When you think of antibiotics, the first thing that probably comes to mind is a doctor prescribing treatment to a sick person. But the vast majority of antibiotics used are actually given to animals on factory farms. This overuse of antibiotics in the agricultural sector is fuelling a global health crisis, with antibiotic-resistant "superbugs" killing more than one hundred Thais every day.
Antibiotics are the silent props of the factory farm system, preventing stressed, confined animals from otherwise getting sick due to the dismal conditions they live in. Around 131,000 tonnes of antibiotics each year are used in farming globally, comprising three quarters of the antibiotics produced in the world and the amount is expected to rise to 300,000 tonnes in 2030, according to an academic article entitled "Reducing antimicrobial use in food animals" published in the journal Science in 2017.
There is now abundant research showing how this overuse of antibiotics in farming is a leading cause of "superbugs", and that these superbugs are infecting workers and spreading into the food supply chain and our environment.
What are superbugs? After the first antibiotic, penicillin, was applied successfully 80 years ago, antibiotics were heralded as a miracle cure and widely prescribed by doctors. But by 2022, their overuse has led to new strains of bacteria, viruses and parasites that have evolved to be resistant to most of the antibiotics commonly used to treat the infections they cause. This means that common operations, like caesarean sections or those performed during cancer treatments, can become dangerous, because antibiotics may not protect against infection.
Indeed, more than a hundred Thais die every day because of superbugs. Yet even though the mortality rate is higher than Covid-19, there is almost a complete lack of awareness about this public health threat. In 2019, the World Health Organization (WHO) listed antimicrobial resistance (AMR) in its top-10 global public health threats facing humanity, and in 2020, antimicrobial resistance became a new indicator for the United Nations Sustainable Development Goals. Information from the Thai National Antimicrobial Resistant Surveillance Center (Narst) at the Ministry of Public Health shows that around 100,000 people are affected by superbugs and 38,000 die each year. While the latest Lancet research from 2019 reveals that 1.27 million people globally died from AMR, a figure that is expected to reach 10 million by 2050.
Antibiotics are typically used at factory farms to either treat sick animals, promote their growth, or prevent disease. Fortunately, the use of antibiotics for growth promotion in several countries, including Thailand, has been banned. The abuse of antibiotics in farming in Thailand is mostly to prevent stressed animals from getting sick due to farms' poor welfare and management. The drugs are typically mixed with food and water and given across group herds.
Thailand has demonstrated its commitment to tackle AMR with the creation in 2017 of Thailand's National Strategic Plan on AMR to reduce antimicrobial use in animals by 30% between 2017 and 2021. The plan, which was recently extended to 2022, has been recognised as an example of multisectoral and multidisciplinary collaboration under the One Health approach. The One Health approach connects human, animal, and environmental health sectors to improve public health.
Under the Thailand's Plan on AMR, the initiative Raise Without Antibiotics (RWA) has been piloted through a public-private partnership in pig farms to offer consumers antibiotic free meat. However, this remains a niche market. Nevertheless, most pork meat on sale in Thailand is still being produced with antibiotics used routinely to prevent animals getting sick. RWA products are also offered at a prime price, making safe meat only accessible to a few. Even if animals are Raised Without Antibiotics, this does not guarantee higher animal welfare standards. The root cause of the issue is the poor welfare in which farmed animals are kept in factory farms, and this must be addressed. Improvement in this area will support United Nations Sustainable Development Goal2 to ensure access by all to safe food.
Pig factory farms in Thailand are discharging huge quantities of pig waste (manure and urine), containing significant quantities of antibiotic resistant genes and superbugs, into public waterways and the wider environment. A study by World Animal Protection in 2018 showed that superbug contamination can be found at the end of the supply chain, in the fresh meat sold in supermarkets in Thailand. The latest investigation by the organisation in 2021 found that superbugs from certain classes of antibiotics that have been banned to mix in animal feed for disease prevention under the regulation by department of livestock development are still present in the environment.
These findings by World Animal Protection also raise questions as to why superbugs from banned antibiotics can still be found in the environment near factory farms four years into the implementation of the national plan. A recent study on "Thailand's national strategic plan on antimicrobial resistance: progress and challenges" recognised pushback against the plan by pharmaceutical companies and retailers who feared reduced profits from sales as a key challenge to implementation.
In addition to agricultural farms, antibiotics are also widely abused in aquaculture in Thailand, such as at fish and shrimp farms. Whereas at chicken and pig farms the antibiotics are mixed into the food and water to feed the animals, at shrimp or fish farms, farmers just throw the antibiotics into the rivers or ponds. This concentrated and intensive application of antibiotics can easily spread to the wider environment.
These shocking findings show that everybody is at risk of exposure to antimicrobial resistant genes as they are present in the environment and in the meat and fish we consume. A ban on the preventive use of antibiotics in factory farms by increasing animal welfare standards would drastically reduce the presence of superbugs in our environment, but also guarantee safe meat for all.
Chokdee Smithkittipol is the Food System Campaign Manager for Thailand for World Animal Protection, an animal welfare organisation. This opinion piece comes ahead of World Health Day tomorrow.