There was a time when simple infections were deadly, but now, thanks to the wide availability of antibiotics, this is merely a relic of the past. But actually, I should say "was," because nowadays, we're using antibiotics so much that the bacteria that cause these infections are becoming resistant. And that should really scare the hell out of all of us.
If we do not change our behavior and wean ourselves off antibiotics, the UN predicts that by 2050, antimicrobial resistance will become our single biggest killer. So we must start to act. But "where to begin" is an interesting question, because we humans are not the only ones using antibiotics. Worldwide, 50 to 80 percent of all antibiotics are used by animals. Not all of these are critical for human health, but if we do not get it under control right now, we're looking at a very scary future for humans and animals alike.
To begin, let's talk about how we ended up here. The first large-scale use of antibiotics was in the early '50s of the last century. In the Western world, prosperity was increasing and people wanted to eat more animal protein. When animals were sick, you could now treat them with antibiotics so they did not die and kept growing. But soon, it was discovered that adding small and regular amounts of antibiotics to the feed kept the animals healthy, made them grow faster and caused them to need less feed. So these antibiotics worked well — really well, actually. And with increasing animal production, also antibiotic use skyrocketed worldwide. Unfortunately, so did antibiotic resistance.
The reason your doctor tells you to finish the entire bottle of antibiotics is if you shorten your dose, you will not kill all of the bugs. And the ones that stick around build up the antibiotic resistance. It's the same problem with giving animals small and regular doses of antibiotics: some bad bugs die but not all of them. Spread that across an entire industry, and you can understand that we accidentally build up a large reservoir of antibiotic-resistant bacteria.
But I hate to break it to you — the problem doesn't stop there. You know who else takes antibiotics? Fluffy, your cat, and Rover, your dog.
Pets rank even amongst the heaviest users of all, and they use antibiotics that are much more critical for human health. Combine this with how close we live with our companion animals and you understand the risk of you picking up antibiotic-resistant bacteria from your own pet.
But how do these antibiotic-resistant bacteria in farm animals affect you? Let me give you an example we have, actually, data on. The levels of antibiotic-resistant salmonella in pigs in Europe against different types of antibiotics range from less than a percent to as high [as] 60 percent. Which means that in most cases, this antibiotic will not work anymore to kill this salmonella. And there was a high correlation between antibiotic-resistant salmonella in the pig and in the final product. Whether that is pork chop, spare ribs or minced meat.
Now, luckily, typically less than one percent of all raw meat, fish or eggs will contain salmonella. And this only poses a risk when not treated well. Still, there are over 100,000 human salmonella cases in the EU and more than a million cases in the US. In the US, leading to 23,000 hospitalizations and 450 people dead each year. With antibiotic-resistant salmonella on the rise, this death toll is likely to increase.
But it's not only about consuming yourself. This year, more than 100 people got infected with a multidrug-resistant salmonella after feeding pig ears, as a treat, to their dog. So we really must cut back on antibiotic use in animal production. And luckily, this is starting to happen.
The EU was the first region to ban putting antibiotics in low doses in the feed. From '99 on, in several steps, the amount of different types of antibiotics allowed was reduced, and in 2006, a complete ban went into place. Antibiotics were only allowed when a veterinarian determined the animal was sick.
Sounds great, right? Problem solved. No, wait, not so fast. As soon as the reduction program started, it was very quickly discovered that antibiotics had been the perfect blanket to cover up a lot of bad farm practices. More and more animals became sick and needed to be cured with ... antibiotics. So instead of the total amount going down, it actually increased. Surely, that was not the way to go. But luckily, that was not the end of the story. The whole European agricultural sector started on a journey, and I think it's a journey anybody can learn from.
This is also the time I personally entered the scene. I joined a large European feed compounder. A feed compounder makes a total diet for a farmer to feed to his animals and often also provides the advice on how to raise the animals in the best way. I was really motivated to work together with my colleagues, veterinarians and, of course, the farmers to figure out how to keep the animals healthy and antibiotic-free.
Now there are three major things that need to happen for antibiotic-free production. Let me walk you through the playbook. To start — and it sounds very obvious — that our hygiene is the place to start. Better cleaning of the stable and the drinking-water lines making it harder for the disease to come in and spread across the stable. That's all very important, but the part I was personally most interested in was better feeding for the animals, better nutrition.
Feeding a well-balanced diet is important. Think about it this way: when you yourself do not eat enough fiber, you do not feel well. Part of the food you consume is not digested by yourself but fermented in your large intestine by bacteria. So you're feeding those microbes with part of your diet. Initially, most young animals were fed low-fiber, high-starch and protein, very finely ground and highly digestible diets. Like being yourself on a diet of hamburger buns, rice, waffles and protein bars. We changed this to a lower-protein, higher-fiber, coarser type of diet. Like being on a diet of whole grains, salad with meat or beans. This shifted the bacterial flora in the animals' guts to the more beneficial ones and reduced the chance that pathogens would flourish.
You might be surprised but not only diet composition, also diet structure plays a role. Simply the fact that the same diet is coarser will lead to a better-developed digestive tract, and thus, a healthier animal.
But the best part was that farmers started to buy this actually, too. Unlike some other parts of the world, Western European farmers mainly still make their independent buying decisions: who to buy the feed from and sell their animals to. So what you're actually selling in the end reflects the actual local need of these farmers. For example, the protein content in piglet diets in countries that are much more vigilant in reducing antibiotics, like, for example, Germany and the Netherlands, were already 10 to 15 percent lower than in a country like the UK, which was slower to pick this up.
But, like with better hygiene, better nutrition helps but will not totally prevent you from becoming sick. So more is needed. And that's why we turned to the microbiome. Making the water with the feed more acidic helps to create an environment that benefits the more beneficial bacteria and inhibits the pathogens. Like fermented food, whether it's yogurt, sauerkraut or salami, they'll all spoil less quickly, too.
Now, with modern techniques, like the ones based on DNA testing, we can see that there are many more different microorganisms present. And this ecosystem, which we call the microbiome, is much more complex. Turns out there are about eight times more microorganisms in your gut as tissue cells in your body. And for animals, the impact is no less. So if we want to work without antibiotics in animal production, we have to make the animals much more robust. So that when a disease strikes, the animals are much more resilient. And this three-pronged nutribiosis approach involving the host, nutrition and the microbiome is the way to do it.
Now the practice of raising animals on an antibiotic-containing or antibiotic-use-provoking diet is a bit cheaper at farm level. But in the end, we are talking about a few percent at the consumer level. That's actually quite affordable for the middle- and high-income part of the world population. And a very small price to pay when our own health or our loved ones' health is at stake.
So what do you think, what direction do we take? Do we allow antimicrobial resistance to become our biggest killer, at huge financial and a special personal cost? Or do we, besides reducing human antibiotic consumption, truly start embracing antibiotic-free animal production? For me, the choice is very obvious. But to make this happen, we have to set reduction targets and make sure that they're followed all around the world. Because farmers compete with each other. And at a country level, trading block or the global market, costs are very important. And also, we have to be realistic. Farmers need to have the possibilities to invest more in better management and better feed in order to achieve this reduction. And besides legal limits, the market can play a role, by offering antibiotic-reduced or antibiotic-free products. And with growing consumer awareness, these market forces will increase in power.
Now everything I've been talking about seems to be great for us. But what about the animals? Now, guess what, their lives get better, too. Better health, less stress, happier life. So now you know. We have the knowledge how to produce meat, eggs and milk without or with very low amounts of antibiotics, and I'll argue it's a small price to pay to avoid a future in which bacterial infections again become our biggest killer.