Antibiotic user fee proposed to curb use, prevent resistance

Veterinarian suggests more education, stricter producer access to drugs

A University of Calgary economist is calling for user fees for antibiotic use in livestock. 


Aidan Hollis, who studies pharmaceutical markets, believes an additional fee on all antibiotic use in livestock would deter low-level uses of antibiotics, reduce the spread of antimicrobial resistance and generate funds to encourage the development of new drugs. 


Specifically, the policy he proposes aims to reduce antibiotic use by discouraging its use for growth promotion. 


The concern is that antimicrobial resistance could develop in livestock and spread to humans, creating a health risk when an antibiotic is no longer effective. 


It’s a common topic at farm meetings, where livestock producers are told that resistance can be selected anytime antimicrobials are used, whether it’s for growth promotion and feed efficiency or for serious therapeutic reasons.


There is already a ban on growth promoting antibiotics in Europe, and the United States has seen several regulatory changes, most recently in December when the Food and Drug Administration introduced a plan to encourage companies to voluntarily change their labels.


The issue has seen greater attention in the U.S. since a large number of cases of methicillin-resistant staphylococcus aureus was found. 


Canada hasn’t seen similar regulatory changes, and no jurisdiction employs a user fee system.


“The resistance issue is a huge one and I would be obviously quite wrong to suggest that the main problem in resistance is agricultural use. That’s obviously not true,” Hollis said in an interview. “Nevertheless, it’s likely to be a problem.”


He made his case for the user fee in an editorial recently published in the New England Journal of Medicine, where he and a co-author liken it to royalties paid by the logging and oil industries. 


“Basically, if you’re using antibiotics to make money, which is what I think farmers do — and it’s perfectly legitimate — but if you’re using antibiotics to make money and you’re thereby essentially enhancing the probability of resistance developing … then maybe you should be paying for that,” said Hollis. 


Leigh Rosengren, who operates an epidemiology consulting firm in Sask-atchewan, said the risk of resistance spreading is real but small.


“While we do definitely want to decrease antimicrobial use, not all antibiotics are created equal.”


Rosengren said Class 1 drugs, which are most important to human health, are already expensive and used with oversight from a veterinarian. 


“I guess I really believe that it’s education and information that’s going to change the way we use products, not necessarily a fee,” she said. 


“Or to that matter, things like the U.S. have done, which have been making them more and more difficult to access.”


Regulations on withdrawal times from drugs are designed to keep antimicrobials out of the food chain. 


“Already the more ‘important’ antibiotics are under veterinary prescription only and we don’t see any new products coming to market that aren’t veterinary prescription and I think we will maybe even see some of the older products shift that way,” said Rosengren.


In the editorial, Hollis doesn’t propose a price or a model for the fee.


Calling it an “economically rational solution,” the authors favour a fee over a stricter ban, which they say could increase food prices.


“It could be set up to basically raise a targeted amount of money or maybe more plausibly, it could be set up so that it basically increases the price just enough to make growth promotion uses relatively unappealing or unprofitable,” said Hollis.