On December 25, state-run China Central Television (CCTV) reported excessive amounts of antibiotics—up to four times the legal limit in the United States—in the Yangtze, Yellow, Huangpu, Liao, and Pearl Rivers, as well as in tap water from cities in Jiangsu and Anhui provinces. Two culprits were named: run-off from poultry farms along the waterways and waste from Shandong Lukang Pharmaceutical, one of China’s four largest producers of antibiotics.
Although not as obviously dangerous as a chemical that can set a river on fire, effluent antibiotics pose a real threat to human health. This kind of drug run-off, especially in the concentrations described by Chinese media, increases the speed at which resistance arises in the environment and ultimately threatens the ability of these commonly used drugs to effectively treat and prevent a growing range of infections.
Many diseases that were once cured by a single course of antibiotics now require several rounds of treatment. There’s also a significant economic cost associated with increased rates of resistance. Reduction in the effectiveness of existing antibiotics by just 1 percent could impose costs of up to $3 trillion in lost human health globally.
The toll of antimicrobial resistance (AMR) is acute in China, the world’s largest consumer of antibiotics. The Ministry of Health (MOH) estimates that each Chinese individual consumes about 138 grams of antibiotics annually, about ten times more than in the United States. But the heavy reliance on antibiotics doesn’t correlate with better health outcomes. Between 2001 and 2005, 150,000 Chinese patients died annually as a result of moderate-to-severe adverse reactions to antibiotics. Treatment of antibiotic resistant infections during that same period cost the country’s healthcare system at least $477 million, with productivity losses of more than $55 million each year. And China has the world’s fastest growth rate of AMR, 22 percent between 1994 and 2000.
The most pervasive source of resistance is not in hospitals, but overuse and abuse of antibiotics by farmers. Farmers add antibiotics directly to animals’ feed to promote growth, because these drugs cause an increase in fat content. But they are medically unnecessary and their primary, albeit unintended, effect is to encourage rates of resistance. It is estimated that half of all antibiotics in China are consumed by livestock. Given that up to 75 percent of antibiotics fed to these animals are excreted unaltered into the environment, it is no wonder that run-off from poultry farms have polluted China’s rivers.
Dumping antibiotic waste directly into water, as Shandong Lukang Pharmaceutical has been accused, is neither a common practice nor a primary driver of resistance globally. But it does pose the same issues that antibiotic waste from farming does, and can be addressed with many of the same strategies used to mitigate run-off from farms.
In terms of policy, China has already taken steps to mitigate the risk of AMR within its own borders. In 2011, China’s MOH launched a campaign to promote rational use of antibiotics in healthcare settings. The MOH reported that only 17 percent of drugs sales in 2012 were antimicrobials, compared to 25 percent in the year the regulations were enacted, suggesting that the policy is having some effect.
The country’s Ministry of Agriculture also regulated the use of antibiotics as growth promoters in 2011, allowing antibiotics to only be purchased with a prescription from a veterinarian, but these regulations don’t seem to be having much of an impact. According to the Global Times, pharmacies in Nanjing still admitted selling these drugs to farmers without prescriptions. This lack of enforcement, coupled with the easy availability and unregulated use of antimicrobial drugs in livestock, is what the Chinese government needs to address next.
Regulations must be enforced in order to make any progress in stemming the tide of AMR. But by releasing this information to the public, the Chinese government is at least acknowledging the serious hazard posed by antibiotics in the environment. Educating the public is the first step in encouraging rational use of these drugs. Antibiotics are a common good, and China should continue to take steps to curb its own out-of-control usage, as well as remain transparent about its abuses.