Preventing Antibiotic Resistance: Look to the Livestock Industry

Among the major drivers of the Antimicrobial Resistance crisis is the misuse and overuse of antibiotics in livestock and feed. Credit: Germán Miranda/IPS.

By Tharanga Yakupitiyage
UNITED NATIONS, May 21 2019 – Antimicrobial resistance is quickly becoming a global crisis and risks reversing a century of progress in health. Some organisations have already geared up and are tackling the issue from its roots.

In a new report, the United Nations Interagency Coordination Group (IACG) on Antimicrobial Resistance estimates that antibiotic resistance could cause 10 million deaths each year by 2050.

Already, drug-resistant infections cause at least 700,000 deaths annually around the world.

“Antimicrobial resistance is one of the greatest threats we face as a global community,” said UN Deputy Secretary-General and Co-Chair of the IACG Amina Mohammed.

“[The report] rightly emphasises that there is no time to wait and I urge all stakeholders to act on its recommendations and work urgently to protect our people and planet and secure a sustainable future for all,” she added.

In 2017, the World Health Organization (WHO) reported that antibiotic resistance was a “global crisis that we cannot ignore” and that if ignored, “will take us back to a time where people feared common infections and risked their lives from minor surgery.”

According to the IACG report, approximately 35 percent of common human infections are already resistant to currently available medicines in some member countries of the Organization for Economic Cooperation and Development (OECD), while resistance rates are as high as 80 to 90 percent in some low- and middle-income countries (LMICs).

The economic impact of antimicrobial resistance would also be catastrophic as healthcare expenditures will rise and sustainable food and feed production will increasingly be at risk.

The World Bank estimates that up to 24 million people could be forced into extreme poverty particularly in low-income countries, and the economic damage could be comparable to the shocks experienced during the 2008-2009 global financial crisis.

“The world is already feeling the economic and health consequences as crucial medicines become ineffective. Without investment from countries in all income brackets, future generations will face the disastrous impacts of uncontrolled antimicrobial resistance,” WHO said.

Among the major drivers of the crisis is the misuse and overuse of antibiotics in livestock and feed.

Though WHO has recommended that the food industry stop using antibiotics to promote growth and prevent disease, nearly three-quarters of the total use of antibiotics worldwide is still used on animals, greatly impacting the health of consumers.

According to the Alliance to Save our Antibiotics, livestock raised for food in the United States are given five times more antibiotics as farm animals in the United Kingdom. In the case of cattle, the difference in dosage rates may be as high as 16 times the rate of dosage per cow in the UK.

As a result, Europe banned the import of American hormone-treated beef.

In Bangladesh, a study found a range of antibiotics in almost 50 percent of poultry feed samples across 14 brands from four districts. The Bangladesh Agricultural Research Council also noted that the levels of antibiotics were far above the levels acceptable to human health.

Among such antibiotics was Oxytetracycline, which is often used to treat chest infections such as bronchitis and pneumonia.

Another review found a high prevalence of antimicrobial resistance in Bangladesh, partially due to the misuse and overuse of antibiotics, including in the livestock sector.

As Bangladesh’s livestock sector is only expected to grow, with plans to export poultry in coming years, sustainable livestock management is necessary in managing growing antibiotic resistance regionally and globally.

One organisation hopes to do just that.

After graduating from Chittagong Veterinary and Animal Sciences University, Salma Sultana saw a shortage of trained veterinarians and farmers resorting to untrained doctors who are most often behind the widespread misuse of antibiotics and thus the frequent death of livestock and rise in antimicrobial resistance.

In 2015, she founded the Model Livestock Advancement Foundation (MLAF) near Dhaka whose vision includes “to have a livestock sector that is sustainable, commercial, and contributing to livelihood, employment, national income, and food security.”

This includes the training and provision of modern and evidence-based animal health services as well as the prevention of antimicrobial resistance.

MLAF is the only educational, research, and animal healthcare voluntary organisation in Bangladesh and has since produced 45 veterinary service providers and 500 livestock entrepreneurs while providing health support to over 5,000 livestock herders.

The organisation has been recognised for its work as it was most recently awarded with the International Arch of Europe Award for Quality and Technology in 2018 and the Joy Bangla Youth Award in 2017 for its contribution to youth training and development.

As the Lancet Planetary Health found that interventions that restrict antibiotic use in food-producing animals reduce antibiotic-resistant bacteria in such animals by up to 39 percent, the work of organisations like MLAF is therefore crucial in the fight to keep the planet and its populations healthy and safe.

Public-Private Partnerships Fad Fails

After the failure and abuses of privatization became apparent, public-private partnerships have since been promoted ostensibly to mobilize private finance for the public purpose. In all too many cases, PPPs have socialized costs and losses while ensuring private financial gains.

By Jomo Kwame Sundaram
KUALA LUMPUR, Malaysia, May 21 2019 – After the failure and abuses of privatization and contracting-out services from the 1980s, there has been renewed appreciation for the role of the state or government. Earlier promoters of privatization have taken a step backward, only to take two more forward to instead promote public-private partnerships (PPPs).

Jomo Kwame Sundaram

PPPs for most purposes
PPPs are essentially long-term contracts, underwritten by government guarantees, with which the private sector builds (and sometimes runs) major infrastructure projects or services traditionally provided by the state, such as hospitals, schools, roads, railways, water, sanitation and energy.

PPPs are promoted by many governments associated with the Organization for Economic Co-operation and Development (OECD) and some multilateral development banks – especially the World Bank – as the solution to the financing shortfall needed to achieve development, including the Sustainable Development Goals (SDGs).

Since the late 1990s, many countries have embraced PPPs in many areas ranging from healthcare and education to transport and infrastructure – with mixed consequences. They were less common in developing countries, but that is changing rapidly, with many countries in Asia, Latin America and Africa now introducing enabling legislation and initiating PPP projects.

PPPs are now an increasingly popular means to finance mega-infrastructure projects, but dams, highways, large plantations, pipelines and energy or transport infrastructure can ruin habitats, displace communities and devastate natural resources. Typically, social and environmental legislation is weakened or circumscribed to attract investors for PPPs.

There are also a growing number of ‘dirty’ energy PPPs, devastating the environment, undermining progressive environmental conservation efforts and exacerbating climate change. PPPs have also led to forced displacement, repression and other abuses of local communities, indigenous peoples, displaced farmers and labourers among others.

PPP financing more public than private
Nevertheless, experiences with PPPs have been largely, although not exclusively, negative, and very few PPPs have delivered results in the public interest. There has been some supposed success with infrastructure PPPs, mainly due to financing arrangements. Generally, PPPs for hospitals and schools have much poorer records compared to infrastructure.

One can have good financing arrangements, due to preferential interest rates, for a poor PPP project. Nevertheless, private finance all over the world still accounts for a small share of infrastructure financing. However, good financing arrangements will not make a bad PPP project any better.

PPPs typically involve public financing for developing countries to attract bids from influential private companies, often from abroad. ‘Blended finance’, export financing and new supposed aid arrangements have become means for foreign governments to support powerful corporations bidding for PPP contracts abroad, especially in developing countries. Incredibly, such arrangements are increasingly counted as overseas development assistance, as North-South, South-South or triangular development cooperation.

Like privatization, PPPs often increase fees or charges for users. PPP contracts often undermine the public interest in other ways, with generous host government incentives and other privileges, often compromising and undermining the state’s obligation to regulate in the public interest. PPPs can limit government capacity to enact new legislation and other policies – such as strengthened environmental or social regulations – that might adversely affect or constrain investor interests.

PPPs – public pain, private gain?
PPP contracts are typically complex. Negotiations are subject to commercial confidentiality, making it hard for civil society and parliamentarians to provide checks and balances in the public and national interest. Such limited transparency significantly increases the likelihood of corruption and undermines democratic accountability.

It is important to establish the circumstances required to achieve efficiency gains and to recognize the longer-term fiscal implications of PPP-related contingent liabilities. Shifting public debt to government guaranteed debt does not really reduce government debt liabilities, but obscures accountability as it is taken off-budget and is no longer subject to parliamentary, let alone public scrutiny.

Hence, PPPs are more likely to be abused because they are typically ‘off balance sheet’ so that they do not show up as government debt, giving the illusion of ‘easy money’ or credit. Despite claims to the contrary, PPPs are typically riskier for governments than for the private companies involved, as the government may be required to step in to assume costs and liabilities if things go wrong.

PPPs also undermine democracy and national sovereignty as such contracts tend not to be transparent and subject to unaccountable international adjudication — due to investor-state dispute settlement (ISDS) commitments — rather than national or international courts. Under World Bank-proposed PPP contracts, for example, national governments can even be liable for losses due to strikes by workers.

Government procurement
One alternative, of course, is government or public procurement. In many instances, PPPs have become the most expensive financing option and much less cost-effective than transparent competitive government procurement. They cost governments significantly more in the long run than if the government procures on an open competitive basis, or if projects are directly financed by government borrowings.

Generally, PPPs are much more expensive than government procurement despite government subsidized credit. However, with a competent government doing good work, government procurement can be efficient and low cost.

With a competent government and accountable consultants, efficient government procurement has generally proved far more cost-effective than PPP alternatives. It is therefore important to establish when and why meaningful gains can be achieved through PPPs, and when these are unlikely.