Food Protection Trends - September/October 2016 - 391

20 percent of fresh vegetables, and 41 percent of tree nuts (7). The National Academy of Sciences finds that over 110 countries do not yet have relevant legislation concerning the appropriate conditions for the importation, manufacture, distribution, and use of veterinary products, including antimicrobials (21). This global issue will require worldwide commitment to mitigation strategies. Without a collaborative effort, the future U.S. food supply, with its international sources, will likely be an increased source for disseminating antibiotic-resistant foodborne pathogens. No one can completely avoid the risk of antimicrobial resistance, and without identifying strategies for judicious antibiotic use, the problem stands to become increasingly severe. Developing effective strategies to minimize resistance, accounting for all antibiotic uses, is critical. 1. Antibiotics are critical and precious and need protection. Antibiotics contribute greatly to our increased lifespan and quality of life. 2. Antibiotics are an important tool for the treatment and prevention of disease in both humans and animals. Healthy animals lead to a healthful food supply. There will likely always be some appropriate antibiotic use in the food supply. As in human health, animal antibiotics will be used at certain times in agriculture. 3. Antibiotic use leads to antibiotic resistance. All uses, whether in the context of human medicine, veterinary medicine, or agriculture, exert selection pressure. 4. With antibiotics, less is better. Antibiotics must be used cautiously. Each usage increases the long-term risk borne by future generations. The balance of risk vs. benefit must be an ongoing dialogue among all stakeholders. DISCUSSION The roundtable participants discussed myriad strategies for addressing antibiotic resistance. These strategies are discussed and followed by proposed recommendations. Credible and trustworthy messengers Messengers must be neutral and trustworthy to gain the public's trust. Organizations such as the American Medical Association (AMA), American Public Health Association (APHA), and the American Veterinary Medical Association (AVMA) are all appropriate bodies to disseminate information to human and animal medical communities. The roundtable participants agreed to build stronger messages to connect such entities to interested food organizations already working on these issues, such as Cargill and McDonald's. Drug companies that manufacture antibiotics also would be important stakeholders to engage. Trusted government agencies, such as the U.S. Centers for Disease Control and Prevention (CDC), have already identified medical use concerns (3). Additional stakeholders could include the Pediatric Infectious Disease Society (PIDS), the Infectious Disease Society of America (IDSA), and the Society for Healthcare Epidemiology of America (SHEA). The Pew Research Center and the Natural Resources Defense Council (NRDC) may also represent potential partners. State and county public health leadership, people in community/grassroots efforts, and faith-based organizations can exert local influence. Supermoms Against Superbugs, a group that has advocated against agricultural use of antibiotics, is another potential collaborator. Antibiotics as a precious resource Antibiotics should be considered "global public goods" critical to human health. Part of the fear concerning antibiotic resistance is the possibility of returning to a preantibiotic era, especially because the new drug development pipeline has largely dried up. Antimicrobial stewardship efforts need to focus on strategies to minimize the risk of resistance in order to protect antibiotics, ultimately benefitting public health. This issue is plagued by misinformation and one-sided arguments. Every use ultimately contributes to resistance, whether it is in humans, animals, or crops (20). The World Health Organization (WHO) declared antibiotic resistance to be a worldwide problem. It would be most effective if all stakeholders would own their share of the problem of mitigating growing resistance. In order to succeed at tackling this complex problem, all stakeholders should display credibility, balance, trust, and transparency. Crafting a message Key stakeholders need to communicate information about antibiotic resistance that is simple, credible, balanced, and tailored to help consumers make informed decisions. Messages should be accessible to lay audiences. Real-world examples (e.g., eliminating antibiotic prescriptions for ear infections) can also demonstrate relevance to broad audiences. With any contentious issue, there will always be a small number of extremists committed to their point of view, but most people reside somewhere in the middle, eager for knowledge and anxious to do what is best for themselves, their children, and their communities. Messages should target individuals who fall in the middle of the belief spectrum. Roundtable participants suggest that information about antibiotics should highlight four main themes: The role of social media At present, Facebook is the most-used online social network for adults. In 2015, 62% of the entire adult population of the U.S. used Facebook (16). Twitter and blogs are other important platforms for discussion of two sides of an issue. Accordingly, conversations should discuss antibiotic resistance on and offline. Dr. Natasha Burgert, Dr. Kevin Pho, and others regularly contribute to online discussion groups like "KevinMD.com" where stories and insights are shared with and among members of the human health and medical community. The site features well-read blogs to discuss medical issues with lay audiences. Forming partnerships with such September/October Food Protection Trends 391

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