23 restaurants to avoid. They have the most antibiotics in their meat

Consumers Union, the policy and action division of Consumer Reports, has put out its third report rating national chain restaurants on their use of antibiotics in meat. The report grades these restaurants from A to F, based upon the restaurant’s policy for the meat and poultry it buys.

The subject of antibiotics in food is a serious one. The United Nations called the practice a global health crisis on par with AIDS. The overuse of antibiotics increases levels of drug-resistant bacteria, which according to the United Nations “will make providing high-quality universal healthcare coverage more difficult if not impossible.” 

The past couple of years has seen some big-name chains making promises to discontinue use of antibiotic-treated meat. McDonald’s, for example has moved away from using poultry that had been treated with important human antibiotics starting last year. But this report reveals we still have a long way to go. 

Here’s how 25 major chain restaurants ranked:

A: Chipotle, Panera Bread

B+: Subway

B: Chick-fil-A

B-: Taco Bell, KFC

C+: McDonald’s

C: Wendy’s

D+: Pizza Hut, Starbucks

D: Dunkin’ Donuts, Jack in the Box, Burger King, Papa John’s

As you can see, there are a lot of chains sitting at the bottom with an “F” grade. Restaurants received an “F” if they “have taken no discernible action to reduce use of antibiotics in their supply chains.” 

Restaurants that got an “A” grade showed “exemplary policies and practices with respect to antibiotic use.” They both serve pork and beef, as well as poultry, raised without antibiotics.

Another thing the report pointed out was that while many restaurants have begun moving away from buying chicken that has been treated with important human antibiotics, there hasn’t been enough of a change when it comes to beef, pork or turkey.

Executive Summary Background The declining ability of antibiotics to cure diseases they once easily vanquished is a growing public health crisis. The Centers for Disease Control and Prevention states that already, at least 23,000 people die annually from antibiotic-resistant infections, and the toll is likely to rise

To combat this trend and preserve the effectiveness

of antibiotics, we must use them less, so that bacteria have less chance to develop immunity to them. Doctors and hospitals must use antibiotics more judiciously. However, some 70 percent of all medically important antibiotics sold in the United States are intended for use not in human medicine, but in animal agriculture.

We must also drastically reduce use in animals, where antibiotics are often

used to promote growth and prevent disease in industrial farming conditions. The nation’s fast food restaurant chains are in a unique position to address the antibiotic resistance crisis. Fast food chains are huge buyers of meat and poultry. A quarter of all chicken produced in the United States is sold through fast food restaurants, according to the National Chicken Council, and McDonald’s has been cited in the media as the largest buyer of beef in the United States.

Fast food restaurants can demand that their suppliers reduce or eliminate antibiotic use in the production of the meat and poultry they purchase. A coalition of organizations, including Consumers Union, Center for Food Safety, Food Animals Concerns Trust, Friends of the Earth, Natural Resources Defense Council and U.S. Public Interest Research Group Education Fund, have called on the nation’s largest fast food and fast casual restaurant chains to adopt policies limiting antibiotic use in their supply chains. This third annual Chain Reaction Report assesses the restaurants’ progress.

Survey and Scorecard Results

The 2017 Chain Reaction III Report and Scorecard ranks America’s 25 largest fast food and fast casual restaurant chains on their antibiotics policies.

The goal of this effort is to help consumers make educated choices about the meat they eat, and encourage the largest chains in these industries to improve their sourcing policies. Our 2017 survey results indicate that increasingly, fast food companies are seeking to address the antibiotic resistance public health crisis by mandating changes in their supply chain. Fourteen of the top 25 companies, a clear majority, have taken at least some steps to limit use of antibiotics in all or some of their supply chains. These fourteen, accounting 

for two-thirds of all fast food industry revenue received passing grades, up from nine last year and 

five the year before. The five companies that made 

a commitment for the first time this year are KFC, Burger King, Starbucks, Dunkin’ Donuts and Jack in the Box.

It is important to note, however, that while remarkable progress has been made to reduce or even eliminate use of medically important antibiotics, this progress has largely occurred in chicken production. With a few exceptions, companies have made little progress in reducing the use of antibiotics in their pork and beef supplies. Only two companies, Chipotle and Panera, currently serve pork and beef, as well as poultry, raised without antibiotics. Both Chipotle and Panera continue to earn an “A” grade in the Scorecard for their exemplary policies and practices with respect to antibiotic use. Subway has adopted a policy that addresses antibiotic use in meat as well as poultry, but implementation in pork and beef is on a long timeline, earning it a “B+.”

KFC improved the most over last year, earning a “B-” compared to last year’s “F”, as a result of making a commitment to transition its entire product line, all chicken, to being raised without antibiotics important in human medicine by the end of 2018.Chick-fil-A, Taco Bell, and Wendy’s have also progressed in implementing their antibiotics commitments in chicken, earning grades in the “B” and “C” range. McDonald’s earned a “C+” this year, the same grade as in 2016, when it announced that all the chicken it served in the U.S. was raised without medically important antibiotics. It made no new commitments on beef or pork, however. In August 2017 McDonald’s published a new “Vision on Antibiotic Stewardship” document that established ambitious goals for limiting use of medically important antibiotics in its entire global supply chain for all of its meats. But time bound policies for pork and beef have not been established under this new vision.

One company, Pizza Hut, received a “D+” grade because it made a token effort, i.e., setting good antibiotics use policies on chicken, and implementing them, but applying them only to a small fraction of its chicken purchases. Starbucks, which made a time bound commitment for poultry, but not for beef and pork, also earned a D+. Three more major chains—Burger King, Jack in the Box, and Dunkin’ Donuts—adopted new policies limiting use of either medically important or all antibiotics in chicken for the first time this year. But they lacked implementation, transparency commitments and/ or timebound commitments for beef and pork, earning them “D”s. Papa John’s adopted a good policy, but it only applies to a portion of its chicken and is not verified by an independent auditor, so it also received a “D.” Unfortunately, 11 of the top 25 fast food chains, including several “fast casual” restaurants like Olive Garden and Applebee’s, have taken no discernable action to reduce use of antibiotics in their supply chains. These companies, some under shareholder pressure for their lack of action, received an “F.” No doubt, the public calls to action aimed at Subway, KFC and its parent company Yum! Brands, and others initiated by the organizations participating in this report and our allies, coupled with action by the investor community, are making a difference (see section on Market Trends). Companies are on notice that their customers and shareholders will hold them accountable for antibiotic use practices in their meat and poultry supply chains. Nonetheless, much swifter and more widespread action is needed from top restaurant chains and leading meat producers to end routine antibiotic use in our meat supply.9 In the long run, changes in the fast food marketplace alone will not stem the rising tide of antibiotic resistance. Ensuring consumers have more choice when it comes to purchasing meat and poultry raised without routine antibiotics use will not sufficiently address the broader risk of resistance from continued misuse of antibiotics in much of the meat industry. For that, we need government to set rules across the industry that prohibit the routine use of antibiotics in food animal production for growth promotion and disease prevention purposes, and set baseline standards that limit acceptable use to treatment of sick animals and to control a verified disease outbreak. (See Recommendations section). To date, government response to this major public health threat has been woefully inadequate.

Antibiotic Resistance and the Role of Antibiotics Misuse in Livestock

According to the World Health Organization (WHO), the Food and Agriculture Organization (FAO), the Centers for Disease Control and Prevention (CDC) and other public health agencies, antibiotic resistance is a major global public health threat. Already, at least 2 million people in the U.S. contract antibiotic-resistant infections and at least 23,000 die as a result of those infections each year.
A 2016 report commissioned by the United Kingdom estimates that unless steps are taken to control antibiotic resistance, deaths from resistant infections will exceed cancer deaths globally by 2050.14 In response to the gravity of the problem, the United Nations convened a special session of the General Assembly in September 2016. It unanimously adopted a resolution in which all nations committed themselves to taking action on the problem Use and misuse of antibiotics, both in human medicine and in livestock production,16 is widespread. A recent study published in the Journal of the American Medical Association indicates that nearly one-third of antibiotics prescriptions in human medicine are not needed.

But as of 2011, 70 percent of antibiotics important for human medicine in the U.S. were sold for use in livestock and poultry production, not in human medicine.18 The amount of medically important antibiotics sold for use in animals in the U.S. continues to rise: up 26 percent between 2009 and 2015 and up 2 percent between 2014 and 2015 alone.19 These drugs have historically been given to animals that are not sick, to accelerate weight gain and prevent disease in crowded and unsanitary industrial farming conditions. Approximately 95 percent of the antibiotics sold for animal use are added to feed and water,20 the preferred way to deliver antibiotics to large flocks or herds of animals at once. This practice is a key contributor to the development of antibiotic resistant bacteria – which can escape farms and pread into communities through air,21 water,22 soil,23 meat,24 and even workers.25 Resistant superbugs can make us sick, or pass on resistance to other bacteria which can make us sick.26 The CDC, the WHO and other leading scientific bodies agree that the use of antibiotics in food animals contributes to antibiotic resistance.27 In December 2015, the American Academy of Pediatrics reviewed the evidence from the perspective of children’s health and concluded that antibiotics should be used “only to treat and control infectious diseases in livestock and not to promote growth or to prevent disease routinely.”28 Similarly, during World Antibiotic Awareness Week in November 2015, the World Health Organization recommended that we need to “[e]nsure that antibiotics given to animals… are only used to control or treat infectious diseases” (emphasis theirs).29 We now face the troubling specter of a kind of “super-superbug,” resistant to every life-saving antibiotic modern medicine has available. In May 2016, a gene, easily transmissible between bacteria that enables the bacteria to withstand colistin— an antibiotic used as a last-resort when all other antibiotics fail—was found in the U.S. for the first time.30 The problem gene was found in E. coli taken from a patient in Pennsylvania and separately from a pig killed at a slaughterhouse. (The same colistin resistance gene was later found in a second pig sample, and in a second U.S. patient.31) Meanwhile, a February 2017 study found this gene to be virtually ubiquitous in Chinese poultry. Extensive testing in Shandong Province found that 90 percent of poultry at slaughterhouses and 87.5 percent of poultry in supermarkets tested positive for this gene.32 The global emergence and spread of a colistin resistance gene underscores why curbing antibiotic use in livestock production is critical to keeping our life-saving antibiotics working. Preserving the effectiveness of antibiotics for human medicine requires ending use of medically important antibiotics in meat and poultry production for growth promotion and routine use for disease prevention. Antibiotics for growth promotion and disease prevention are often given routinely to all animals in a herd or flock at specific times in their lives and in some cases practically the whole time they are on the farm. Animal antibiotic use should be limited to treatment of sick animals or, in very limited circumstances, on a temporary basis, to control a verified disease outbreak. As of January 2017, FDA Guidance 213 prohibits the sale of medically important antibiotics for growth promotion, but allows routine use for disease prevention if overseen by a veterinarian. Allowing prevention use permits antibiotic use to continue unabated in many cases. We are thus encouraging fast food chains, and their suppliers, to go beyond FDA’s minimum requirements in order to make significant progress in curbing antibiotic resistance.

Discussion

In Chain Reaction’s third year, our priority remains 

to encourage companies to adopt strong policies 

that prohibit routine antibiotics use for growth 

promotion and disease prevention across all the 

meats they serve, even if those policies are not yet 

fully implemented. Our scoring reflects this priority, 

with 40 points out of 100 offered for good policies 

that include timebound commitments.

However, as more companies adopt such policies, 

implementation continues to be important. A total 

of 32 points may be earned for full implementation 

of good policies. In the future, we anticipate offering 

an even greater share of points for implementation, 

i.e. to companies making good on their commitments 

and serving meat and poultry that meets their stated 

antibiotics use standards. 

A sound antibiotics program is also transparent 

with consumers and the public. A total of 28 points 

are offered for independent third-party verification 

of compliance with policies, keeping consumers 

regularly apprised of progress, and responding to 

our survey. See Appendix 2 for further discussion of 

scoring criteria.

What’s on Your Plate

While customers may support a company that 

announces plans to purchase meat and poultry 

raised without routine antibiotics use in the future, 

most are likely to be more interested in what they 

will find on their plates today. At Panera or Chipotle, 

consumers can be confident that they will find 

a variety of meat and poultry—chicken, turkey, 

pork, and beef—raised without the routine use of 

antibiotics. At any one of McDonald’s, Taco Bell’s or 

Subway’s locations nationwide, customers can now 

be confident that 100 percent of the chicken ordered 

meets this standard. At Pizza Hut and Papa John’s, 

any chicken used as a pizza topping is raised without 

routine antibiotics (but note that this policy does not 

apply for the chicken wings at either restaurant!). 

According to Wendy’s, all of their chicken will be 

raised without medically important antibiotics by 

the end of 2017. And Chick-fil-A says 70 percent of 

their chicken will be raised without antibiotics by the 

year’s end.

Recommendations

For Restaurant Chains

» Make firm, timebound commitments to phase 

out antibiotics use except for treatment of 

sick animals or control of an identified disease 

outbreak in their meat and poultry supply. It 

is incumbent upon major restaurant chains 

to engage their producers to improve animal 

husbandry and find safer, healthier alternatives 

to routine antibiotics use. 

» Expand commitments beyond chicken to all 

meat, including beef, pork, and turkey. 

» Improve data collection and transparency about 

which antibiotics are actually being used by 

supplying farms, in what quantities, and for what 

species. 

» Provide regular progress updates for customers 

and investors and use third-party auditors to 

verify progress. 

» Multinational companies, such as McDonald’s, 

Subway, and Yum! Brands (which owns KFC, 

Pizza Hut and Taco Bell) should institute global 

sourcing policies equal to or better than what 

they have in the U.S. McDonald’s has taken a 

commendable first step in this direction by 

establishing goals for all its meat and poultry 

suppliers worldwide to limit medically important 

antibiotics use in its supply chain, except 

for treatment of sick animals. McDonald’s 

announced its first steps in implementing 

this is in its chicken supply in August 2017, 

albeit for a small group of the highest priority 

drugs. But superbugs can easily cross national 

borders. All three companies should implement 

comprehensive change globally as soon as 

possible.

For Consumers

» When purchasing meat, seek options raised 

without routine antibiotics use. 

» Wherever you eat, ask restaurant managers 

about their meat sourcing policies and practices 

and make sure they know that you’re looking 

for options that are healthier for you, animals 

and the environment—including meat produced 

without the routine use of antibiotics and other 

drugs. Appendix 3 includes a summary of 

company policies, as well as links to published 

policies where available.

» Visit the websites and social media pages of top 

restaurant chains and leave comments asking 

them to switch to meat raised without use of 

antibiotics and other drugs except for treatment 

of sick animals or an identified disease outbreak 

and to provide more sustainably produced 

alternatives like organic and grassfed meat. 

» Visit the websites of the organizations that have 

authored this report and join our campaigns 

calling on top restaurant chains to commit to 

better meat and poultry sourcing policies.