Most meat animals are raised with the assistance of daily doses of antibiotics. By 2050, antibiotic resistance will cause a staggering 10 million deaths a year
Every year I spend some time in a tiny apartment in Paris, seven storeys above the mayor’s offices for the 11th arrondissement. The Place de la Bastille – the spot where the French revolution sparked political change that transformed the world – is a 10-minute walk down a narrow street that threads between student nightclubs and Chinese fabric wholesalers.
Twice a week, hundreds of Parisians crowd down it, heading to the marché de la Bastille, stretched out along the center island of the Boulevard Richard Lenoir.
Blocks before you reach the market, you can hear it: a low hum of argument and chatter, punctuated by dollies thumping over the curbstones and vendors shouting deals. But even before you hear it, you can smell it: the funk of bruised cabbage leaves underfoot, the sharp sweetness of fruit sliced open for samples, the iodine tang of seaweed propping up rafts of scallops in broad rose-colored shells.
Threaded through them is one aroma that I wait for. Burnished and herbal, salty and slightly burned, it has so much heft that it feels physical, like an arm slid around your shoulders to urge you to move a little faster. It leads to a tented booth in the middle of the market and a line of customers that wraps around the tent poles and trails down the market alley, tangling with the crowd in front of the flower seller.
In the middle of the booth is a closet-size metal cabinet, propped up on iron wheels and bricks. Inside the cabinet, flattened chickens are speared on rotisserie bars that have been turning since before dawn. Every few minutes, one of the workers detaches a bar, slides off its dripping bronze contents, slips the chickens into flat foil-lined bags, and hands them to the customers who have persisted to the head of the line.
I can barely wait to get my chicken home.
Chickens roam in an outdoor enclosure of a chicken farm in Vielle-Soubiran, south-western France. Photograph: Iroz Gaizka/AFP/Getty Images
The skin of a poulet crapaudine – named because its spatchcocked outline resembles a crapaud, a toad – shatters like mica; the flesh underneath, basted for hours by the birds dripping on to it from above, is pillowy but springy, imbued to the bone with pepper and thyme.
The first time I ate it, I was stunned into happy silence, too intoxicated by the experience to process why it felt so new. The second time, I was delighted again –and then, afterward, sulky and sad.
I had eaten chicken all my life: in my grandmother’s kitchen in Brooklyn, in my parents’ house in Houston, in a college dining hall, friends’ apartments, restaurants and fast food places, trendy bars in cities and old-school joints on back roads in the south. I thought I roasted a chicken pretty well myself. But none of them were ever like this, mineral and lush and direct.
I thought of the chickens I’d grown up eating. They tasted like whatever the cook added to them: canned soup in my grandmother’s fricassee, her party dish; soy sauce and sesame in the stir fries my college housemate brought from her aunt’s restaurant; lemon juice when my mother worried about my father’s blood pressure and banned salt from the house.
This French chicken tasted like muscle and blood and exercise and the outdoors. It tasted like something that it was too easy to pretend it was not: like an animal, like a living thing. We have made it easy not to think about what chickens were before we find them on our plates or pluck them from supermarket cold cases.
I live, most of the time, less than an hour’s drive from Gainesville, Georgia, the self-described poultry capital of the world, where the modern chicken industry was born. Georgia raises 1.4bn broilers a year, making it the single biggest contributor to the almost 9bn birds raised each year in the United States; if it were an independent country, it would rank in chicken production somewhere near China and Brazil.
Yet you could drive around for hours without ever knowing you were in the heart of chicken country unless you happened to get behind a truck heaped with crates of birds on their way from the remote solid-walled barns they are raised in to the gated slaughter plants where they are turned into meat. That first French market chicken opened my eyes to how invisible chickens had been for me, and after that, my job began to show me what that invisibility had masked.
My house is less than two miles from the front gate of the Centers for Disease Control and Prevention, the federal agency that sends disease detectives racing to outbreaks all over the world. For more than a decade, one of my obsessions as a journalist has been following them on their investigations – and in long late-night conversations in the United States and Asia and Africa, with physicians and veterinarians and epidemiologists, I learned that the chickens that had surprised me and the epidemics that fascinated me were more closely linked than I had ever realized.
I discovered that the reason American chicken tastes so different from those I ate everywhere else was that in the United States, we breed for everything but flavor: for abundance, for consistency, for speed. Many things made that transformation possible.
But as I came to understand, the single biggest influence was that, consistently over decades, we have been feeding chickens, and almost every other meat animal, routine doses of antibiotics on almost every day of their lives.
Antibiotics do not create blandness, but they created the conditions that allowed chicken to be bland, allowing us to turn a skittish, active backyard bird into a fast-growing, slow-moving, docile block of protein, as muscle-bound and top-heavy as a bodybuilder in a kids’ cartoon. At this moment, most meat animals, across most of the planet, are raised with the assistance of doses of antibiotics on most days of their lives: 63,151 tons of antibiotics per year, about 126m pounds.
Farmers began using the drugs because antibiotics allowed animals to convert feed to tasty muscle more efficiently; when that result made it irresistible to pack more livestock into barns, antibiotics protected animals against the likelihood of disease. Those discoveries, which began with chickens, created “what we choose to call industrialized agriculture”, a poultry historian living in Georgia proudly wrote in 1971.
Chicken prices fell so low that it became the meat that Americans eat more than any other – and the meat most likely to transmit food-borne illness, and also antibiotic resistance, the greatest slow-brewing health crisis of our time.
For most people, antibiotic resistance is a hidden epidemic unless they have the misfortune to contract an infection themselves or have a family member or friend unlucky enough to become infected.
Drug-resistant infections have no celebrity spokespeople, negligible political support and few patients’ organizations advocating for them. If we think of resistant infections, we imagine them as something rare, occurring to people unlike us, whoever we are: people who are in nursing homes at the end of their lives, or dealing with the drain of chronic illness, or in intensive-care units after terrible trauma. But resistant infections are a vast and common problem that occur in every part of daily life: to children in daycare, athletes playing sports, teens going for piercings, people getting healthy in the gym.
And though common, resistant bacteria are a grave threat and getting worse.
They are responsible for at least 700,000 deaths around the world each year: 23,000 in the United States, 25,000 in Europe, more than 63,000 babies in India. Beyond those deaths, bacteria that are resistant to antibiotics cause millions of illnesses – 2m annually just in the United States – and cost billions in healthcare spending, lost wages and lost national productivity.
It is predicted that by 2050, antibiotic resistance will cost the world $100tn and will cause a staggering 10m deaths per year.
Disease organisms have been developing defenses against the antibiotics meant to kill them for as long as antibiotics have existed. Penicillin arrived in the 1940s, and resistance to it swept the world in the 1950s.
Tetracycline arrived in 1948, and resistance was nibbling at its effectiveness before the 1950s ended. Erythromycin was discovered in 1952, and erythromycin resistance arrived in 1955. Methicillin, a lab-synthesized relative of penicillin, was developed in 1960 specifically to counter penicillin resistance, yet within a year, staph bacteria developed defenses against it as well, earning the bug the name MRSA, methicillin-resistant Staphylococcus aureus.
After MRSA, there were the ESBLs, extended-spectrum beta-lactamases, which defeated not only penicillin and its relatives but also a large family of antibiotics called cephalosporins. And after cephalosporins were undermined, new antibiotics were achieved and lost in turn.
Each time pharmaceutical chemistry produced a new class of antibiotics, with a new molecular shape and a new mode of action, bacteria adapted. In fact, as the decades passed, they seemed to adapt faster than before. Their persistence threatened to inaugurate a post-antibiotic era, in which surgery could be too dangerous to attempt and ordinary health problems – scrapes, tooth extractions, broken limbs – could pose a deadly risk.
For a long time, it was assumed that the extraordinary unspooling of antibiotic resistance around the world was due only to misuse of the drugs in medicine: to parents begging for the drugs even though their children had viral illnesses that antibiotics could not help; physicians prescribing antibiotics without checking to see whether the drug they chose was a good match; people stopping their prescriptions halfway through the prescribed course because they felt better, or saving some pills for friends without health insurance, or buying antibiotics over the counter, in the many countries where they are available that way and dosing themselves.
But from the earliest days of the antibiotic era, the drugs have had another, parallel use: in animals that are grown to become food.
Eighty percent of the antibiotics sold in the United States and more than half of those sold around the world are used in animals, not in humans. Animals destined to be meat routinely receive antibiotics in their feed and water, and most of those drugs are not given to treat diseases, which is how we use them in people.
Instead, antibiotics are given to make food animals put on weight more quickly than they would otherwise, or to protect food animals from illnesses that the crowded conditions of livestock production make them vulnerable to. And nearly two-thirds of the antibiotics that are used for those purposes are compounds that are also used against human illness – which means that when resistance against the farm use of those drugs arises, it undermines the drugs’ usefulness in human medicine as well.
Resistance is a defensive adaptation, an evolutionary strategy that allows bacteria to protect themselves against antibiotics’ power to kill them. It is created by subtle genetic changes that allow organisms to counter antibiotics’ attacks on them, altering their cell walls to keep drug molecules from attaching or penetrating, or forming tiny pumps that eject the drugs after they have entered the cell.
What slows the emergence of resistance is using an antibiotic conservatively: at the right dose, for the right length of time, for an organism that will be vulnerable to the drug, and not for any other reason. Most antibiotic use in agriculture violates those rules.
Resistant bacteria are the result.
Antibiotic resistance is like climate change: it is an overwhelming threat, created over decades by millions of individual decisions and reinforced by the actions of industries.
It is also like climate change in that the industrialized west and the emerging economies of the global south are at odds. One quadrant of the globe already enjoyed the cheap protein of factory farming and now regrets it; the other would like not to forgo its chance. And it is additionally like climate change because any action taken in hopes of ameliorating the problem feels inadequate, like buying a fluorescent lightbulb while watching a polar bear drown.
But that it seems difficult does not mean it is not possible. The willingness to relinquish antibiotics of farmers in the Netherlands, as well as Perdue Farms and other companies in the United States, proves that industrial-scale production can be achieved without growth promoters or preventive antibiotic use. The stability of Maïsadour and Loué and White Oak Pastures shows that medium-sized and small farms can secure a place in a remixed meat economy.
Whole Foods’ pivot to slower-growing chicken – birds that share some of the genetics preserved by Frank Reese – illustrates that removing antibiotics and choosing birds that do not need them returns biodiversity to poultry production. All of those achievements are signposts, pointing to where chicken, and cattle and hogs and farmed fish after them, need to go: to a mode of production where antibiotics are used as infrequently as possible – to care for sick animals, but not to fatten or protect them.
That is the way antibiotics are now used in human medicine, and it is the only way that the utility of antibiotics and the risk of resistance can be adequately balanced.