The Abstinence Method

The Abstinence Method

Dutch farmers just say no to antibiotics for livestock.

Photography by Henk Wildschut

To American eyes, the Hoeve de Hulsdonk farm, outside the small town of Beers in the southeastern Netherlands, looks like some radical exercise in farming transparency. There’s a bike trail to lure you onto the property, and picnic tables to keep you there. The dark metal barn, towering two stories above the farmhouse and tractors, has huge horizontal windows punched into its sides. And if you’d like a better view of the more than 17,000 pigs raised there each year, you can climb stairs to a public viewing parlor, and look down on the hogs from above.

All this because owner Gerbert Oosterlaken believes the more you can see, the better.

Along with every other livestock producer in the Netherlands, Oosterlaken is in the midst of a high-stakes, government-mandated experiment: Can large-scale meat production succeed without routine use of antibiotics? “Growth promoters,” the microdoses of everyday antibiotics given to livestock to fatten them, have been banned in Europe since 2006—but the Netherlands decided to go even further. Since 2009, Dutch farmers have cut animal drug use by half without harming either animal welfare or their own profits. Four years into the project, their accomplishment has huge implications for farming throughout the world.

“We decided that animal health, and human health, would be our priority,” Oosterlaken told me last fall in his barn, surrounded by warm plastic-lined pens where sows snoozed and new piglets squealed. “I don’t need to take antibiotics every day. There’s no reason my pigs should either.”

Overalls and boots whose colors correspond to different zones, helping control the spread of diseases.
Blue boots on wall.
Yellow boots on wall.

    Antibiotics have been a crucial (and controversial) component of meat production for decades. In the late 1940s, biologists inadvertently discovered that feeding livestock tetracycline made the animals grow faster and from that revelation, an industry was born. Today, food-producing animals raised and eaten in the United States receive almost 30 million pounds of antibiotics per year. That’s several times what our country’s 300 million humans take and, unlike humans, animals receive antibiotics when they are not sick.

    Most of those 30 million pounds are given to pigs, chickens and cattle in small doses every day, for growth promotion and disease prevention — that is, to fatten them and protect them from the conditions in which they are raised.

    This routine drugging has been debated almost since farmers began doing it in the 1950s. The doses given to livestock
 to promote growth or prevent disease are smaller than the amount it would take to cure sick animals; they kill only the weak bacteria, letting stronger, drug-resistant ones survive and spread. British scientists began detecting a spike in antibiotic-resistant infections in humans in the 1960s, and in 1977, the U.S. Food and Drug Administration tried to ban some routine animal dosing, blaming it for increasing amounts of antibiotic resistance. Since then, hundreds of scientific studies have traced a link between antibiotic use in livestock and antibiotic-resistant bacteria on farms and in the outside world.

    At the same time, antibiotic-resistant human illnesses have been worsening around the world, producing what the director of the U.S. Centers for Disease Control and Prevention calls “nightmare bacteria” that cannot be treated by traditional methods.

    So if the Netherlands can reduce routine antibiotic use without harming its farmers’ survival, maybe other countries can, too.

    Large-scale agriculture proponents reject any link between farms and human health problems. In publications and testimony, spokespeople for conventional meat production have said that taking away antibiotics would cut productivity and raise costs.

    But the Netherlands’ success demonstrates this isn’t true. The country is tiny, but its livestock-raising is intensive and high-tech: 17 million people and about 118 million farm animals share a space only the size of Maryland, yet the Netherlands is Europe’s leading meat exporter. So if the Netherlands can reduce routine antibiotic use without harming its farmers’ survival, maybe other countries can, too.

    Ten years ago, the Netherlands was in a paradoxical position. It had very low rates of antibiotic resistance as a result of strict rules for infection prevention in hospitals and mutual agreements about when to use the most powerful drugs. “In human health care, we’ve been top of the class,” says Marieke Mossink, head of the infectious diseases division at the Ministry of Health, Welfare and Sport. “So the difference between our health care and our agriculture was huge.” It turns out that farms in the Netherlands were European leaders in antibiotic use.

    In 2004, the effects of that largescale antibiotic use emerged. A pig farmer’s toddler daughter was taken to a hospital for surgery, received the routine check for resistant bacteria that all Dutch hospital patients get and was discovered to be carrying MRSA, aka drug-resistant staph — a virulent, hard-to-treat infection that can become life-threatening. That was extraordinary: MRSA has become more common in the U.S., but the Netherlands had almost none because of its tight controls on antibiotic use in health care. The girl’s parents carried the organism too; so did their friends, and so did one of their pigs. The strain had a unique resistance signature, indicating it had developed in pigs because of the antibiotics they were given every day, and it was soon found throughout the country, contaminating farms and infiltrating health care. (To this day, when members of Dutch farm families go into hospitals, they are put into isolation rooms until lab tests show they are clear of the germ.)

    With the intention of preventing disease, it takes two to three days to thoroughly disinfect the floor and clear it of manure.

    The idea that farming could transmit a threat to the rest of society shook national confidence. “Many people in the Netherlands have animal production at their back door, so they are always looking at what’s happening,” says Dr. Albert Meijering, a policy officer at the Ministry of Economic Affairs. The “pig MRSA” outbreak — subsequent investigations found the bacteria throughout Europe and in Canada and the U.S. — was followed by another shock: an outbreak on goat farms of Q fever, a disease so infectious that the U.S. government considers it a potential bioterror agent.

    The final blow was the 2009 discovery that another drug-resistant infection, more serious than MRSA, was infiltrating the country. This one, which goes by the acronym ESBL, was spreading via gut bacteria, even in people who had no obvious link to farming. And when researchers looked for the source, they found it in food animals, identifying the related bacteria in patients, in chickens and on chicken meat.

    So, the Dutch minister of agriculture, Gerda Verburg, decided to be bold. She brought the evidence of antibiotic use and its health risks to powerful private organizations (analogous to the U.S. Poultry & Egg Association and National Pork Producers Council) that oversee the raising of different types of animals.

    With their buy-in, she developed a tough new policy: No more preventive dosing. Antibiotics after a veterinary inspection only. And farmers would be expected to cut their use severely: by 20 percent in one year, and 50 percent in three.

    It could have sparked a revolt. Instead, Dutch farmers buckled down. In 2013, the ministry announced that antibiotic sales to livestock farms dropped 56 percent between 2007 and 2012. Farmers had effectively stopped using the most-critical drugs, the ones that posed the greatest risk of creating dangerous resistance in humans.

    Gerbert Oosterlaken, on his farm.
    A sow sleeps with her piglets. Because stress can trigger disease, the babies are kept with their mother longer than usual.
    The visitor's center on Oosterlaken's farm. The mere act that he allows visitors to visit his pig operation is emblematic of the difference between the American and Dutch perspectives on agricultural protocol. Most large-scale livestock operations in the U.S. discourage gawkers.

      “This was done without any big consequences in efficiency, or financial returns,” marvels Jan Kluytmans, a professor of microbiology who monitors antibiotic resistance at Amphia Hospital in the university town of Breda in the southern part of the Netherlands. “I think it indicates they were using too much.”

      The Dutch government’s new antibiotic system is complex but straightforward. Because antibiotics can only be obtained by prescription — not, as in the U.S., from a feed mill or a farm-supply store — veterinarians are the gatekeepers. In fact, farmers must register the name of the veterinarian they work with, which prevents them from shopping around. All farm drug prescriptions become part
of a national database, and farms raising the same type of animal are ranked against each other to gauge how well they are doing. (This year, veterinarians will be ranked against each other as well, to reveal who is prescribing the most drugs.) Antibiotics are also rated; to prescribe the drugs most likely to stimulate serious resistance, a veterinarian must demonstrate that a susceptibility test has been performed and that no other drug will work.

      There are points of tension. Disease-prevention dosing can be a hedge against sloppy practices: With the drugs no longer available, farmers have to pay close attention to hygiene, diet and stress. Not all are willing to do so.

      A Dutch broiler farm that 160,000 chickens call home.

      Good farmers, though, see the new rules as a spark for innovation. In the tiny town of Reek, a few miles from Oosterlaken’s piggery, brothers Rob and Egbert Wingens raise hundreds of thousands of broiler chickens on a farm they inherited and expanded. They tinker with their feed recipe and the temperature in the sheds; lately, to avoid transport stress, they have been buying eggs instead of chicks and hatching the birds in the same building they are raised in. Broilers raised en masse often seem skittish and anxious; but when Rob Wingens opened a barn door for a peek, his 3-week-old chickens tumbled out on sturdy legs and pecked inquisitively at my boots. “In a normal flock, we might lose 3 percent of the birds to early death,” he says. “With the changes we have made, we have forced it down by 1 percent.”

      The Dutch government's new program for restricting antibiotics began in 2010. The graph shows why: Despite a ban on growth promoters, antibiotic use did not diminish.
      Compared to 2009, the last year of unrestricted use, antibiotic use per type of animal fell sharply.

        Oosterlaken also revels in the challenge of farming without the crutch of antibiotics, and proudly shows off the changes he has made on his farm. He is obsessive about biosecurity, requiring visitors to shower and shampoo, change into fresh clothes and underwear that he supplies and then don scrubbed boots color-keyed to different areas. He keeps his barns warm and installed filters to strain ammonia from the air. He lets his sows bear their litters in “loose pens” that keep mother and offspring together, leaves the piglets with their mothers a week longer than standard and feeds them on the pen floor instead of a trough so they eat more slowly. “Really, what we have done is go back to old systems,” he says.

        So has all this attention to detail actually helped animal and human antibiotic resistance? Early data says yes. The 2013 edition of the Netherlands’ annual report on antibiotic usage in animals shows resistant bacteria declining in pigs, veal, chickens and dairy cattle. What will really prove its worth, though, is whether antibioticresistant infections decline in humans too. Kluytmans believes he can see signs of progress. “We can say for sure there is no further increase, and there may even
be a decrease” of ESBL-resistant bacteria in humans, he tells me. “We have to be very careful with this. But if it can be proven, it will be an example that, even on a large scale, you can turn back the tide.”

        This could be the proof that recalcitrant countries like the U.S. will require to think about similar changes. It is validation that the Netherlands needs as well to keep antibiotic reduction going. The Ministry of Agriculture has set
a new goal of reducing drug use again. It wants to force antibiotic use on farms down to 30 percent of where things were before the program started. This stage, everyone agrees, will be the difficult one.

        “We are halfway to where we want to be,” says Mossink, in reference to the Health Ministry. “We need farmers and veterinarians to accept their new roles. We’ll need different stables, different food. We’ll need consumers to be willing to pay a bit more, because meat will be more expensive.”

        Really, she adds, “We are trying to reinvent agriculture in the Netherlands.”

        Interviews with farmers and ministry staff were arranged by the Embassy of the Kingdom of the Netherlands in cooperation with the Pew Charitable Trusts. This story was produced in collaboration with the Food & Environment Reporting Network, an independent, nonprofit news organization that paid reporting and travel expenses.

        (Editor’s Note: A previous version of this article contained a mislabeled y-axis on the for “Trends in antibiotic use  per species, 2009-2012.” It originally read: “% of days per year antiobiotic given.” This label has been updated to read: “Antibiotic use compared to 2009 by percentage of 2009 use.” Captions were also added to both graphs in the piece to provide further context. We regret the error.)