0:00:00.841,0:00:03.833
There was a time[br]when simple infections were deadly,

0:00:03.857,0:00:07.293
but now, thanks to the wide[br]availability of antibiotics,

0:00:07.317,0:00:09.651
this is merely a relic of the past.

0:00:10.030,0:00:12.260
But actually, I should say "was,"

0:00:12.284,0:00:16.442
because nowadays,[br]we're using antibiotics so much

0:00:16.466,0:00:18.880
that the bacteria[br]that cause these infections

0:00:18.904,0:00:20.497
are becoming resistant.

0:00:20.521,0:00:23.610
And that should really scare[br]the hell out of all of us.

0:00:24.125,0:00:28.339
If we do not change our behavior[br]and wean ourselves off antibiotics,

0:00:28.363,0:00:31.704
the UN predicts that by 2050,

0:00:31.728,0:00:36.323
antimicrobial resistance[br]will become our single biggest killer.

0:00:36.887,0:00:38.759
So we must start to act.

0:00:39.681,0:00:41.998
But "where to begin"[br]is an interesting question,

0:00:42.022,0:00:45.251
because we humans are not[br]the only ones using antibiotics.

0:00:45.275,0:00:50.133
Worldwide, 50 to 80 percent[br]of all antibiotics are used by animals.

0:00:50.863,0:00:53.426
Not all of these are critical[br]for human health,

0:00:53.450,0:00:55.942
but if we do not get it[br]under control right now,

0:00:55.966,0:00:59.542
we're looking at a very scary future[br]for humans and animals alike.

0:01:00.809,0:01:04.181
To begin, let's talk[br]about how we ended up here.

0:01:04.205,0:01:09.543
The first large-scale use of antibiotics[br]was in the early '50s of the last century.

0:01:09.863,0:01:12.601
In the Western world,[br]prosperity was increasing

0:01:12.625,0:01:15.315
and people wanted to eat[br]more animal protein.

0:01:15.831,0:01:18.895
When animals were sick,[br]you could now treat them with antibiotics

0:01:18.919,0:01:20.966
so they did not die and kept growing.

0:01:20.990,0:01:22.387
But soon, it was discovered

0:01:22.411,0:01:25.704
that adding small and regular amounts[br]of antibiotics to the feed

0:01:25.728,0:01:27.212
kept the animals healthy,

0:01:27.236,0:01:29.061
made them grow faster

0:01:29.085,0:01:31.037
and caused them to need less feed.

0:01:31.061,0:01:33.323
So these antibiotics worked well --

0:01:33.347,0:01:35.021
really well, actually.

0:01:35.045,0:01:37.363
And with increasing animal production,

0:01:37.387,0:01:40.398
also antibiotic use skyrocketed worldwide.

0:01:41.034,0:01:44.018
Unfortunately,[br]so did antibiotic resistance.

0:01:45.066,0:01:49.399
The reason your doctor tells you[br]to finish the entire bottle of antibiotics

0:01:49.423,0:01:53.058
is if you shorten your dose,[br]you will not kill all of the bugs.

0:01:53.082,0:01:57.123
And the ones that stick around[br]build up the antibiotic resistance.

0:01:57.923,0:02:02.133
It's the same problem with giving animals[br]small and regular doses of antibiotics:

0:02:02.157,0:02:04.839
some bad bugs die but not all of them.

0:02:04.863,0:02:07.276
Spread that across an entire industry,

0:02:07.300,0:02:09.768
and you can understand[br]that we accidentally build up

0:02:09.792,0:02:13.339
a large reservoir[br]of antibiotic-resistant bacteria.

0:02:15.006,0:02:16.560
But I hate to break it to you --

0:02:16.584,0:02:18.651
the problem doesn't stop there.

0:02:18.998,0:02:21.656
You know who else takes antibiotics?

0:02:21.680,0:02:23.921
Fluffy, your cat, and Rover, your dog.

0:02:23.945,0:02:25.064
(Laughter)

0:02:25.088,0:02:28.415
Pets rank even amongst[br]the heaviest users of all,

0:02:28.439,0:02:29.832
and they use antibiotics

0:02:29.856,0:02:32.148
that are much more critical[br]for human health.

0:02:32.709,0:02:36.831
Combine this with how close[br]we live with our companion animals

0:02:36.855,0:02:38.577
and you understand the risk

0:02:38.601,0:02:43.299
of you picking up antibiotic-resistant[br]bacteria from your own pet.

0:02:45.141,0:02:48.153
But how do these[br]antibiotic-resistant bacteria

0:02:48.177,0:02:50.109
in farm animals affect you?

0:02:50.133,0:02:52.856
Let me give you an example[br]we have, actually, data on.

0:02:53.600,0:02:58.100
The levels of antibiotic-resistant[br]salmonella in pigs in Europe

0:02:58.124,0:03:00.545
against different types of antibiotics

0:03:00.569,0:03:04.307
range from less than a percent[br]to as high [as] 60 percent.

0:03:04.728,0:03:06.625
Which means that in most cases,

0:03:06.649,0:03:10.378
this antibiotic will not work anymore[br]to kill this salmonella.

0:03:11.228,0:03:13.164
And there was a high correlation

0:03:13.188,0:03:16.109
between antibiotic-resistant[br]salmonella in the pig

0:03:16.133,0:03:17.871
and in the final product.

0:03:17.895,0:03:19.807
Whether that is pork chop,

0:03:19.831,0:03:21.474
spare ribs or minced meat.

0:03:21.950,0:03:25.388
Now, luckily, typically[br]less than one percent

0:03:25.412,0:03:27.911
of all raw meat, fish or eggs

0:03:27.935,0:03:29.352
will contain salmonella.

0:03:29.847,0:03:32.958
And this only poses a risk[br]when not treated well.

0:03:33.530,0:03:38.195
Still, there are over 100,000[br]human salmonella cases in the EU

0:03:38.219,0:03:40.885
and more than a million cases in the US.

0:03:41.822,0:03:45.107
In the US, leading[br]to 23,000 hospitalizations

0:03:45.131,0:03:47.844
and 450 people dead each year.

0:03:49.201,0:03:51.511
With antibiotic-resistant[br]salmonella on the rise,

0:03:51.535,0:03:54.053
this death toll is likely to increase.

0:03:55.416,0:03:58.029
But it's not only[br]about consuming yourself.

0:03:58.053,0:04:00.831
This year, more[br]than 100 people got infected

0:04:00.855,0:04:03.656
with a multidrug-resistant salmonella

0:04:03.680,0:04:06.814
after feeding pig ears,[br]as a treat, to their dog.

0:04:07.915,0:04:11.923
So we really must cut back[br]on antibiotic use in animal production.

0:04:11.947,0:04:14.050
And luckily, this is starting to happen.

0:04:14.534,0:04:17.101
The EU was the first region to ban

0:04:17.125,0:04:19.998
putting antibiotics[br]in low doses in the feed.

0:04:20.022,0:04:22.664
From '99 on, in several steps,

0:04:22.688,0:04:25.763
the amount of different types[br]of antibiotics allowed was reduced,

0:04:25.787,0:04:28.660
and in 2006, a complete ban[br]went into place.

0:04:29.089,0:04:30.771
Antibiotics were only allowed

0:04:30.795,0:04:33.513
when a veterinarian determined[br]the animal was sick.

0:04:34.168,0:04:35.327
Sounds great, right?

0:04:35.351,0:04:36.521
Problem solved.

0:04:36.545,0:04:38.012
No, wait, not so fast.

0:04:38.625,0:04:41.220
As soon as the reduction program started,

0:04:41.244,0:04:43.252
it was very quickly discovered

0:04:43.276,0:04:45.633
that antibiotics had been[br]the perfect blanket

0:04:45.657,0:04:47.905
to cover up a lot of bad farm practices.

0:04:48.276,0:04:50.204
More and more animals became sick

0:04:50.228,0:04:52.895
and needed to be[br]cured with ... antibiotics.

0:04:53.347,0:04:55.791
So instead of the total amount going down,

0:04:55.815,0:04:57.282
it actually increased.

0:04:57.879,0:05:00.156
Surely, that was not the way to go.

0:05:00.180,0:05:02.878
But luckily, that was not[br]the end of the story.

0:05:02.902,0:05:06.195
The whole European agricultural sector[br]started on a journey,

0:05:06.219,0:05:08.887
and I think it's a journey[br]anybody can learn from.

0:05:09.878,0:05:12.402
This is also the time[br]I personally entered the scene.

0:05:12.426,0:05:15.160
I joined a large European feed compounder.

0:05:15.184,0:05:19.807
A feed compounder makes a total diet[br]for a farmer to feed to his animals

0:05:19.831,0:05:21.771
and often also provides the advice

0:05:21.795,0:05:24.323
on how to raise the animals[br]in the best way.

0:05:24.657,0:05:27.451
I was really motivated[br]to work together with my colleagues,

0:05:27.475,0:05:29.855
veterinarians and, of course, the farmers

0:05:29.879,0:05:33.712
to figure out how to keep the animals[br]healthy and antibiotic-free.

0:05:34.212,0:05:36.712
Now there are three major things[br]that need to happen

0:05:36.736,0:05:38.387
for antibiotic-free production.

0:05:38.411,0:05:40.362
Let me walk you through the playbook.

0:05:40.386,0:05:42.847
To start -- and it sounds very obvious --

0:05:42.871,0:05:44.911
that our hygiene is the place to start.

0:05:45.212,0:05:47.942
Better cleaning of the stable[br]and the drinking-water lines

0:05:47.966,0:05:51.585
making it harder for the disease[br]to come in and spread across the stable.

0:05:52.419,0:05:53.934
That's all very important,

0:05:53.958,0:05:56.395
but the part I was personally[br]most interested in

0:05:56.419,0:05:58.133
was better feeding for the animals,

0:05:58.157,0:05:59.307
better nutrition.

0:05:59.760,0:06:02.228
Feeding a well-balanced diet is important.

0:06:02.252,0:06:03.411
Think about it this way:

0:06:03.435,0:06:06.583
when you yourself do not eat[br]enough fiber, you do not feel well.

0:06:07.061,0:06:10.101
Part of the food you consume[br]is not digested by yourself

0:06:10.125,0:06:13.045
but fermented in your large[br]intestine by bacteria.

0:06:13.379,0:06:16.517
So you're feeding those microbes[br]with part of your diet.

0:06:17.768,0:06:21.371
Initially, most young animals[br]were fed low-fiber,

0:06:21.395,0:06:23.204
high-starch and protein,

0:06:23.228,0:06:26.209
very finely ground[br]and highly digestible diets.

0:06:27.041,0:06:29.850
Like being yourself on a diet[br]of hamburger buns,

0:06:29.874,0:06:32.199
rice, waffles and protein bars.

0:06:33.342,0:06:36.712
We changed this to a lower-protein,

0:06:36.736,0:06:39.307
higher-fiber, coarser type of diet.

0:06:39.807,0:06:43.723
Like being on a diet of whole grains,[br]salad with meat or beans.

0:06:44.363,0:06:47.103
This shifted the bacterial flora[br]in the animals' guts

0:06:47.127,0:06:48.863
to the more beneficial ones

0:06:48.887,0:06:51.944
and reduced the chance[br]that pathogens would flourish.

0:06:52.457,0:06:53.687
You might be surprised

0:06:53.711,0:06:56.815
but not only diet composition,[br]also diet structure plays a role.

0:06:57.203,0:07:00.195
Simply the fact[br]that the same diet is coarser

0:07:00.219,0:07:02.536
will lead to a better-developed[br]digestive tract,

0:07:02.560,0:07:04.427
and thus, a healthier animal.

0:07:05.564,0:07:09.570
But the best part was that farmers[br]started to buy this actually, too.

0:07:10.136,0:07:12.086
Unlike some other parts of the world,

0:07:12.110,0:07:16.228
Western European farmers mainly still make[br]their independent buying decisions:

0:07:16.252,0:07:18.704
who to buy the feed from[br]and sell their animals to.

0:07:19.149,0:07:21.196
So what you're actually selling in the end

0:07:21.220,0:07:23.701
reflects the actual local need[br]of these farmers.

0:07:24.339,0:07:25.498
For example,

0:07:25.522,0:07:27.204
the protein content in piglet diets

0:07:27.228,0:07:30.323
in countries that are much more vigilant[br]in reducing antibiotics,

0:07:30.347,0:07:32.566
like, for example,[br]Germany and the Netherlands,

0:07:32.590,0:07:34.934
were already 10 to 15 percent lower

0:07:34.958,0:07:38.162
than in a country like the UK,[br]which was slower to pick this up.

0:07:39.742,0:07:43.099
But, like with better hygiene,[br]better nutrition helps

0:07:43.123,0:07:46.020
but will not totally prevent you[br]from becoming sick.

0:07:46.044,0:07:47.424
So more is needed.

0:07:47.760,0:07:50.236
And that's why we turned[br]to the microbiome.

0:07:50.831,0:07:53.006
Making the water with the feed more acidic

0:07:53.030,0:07:54.815
helps to create an environment

0:07:54.839,0:07:57.204
that benefits the more beneficial bacteria

0:07:57.228,0:07:59.028
and inhibits the pathogens.

0:07:59.514,0:08:00.665
Like fermented food,

0:08:00.689,0:08:03.566
whether it's yogurt, sauerkraut or salami,

0:08:03.590,0:08:05.578
they'll all spoil less quickly, too.

0:08:07.018,0:08:08.812
Now, with modern techniques,

0:08:08.836,0:08:11.415
like the ones based on DNA testing,

0:08:11.439,0:08:15.141
we can see that there are many more[br]different microorganisms present.

0:08:15.165,0:08:18.156
And this ecosystem,[br]which we call the microbiome,

0:08:18.180,0:08:20.267
is much more complex.

0:08:21.109,0:08:25.379
Turns out there are about eight times[br]more microorganisms in your gut

0:08:25.403,0:08:27.336
as tissue cells in your body.

0:08:27.815,0:08:30.101
And for animals, the impact is no less.

0:08:31.495,0:08:34.582
So if we want to work[br]without antibiotics in animal production,

0:08:34.606,0:08:37.590
we have to make the animals[br]much more robust.

0:08:37.614,0:08:39.487
So that when a disease strikes,

0:08:39.511,0:08:41.353
the animals are much more resilient.

0:08:41.920,0:08:44.951
And this three-pronged[br]nutribiosis approach

0:08:44.975,0:08:48.475
involving the host, nutrition[br]and the microbiome

0:08:48.499,0:08:50.094
is the way to do it.

0:08:50.118,0:08:54.077
Now the practice of raising animals[br]on an antibiotic-containing

0:08:54.101,0:08:57.823
or antibiotic-use-provoking diet[br]is a bit cheaper at farm level.

0:08:59.132,0:09:02.910
But in the end, we are talking about[br]a few percent at the consumer level.

0:09:02.934,0:09:04.466
That's actually quite affordable

0:09:04.490,0:09:07.633
for the middle- and high-income[br]part of the world population.

0:09:07.657,0:09:09.696
And a very small price to pay

0:09:09.720,0:09:13.146
when our own health[br]or our loved ones' health is at stake.

0:09:13.965,0:09:16.403
So what do you think,[br]what direction do we take?

0:09:16.823,0:09:21.260
Do we allow antimicrobial resistance[br]to become our biggest killer,

0:09:21.284,0:09:24.484
at huge financial[br]and a special personal cost?

0:09:24.974,0:09:29.494
Or do we, besides reducing[br]human antibiotic consumption,

0:09:29.518,0:09:33.037
truly start embracing[br]antibiotic-free animal production?

0:09:33.371,0:09:35.704
For me, the choice is very obvious.

0:09:36.085,0:09:37.601
But to make this happen,

0:09:37.625,0:09:39.299
we have to set reduction targets

0:09:39.323,0:09:42.434
and make sure that they're followed[br]all around the world.

0:09:42.458,0:09:44.403
Because farmers compete with each other.

0:09:44.427,0:09:45.776
And at a country level,

0:09:45.800,0:09:47.704
trading block or the global market,

0:09:47.728,0:09:49.553
costs are very important.

0:09:49.577,0:09:51.260
And also, we have to be realistic.

0:09:51.284,0:09:53.458
Farmers need to have the possibilities

0:09:53.482,0:09:56.672
to invest more in better[br]management and better feed

0:09:56.696,0:09:58.505
in order to achieve this reduction.

0:09:59.474,0:10:02.527
And besides legal limits,[br]the market can play a role,

0:10:02.551,0:10:06.336
by offering antibiotic-reduced[br]or antibiotic-free products.

0:10:07.038,0:10:09.180
And with growing consumer awareness,

0:10:09.204,0:10:11.814
these market forces[br]will increase in power.

0:10:12.675,0:10:15.960
Now everything I've been talking about[br]seems to be great for us.

0:10:15.984,0:10:17.784
But what about the animals?

0:10:18.175,0:10:20.476
Now, guess what,[br]their lives get better, too.

0:10:20.500,0:10:23.233
Better health, less stress, happier life.

0:10:23.839,0:10:25.156
So now you know.

0:10:25.180,0:10:30.323
We have the knowledge[br]how to produce meat, eggs and milk

0:10:30.347,0:10:33.735
without or with very low[br]amounts of antibiotics,

0:10:33.759,0:10:36.308
and I'll argue it's a small price to pay

0:10:36.332,0:10:39.430
to avoid a future[br]in which bacterial infections

0:10:39.454,0:10:41.587
again become our biggest killer.

0:10:41.905,0:10:43.078
Thank you.

0:10:43.102,0:10:46.352
(Applause)