An expert's point of view on a current event.

China’s Farms Are Petri Dishes of Antibiotic Resistance

Poorly enforced regulation is causing a slow-moving pandemic.

A worker feeds the piglets in a hog pen in China
A worker feeds the piglets in a hog pen in Suining in China's southwest Sichuan province on Feb. 21. China/Barcroft Media via Getty Images

The first alarm came from China. It was a startling discovery—likely the result of how animals were raised for human consumption—that was a global health crisis in waiting, experts warned.

But by then it was already too late to contain its spread.

Soon, the gene, known as “mcr-1,” was found in countries around the world, shocking researchers who study how bacteria and other pathogens evolve to resist the drugs prescribed to defeat them.

The first alarm came from China. It was a startling discovery—likely the result of how animals were raised for human consumption—that was a global health crisis in waiting, experts warned.

But by then it was already too late to contain its spread.

Soon, the gene, known as “mcr-1,” was found in countries around the world, shocking researchers who study how bacteria and other pathogens evolve to resist the drugs prescribed to defeat them.

This phenomenon, known as antimicrobial resistance, is receiving renewed attention as the current coronavirus crisis reminds the world how destructive public health emergencies can be. Though antimicrobial resistance’s effects are unlikely to be as acute as COVID-19’s, over the long term it could be deadlier. A slow-moving pandemic, it causes about 700,000 deaths yearly, including over 200,000 people who die from tuberculosis that is resistant to at least one drug.

The discovery of mcr-1, reported in 2015, and its rapid global spread set off particularly loud alarm bells because the gene gives bacteria resistance to colistin, an antibiotic with serious side effects that is used when others have failed, and because the gene is of a type that is easily transmissible between different families of bacteria. In a worst-case scenario, it could mix with other types of resistance to create untreatable strains of bacteria known as “superbugs.”

In a world where the spread of antimicrobial resistance isn’t curbed, all doctors can do to fight what are now common ailments is treat their symptoms—a situation similar to the one they face at present with COVID-19. Procedures whose infection risks are currently mitigated with antibiotics, including chemotherapy and hip replacements, will become too risky to perform. In total, antimicrobial resistance’s yearly death toll is predicted to rise to 10 million by 2050, higher than cancer’s death toll today.

And as microbiologists warned years ago that China’s natural reservoir of SARS-like viruses and the local practice of eating wild animals made the country a probable source of a new viral outbreak, so too was it unsurprising that scientists eventually traced mcr-1’s likely origin to one of China’s many pig farms.

Misuse and overuse of antimicrobials in intensive livestock production is a major force behind the spread of antimicrobial resistance. Farmers buy nearly three-quarters of all antibiotics worldwide, many of which contain the same compounds used to treat sick humans. The drugs keep animals healthy despite crowded living conditions and, because animals expend less energy fighting pathogens, accelerate their growth. Such practices are believed to be widespread in China, which leads the world in pork and chicken meat production. Its aquaculture industry, another large antibiotics consumer, is bigger than those of all other countries combined.

Reliable public figures to make up-to-date international comparisons on antibiotics usage are scarce, but, in 2015, a Chinese researcher put the country’s consumption of the medicines, for both animal and human use, at nearly half the global total. A paper from the same year estimated China’s share at about a quarter of the world’s and predicted its usage would increase rapidly in absolute terms. When looking at antimicrobial resistance in food animals, China and India are the world’s biggest hot spots, according to another study published last year. As such, even though antimicrobial resistance is a global issue, China’s role is crucial, says Thomas van Boeckel, a professor at the Swiss Federal Institute of Technology in Zurich and a co-author of both studies.

To its credit, the Chinese government has formed an ambitious plan to tackle the issue. Following the World Health Organization’s launch of its Global Action Plan on Antimicrobial Resistance in 2015, China has enacted a variety of “aggressive” policies to limit antibiotics consumption, said Zhou Wanqing, an associate at the environmental nongovernmental organization Brighter Green. “The government is aware of the vicious cycle: the more antibiotics used, the worse the resistance, which pushes the growers to use even more antibiotics.”

“Their reaction has been very swift,” van Boeckel told Foreign Policy. But, without a public monitoring system for antibiotics use, which has proved effective in fighting antibiotics abuse in Europe, there is no way to know whether China’s policies are having their stated effect, he said. Evasion of regulations is common in China across most sectors, from construction to medicine, and agriculture is no exception. Enforcement appears inadequate. A survey published in January found that three-quarters of sampled chicken farms continued to use antibiotics that had been placed on the country’s ban list. Against regulations, majorities of farmers were able to buy antibiotics without a prescription and neglected to keep records of their antibiotics use, it found.

Efforts to rein in overuse of antibiotics in Chinese hospitals, which intensified in 2011, have been more successful, Xiao Yonghong, an infectious disease professor at Zhejiang University in eastern China, told Foreign Policy. Government figures for larger hospitals show that antibiotics use, measured per patient-days, dropped 43 percent in just three years. Though, Xiao said, “much still remains to be improved at more basic levels of care” such as at small clinics. Also, other researchers, using a different data set and looking at total usage, arrived at the opposite conclusion: a 40 percent increase between 2011 and 2018. This divergence from official figures, they write, is hard to explain but could be due to an increase in how many people seek inpatient care at hospitals.

Even though COVID-19 is caused by a virus and thus cannot be treated with antibacterial methods, the global fight against the disease is likely speeding up the spread of antimicrobial resistance. Bacterial infections are common during viral pandemics—the majority of deaths during both the 1918-1919 Spanish flu and 2009 H1N1 pandemics were caused by bacterial pneumonia. To prevent COVID-19 patients catching such secondary infections, overburdened hospitals the world over are administering antibiotics without the usual care or moderation.

To Xiao, the pandemic has a silver lining. “Everyone is reflecting on public health, and how it can be improved,” he said. The outbreak of COVID-19, likely the result of humans getting into close contact with wild animals and disturbing their habitats, is also an argument in favor of “One Health”—the concept, popularized by WHO and other organizations following the H5N1 avian influenza outbreaks in the early 2000s, that human health is inextricably linked to the health of all ecosystems. Similarly, Xiao said, the high levels of antibiotic-resistant bacteria and genes found in Chinese rivers and lakes as a result of agricultural drug use show that solving the issue of antimicrobial resistance also goes beyond hospitals. One study found several veterinary antibiotics in the urine of Shanghainese schoolchildren.

Bacteria will inevitably continue to develop resistance. “That’s just basic Darwinian evolution,” van Boeckel said. Though pharmaceutical companies have found it hard to recover investments into finding new antibiotics, new treatments will have to be developed to replace current ones. But countries, chief among them China, getting a better grip on their antibiotics use will go a long way. “There are things you can do to reduce antimicrobial resistance level and the most obvious one is to decrease [antibiotics] consumption,” he said. As a top producer and importer of meat, China has enough clout to set the world’s standards for agricultural antibiotics use, van Boeckel said. “What would be a huge game-changer is for China to truly acknowledge and accept that they have to be the leader on this to solve the problem globally.”

The slow-rolling nature of antimicrobial resistance means we can blunt its deadly potential. “We have the time and the opportunity to do something about this,” Xiao said, referring to the global struggle against the phenomenon. “It’s just a matter of whether we will.”

Kevin Schoenmakers is a freelance writer specializing in China.

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