believed that more auditing is needed for beef cattle raised without antibiotics (p<0.0001). Figure 88 Auditing. More stringent health and welfare auditing/assessment is needed for beef cattle raised without antibiotics. Respondent Opinions on Antibiotic Resistance Questions 24 and 25 asked respondents to what degree they agreed or disagreed with several statements regarding antibiotic use and resistance. The first statement related to the impact of antibiotic use in the beef industry on problems in human medicine; the majority of respondents agreed or strongly agreed that antibiotic use in beef cattle does not cause problems in human medicine. The second statement related to the impact of antibiotic use in the beef industry on the ability to treat beef cattle infections in the future; respondents were mixed in their opinion of this statement. The third statement stated that antibiotic use in the beef industry would make human infections more difficult to treat; the majority of respondents disagreed or strongly disagreed with the statement. The fourth statement related to the willingness of respondents to use alternatives to antibiotics if they were equally effective; the majority of respondents agreed or strongly agreed with this statement. 74

Figure 89 Antibiotic Resistance Problems in Human Medicine. Antibiotic use in the beef industry/my beef cattle does not cause problems in humans. Figure 90 Antibiotic Resistance Resistant Bacteria in Beef Cattle. Antibiotic use in the beef industry/my beef cattle will make it harder to treat infections in beef cattle in the future. Figure 91 Antibiotic Resistance Resistant Bacteria in Humans. Antibiotic use in the beef industry/my beef cattle leads to bacterial infections in humans that are more difficult to treat. 75

Figure 92 Antibiotic Resistance Antibiotic Alternatives. I would be willing to treat my beef cattle with antibiotic alternatives if they were equally effective. 76

Dairy Characteristics of respondents (Q6.4-6.8) We received 81 completed responses from participants in the dairy cattle industry. Q1.3 and Q1.4 identified the role of each respondent in animal agriculture and whether the respondent was located within the U.S. or internationally (Table 18). Six international respondents were excluded from this analysis due to their small number, and the potential for varying regulatory and production systems to influence responses. Most of the U.S. respondents were practicing veterinarians (n=52, 64.2%), producers (n=12, 14.8%) and academic veterinarians (n=10, 12.4%). Producers were self-identified as manager/producer/grower/rancher/owner, and academic veterinarians were self-identified as research/academic/government veterinarian (See Terminology). According to Q6.2, more than half of the respondents are currently working with (n=37, 45.7%) or have previously worked with (n=11, 13.6%) dairy cattle being raised without antibiotics (RWA respondents). The remaining respondents (n=11, 40.7%) had never worked with dairy cattle raised without antibiotics (Conventional respondents). Table 18 Characteristics of Dairy Participants n = 81 Role n % Practicing veterinarian 52 64.2 Research/Academic/Government veterinarian 10 12.4 Research/Academic/Government non-veterinarian - - Manager/Producer/Grower/Rancher/Owner 12 14.8 Technical services 6 7.4 Other 1 1.2 Country of Experience United States 75 92.6 International 6 7.4 Experience with RWA Current experience 37 45.7 Previous experience 11 13.6 No experience 33 40.7 In Q6.4, RWA respondents addressed the reasons why they decided to work with dairy cattle where the use of antibiotics was not allowed (Table 19). The most commonly identified reason was to fulfill a client/customer request (n=34, 77.3%). In Q6.5 Conventional respondents addressed reasons why they decided not to work with dairy cattle where the use of antibiotics was not allowed; already raising animals in a responsible use program (n=22, 71.0%) and concerns about negative impacts to animal health and welfare (n=20, 64.5%) were commonly identified reasons (Table 19). 77

Table 19 Production Type Decision Factors. Which of these factors contributed to your decision to work with dairy cattle in an RWA/Conventional production system? n % RWA Respondents 44 To decrease antibiotic resistance 1 2.3 To improve animal health and welfare 4 9.1 To increase sale price of animals/product 4 9.1 To gain market entry into a retail program 4 9.1 To fulfill a client/customer request 34 77.3 To eliminate the use of medically important antibiotics 2 4.6 Conventional Respondents 31 Not profitable 2 6.5 Concerned about negative impacts to animal health and welfare 20 64.5 No market pressure 6 19.4 Not a sustainable consumer trend 3 9.7 Food safety concerns 6 19.4 Already eliminated the use of medically important antibiotics 3 9.7 Already raising animals in a responsible use program 22 71.0 Q6.6 and 6.7 asked respondents about their experience with different types of RWA programs or for Conventional respondents, if they have ever considered enrolling in an RWA program (Table 20). RWA respondents reported participating in a variety of programs including some having not participated in any formal program (n=10, 22.7%). The majority of Conventional respondents reported they have not considered raising dairy cattle under any of these program types (n=25, 80.7%). Table 20 RWA Program Types. Do you have experience in/have you considered working with dairy cattle in any of these RWA program types? RWA Conventional n % n % Program Type 44 31 Industry sponsored program 9 20.5 - - Private/Retail/Restaurant/Food Service program 8 18.2 4 12.9 Packer/Processor program 10 22.7 - - State/Federal government program 6 13.6 2 6.5 No program 10 22.7 25 80.7 Q6.8 addressed whether the respondents were part of an animal welfare program (Table 21). The majority of RWA and Conventional respondents participated in an industry sponsored program (n=21, 47.7% and n=23, 75.2% respectively) with Conventional respondents being more likely to be enrolled in this program type (p=0.0228). For Conventional respondents, the second most popular welfare program type was packer/processor programs (n=8, 25.8%). Nearly one-fourth of RWA respondents reported not being enrolled in any welfare program (n=10, 22.7%). 78

Table 21 Welfare Program Enrollment. Are the dairy cattle you work with currently part of an animal welfare program? RWA Conventional n % n % Program Type 44 31 Industry sponsored quality assurance program 21 47.7 23 75.2 Private/Retail/Restaurant/Food Service animal welfare program 8 18.2 4 12.9 Packer/Processor animal welfare program 7 15.9 8 25.8 State/Federal government animal welfare program 2 4.6 2 6.5 No program 10 22.7 6 19.4 Disease and Welfare challenges (Q6.9-6.13) Q6.9 and 6.10 asked respondents about the disease challenges that are problematic when raising dairy cattle in their respective production systems (RWA or conventional). Bovine respiratory disease was by far the most problematic disease challenge when raising dairy cattle without antibiotics (RWA respondents) but was much less concerning, receiving mixed rankings, for conventional systems (Conventional respondents). The RWA and conventional respondents both identified mastitis as a top disease challenge (second to bovine respiratory disease for RWA respondents) with metritis, and calf scours following as other important disease challenges. These responses are shown in Figures 94-96 below, where Figure 94 uses a heat map to display the cumulative ranks for each disease, while Figures 95 and 96 show the disease composition within each rank. 79

Figure 93 Disease Challenges Heat Map. Rank these disease challenges in order of most to least problematic when raising dairy cattle (without antibiotics). 80

Figure 94 Disease Challenges by Rank, RWA Respondents. Rank these disease challenges in order of most to least problematic when raising dairy cattle without antibiotics. Figure 95 Disease Challenges by Rank, Conventional Respondents. Rank these disease challenges in order of most to least problematic when raising dairy cattle. 81

Q6.11 and 6.12 addressed broad health and welfare challenges that are problematic when raising dairy cattle. Concerns about reproductive systems disorders was the most common response by RWA respondents followed closely by digestive system disorders and central nervous system disorders and reproductive systems disorders as their most problematic diseases. Conventional respondents were more divided in their responses, with a small majority ranking central nervous system disorders and reproductive systems disorders as top diseases. These responses are shown in Figures 97-99 below, where Figure 97 uses a heat map to display the cumulative ranks for each challenge, while Figures 98-99 show the composition within each rank. Figure 96 Welfare Challenges Heat Map. Rank these health and welfare challenges in order of most to least problematic when raising dairy cattle (without antibiotics). 82

Figure 97 Welfare Challenges by Rank, RWA Respondents. Rank these health and welfare challenges in order of most to least problematic when raising dairy cattle without antibiotics. Figure 98 Welfare Challenges by Rank, Conventional Respondents. Rank these health and welfare challenges in order of most to least problematic when raising dairy cattle. 83

Q6.13 asked respondents in their respective RWA and Conventioanl systems if there are effective tools to manage the disease challenges they ranked in Q6.9 and 6.10. Overall, the majority of respondents believed that all diseases except for anaplasmosis could be prevented or managed without antibiotics (figure 100-102). Anaplasmosis was ranked the least more problematic disease by both RWA and conventional respondents (Figure 94). Management strategies and vaccines were cited most commonly at the tools used against these diseases. Figure 99 Disease Management, All Respondents. Are there effective tools to prevent/manage these disease syndromes without the use of antibiotics? Figure 100 Disease Management, RWA Respondents. Are there effective tools to prevent/manage these disease syndromes without the use of antibiotics? 84