Anna Borenstein

Israel lags behind global efforts to halt deadly “superbugs”

September 22, 2019

India banned “last-hope” drug misused in livestock, and the WHO has launched a global campaign against drug-resistant bacteria. But Israel lags behind. Infectious disease expert Prof. Myriam Weinberger: Foodborne infections are skyrocketing

India’s government has banned the use of a “last hope” antibiotic known as colistin in farmed animals to help stop the growing spread of drug-resistant “superbugs,” a threat the World Health Organization (WHO) has labeled a “global health emergency.” The WHO is calling for strict regulation of all antibiotics in farmed animals. Israel – the world’s largest poultry consumer per capita – lags behind.

Colistin is a last-resort antibiotic used to treat critically ill patients when all other drugs have failed. In 2015, panic spread across the medical community when scientists identified a colistin-resistant gene in bacteria from Chinese pigs. Moreover, the mutation was of a kind easily shared between bacteria and soon spread to animals and humans across five continents.

Reckless farming practices are likely at fault. Despite its lifesaving use in humans, colistin has been used for years in livestock as a growth promoter that dramatically shortens birth-to-market cycles. Indeed, from their very first days, chicks, fish and other farmed animals are given a cocktail of drugs – primarily to prevent (rather than treat) disease and boost profits. Some of these drugs are critical for treating human disease – from pneumonia to lethal bloodstream infections.

Experts claim this uncontrolled antibiotic use is turning farmed animals into reservoirs of drug-resistant bacteria that can easily spread. In parallel, though only a fraction of that used in farmed animals, antibiotic usage in humans is also problematic, with the WHO estimating that in many countries, more than half the antibiotics are inappropriately applied.

“Antimicrobial resistance is an invisible pandemic,” says the WHO’s Dr. Mariângela Simão. “We are already starting to see signs of a post-antibiotic era, with the emergence of infections that are untreatable by all classes of antibiotics.

According to the WHO, common illnesses, including certain sexually transmitted diseases, respiratory and urinary tract infections, are already becoming untreatable. Bacterial resistance is now claiming the lives of 700,000 people annually – one person per minute – and barring intensive global efforts could kill 10 million annually by 2050 and cost the global economy an estimated $6 trillion.

The loss of effective antibiotics – the “miracle cure” first discovered by Alexander Fleming in 1928 – could render common medical procedures too risky, from c-sections to joint replacements, diabetes management, and chemotherapy.

Bacterial resistance is now claiming the lives of 700,000 people annually – one person per minute – and barring intensive global efforts could kill 10 million annually by 2050 and cost the global economy an estimated $6 trillion. Photo by Drew Hays on Unsplash

An Arms Race Doomed from the Start

Antimicrobial resistance occurs naturally. It’s a race between tiny disease-causing organisms – like bacteria, viruses, parasites and fungus – and the drugs crafted to target them. Due to variations naturally present in all populations, some bugs survive exposure to drugs and then multiply extensively, passing on this resistance. The catch – which Fleming already wisely foretold in his 1945 Nobel Prize acceptance speech – is when humans misuse the painstakingly-fashioned drugs. This is precisely the case in today’s conventional farming, where antibiotics are both overused and administered in low dosages over long periods.

“It is not difficult to make microbes resistant in the laboratory by exposing them to concentrations not sufficient to kill them,” Fleming and later others cautioned.

India’s new ban, deemed by its health ministry as “necessary and expedient in public interest” prohibits the manufacture, sale, and distribution of colistin for all food-producing animals. However, it doesn’t ban other antibiotics as growth promoters or therapeutics. Indeed, while the European Union banned antibiotic growth promoters already in 2006 and the U.S. followed suit in 2017, this practice remains commonplace in many countries, including Israel.

Superbugs, Israeli Style

According to the OECD, Israel’s annual meat consumption is record-breaking, checking in fourth in overall meat consumption per capita (after Argentina, the U.S., and Brazil), and number one in poultry, with nearly 65 kg per person annually. The poultry industry alone boasts an estimated 5.5 billion NIS ($1.56 billion) in yearly revenue – an impressive 17% of Israel’s total agricultural profits.

But this blue and white success story has a darker side. In 2018, 47% of Israel’s poultry farms tested positive for salmonella, and an estimated 18% of the country’s eggs were contaminated. Israel’s foodborne infections have skyrocketed, reaching an estimated 100,000 salmonella and 270,000 campylobacter cases per year, according to Prof. Myriam Weinberger, Chair of the Israeli Society for Infectious Diseases. Both illnesses are generally written off as a fleeting ‘stomach virus.’ However, they can cause life-threatening complications – primarily in young children and the elderly. For instance, if invading the bloodstream, salmonella mortality rates reach 30% in Israelis aged 70 and above. Additionally, an increasing number of salmonella and campylobacter-causing bacteria are able to shrug off previously potent antibiotics. Some strains are even resistant to more than one drug.

“Israel is one of the few Western countries still allowing largescale antibiotic usage in poultry,” explains Weinberger. “This policy drives bacterial resistance, which then impacts us through infected meat and eggs. Studies show that urine from infected chickens has even seeped into some of Israel’s groundwater.”

Arik Melamed, an organic and free-range chicken farmer in Kfar Hanagid thinks of Israel’s poultry industry as a ‘circle of disease and antibiotic dependency.’ “In addition to antibiotic growth promoters, which shorten market cycles but harm chicken health, poultry is fed “meat-meal” – animal parts (including chicken meat and feathers) discarded at slaughter, dried and ground to a flour. The meat-meal provides a cheap source of protein but also causes stomach abscesses, which farmers then prevent with more antibiotics. Finally, conventional coops are severely overcrowded (with up to 16 chickens per square meter) making it virtually impossible for them to move and exercise. The cramped, dirty conditions also breed disease, which triggers yet more antibiotic dependency.”

In 2018, 47% of Israel’s poultry farms tested positive for salmonella, and an estimated 18% of the country’s eggs were contaminated. Photo by Artem Beliaikin on Unsplash

By the time results are in, we’ve eaten the meat  

“Israel’s chicken coops are way behind modern biosafety standards,” says Weinberger. “There’s been talk about this for years, but nothing has happened. Studies have shown that chickens raised without growth promoters are healthier and Israel’s laws actually limit their use, but there’s little or no enforcement.”

Dr. Giddy Tzipori, a veterinarian, heading Israel’s Institute for Food Safety and Quality, seconds Weinberger’s concern. “A percentage of chicken brought to slaughter are inspected for foodborne infections as well as pesticide residues. But by the time results are in (generally 48–72 hours later) you and I have most likely eaten the meat,” says Tzipori.

According to Tzipori, the Ministry of Agriculture employs less than 200 food safety inspectors nationwide, but things are worse at Israel’s health ministry, where in addition to overseeing agricultural food-safety, inspectors must monitor thousands of other businesses, including restaurants and pools. “The inspectors are professional, but when there’s so much to supervise, you cut corners. The public pays the price,” says Tzipori. (For perspective, according to the 2016 State Comptroller report, roughly 3,900 Kashrut inspectors are employed nationwide.)

Israel’s Ministry of Agriculture responded that it began monitoring antimicrobial use in livestock in 2014 and now annually reports the prevalence of resistant bacteria in slaughterhouses as well. “These two programs represent the first steps towards an official monitoring program that will limit the use of certain antimicrobials in the livestock industry,” the ministry said, noting that increased regulation has already cut salmonella egg contamination by 18% (from 30% down to 12% this past July).

Israel’s Ministry of Health responded that the “usage of antibiotics in Israel’s livestock is under the authority and responsibility of the Ministry of Agriculture.” Their claim is puzzling given a State comptroller report asserting that the supervision of animal-sourced foods falls collectively on the ministries of agriculture, health, and local authorities.

As this passing the buck continues, two key questions remain for Israel’s public: Is our food safe, and on a broader scale, are authorities working fast and effectively enough to help prevent a post-antibiotic world?

This ZAVIT article was also published in The Jerusalem Post on 09/22/2019.