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Wearing only silver toe rings on her bare feet, Manisha Bal Reddy pads through her flock of 4,800 cackling chickens in a coop in south India to retrieve a blue and white bottle on the husk-covered floor. It contains a mix of three antibiotics, including the last one currently available to treat the most perilous bloodstream infections in people.
The drug cocktail is to be added to the birds’ drinking water, according to notes scrawled in a candy-pink logbook. Daily entries direct Manisha and her husband, G. Bal Reddy, to use five antibiotics over six weeks. The instructions are written and signed by a supervisor from SR Group, the broiler company that supplied the couple with chicks, feed and medicines, and bought the birds back when they were ready for slaughter.
All of the antibiotics listed in the logbook are legal for veterinary use in India, but two are banned or not approved for use in poultry in the U.S., Canada, the European Union and Australia, where authorities have sought to prolong their efficacy in people. Worldwide, animals consume more antibiotics than humans, an amount researchers estimate will jump 67 percent in the 20 years through 2030 as India, China, Brazil and other developing countries expand livestock production to meet unprecedented demand for animal protein.
While antibiotics are helping to sustain intensive food production, doctors worry their uncontrolled use on farms is turning animals into reservoirs of hard-to-kill bacteria that can spread rapidly and globally. G. Bal Reddy said it seems he’s fighting a losing battle. “We have to use more medicines these days,” he said. “Diseases have become harder to beat in the last two to three years.”
About 100 miles from the poultry farm in Telangana state, medical college microbiologists studying a bacterium spreading mostly in hospitals reported in June that 6.7 percent of specimens were resistant to all antibiotics. While the Indian government doesn’t keep data on deaths due to antibiotic-resistant infections, one study by researcher Ramanan Laxminarayan and colleagues estimated that more than 58,000 newborns died nationwide in 2013 from bacterial infections capable of evading most antibiotics.
“The world is on the brink of losing its miracle cures,” World Health Organization Director-General Margaret Chan said in an email. Once antibiotics stop working, hip replacements, organ transplants, cancer chemotherapy and care of preterm infants will be far more difficult or even too dangerous to undertake.
Failure to act on drug-resistant infections will lead to 10 million extra deaths a year and cost the global economy $100 trillion by 2050, according to a February 2016 report on antimicrobial resistance commissioned by U.K. Prime Minister David Cameron. Jim O’Neill, the British economist who coined the acronym BRIC for Brazil, Russia, India and China, is chair of the independent review.
“We need to act now—governments, industry and all 7 billion individuals—to eliminate this otherwise inevitability,” said O’Neill, a former chairman of Goldman Sachs Asset Management, who is now Commercial Secretary to the Treasury, in an e-mail.
Drug-defying germs, which can spread internationally in infected travelers in hours, threaten to reverse a century of progress in human and animal health, and are a risk to global food security, the Food and Agriculture Organization said on Feb. 10.
“How can we reduce rural poverty when the drugs given to ill farm workers and their families no longer have effect?” FAO Deputy Director-General Maria Helena Semedo told European ministers of health and agriculture at a conference on antimicrobial resistance in Amsterdam. “How can we eliminate hunger or improve sustainability when we cannot cure sick animals?”
Rich countries began using antibiotics once the incidence of infectious diseases had plummeted following public-health improvements. In India, antibiotics are often used as a substitute for sanitation and hygiene, said researcher Laxminarayan, who is director of the Center for Disease Dynamics, Economics & Policy. Consequently, the nation shoulders among the highest rates of antibiotic resistance in the world.
A panel advising the Indian government in 2011 called for restrictions on antibiotic use in both people and animals following the discovery of a superbug-spawning gene in a patient from New Delhi that spread to dozens of countries within a few years. Five years later, there still are no regulations governing the use of antibiotics in livestock and a lack of enforcement of existing rules means medicines are often bought without a prescription.
“India does not have significant regulatory control over either the manufacture or sale of antibiotic agents,” said Brian Evans, a deputy director general of the World Organisation for Animal Health, the Paris-based policy-setting group representing 180 countries. “Potentially, up to 50 percent of our member-countries do not have appropriate legislation at this time.”
The Bal Reddys’ farm is an example of what that laxity allows. The logbook, labeled “farmer’s flock record,” shows they were instructed to begin a series of antibiotic regimens on Oct. 25, the day after the couple took delivery of the newly hatched chicks. A solution combining enrofloxacin, ciprofloxacin and colistin was started on Nov. 19 and continued for six days. The bottle’s label says it’s an “animal feed supplement” that should be mixed in drinking water for the “prevention of respiratory infections.”
On Dec. 1, the Bal Reddys were instructed to use two more antibiotics to help sanitize their shed after the chickens were collected for slaughter. An additional antibiotic, gentamicin, was delivered on Nov. 16, though there is no record of it being used.
SR Group, the broiler company that supplied the drugs, only uses antibiotics when it’s “imperative” and employs as many as 20 veterinarians, said S. Ravinder Reddy, the company’s technical director. “Nobody uses antibiotics unnecessarily because we are professionals,” he said in a March 4 telephone interview. “We are not illiterate farmers. We know what we are doing.”
SR Group doesn’t allow the use of medicines that are also used in people on its flocks because of the threat to human health, Reddy said. “Whatever medicines that are used in chicken are not used in humans,” he said. Reddy didn’t respond to questions about observations that some farmers were instructed to use colistin and ciprofloxacin—antibiotics deemed “critically important” by the WHO.
Visits to 13 other farms in the Ranga Reddy district—some of which supply to, and are supervised by other broiler companies—revealed widespread use of antibiotics in feed and water, and by injection to thwart current and potential disease outbreaks.
The use of antibiotics at low or sub-therapeutic strengths is known to speed growth in food-animals—an outcome acknowledged by organizations including the American Veterinary Medical Association and the Animal Health Institute, which say the drugs help eliminate bugs so that the animals’ gut can absorb nutrients more efficiently with less feed.
Information about the antibiotics used, and their duration and method of delivery was gathered from interviews with farmers, product labels observed on the farms, delivery receipts and the handwritten instructions by field staff in flock management logbooks that carried the logos of some of India’s biggest chicken companies.
Records shown by the farmers indicated that at least nine antibiotics were in use, five of which are critical for treating everything from pneumonia to lethal bloodstream infections in humans. Among them were products made by Bayer AG, Zoetis Inc. and Cadila Healthcare Ltd.’s Zydus animal health unit, which are prohibited for use in poultry in Canada, the U.S., the European Union and Australia.
Most of the farmers didn’t know what an antibiotic was, describing it as just one of the vitamins, medicines and disinfectants they use to keep the birds healthy. On visits to three veterinary shops in the district, sales staff were willing to sell antibiotics without a prescription, which would violate a drug law. At least one of them violated another part of the law by not recording the purchaser’s name and address.
None of the farms visited had treatment systems for managing effluent from their chicken coops, with the liquid waste typically running freely into gardens growing vegetables that were consumed by their families, with surplus sold to the public.
Enrofloxacin made by Bayer and Zoetis, and a similar drug levofloxacin, manufactured by Zydus, were contained in bottles shown by six farmers, who said the contents were added to water and given to chicks as young as 1 day old to stave off disease.
Both drugs are in the same antibiotic class and allowed for veterinary use in India. Still, enrofloxacin should only be used to treat ill animals and under the supervision of a veterinarian and not to prevent disease or promote growth, Bayer and Zoetis said. A Zydus spokeswoman acknowledged questions sent by e-mail, but didn’t respond to follow-up e-mails seeking a response.
“Enforcement by local authorities of regulation requiring a veterinary prescription for these products will help protect the health of people and animals,” Zoetis said in an e-mailed response to questions.
The Indian government’s National Policy for Containment of Antimicrobial Resistance, a 55-page document released in 2011, called for a ban on the non-therapeutic use of antibiotics and over-the-counter sales, and recommended rules for livestock use. The proposed drug restrictions incited protest and the policy was shelved soon after.
In 2013, India’s Health Ministry added 24 antibiotics to a list of drugs whose sale requires pharmacists to retain details of the prescription in a register for three years. The measures, though, were primarily aimed at human medicine and cover only two of the nine antibiotics found on the Ranga Reddy poultry farms. There are no directives governing the usage of the other seven drugs.
Regulations made by the central government depend on under-resourced state officials to implement and enforce, said N.K. Ganguly, a former director general of the Indian Council of Medical Research, who was one of 13 members of a task force that prepared the 2011 policy document. Still, he said he’s confident India is on the right track.
“All of these you will see will start to take effect in another half a decade,” Ganguly said. “It takes time with the vastness of the country.”
As it is now, the government doesn’t collect data nationally on the volume of antibiotics used in either animals or humans or prohibit their use as growth promoters in livestock. It banned the use of certain antibiotics only in aquaculture in 2011, and says it only monitors drug residues in chicken meat destined for export.
The agriculture ministry issued guidelines to state authorities in December 2014, advising that antibiotics shouldn’t be allowed in feed, and should be tracked from manufacturer to users. The one-and-a-half-page circular didn’t specify whether the suggestions were mandatory or how they would be enforced.
Agriculture Minister Radha Mohan Singh didn’t respond to written and verbal interview requests. S.K. Dutta, assistant commissioner, and Sagar Mehra, director of the ministry’s department of animal husbandry, dairying and fisheries, declined to say if a policy was being drafted or answer questions when contacted by phone.
“India is definitely the country of most importance when it comes to the need for surveillance,” says Thomas Van Boeckel, a post-doctoral research fellow at the Swiss Federal Institute for Technology in Zurich, who was part of the team that conducted the first attempt to quantify global antibiotic consumption in animals.
India consumes the largest volume of antibiotics in the world, but the consumption per-person, at 10.7 units, is about half the 22 units per person consumed in the U.S., according to the Center for Disease Dynamics, Economics & Policy in Washington.
Use of antibiotics in animals in India is projected to more than double by 2030, driven by a surge in chicken production, Van Boeckel and colleagues showed in a study in November 2014. In a country with twice as many meat-eaters as vegetarians, chicken consumption is now 14 times higher than in 1985.
The solution isn’t to ban bactericidal drugs on farms, said Vincent Doumeizel, a vice president at Lloyd’s Register Quality Assurance in London, where he focuses on food safety and sustainability. “It’s absolutely impossible at the moment,” he said. “Banning them would just collapse the current production system overnight.”
“That leads us to the next question: are animals a good way to get protein?” Doumeizel said. “That’s a big concern because we won’t be able to feed 9 billion people with animal protein.”
In the U.S., the Food and Drug Administration asked drug manufacturers in December 2013 to voluntarily stop selling antibiotics for growth promotion, but the regulator still allows them to be used to prevent infections.
“That’s a massive, massive loophole,” said Lance Price, a genomic epidemiologist at George Washington University, who testified to U.S. Congress in April 2013 on antibiotic resistance. “And if we don’t get good laws on the books, then how do we ask China or India to cut back?”
Seshagiri Rao, who is authorized to dispense prescribed veterinary medicines from a shop in Hayathnagar, in Ranga Reddy district, suspects something’s not right. Farmers are raising too many chickens, too fast, he said, having almost reduced by half the time it takes for chicks to reach slaughter-weight during the past two decades.
“The medicines we used seven or eight years ago don’t work anymore,” he said, adding that farmers have begun asking for new, more powerful remedies. “But what happens when those stop working? There’s nothing left.”
--With assistance from Ganesh Nagarajan and Pratik Parija.
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