Heidi Vittetoe wants consumers to put livestock antibiotic use into perspective.

“A lot of times you hear things that would imply that we shovel antibiotics at livestock, and really, nothing could be further from the truth,” the Washington, Iowa, hog farmer said. “In the whole life of a pig, the amount of antibiotic that the pig would get via feed would fit in (a) water bottle cap.”

Heightened concern about antibiotic resistance has put livestock antibiotic use into question, but not without pushback from large hog confinement operators like Vittetoe who say they are using antibiotics judiciously.

But while antibiotic sales reports are available publicly, robust data for making clear decisions about antibiotic regulation in animals do not exist.

“Sales data, in general, cannot provide. . . information on exactly why these antibiotics are used,” Dr. Karin Hoelzer of Pew Charitable Trust’s Antibiotic Resistance Project said. “What specific disease or condition—what’s the cause for using these antibiotics?”

Hoelzer and the Antibiotic Resistance Project are calling for clearer usage data to identify opportunities to reduce antibiotic use in livestock.

Iowa is home to nearly one third of the nation’s hogs, with more than 22 million hogs at a given time, or about seven hogs for every Iowan.

How animals are housed, fed and raised largely determines the need for antibiotics. Outlawing livestock antibiotic use would upend deep-seated practices of most large hog confinement operations.

Denny Rehberg, a small-scale antibiotic-free hog farmer in Walker, Iowa, raises hogs outdoors. He is no fan of hog confinement operations.

“Did the pig create the environment, or did the building create the pig? I’m thinking the building created the pig, is what we got today,” he said.

Helaina Thompson/IowaWatch

Denny Rehberg at his farm near Walker, Iowa, in January 2018.

In the United States, roughly 70 percent of antimicrobials important in human health are sold for livestock use. Antimicrobials kill or slow the growth of microorganisms such as bacteria, viruses and fungi. Antimicrobials used in animals are classified as ‘important in human health’ when they can be used for both human and animal medicine. Antibiotics are one type of antimicrobial specific to bacteria, although the two terms are often used interchangeably.

The pork and beef industries lag behind the chicken industry in reducing antibiotic use, critic Avinash Kar of the Natural Resources Defense Council said in an online statement following the December 2017 release of an FDA antimicrobial sales report.

The report estimated that 2016 sales of antimicrobials approved for use in livestock decreased overall by 10 percent from 2015. However, since the FDA began collecting data in 2009, overall antimicrobial sales have increased by 9 percent. In 2016, 6 six percent of antimicrobials important in human health were intended for use in chickens, while 37 percent were intended for use in swine, and 43 percent of antimicrobials were intended for use in cattle. Reports of years before prior to 2016 did not categorize antimicrobial use by type of animal.


The Des Moines-based National Pork Board called the report “validation of the hard work U.S. pig farmers have put in to reduce the overall need for antibiotics while still protecting the health and welfare of the pigs under their care.”

Pork producers have taken on greater responsibility for antimicrobial use. In January 2017, amidst growing pressure from consumers and activist groups, the Food and Drug Administration (FDA) implemented a new rule for livestock producers that requires a veterinarian’s permission—called a Veterinary Feed Directive—to mass medicate animals with antibiotics important in human health through feed. The rule also says antibiotics can be used for disease treatment and prevention, but no longer for growth promotion. A 2017 antimicrobial sales report showing results from these changes is expected to be released by the FDA later this year.

From conversations with colleagues, Dr. Chris Rademacher, a swine extension veterinarian at Iowa State University, said he expects the next FDA report will show a decrease in swine antimicrobial sales.


Vittetoe is the general manager of J.W. Vittetoe Pork, Ltd., a concentrated animal feeding operation (CAFO) that produces 300,000 hogs annually. She has 80 employees and works with 40 local farmers as contract growers.

Vittetoe said the FDA’s Veterinary Feed Directive rule “has created a fair amount of tracking burden,” requiring extra paperwork. But, “if those things help consumers feel a higher level of trust, that we are working with them, not against them, to produce a safe, affordable food supply, then fine,” she said.

Hogs in large confinement areas are treated with antibiotics for a variety of reasons. For example, they are weaned from their mothers before they can acquire all of the antibodies they need. Other reasons include the food in their diets and the animals’ close proximity to each other, which could spread disease quickly.

Vittetoe said she opposes removing antibiotics from her facility. “Is that really the best animal welfare?  Is that really the best well-being of animals is to say, we’re gonna withhold antibiotics? No.”

“Nobody wants animals to die from sickness.”

Although the FDA has outlawed the use of antibiotics for growth promotion, critics, including the World Health Organization, fault the FDA for allowing antibiotics to be used preventatively when disease risk exists but no clinical signs are present. For example, pork producers like Vittetoe often use antibiotics to support piglets during weaning, when their health becomes more vulnerable.

In 2007, the Animal Health Institute estimated 13 percent of animal antibiotics were used for growth promotion, suggesting the majority of antibiotics used in agriculture have been employed for disease prevention and treatment. It is difficult to determine the percentage of antibiotics intended for preventative use because those drugs have often overlapped with antibiotics intended for growth promotion. Sales data have not distinguished between the two reasons for use. (See pg. 21 of the FDA report)

Rehberg said there are other ways to prevent disease.

“What do you need to get away from antibiotics? You need back fat. You need the sunshine and the fresh air,” he said.

For nearly 27 years, Rehberg and Lea Rehberg, his wife, have raised hogs without antibiotics. Before that, the Rehbergs operated a CAFO and used antibiotics on their hogs regularly. Rehberg was preparing to leave the industry when his young son’s ear infections stopped responding to antibiotics, which “put a spark in our heads,” he said.

“Even back then people were associating antibiotics in animals with antibiotics in humans. And at some point in time there was gonna be resistance built up for the antibiotics,” Rehberg said. “So, at that point in time I thought, well, it’s just time that I do my part and try to go antibiotic-free and see how it works. Which, it’s worked fine.”

The reason for his son’s ear infections was unknown, but Rehberg’s concerns were grounded in what is now widely accepted by public health experts: overuse and misuse of antibiotics drives bacterial resistance which could make the drugs less effective in animals and humans.

Furthermore, drug-resistant bacteria can spread from animals to humans via contaminated meat, water, soil and manure. One Iowa City Veterans Administration Health Care Systemstudy found that patients who lived within one mile of a large hog confinement were about three times as likely to carry the bacteria methicillin-resistant Staphylococcus aureus, or MRSA. The bacteria was not necessarily antibiotic-resistant or making the patients sick.

At most, Rehberg raises 400 hogs per year, he said. He recognized that his operation is vastly different from those of large producers like Vittetoe. “I have the tools that work with my operation,” he said, “and they have to have a completely different toolbox to work with their operation.”

Critics of preventative use of antibiotics say using antibiotics for that use takes the place of more expensive and time-consuming animal husbandry techniques, such as later weaning and spreading animals out.

To date, two U.S. states have adopted tougher antibiotic usage laws—California and Maryland have passed bills restricting routine antibiotic use for disease prevention. Both laws went into effect on Jan. 1, 2018. No such bills have been introduced in Iowa.

“Our opponents are really gonna’ start to focus on this prevention usage now,” Rademacher said in a 2017 World Pork Expo presentation in response to the new laws in California and Maryland. “That’s kind of where I think the battle lines will start to begin to be drawn.”