Antibiotics in pig meat production: restrictions as the odd case and overuse as normality? Experiences from Sweden and Italy

The high consumption of antibiotics in food animal production contributes significantly to the global challenge of antibiotic resistance (AMR). This paper examines the contrasting experiences of Sweden and Italy, representing the lowest and among the highest antibiotic consumption rates in the EU, respectively, focusing on pig meat production. The introduction establishes the link between the high antibiotic use in Italian pig farming (associated with products like Parma ham) and its implications for public health, specifically impacting the treatment of secondary infections like those caused by COVID-19. It highlights the significant difference in antibiotic consumption between the two countries – approximately 20 times higher in Italy than in Sweden. The 1998 EU regulations, culminating in the 2006 ban on antibiotics as growth promoters, are discussed, indicating that while the ban was a step towards reduced use, other justifications for continued high consumption emerged. The paper's aim is to understand the systemic changes that have enabled Sweden to significantly reduce its antibiotic consumption while exploring the factors hindering such progress in Italy. The paper aims to go beyond simple comparisons of production practices, focusing instead on the systemic shifts that determine antibiotic usage levels.

The paper draws upon a wide range of literature, including reports from ESVAC, WHO, and FAO, to provide data on global and country-specific antibiotic consumption and resistance patterns. Published antibacterial and animal health studies inform the global AMR challenge, while social science and humanities literature helps explain the emergence of antibiotic-dependent food production systems. The work of authors like Van Boeckel et al. (2015, 2017) on global antimicrobial use in livestock, Kirchhelle (2018) on the history of antibiotics in food production, and Kahn (2016) on the political aspects of AMR are highlighted. The authors also refer to the Swann report (1969), which recognized the link between antibiotic use and resistance but also acknowledged the economic advantages of low-concentration antibiotic use in animal growth. The review emphasizes the differing antibiotic consumption patterns in Italy and Sweden, with Italy's high use of broad-spectrum antibiotics contrasted with Sweden's use of older, narrow-spectrum antibiotics. The literature underlines the significantly higher burden of antibiotic-resistant bacteria in Italy compared to Sweden, a disparity linked to Sweden's long-standing public health approach to drug control.

The study employs a process-oriented innovation approach, drawing on industrial network research, to understand the interconnectedness of social and material resources in antibiotic usage. The authors analyze the different resource interaction patterns in user, producing, and developing settings. Data collection involved 42 personal interviews and site visits with stakeholders in Sweden and Italy, including farmers, slaughterhouses, food processing firms, veterinarians, researchers, representatives from the retail industry, and consumer organizations. The interviews explored the role of antibiotics and AMR in the different settings. The researchers also used reports from ESVAC, WHO, and FAO for data on animal antibiotic consumption and resistance patterns. Published studies in antibacterial resistance and animal health provided further insight. Finally, observations from a workshop on antibiotics and resistance in pig meat production added to the data collection.

The Swedish case demonstrates a successful reduction in antibiotic use, attributed to a multi-faceted approach. The engagement began with media coverage raising public awareness of antibiotic overuse. This, combined with the concerns of insiders (pioneering farmers and managers within the Swedish Farmers Association), led to a voluntary phasing out and eventually a 1986 legal ban on growth promoter antibiotics and routine group treatments. This ban prompted the development of a new production system emphasizing biosecurity and precautionary health measures such as free-ranging sows, improved hygiene protocols, and increased veterinary oversight. Despite initial challenges, antibiotic consumption dropped significantly. However, this progress has had drawbacks since the integration to the EU. The Italian case stands in contrast. Despite EU regulations, high antibiotic consumption persists due to a lack of widespread public awareness and limited media attention to AMR in food production. Conflicts of interest among different types of veterinarians, combined with a focus on maintaining the 'Italian food' brand reputation, hinder progress towards significantly reducing antibiotic use. While there have been initiatives like the 'National Plan to Fight Antimicrobial Resistance' and actions from some retailers, these have not led to a systematic reduction of antibiotic use. The high prevalence of LA-MRSA and other antibiotic-resistant bacteria in Italian pig herds highlights the severity of the situation. Tables in the study illustrate the significant differences between the Swedish and Italian systems in terms of antibiotic consumption, production practices, and resistance levels.

The study highlights the critical role of broader societal engagement in reducing antibiotic use. The Swedish experience demonstrates that a legal ban alone is insufficient; a systemic change across the production and consumption chain is crucial. The successful Swedish model involved the active participation of various stakeholders, supported by public awareness generated through media coverage. In contrast, the lack of public and media attention in Italy, coupled with the challenges in balancing economic interests and public health concerns, has hindered effective change. The study underscores the complexities of tackling AMR in food production, highlighting the need for multi-faceted interventions that address both the economic and social dimensions of the problem. The findings raise critical questions about the role of regulatory frameworks, consumer behavior, and industry incentives in shaping antibiotic use in agriculture.

The study concludes that successfully reducing antibiotic use in animal agriculture requires a holistic approach that goes beyond mere legislation. The Swedish experience illustrates the importance of combining public awareness, industry engagement, and substantial investment in alternative production systems. While the Italian case underscores the challenges of balancing economic interests and public health goals, the study stresses the need for more substantial action than the current regulatory frameworks. Future research could explore comparative studies across other countries and regions to identify factors conducive to effective antibiotic stewardship. Further research should also investigate the effectiveness of different communication strategies to raise public awareness of AMR and the economic and social implications of transitioning to antibiotic-free production systems.

The study acknowledges the limitations of relying on interviews as the primary data source, although this was complemented by secondary data from various reports and publications. The study focuses on two specific countries and might not fully represent the diversity of situations across all EU countries. Further research should examine a wider range of countries and production systems to enhance generalizability. The relatively small size of the workshop participant group constitutes another limitation of the study.