§ 2701. FINDINGS.

(a) The overuse of antibiotics, also known as antimicrobial drugs, in human medicine and in meat and poultry production poses a pressing environmental and public health threat by allowing antibiotic-resistant bacteria to multiply and spread. In 2013, the Centers for Disease Prevention and Control (“CDC”) identified antibiotic resistance as one of the top five health threats facing the country in the near future.

(b) In a 2013 report on antibiotic resistance threats in the United States, the CDC estimated that every year at least 2 million people contract antibiotic-resistant infections, and at least 23,000 people die as a result of these infections. Some researchers have estimated these infections cost the United States as much as $55 billion annually due to excess healthcare costs and lost productivity.

(c) Increasingly, antibiotic-resistant bacteria are leading to infections that can be difficult to treat, require longer and more expensive hospital stays, and are more likely to be fatal than non-resistant bacterial infections. Without effective antibiotics, procedures such as chemotherapy, dialysis, and many surgeries become much riskier for patients because of the high risk of bacterial infections associated with these procedures.

(d) While improper use of antibiotics in the healthcare sector is a contributing factor, organizations such as CDC, the Food and Drug Administration (“FDA”) and the World Health Organization (“WHO”) recognize that the overuse and misuse of antibiotics in food animals is a significant source of the antibiotic-resistant bacteria that affect humans. In a 2015 American Academy of Pediatrics (“AAP”) technical report, the authors stated that the “use of antimicrobial agents in agriculture can harm public health, including child health, through the promotion of resistance.”

(e) Scientists recognize a growing “reservoir” of antibiotic resistance in our communities and environment. A significant portion of antibiotics administered to livestock are excreted in urine and manure, which are then spread as fertilizer on agricultural land. From there, antibiotics can run off into waterways and spread in other ways through the environment. This can lead to the proliferation and spread of resistant bacteria.

(f) Antibiotic-resistant bacteria have been found in drinking water near livestock facilities, in the top soil of dairies, and in the air downwind from industrial swine facilities and cattle feedlots. In addition to traveling off farms in water, air, and soil, antibiotic-resistant bacteria can be found on fruits and vegetables where manure has been applied to crops. Furthermore, insects and rats can carry resistant bacteria away from farms. Workers can also unwittingly carry antibiotic- resistant bacteria from livestock production facilities or processing plants into their communities. Antibiotic-resistant bacteria can pass their resistant genes on to other bacteria. This allows some bacteria, including bacteria in the human gut, to become resistant to antibiotics that they have never encountered. Several recent studies indicate that living near livestock operations or near fields treated with manure can increase individuals’ risk of contracting antibiotic- resistant infections or being colonized by antibiotic-resistant bacteria.

(g) In addition, scientists and governmental agencies routinely find antibiotic-resistant bacteria on animals at slaughter and on raw meat in grocery stores. In 12 years of testing through the National Antimicrobial Resistance Monitoring System (“NARMS”), the FDA has identified antibiotic-resistant bacteria that can cause illness on retail pork, chicken, ground beef, and ground turkey every year. For example, in the most recent reported testing in 2012, 33% of Salmonella, 60% of Enterococcus faecium, 30% of E. coli and, 11% of Campylobacter coli found in chicken were multidrug resistant (resistant to at least three antibiotic classes). WHO and CDC have deemed antibiotic-resistant infections from food pathogens a serious threat.

(h) A recent example illustrates the risks of injudicious use of antibiotics, which can cause global problems. In 2015, a study in China identified plasmid encoded colistin resistance (mcr-1), which is easily transferable to other bacteria, in a significant fraction of pig samples that had been collected for routine surveillance. Scientists believe the resistance was a result of colistin in animal feeds, which is not allowed for use in the United States. The same colistin resistance was detected in hospital patients. A couple of months later, alarmed scientists around the world had discovered the same colistin resistance in 19 countries, including in child and elderly patients, in the guts of healthy humans, in water, on retail meat, and in animals. Because the colistin gene was detected more often in animals than in people, the authors of the original study say it is likely that this form of colistin resistance originated in animals and spread to people.

(i) In January 2017, FDA completed implementation of its Guidance 213, enacting rules requiring veterinary approval for a host of antibiotics that were previously available over the counter for growth promotion purposes. It also announced the withdrawal of approval for a portion of new animal drug applications that indicated the use of antibiotics for growth promotion for animals used to produce meat and poultry. However, antibiotics in every medically important class that was approved for growth promotion in livestock production will remain available for use at similar or the same doses for disease prevention. Even under Guidance 213, antibiotic products could continue to be administered to animals that are not sick in low doses on a routine basis in their feed and/or water prophylactically. Furthermore, Guidance 213 does not require use reduction targets or a means to track progress toward reduction of the use of antibiotics in livestock operations.

(j) According to 2009-2014 domestic sales and distribution data collected from pharmaceutical companies by the FDA, sales of medically-important antibiotics for food animals have increased every year and by 23% over the five-year period. From 2013 to 2014, the first year for voluntary implementation of Guidance 213, antibiotic sales of medically-important antibiotics increased by 3%.

(k) Both the Netherlands and Denmark have achieved significant reductions in livestock antibiotic use only after both routine disease prevention and growth promotion uses were banned. According to the government of the Netherlands, antibiotic use in the Dutch livestock industry fell by 59% between 2009 and 2014. Between 1992 and 2008, Denmark reduced antibiotic use in swine production by almost 50%, while still experiencing a nearly 50% increase in production.

(l) There is no federal program in the United States to collect comprehensive and representative data on antibiotic use in livestock or poultry, nor any federal regulatory proposal to do so. The only information available is sales data that does not break down use by species or medical reason for use.

(m) In 2015, Governor Brown signed SB 27, a first-in-the nation law, which puts all medically-important antibiotics under veterinary oversight and restricts prophylactic use of antibiotics in livestock so that antibiotics may not be administered routinely. In addition, SB 27, codified at Section 14400 et seq. of the California Food and Agriculture Code, directs the California Department of Food and Agriculture to monitor antibiotic use, sales, and antibiotic resistance. However, the law applies to livestock and poultry produced in California only.

(n) The marketplace remains fragmented and confusing for consumers. Other than for products labeled “Organic” or “No Antibiotics Administered,” antibiotic use practices remain opaque or misleading. For example, meat and poultry products may have been produced with regular use of antibiotics yet labeled “natural,” and products may claim to be produced without the use of “growth-promoting antibiotics” while using antibiotics routinely for disease prevention with growth-promoting effects. Should producers choose to label their products as compliant with SB 27, such labels will add to this confusing mix.

(o) San Francisco can play a pivotal role in addressing the inappropriate use of antibiotics in meat production by increasing transparency of antibiotic use practices by collecting, analyzing, and explaining the myriad policies on antibiotic use for raising livestock and poultry and the implications of different levels of antibiotic use for environmental health, antibiotic resistance and public health.

(Added by Ord. , File No. 170763, App. 10/24/2017, Eff. 11/23/2017)