Safe Food: The Politics of Food Safety (46 page)

Anthrax is normally a veterinary problem. Infected animals are so visibly sick that farmers cull them before they get into the meat supply. Infected cows are too sick to produce milk, or they produce milk of unusable quality, which is why milk and cheese are not known sources of anthrax. Digestive acids and enzymes—and cooking—ordinarily kill the bacteria, and people seem to have some natural immunity. Because heavy bacterial infestations overcome these defenses and spores resist them, people occasionally acquire anthrax from eating undercooked meat from sick or downer water buffalo, goats, sheep, and cattle. Even so, food-borne anthrax is so rare that medical journals like to report the occasional cases. In August 2000, for example, Minnesota health officials described an outbreak of anthrax in a farm family whose members ate meat from a downer steer. When family members became ill, investigators discovered that the carcass was heavily infested with anthrax bacteria.
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Anthrax would be almost nonexistent in people if eating it were the only route of infection, but it also causes disease through the skin and lungs. The skin disease comes from handling infected carcasses. The lung disease comes from breathing in spores from infected animal skins or soil. These forms also are relatively rare. In the United States, health officials reported about 225 cases of the skin disease over the 50-year period from 1944 to 1994. In 2001, they added to this total a man in North Dakota who had disposed of five cows dead of anthrax. Officials logged
only 18 cases of inhalation anthrax from 1900 to 1978, and just two from 1992 to 2000.
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Nevertheless, the hardiness and lethality of anthrax spores has long suggested their potential as agents of germ warfare, and numerous countries worked on secret anthrax bioweapons projects during the Cold War. Much of what is known about weapons-grade anthrax comes from studies of a single epidemic in the former Soviet Union in 1979. When the Soviet state collapsed, scientists were able to trace the epidemic to an accidental release of an aerosol of anthrax spores from a nearby germ weapons factory. Nearly all of the unlucky people and animals who developed the disease were downwind of the factory when the plume of invisible spores blew over.
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Even before the U.S. anthrax mailings in 2001, experts on bioterrorism understood that anthrax is simple to grow, is durable, and is suitable for many forms of delivery, and that many countries had stockpiled spores: “The long-dreaded concern that chemical and biological weapons might reach terrorist hands is now a reality.”
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The United States worked on inhalation anthrax during the Cold War, and although it and numerous other countries signed a treaty in 1993 against this use, at least 10 countries are thought to be working on such projects. Ironically, because the spores mailed in 2001 were weapons-grade, some experts suspected they must have come from a U.S. military insider eager to demonstrate the need for more research on biological weapons. They were proven correct after a long, poorly handled investigation.
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The effects were devastating. During the following year, health officials logged 22 cases of anthrax caused by the mailings, among them five deaths. They investigated hundreds of reports of possible exposure and closed several government buildings to clear them of spores. As political commentator Daniel Greenberg explained, it had taken a “malevolently brilliant [attack] ideal to reach the ears and fears of the public.” The attack focused attention on anthrax and induced political leaders to take action against bioterrorism. In 2002, President George W. Bush authorized $1.1 billion for bioterrorism control, much of it for strengthening the capacity of the public health system.
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Dealing with anthrax attacks, however, is no simple matter. As a preventive measure, officials treated 32,000 people who
might
have been exposed to anthrax with the protective antibiotic ciprofloxacin (cipro). Cipro is the most effective antibiotic against anthrax, largely because weapons programs deliberately created strains of the bacteria resistant to more common antibiotics such as penicillin. The drug produces unpleasant side effects—itching, swelling, and breathing problems—in
nearly 20% of its takers. For this reason, and because of carelessness or inconvenience, many people stop taking the drug before completing the full course of treatment, thereby establishing conditions that favor the emergence of cipro-resistant anthrax—an utterly alarming scenario.
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Cipro has additional connections to food safety issues. It is a fluoroquinolone antibiotic closely related to another antibiotic, enrofloxacin, that is widely used to treat chickens and turkeys for respiratory ailments. The antibiotics are essentially the same; chickens metabolize enrofloxacin to cipro. Doctors have treated human infections with fluoroquinolone antibiotics since 1986, but resistance did not become a problem until 1996, when the FDA authorized use of these drugs to treat bacterial infections in poultry. As is customary, farmers fed the drug to entire flocks of chickens even if just a few were sick. Baytril, the enrofloxacin drug produced by Bayer, for example, is used on 128 million chickens worldwide and generates about $150 million in annual sales. By 1999, 18% of
Campylobacter
in chickens resisted enrofloxacin, and people exposed to such chicken bacteria could no longer be treated with cipro; 9,000 such cases were recorded that year. In 2000, the FDA proposed to ban the use of fluoroquinolone antibiotics in poultry feed. The other company making the poultry drug, Abbott Laboratories, agreed to discontinue using it in chickens, but Bayer contested the ban and keeps Baytril on the market. Bayer argues that the problem is overestimated and that withdrawing the drug would have little effect on the extent of antibiotic resistance. The company explains that using antibiotics in chickens is good for people as well as poultry: “If we are what we eat, we’re healthier if they’re healthier.”
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Drug companies may have little choice about giving up such drugs, however. Early in 2002, the three largest U.S. chicken producers, Tyson Foods among them, said they would reduce use of enrofloxacin, and McDonald’s said it had decided a year earlier not to use meat from animals treated with fluoroquinolone antibiotics.
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Anthrax is not yet resistant to cipro, but it is likely to become so if the drug is given indiscriminately to large numbers of people who do not need it and do not complete the full course of treatment. The continued use of the analogous drug in chickens will almost certainly increase the numbers and kinds of resistant bacteria. In Taiwan, 60% of pathogenic
Salmonella
isolated from hospital patients have been shown to resist cipro; genetic techniques indicated that the resistant bacteria originated in herds of pigs treated with the drug. Scientists have now shown that giving cipro to chickens rapidly selects for resistant
Campylobacter
.
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These antibiotics connect to the issues discussed in this book in one
other way. In yet another ironic twist, Bayer, the maker of enrofloxacin, acquired Aventis CropScience in December 2001 for
6 billion (euros), thereby becoming the owner of StarLink corn and other transgenic varieties. The merger unites the crop protection activities of Bayer and Aventis into a new company, Bayer CropScience, expected to generate more than
8 billion in annual sales by 2005.
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In revealing the vulnerability of the United States to harm from terrorists, the September 2001 attacks affected food safety issues in at least four ways. They (1) shifted the common use of the term
food security
to mean protection of the food supply against bioterrorism, (2) raised alarms about the ways food and biotechnology could be used as biological weapons, (3) encouraged more forceful calls for a single food agency to ensure food security, and (4) focused attention on the need for a stronger public health system to address food safety crises. Despite the apparent unity of purpose in dealing with the aftermath of the attacks, each of these effects displays the usual politics, to which we now turn.

Prior to the terrorist attacks, food security in the United States had a relatively narrow meaning that derived from the need to establish criteria for deciding whether people were eligible to receive welfare and food assistance. In the 1980s, the U.S. government expanded its definition of “hunger” to include involuntary lack of access to food—the
risk
of hunger as well as the physical experience. By this definition, food security came to mean
reliable access to adequate food
.
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The international definition is broader, however. In 1948, the United Nations adopted the Universal Declaration on Human Rights, which said, “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and the necessary social services, and the right to security in the event of unemployment, sickness, disability, widow-hood, old age or other lack of livelihood in circumstances beyond his control.”
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Many interpret this provision to mean that people have a
right
to food security, in this case encompassing five elements: (1) reliable access to food that is not only (2) adequate in quantity and quality, but
also (3) readily available, (4) culturally acceptable, and (5) safe. With respect to safety, the Geneva Convention of August 1949, an international agreement on the protection of civilians during armed conflict, expressly prohibited deliberate destruction or pollution of agriculture or of supplies of food and water. These broader meanings derived from work in international development, where it was necessary to distinguish the physical sensation of hunger (which can be temporary or voluntary), from the chronic, involuntary lack of food that results from economic inequities, resource constraints, or political disruption.
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The significance of the lack-of-access meaning of food security is evident from a health survey conducted in a remote region of Afghanistan just a few months prior to the September 2001 attacks. Not least because of decades of civil strife, Afghanistan is one of the poorest countries in the world, and its health indices are dismal: a life expectancy of 46 years (as compared to 77 years in the United States) and an infant mortality rate of 165 per 1,000 live births (as compared to 7).
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At the time of the survey, the United Nations World Food Programme estimated that 3.8 million people in Afghanistan lacked food security and therefore required food aid. Investigators examined the health consequences of this lack and found poor nutritional status to be rampant in the population and a contributing factor in nearly all of the deaths that occurred during the survey period. Half of the children showed signs of stunted growth as a result of chronic malnutrition. Scurvy (the disease resulting from severe vitamin C deficiency) alone accounted for 7% of deaths among children and adults. Because visible nutrient deficiency diseases like scurvy are
late
indicators of malnutrition, the investigators viewed the level of food insecurity as a humanitarian crisis—less serious than in parts of Africa, but worse than in Kosovo during its 1999 upheavals.
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After October 2001, when bombing raids led to further displacement of the population, the United Nations increased its estimate of the size of the food insecure population to 6 million and predicted that the number would grow even larger as humanitarian aid became more difficult to deliver.

In part to alleviate shortages caused by the bombings, resulting dislocations, and the collapse of civic order, the United States began a program of food relief through airdrops. The packages, labeled “Food gifts from the people of the United States of America,” contained freeze-dried lentil soup, beef stew, peanut butter, jelly, crackers, some spices, and a set of plastic utensils, and provided one day’s food ration for an adult—about 2,200 calories. Beginning in October 2001, airplanes dropped about
35,000 food packages a day. The quantities alone suggested that their purpose had more to do with politics than food security.
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A British commentator did the calorie counts: