In a world without antibiotics, most of us would likely not survive past the age of 60. One in 20 babies would probably die before their first birthday, and a simple scratch or a urinary tract infection could be fatal.
It is why resistance to antibiotics is such a threat: the World Health Organization (WHO) lists antimicrobial resistance (AMR) as one of humankind’s top 10 global public health issues. Rising AMR means that common, previously treatable infections, such as respiratory and bloodstream infections, become increasingly difficult or impossible to treat.
In the first comprehensive analysis of the global impact of AMR published last year in The Lancet, researchers estimate that more than 1.2 million people — and potentially millions more — died in 2019 as a direct result of antibiotic-resistant bacterial infections. Another study estimates that as many as 10 million people could die annually from AMR by 2050.
Typically, AMR occurs naturally over time, usually through genetic changes. But the accelerated speed of the spread today is due to decades of misuse and overuse of antibiotics.
And while countries and health organisations scramble to set up guidelines and educational programmes on appropriate antibiotic use, help may be coming from an unexpected source: cutting-edge food technology.
And while what we eat may not seem directly related to antibiotic resistance, AMR emerges in a variety of settings. “AMR occurs globally due to the inappropriate use of antibiotics by pharmacists and hospitals, doctors, and in the environment, for example, with the dumping of waste,” says Dr Anucha Apisarnthanarak, professor and chief of Infectious Diseases at Thammasat University Hospital in Thailand.
But it is not only the human health setting that is to blame; antibiotics are misused in animal farming, too. This is a threat to human health in various ways, including through direct consumption of meat infected with antibiotic-resistant pathogens. Dr Apisarnthanarak points to the example of the high incidence of resistant salmonella in Thailand and how infected exported meat spreads the pathogens beyond its borders.
In fact, more antibiotics (an estimated 60 to 75 per cent) are used in animal farming than in human medicine. A study by Holger Heuer, Heike Schmitt, and Kornelia Smalla found that the spread of antibiotic resistance through the food chain may be greater than through hospital transmission. Raising livestock puts people in contact with large numbers of animals — especially confined animals — increasing the chance of the spread of disease.
Also, figures vary, but anything from 58 to 90 per cent of antibiotics are excreted, largely unmetabolised, increasing the risk of transferring AMR genes to bacteria in the environment.
Of the 27 classes of antibiotics used in animal farming, 20 are also used in human medicine, according to the OECD. These include drugs that are so valuable to human health that doctors describe them as “the last line of defense”.
A cultivated solution?
The problem is, indeed, both pressing and vast. This is where cultivated meat (cells that are grown in a bioreactor) and food made through precision fermentation may offer a glimmer of hope since they require minimal, or no, antibiotics in the production process.
Precision fermentation is a process that has been used for the last 50 years to produce antibiotics, vitamins, and insulin. It involves programming micro-organisms to make complex organic molecules, such as proteins.
“As there are no animals used to make our whey protein, we don’t have the same level of risk of animal-derived pathogens,” says Alex Brittan, senior vice president at Perfect Day, a California-based company that makes milks, cheeses, and ice creams through precision fermentation.
Recently, Perfect Day launched its cow-free milk brand, Very Dairy, in Singapore at the end of last year, and they launched in Hong Kong this summer. They also have their sights set on Malaysia, India, and beyond, pending regulatory approval.
Still, while companies like Perfect Day face little to no resistance in getting their product to market, the same cannot be said for cultivated meat. In 2020, Singapore became the first country to legalise the sale of cultivated meat. At Huber’s Bistro on Dempsey Road, the public can sample cultivated chicken from California-based Good Meat.
Three years later, the United States (US) has finally become the second country to give regulatory approval to Good Meat and Upside Foods (formerly Memphis Meats, the world’s first cultivated meat company). Still, even if more countries give regulatory approval, it will likely be many years before cultivated meat becomes a significant source of the world’s calories.
Opinions on laboratory-produced food, especially cultivated meat, are divided. In March, Italy’s right-wing government, led by Giorgia Meloni, backed a bill to ban cultivated meat and other synthetic foods.
The proposed ban aims to protect Italian farming, food heritage, and the health benefits of a traditional Mediterranean diet. Those on the other side of the fence argue that, as well as being more ethical and having a lower environmental impact, laboratory-produced foods are, in a way, more natural.
“There’s nothing unnatural about cells growing this way — it’s actually purer and cleaner than conventional, factory farmed chicken,” says Aaron Yeo, director of operations of Good Meat in Singapore.
Michelin-starred chefs, including José Andrés and Dominique Crenn in the US, have partnered with Good Meat and Upside Foods respectively to serve cultivated meat in their restaurants. This will hopefully help to temper consumer perceptions of cultivated meat being unnatural — or “Frankenstein”.
Challenges of scale
Perhaps the biggest blocker to cultivated meat being more widely consumed, though, is its price. “The biggest challenges are the technical and scientific challenges to scaling up production and bringing down costs to make cultivated meat,” says Andrew Noyes, vice president at Eat Just, the parent company of Good Meat.
As food technology advances every day, its potential grows. But how quickly these new foods become widely available and how universally they are embraced is unclear. Proteins made through precision fermentation and cultivated meats offer an alternative to the factory farming of animals and would help in some ways to mitigate the problem of antibiotic resistance. Unfortunately, they face their own resistance from multiple sources — one of which is price.
While the cultivated chicken dishes at Huber’s are priced the same as those using regular farmed chicken, Good Meat subsidises each plate. Prices have since dropped from the staggering USD$330,000 (S$445,000) it cost Professor Mark Post of Maastricht University to make the first cultivated meat burger back in 2013 to around USD$9 to USD$9.80. But for the time being, Good Meat’s cost of cultivated chicken cannot compete with regular farmed chicken.
And whether Good Meat’s new Singapore facility — with its 6,000-litre bioreactor that is the largest known vessel for avian and mammalian cell culture — will increase scalability and lower manufacturing costs substantially, remains to be seen.