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Antibiotic Use in US Farm Animals Was Falling. Now It’s Not

Antibiotic Use in US Farm Animals Was Falling. Now It’s Not

That was thought to be the best the US could do, especially with the pro-business Trump administration about to take over. But researchers knew in advance that a growth promoter ban would be inadequate. They already had an example of why it wouldn’t work: A few years earlier, the government of the Netherlands had noticed that, despite the EU ban in 2006, sales of antibiotics to Dutch farms kept rising. An investigation by academics working with regulatory agencies revealed that companies selling ag antibiotics in the Netherlands had changed the labeling on growth promoters to “preventative use” to circumvent the new law.

That seems to be what has happened in the US. One means of using antibiotics was made illegal, so producers found a different path. “There was a huge increase in ‘therapeutic’ use right after the elimination of growth promotion,” says Lance Price, a microbiologist and professor at the George Washington University’s Milken Institute School of Public Health and founding director of its Antibiotic Resistance Action Center. “It was a perfect parallel to what happened in the Netherlands, where they just changed what they called it.”

The new federal data does hold one bright spot. The 2020 report reveals that of all the antibiotics sold for agricultural use, raising chickens—the most commonly consumed meat in the US—accounts for only 2 percent of the drugs. That’s compared to 41 percent each for cattle and hogs, and 12 percent for turkeys. It represents a complete turnaround for the US chicken industry that began in 2014, when Perdue Foods, then the nation’s fourth-largest producer, announced it was taking its entire operation antibiotic-free.

“Only 1 percent of broiler chickens in the US are produced with what the industry calls ‘full-spectrum antibiotics,’” Wellington says. “And more than half are raised ‘No Antibiotics Ever.’ That’s incredible. But it means that we’re at a standstill with pig and cattle production.”

In 2018, the year after the growth-promoter ban went into effect, the FDA announced it was launching a 5-year plan to further regulate farm antibiotics. But progress has been slow. In June, the agency introduced new rules that would reclassify those remaining over-the-counter drugs—a small number of injectable and topical antibiotics—as prescription-only.

Activists are impatient for the agency to do more. An open letter by researchers published earlier this year, asking the Biden administration for big sweeping actions, did not provoke any response. So advocates are focusing on smaller changes that they feel are reasonable for the FDA to make: more regulation, especially on how long antibiotics can be used in any single animal or herd, and more data-gathering that would allow better insight into how antibiotics are being misused. Annual reporting that tracks resistance rates in bacteria taken from humans and animals, and matches it to both sales and use data, is routine in the EU. In the US, no such comprehensive reports exist.

“First, if the FDA had actually done what it proposed in 2017, we would know more—that is, instead of just reporting sales, report sales with a denominator that reflects the size of the animal population,” says David Wallinga, a physician and senior officer at NRDC and coauthor of the analysis of FDA data. “That’s what they’ve been doing in Europe since 2010. And the second thing is to actually collect data at the farm level on antibiotic use.”

The UK Government Wants to Sequence Your Baby’s Genome

The UK Government Wants to Sequence Your Baby’s Genome

In November 2019, Matt Hancock, then the United Kingdom’s health secretary, unveiled a lofty ambition: to sequence the genome of every baby in the country. It would usher in a “genomic revolution,” he said, with the future being “predictive, preventative, personalized health care.” 

Hancock’s dreams are finally coming to pass. In October, the government announced that Genomics England, a government-owned company, would receive funding to run a research pilot in the UK that aims to sequence the genomes of between 100,000 and 200,000 babies. Dubbed the Newborn Genomes Programme, the plan will be embedded within the UK’s National Health Service and will specifically look for “actionable” genetic conditions—meaning those for which there are existing treatments or interventions—and which manifest in early life, such as pyridoxine-dependent epilepsy and congenital adrenal hyperplasia. 

It will be at least 18 months before recruitment for participants starts, says Simon Wilde, engagement director at Genomics England. The program won’t reach Hancock’s goal of including “every” baby; during the pilot phase, parents will be recruited to join. The results will be fed back to the parents “as soon as possible,” says Wilde. “For many of the rare diseases we will be looking for, the earlier you can intervene with a treatment or therapy, the better the longer-term outcomes for the child are.”

The babies’ genomes will also be de-identified and added to the UK’s National Genomic Research Library, where the data can be mined by researchers and commercial health companies to study, with the goal of developing new treatments and diagnostics. The aims of the research pilot, according to Genomics England, are to expand the number of rare genetic diseases screened for in early life to enable research into new therapies, and to explore the potential of having a person’s genome be part of their medical record that can be used at later stages of life. 

Whole genome sequencing, the mapping of the 3 billion base pairs that make up your genetic code, can return illuminating insights into your health. By comparing a genome to a reference database, scientists can identify gene variants, some of which are associated with certain diseases. As the cost of whole genome sequencing has taken a nosedive (it now costs just a few hundred bucks and can return results within the day), its promises to revolutionize health care have become all the more enticing—and ethically murky. Unraveling a bounty of genetic knowledge from millions of people requires keeping it safe from abuse. But advocates have argued that sequencing the genomes of newborns could help diagnose rare diseases earlier, improve health later in life, and further the field of genetics as a whole. 

Back in 2019, Hancock’s words left a bad taste in Josephine Johnston’s mouth. “It sounded ridiculous, the way he said it,” says Johnston, director of research at the Hastings Center, a bioethics research institute in New York, and a visiting researcher at the University of Otago in New Zealand. “It had this other agenda, which isn’t a health-based agenda—it’s an agenda of being perceived to be technologically advanced, and therefore winning some kind of race.”

New Booster Approvals, Data on Kids’ Shots, and More News

New Booster Approvals, Data on Kids’ Shots, and More News

More boosters are approved, kids’ shots prove effective, and more countries open up. Here’s what you should know:

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The FDA and CDC approve Moderna and J&J boosters

Yesterday, the US Centers for Disease Control and Prevention endorsed boosters for eligible people who received initial doses of the Moderna or Johnson & Johnson vaccines, which means that tens of millions more Americans can get an additional shot as soon as today. The agency’s approval followed similar authorization from the FDA the day prior. The FDA, and later the CDC, also said that people who are eligible for boosters can get them from a different drugmaker than their first shots. There’s some evidence to show that any extra dose increases immunity, and in particular that people who got a first shot from Johnson & Johnson had a much better immune response if they got a second dose of an mRNA vaccine. The FDA said anyone who got a Johnson & Johnson shot is eligible for a booster two months after their initial vaccination.

Already, there are more boosters than first doses being administered in the US. But some medical ethicists and international organizations continue to voice their dismay with the way the US has prioritized eradicating any infection within its own borders over helping other countries secure initial doses, thereby reducing severe illness and death worldwide.

Pfizer and BioNTech submit data to the FDA demonstrating their vaccine’s efficacy in kids

Pfizer and BioNTech submitted data to the FDA today showing that their Covid-19 vaccine proved 90.7 percent effective at preventing symptomatic disease in children ages 5 to 11 during clinical trials. Participants received one-third of the adult dosage and saw only mild side effects. There were no cases of severe illness or myocarditis or pericarditis, heart conditions that have been seen in some other age groups of vaccine recipients, notably young men. Earlier this week the White House outlined its plan for distributing shots to kids once they’re approved, which could happen within weeks. The administration will partner with pediatricians’ offices and community clinics, among other health care providers, and will focus on educating parents about the shots.

Pfizer and BioNTech also filed with Health Canada for approval of their vaccine in younger kids this week. When it comes to vaccinating adolescents, Canada has been an exemplar. It was the first country to approve shots for kids ages 12 to 15 last spring, and more than 80 percent of Canadians 12 and older are fully inoculated.

Countries around the world ease restrictions for vaccinated residents and tourists

On Friday, Melbourne, Australia’s second-largest city, reopened after being locked down for 262 days, the longest cumulative lockdown for any city in the world during the pandemic. It follows in the footsteps of Sydney, where restrictions began easing two weeks ago. Starting next month, fully vaccinated international travelers will no longer need to quarantine when entering the two cities. In neighboring New Zealand, Prime Minister Jacinda Ardern said that country’s lockdown will end when 90 percent of eligible residents are vaccinated; so far, 86 percent of the population has received at least one dose. Kuwait also announced it will lift restrictions for people who’ve been vaccinated. And Thailand has said it will open up to visitors who’ve received their shots.

Covid Misinformation Protests, Pediatric Cases, and More News

Covid Misinformation Protests, Pediatric Cases, and More News

Reddit users protest misinformation, pediatric cases trend upward, and countries change travel advisories. Here’s what you should know:

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Reddit moderators protest the rise of Covid misinformation online

In the past week, dozens of Reddit moderators coordinated a blackout to protest the company’s lax policies on Covid disinformation, making their subreddits private and posting messages critical of the platform. Reddit initially responded with statements about the importance of free speech, but on Wednesday reversed course and quarantined 54 Covid-denial subreddits, adding more hoops people need to jump through to join and limiting the spread of content. It also banned /r/NoNewNormal, a large subreddit that has been quarantined since mid-August for spamming other communities with falsehoods about the virus.

One instance of misinformation that has propagated on Reddit and elsewhere is the trend of vaccine-hesitant people taking ivermectin, an antiparasitic commonly used in livestock, to treat or prevent the disease. While the Food and Drug Administration and Centers for Disease Control and Prevention have warned against using the drug, which has not proven to be a remedy and can cause severe illness, just this week podcast host Joe Rogan said he took it after testing positive for Covid-19.

Pediatric cases continue to rise, to the concern of parents and officials

Last week, children accounted for 22.4 percent of weekly reported Covid-19 cases in the US, and the rate of cases among kids is rising. Coupled with the start of the school year and a surge of respiratory syncytial virus (RSV) cases, there’s mounting concern about the urgency of protecting children, especially as pediatric hospitals experience an “unprecedented strain.” The CDC has recommended universal indoor masking for all students, teachers, staff, and visitors at schools, regardless of vaccination status. And the US Department of Education is investigating five states over concerns that their mask mandate bans could be discriminatory against students with disabilities and health conditions that make them more vulnerable to Covid-19.

As pediatric cases rise, some parents, physicians, and scientists have been debating the ethics of vaccinating kids by prescribing shots “off-label,” or offering a drug for a reason or to a group not studied during the approval process. Now that Pfizer-BioNTech’s vaccine has full FDA approval, this may be possible—but most experts and officials strongly discourage it.

Changing restrictions and a holiday weekend impact travel

Earlier this week, the European Union voted to change its travel restrictions, notably removing the US from its list of safe countries for nonessential travel. These are recommendations, and it’s up to individual member nations to decide whether and how to enforce them. The change will most likely affect unvaccinated Americans. The US has yet to reopen its doors to tourists from the EU, and the CDC added seven new places to its list of highest-risk destinations this week, including Switzerland and Puerto Rico. The agency has also urged Americans to be cautious this holiday weekend, particularly those who are unvaccinated.

All of the changing protocols and uncertainty surrounding pandemic travel have been a boon for one industry: travel advisers. A recent survey of American tourists found that roughly 17 percent were likely to get professional help booking a trip for the first time when the pandemic is over.

Daily Distraction

Video game tutorials can be overly complicated, unhelpful, or just plain annoying. But even so, they’re more necessary now than ever.

Something to Read

Decades ago, evolutionary biologist Richard Lewontin made waves studying the genetic overlap between different racial groups, and concluded that many of the differences that define us in society aren’t reflected in our DNA. Lewontin may have passed away this summer, but his work is enduringly relevant.

Sanity Check

If you have a child heading back to school this fall, chances are you need to refresh your mask stash. Here are a few of our favorite face coverings for kids.

One Question

Why did Florida’s Covid surge screw with its water supply?

The pandemic is worse than it’s ever been in Florida. And last week the Tampa Bay water utility announced that, with so much liquid oxygen going to hospitals’ Covid wards, it wasn’t able to properly treat its water; the plant’s supply had been reduced by about half. Liquid oxygen is used in two ways: to disinfect water and to keep it from smelling terrible. Officials insist that the quality of drinking water remains safe. But they may substitute something else for oxygen to improve the water’s smell, and have encouraged people to limit water use as the pandemic rages. The one other thing Floridians can do to improve the situation, if they haven’t already? Go get vaccinated.

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Would It Be Fair to Treat Vaccinated Covid Patients First?

Would It Be Fair to Treat Vaccinated Covid Patients First?

Around the world, hospitals and clinicians have broadly agreed that both Covid and non-Covid patients should have the same triage principles applied, that care shouldn’t be first-come, first-served (because of differences in accessibility), and that the primary metric should be getting the greatest number of people to leave the hospital alive. Cultural values sometimes come into play about whether to consider a more subtle prognosis: quality of life, or years lived, or, like, which person is somehow more valuable, if that was even calculable. (And triage isn’t the only way to divide vaccinated and unvaccinated people; the fact that private insurers are pulling back on paying for Covid care seems like a pretty good repudiation of the idea of forgoing one’s shots.)

One thing ethicists and clinicians have come back to again and again is avoiding “categorical exclusion criteria,” attributes that knock someone out of the triage running. For example, before the widespread availability of vaccines, elderly Covid patients died at a much higher rate than younger ones. But nobody wanted to exclude old people from treatment, right? That’d be monstrous. Or, as a team of Swiss ethicists argued last spring, you might distinguish between “first-order criteria,” like demographics, and “second-order criteria,” more subtle stuff that’d only come into play in a tiebreaker—two patients, alike in every possible way, similar prognoses, similar diagnoses. But deciding what differences to take into account is very tricky. If it’s health status, how do you assess that? How might socioeconomic status influence prognosis, and can you account for that equitably? What ethicists and the Texas task force were floating is, essentially, whether vaccination status might be a second-order exclusion criterion—even though, to be clear, one of the task force’s main points is that vaccination status could not, by itself, be a categorical exclusion criterion.

In part, that’s because the whole idea comes with a caveat the size of, well, Texas. Yes, far fewer vaccinated people get severely ill. But no one knows if severely ill vaccinated people have better outcomes—more survivability—than severely ill unvaccinated people. It seems likely that once you’re sick enough to be in the hospital, you’re sick enough to be in the hospital. But as far as I can tell, no such published data exists. “I personally have that sense from the data I’ve seen, but that is very preliminary data. There is no peer-reviewed study showing that,” Fine says. “So one has to be careful.”

Careful indeed. A big part of the rationale for triage guidelines is consistency, so individual doctors don’t have to rely on their intuitions. “Covid has taught us lots of things, but certainly that there’s a lot of implicit bias within the health care system, and certainly with Covid outcomes,” Lo says. “And we want not to make that worse.”

Plus, as much as we all might understand and empathize with the rage and frustration of health care workers—emotionally drained, epidemiologically at risk—whatever blame we might place could well be misdirected. “We know people are frustrated and angry, but that’s not a basis for decisionmaking,” Fine says.

Vaccination status, as Fine notes, is more complicated than that anger might allow. “I think we have to be really careful about saying someone chose not to be vaccinated. Some people do,” Lo says. “But there are still people who have difficulty making an appointment, who aren’t internet-savvy, who don’t speak English as a first language. A lot of people work in jobs where they don’t have time off, or if they get even a day of adverse effects from the vaccine and can’t work, their pay gets docked.” And how would a clinician trying to triage based on vaccination status distinguish among those groups, even if they were allowed to?

For that matter, even the people who resist vaccination because think they’ll never get sick, or that if they do then a horse deworming drug will save them, or that vaccines contain magnetizing 5G antennas through which Bill Gates can turn them into werewolves (They don’t! None of those things are things!)—those people have been lied to by leaders they trusted. Bad information is cheap; better information is expensive. And as ugly as the Covid numbers might be getting across the South, rage might be better directed at political leaders who are resisting basic public health measures instead of the people suffering as a result.

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