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

The paper examines why antibiotic use in pig production differs so markedly between Italy (244 mg/PCU) and Sweden (12.5 mg/PCU), and how these differences relate to public health risks linked to antimicrobial resistance (AMR). It situates animal antibiotic consumption—two-thirds of global antibiotic use—within the context of routine prophylaxis and growth promotion in intensive systems, with transmission pathways to humans via environment, food, and farm work. The authors highlight EU regulatory history (1998–2006 bans on antibiotics as growth promoters), Sweden’s earlier 1986 national ban, and differences in antibiotic classes used (narrow-spectrum in Sweden versus higher broad-spectrum use in Italy). The core research aim is to pinpoint the role and drivers of antibiotic use in Swedish and Italian pig meat production and to identify system-level changes necessary for substantial reductions, emphasizing that the study seeks to outline systemic enablers rather than make a strict farm-by-farm comparison.

The review traces antibiotics’ trajectory from ‘magic bullets’ to embedded economic tools in intensive animal agriculture. Key points include: (1) post-1949 findings (Stokstad & Jukes) spurred massive research and adoption of antibiotics as feed additives; (2) antibiotics enabled intensification (higher stocking density, faster growth, reduced labor) and became routine for group treatment in pigs and poultry; (3) the Swann Report (1969) recognized health risks and recommended restricting certain classes but left a back door via veterinary prophylaxis, limiting impact; (4) across Europe, except Sweden, early restrictions on growth promoters had minimal effect due to continued non-therapeutic uses and prescriptions; (5) public debates sparked by environmental and animal welfare movements (Carson, Harrison) contrasted with policy and commercial incentives that favored antibiotic-dependent systems; (6) later analyses emphasize how political cultures and path dependencies shape national antibiotic policies and resistance burdens.

The study adopts a process-oriented innovation perspective (Industrial Network approach), focusing on resource interaction patterns across using, producing, and developing settings. Data collection combined: (1) 42 semi-structured interviews with actors across Sweden and Italy (farmers; slaughterhouses/processing firms; farmers’ associations; veterinarians; microbiologists; medical researchers; retail and consumer organization representatives), including site visits; (2) analysis of international and national reports (ESVAC/EMA, WHO, FAO) and published studies on antimicrobial use/resistance and animal health; (3) participant observation at a May 2019 Uppsala University workshop on antibiotics and resistance in pig meat production; and (4) media and policy document analysis (EU regulations, national plans, retailer policies). The study’s aim is descriptive-analytical, outlining systemic changes enabling reduced antibiotic use rather than conducting a strict comparative causal analysis.

- Sweden’s systemic transition: Sweden banned antibiotic growth promoters in 1986, initiating broad changes in production to compensate for the loss of routine prophylaxis. After initial spikes in infections and piglet mortality, coordinated investments in biosecurity and animal health (batch-based production; redesigned stables with stage-specific sections; extended weaning ≥26 days for ≥90% of piglets; quarantine for new animals; strict hygiene; no tail docking; straw bedding; restrictions on transporter entry; veterinary oversight with state-employed District Veterinarians; individual medical records for animals) reduced antibiotic use from ~50 mg/PCU pre-ban to ~30 mg/PCU in early 1990s and to ~11–12 mg/PCU by 2018 (about 10% group treatments remaining). Sweden predominantly uses narrow-spectrum penicillins; LA-MRSA in pig herds is not detected in screening; Salmonella control is strong. - Role of outsiders/insiders in Sweden: Media, authors, and researchers raised public concern from the late 1960s onward; pioneering farmers and the Swedish Farmers Association drove voluntary phase-out (1981) and pushed for the 1986 legal ban. A 1988 animal welfare law reinforced precautionary health. Despite expectations, market rewards lagged; EU accession (1995) led to competition from lower-cost, higher-antibiotic systems, reducing Swedish production from ~4 million pigs to ~2.6 million/year. Around 2014, retailers (ICA, Coop, Axfood) adopted policies restricting routine antibiotic use and branded ‘Swedish meat’, improving consumer acceptance despite a 0.2–0.3 Euro/kg price premium. - Italy’s persistent high use and system characteristics: Italy recorded 244 mg/PCU (2018) veterinary antibiotic sales and high broad-spectrum use; LA-MRSA is prevalent (~35% of herds). Production is dominated by large integrated firms in the North, with ‘open cycle’ systems: early weaning (≈21 days common in open systems), frequent transport and mixing of pigs between specialized farms, high stocking densities, common tail docking and sow fixation (~123 days/year), limited bedding, and environmental stressors (humidity up to 80%, temperatures 30–35°C). These conditions increase disease risk and stress, underpinning routine prophylactic group treatments via electronic veterinary prescriptions. Professional role overlaps (firm, private, and public veterinarians; potential conflicts of interest) and limited enforcement enable ongoing prophylaxis. - Policy and public engagement differences: Italy’s public awareness of AMR is low; pressure for change stems mainly from EU-level scrutiny (ECDC 2017 country visit; PNCAR 2017–2020 plan; mandatory electronic veterinary prescriptions in 2018; 2020 parliamentary motions). Retail initiatives (e.g., Coop-Italia, 2017) have been incremental and framed as marketing experiments; consumer response to ‘antibiotic-free’ labels is mixed. Small/organic producers (notably poultry first) show more adaptation than dominant pig producers, who fear brand damage to ‘Italian food’ quality labels. - Cross-case insight: Legal bans alone are insufficient. Effective reduction requires: (1) shared beliefs among adopters regarding AMR risks, (2) willingness and capacity to invest in new material and organizational structures (biosecurity, facility redesign, husbandry practices), and (3) a ‘fair’ distribution of costs and benefits across producers, retailers, healthcare, and society. Sweden’s experience shows the heavy transitional costs borne by producers and the long delay before market recognition; Italy illustrates how strong food branding and weak public debate can maintain status quo.

The findings address the research questions by demonstrating that antibiotic use levels are shaped by socio-technical systems, path dependencies, and incentive structures rather than by technical feasibility alone. Sweden achieved sustained reductions through coordinated insider mobilization (farmers, associations, veterinarians, researchers) catalyzed by outsider pressure (media, public debate), plus regulatory backing and extensive material reconfiguration of production. Yet benefits (reduced AMR risk) accrue largely outside the farm gate, while costs fall on producers, creating a misaligned incentive environment that delayed market rewards until retailers reframed value propositions to consumers. In Italy, absent strong public discourse on AMR and with powerful quality-brand narratives, producers and policymakers have prioritized continuity, tolerating prophylactic group treatments despite EU restrictions on growth promotion and introducing only incremental oversight (e-prescriptions) without banning prophylaxis. The comparison underscores that bans must be coupled with investment support, clear veterinary governance, biosecurity standards, and retailer/consumer alignment to shift routines. It also highlights heterogeneity in veterinary roles and enforcement as critical levers and risks.

The paper shows that radically reducing antibiotics in pig production is achievable with existing knowledge by reconfiguring production systems toward precautionary health and biosecurity, as Sweden has done. However, legal prohibition of routine group treatment is not sufficient; change requires shared norms, targeted investments in facilities and practices, robust veterinary governance, and economic mechanisms that distribute costs and benefits so producers are incentivized to adopt. Italy’s experience illustrates how branding, governance gaps, and limited public awareness can entrench prophylactic use. Future efforts should pair regulatory bans (e.g., EU veterinary medicines/medicated feed regulations effective January 28, 2022) with sustained cross-actor coordination, transparency in veterinary roles, retail procurement standards, and consumer communication. Potential future research could examine implementation of the 2022 EU regulations across member states, the design of incentive schemes to share costs, and impacts on global trade competitiveness for producers transitioning away from prophylaxis.

The study is qualitative and descriptive, based on 42 interviews, document analysis, and participant observation, and explicitly does not provide a strict, detailed comparative causal analysis of all practice variants or direct resistance outcomes. Data from interviews are not publicly available due to privacy, and some national statistics (e.g., certain surveillance samples) are limited in size. Findings reflect the Swedish and Italian contexts and may not generalize to all EU production systems.