Moving the Marketplace: Getting Major Restaurant Chains to Follow Subway and McDonald’s on Antibiotics

Fall 2016: KFC Save ABX

Overview of the Problem, Solution and Campaign

Due to overuse, antibiotics are beginning to fail. 1 Public health experts warn that we’re approaching a post-antibiotic era where simple infections will once again kill.

Millions of Americans are made sick each year with bacteria that are resistant to antibiotics – “superbugs.” At least 23,000 of them die.2 The problem is increasing. A recent study found that in 2050 antibiotic-resistant bacteria will kill more people worldwide than cancer does today.3

General use of antibiotics, but in particular overuse and misuse, contributes to this growing problem.

Some of the biggest users of antibiotics are large, industrial farms, many of which routinely give antibiotics to livestock and poultry even when animals aren’t sick. Approximately, 70% of medically-important antibiotics sold in the U.S. are for use on food animals.4 To keep antibiotics working, we need to limit antibiotics to situations when animals are sick, or to stop known infectious outbreaks on the farm.

The merits of the argument haven’t convinced large industrial farms and drug companies to adopt reforms. Together, they’ve successfully protected their current farming methods and their pocketbooks by bottling up efforts in Congress and the FDA to stop inappropriate use of antibiotics.

In our campaigns, we’re primarily targeting large restaurant chains, asking them to commit to serving meat raised without routine use of antibiotics. When these chains act, it puts market pressure on the companies that raise the animals to change the way they use antibiotics. Additionally, restaurants make an

1 World Health Organization Media Release: WHO’s first global report on antibiotic resistance reveals serious, worldwide threat to public health, downloaded from http://www.who.int/mediacentre/news/releases/2014/amr-report/en/ 2 U.S. Centers for Disease Control, Antibiotic Resistance Threats in the United States, 20133 The Review on Antimicrobial Resistance, Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations, December 2014, 5.4 The Pew Charitable Trusts, Human Health and Industrial Farming 101, 9 August 2012.

ideal target for grassroots campaigns because their brands are well-known to the average consumer, and these chains protect their brands and images with great zeal.

We launched our first restaurant campaign in January 2015, targeting McDonald’s. After two months, we helped convince McDonald’s to take a super-sized step in the right direction. The golden arches committed to phase out medically-important antibiotics in their chicken within two years.5 With this commitment, they joined early adopters such as Chipotle, Panera Bread, Chick-fil-A, Shake Shack, Elevation Burger and others that have stopped serving, or have committed to stop serving, meat raised on routine antibiotics. Granted, the McDonald’s commitment was only for chicken.

After the McDonald’s announcement, Tyson Foods announced a plan to phase out medically-important antibiotic use in their chicken production. It was no coincidence. McDonald’s is a major customer of Tyson Foods, and Tyson wants to keep selling them chicken.6

Next we called on Subway, the chain with more restaurants than any other, to stop serving meat raised on antibiotics. Why Subway? They’re big enough to have an impact in the market. Plus, they market themselves as the “eat fresh” brand, making them susceptible to accusations that McDonald’s is in front of them on an important public health issue.

We called on Subway to take action on April 1, 2015, doing so with NRDC, Friends of the Earth, Consumers Union and Keep Antibiotics Working. Then silence. We called on them to take action in mid-June from these same groups and many others, a total of sixty public interest organizations. Silence.

Finally, two days before the coalition announced a plan to descend on corporate headquarters on October 22 to deliver roughly 270,000 petition signatures – 110,000 from us – Subway announced their policy. They’ll phase out antibiotic use in all their meats within 10 years, starting with chicken by the end of 2016, followed by turkey by the end of 2019, and beef and pork by 2025.7 Subway has already introduced a new chicken sandwich raised without antibiotics.

Now we’re using the momentum of getting the two largest franchises – McDonald’s leads in total sales and Subway leads in number of restaurants – to get others to follow. We’re already seeing more progress. In April, Taco Bell committed to stop serving chicken raised on medically important antibiotics by 2017, and Wendy’s made the same commitment in August. Take notice KFC, Applebee’s, Burger King, Pizza Hut, Panda Express, Olive Garden, In-N-Out in the southwest, Bojangles’ in the southeast, and Culver’s in the Midwest. You’re next.

KFC is our main target right now. We started campaigning on them in late January. In April KFC’s partner brand, and one of our targets, Taco Bell committed to the same policy on chicken as McDonald’s. We used that momentum to call on KFC to follow their lead. After a coordinated action with our partners during its annual shareholder meeting in May, followed by a series of actions throughout the summer, KFC’s parent company said that the “position on antibiotics is currently being reviewed to determine the viability for our suppliers to go beyond the FDA guidelines for antibiotic usage.”8

We got KFC’s attention, and now it’s time to ramp up the visibility and consumer pressure to show KFC that there is no time to waste when it comes to protecting our life-saving antibiotics.

5 McDonald’s, McDonald’s USA Announces New Antibiotics Policy and Menu Sourcing Initiatives (press release), 4 March 2015.6 Dan Charles, “Tyson Foods to Stop Giving Chickens Antibiotics Used by Humans,” NPR, 28 April 2015.7 Subway, Subway Restaurants Elevates Current Antibiotic-Free Policy U.S. Restaurants Will Only Serve Animal Proteins That Have Never Been Treated With Antibiotics (press release), 20 October 2015.8 Jere Downs, “Antibiotics in KFC chicken ‘being reviewed’,” Louisville Courier Journal, 9 August 2016.

Problem: In Depth

Antibiotics May Stop Working

We rely on antibiotics to treat everything from relatively simple infections like strep throat, to more serious and life- threatening illnesses like pneumonia or post-surgery internal infections. Unfortunately, antibiotics are losing their effectiveness and are beginning to fail.9

When bacteria are exposed to an antibiotic, most of them will be susceptible to the drug and die. Some of the organisms, however, possess genes that will allow them to survive the onslaught. Left without competition for food from their more vulnerable counterparts, these resistant ‘superbugs,’ replicate very quickly. For instance a single drug-resistant E. coli bacterium can multiply into more than a billion E. coli cells in just 24 hours. Furthermore, these resistant cells can pass on their resistance to other, unrelated bacteria. Thus, the more antibiotics that are used, the more opportunities bacteria have to develop resistance.

Despite this well-recognized phenomenon, antibiotics continue to be inappropriately used in massive, untargeted and unrestricted quantities and are not limited to the treatment of sick animals. As a consequence, bacterial resistance to antibiotics is now cited by health experts in the United States and across the globe as one of the most serious public health crises of our time.

A bacterial gene that allows bacteria to resist colistin, an antibiotic considered the last resort for treating bacterial infections when other treatments fail, was found on a Chinese pig farm in November 2015.10 Scientists believe the resistant gene originated in Chinese pig farms, which often dose pigs regularly with colistin. Colistin resistant bacteria have since been reported in over thirty countries, in both animals and humans. Recently, the first reported case of a bacteria resistant to both colistin and another last resort antibiotic, carbapenem, was found in the U.S. in a man treated in a New Jersey hospital.11

Recognizing the urgency of the problem, in September 2013 and April 2014, the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) released detailed studies on bacterial resistance. The CDC report found at least two million Americans are sickened by drug-resistant bacteria each year, 23,000 fatally. Additionally, the WHO report cited estimations that ‘superbug’ infections resulted in eight million additional days in hospitals, which costs between $21 and $34 billion each year in the U.S. alone.

People at especially high risk include patients who receive chemotherapy or radiation treatment for cancer, or have undergone complex surgeries, dialysis, or organ and bone marrow transplants. These patients are much more susceptible to bacterial infections, and treatment relies often on effective antibiotics to ensure recovery. A drug-resistant infection could mean more stress, illness, cost and sometimes death.12

WHO Assistant Director-General Keiji Fukuda warned:

9 World Health Organization, “Antimicrobial resistance” Fact Sheet N 194, April 2015.10 Maryn McKenna, “Apocalypse Pig: The Last Antibiotic Begins to Fail,” National Geographic, 11 November 201511 Lindzi Wessel, “Superbug resistant to two last resort antibiotics found in US for first time,” 29 August 201612 U.S. Centers for Disease Control, Antibiotic Resistance Threats in the United States, 2013: p 24

Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era in which common infections and minor injuries, which have been treatable for decades, can once again kill.13

The Meat Industry’s Role and Opposition

The food industry is one of the stakeholders that need to take action. Seventy percent of antibiotics in classes used in human medicine are sold for use in food animals. This is done to increase the speed at which animals gain weight and to prevent disease caused by unhealthy and unsanitary conditions.14

The use of antibiotics in livestock production on this massive scale—many uses are identical (or nearly so) to human medicines such as those containing penicillin, tetracycline, erythromycin, and sulfonamide—accelerates the development of drug-resistant bacteria.15

Once replicated in animals, resistant bacteria can make their way to humans through contaminated food, airborne dust blowing off farms, and water and soil polluted with contaminated feces.

A growing body of evidence documents this phenomenon, including:

A February 2014 study in Infection Control and Hospital Epidemiology found that the patients in an Iowa VA residential hospital who had resided within 1 mile of large swine facilities were nearly twice as likely to have Methicillin-Resistant Staphylococcus (MRSA) colonization at time of admission than were patients not living in close proximity to large, confined animal feedlots.

A U.S. study in 2012 linked E. coli in poultry and E. coli infections in humans.16

A 2007 study in Minnesota and Wisconsin found that antibiotic resistant E. coli in people was likely to have come from poultry.17

An April 1999 study by the Government Accountability Office concluded that resistant strains of three microorganisms that cause food-borne illness or disease in humans—Salmonella, Campylobacter, and E. coli—are linked to antibiotic use in animals.18

The U.S. Food and Drug Administration (FDA) has also documented the threat of factory farm antibiotics use to human health. According to documents obtained by the Natural Resources Defense Council, between 2001 and 2010, the FDA reviewed the safety of thirty of its antibiotics approved for use in

13 World Health Organization Media Release: WHO’s first global report on antibiotic resistance reveals serious, worldwide threat to public health, downloaded from http://www.who.int/mediacentre/news/releases/2014/amr-report/en/ 6/25/2014 14 Pew Charitable Trusts, Human Health and Industrial Farming 101, downloaded from http://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2012/08/09/human-health-and-industrial-farming-101 6/22/201415 Jerome A. Paulson et al., December 2015, “Nontherapeutic Use of Antimicrobial Agents in Animal Agriculture: Implications for Pediatrics,” Pediatrics.16Food-borne origins of Escherichia coli causing extraintestinal infections. A.R. Manges, J.R. Johnson. Clinical Infectious Diseases. 2012. 55(5): 712-719

17J.R. Johnson et al., June 2007, “Antimicrobial DrugResistant Escherichia coli from Humans and Poultry Products, Minnesota and Wisconsin, 2002-2004,” Emerging Infectious Diseases.

18 United States General Accounting Office, Food Safety: The Agricultural Use of Antibiotics and its Implications for Human Health, April 1999: p 1

animal feed. The agency rated 18 of these drugs as posing a ‘high risk’ to human health because they could lead to exposure of humans to superbugs through the food chain.19

Doctors are overwhelmingly concerned about the problem. In a poll released by U.S. PIRG and Consumer Reports, 93 percent of doctors said they were concerned about the practice of using antibiotics on healthy animals for growth promotion and disease prevention. In addition, 85 percent of doctors said that in the last year, one or more of their patients had a presumed or confirmed case of a drug-resistant infection.20

Some major meat producers are catching onto the widespread consumer demand for meat raised without antibiotics and taking steps to meet it. Recently Tyson Foods announced a new line of pork raised without antibiotics21 and Perdue—the third largest chicken producer in the country—highlighted that 2/3 of their flock is now produced without antibiotics22.

However, overall the meat industry remains opposed to any efforts to reduce the routine use of antibiotics. They support the FDA guidelines that phase out antibiotics for growth promotion, which will make little difference because the antibiotics can still be used routinely to prevent disease.

Industry arguments:1. All meat is “antibiotic free” because there are never antibiotics in the meat people consume.

R. This is true, and also completely irrelevant. The problem is that the animals are raised with routine antibiotics, and due to the overuse in that setting antibiotic resistant bacteria multiply rapidly and spread off the farm in a number of ways (ex. contaminated food, airborne dust blowing off farms, and water and soil polluted with contaminated feces) 2. Without antibiotics we can’t properly care for animals, resulting in animals suffering unnecessarily. R. We advocate for eliminating the routine use of antibiotics on animals that are not sick to promote growth or prevent disease. Antibiotics can and should be used to treat sick animals or to control a verified disease outbreak. But even when chains like Chipotle, Panera and Subway go whole hog and say “no antibiotics ever,” then the meat from animals that received routine antibiotics is sold to different vendors—including all of our current targets—and marketed accordingly.

Solution: In Depth

To combat the spread of antibiotic resistant bacteria, antibiotics for food animals should be used sparingly and only on sick animals, or to contain verified disease outbreaks.

This is what’s called for in the CALPIRG-supported law passed this fall (2015) by the California Legislature and signed by Governor Jerry Brown. And it can be done. The U.S. Department of Agriculture said in a January 2009 report that the presumed economic and production benefits of antibiotics in animal feed can be largely achieved by improved cleanliness of animal houses and improved testing for diseases.23

19Natural Resources Defense Council, Playing Chicken with Antibiotics, downloaded from http://www.nrdc.org/food/saving-antibiotics/antibiotic-feed-FDA-documents.asp 6/20/2014

20 http://www.uspirg.org/news/usp/new-poll-reveals-overwhelming-majority-doctors-concerned-about-antibiotics-use-healthy-food21 Deena Shanker, “Just months after Big Pork said it couldn’t be done, Tyson is raising up to a million pigs without antibiotics,” Quartz, 24 February 2016. 22 Chicago Tribune, Antibiotic-free Chicken Chasing Cage-free Eggs. Feb 27, 2016: http://www.chicagotribune.com/business/ct-antibiotic-free-meat-0227-biz-20160226-story.html

Action to curb unnecessary antibiotic use on factory farms is growing across the globe. For instance, Denmark instituted a process that banned the use of antibiotics in animal feed to make animals grow faster. The policy also banned the use of antibiotics for many types of disease prevention, a use often employed to allow crowded and unsanitary conditions. As a result, antibiotic use in Denmark has dropped by 50 percent without a loss in productivity.24

To combat increasing bacterial resistance, including the spread of drug-resistant Salmonella and E. coli, in 2008 the Netherlands also instituted a series of rules that required a 70 percent reduction in antibiotic use in livestock production. According to a 2013 report published by the Dutch Central Veterinary Institute, clear indications exist that the occurrence of antimicrobial resistance in animals is decreasing in the Netherlands.25

Ultimately, the solution to this problem in the U.S. is to enact similar federal policy that stops the overuse of antibiotics on animal farms. Strong action at the federal level, however, is not realistic at this point.

Case in point: in the late 1970’s the U.S. Food and Drug Administration began taking action to limit antibiotic use on farm animals, but after threats from Congress (one former congressman in particular) to reduce the agency’s funding, the FDA ended efforts to regulate antibiotics use on food animals.26

But if more states follow the lead of California, the federal government may take action. Or if more chains follow the lead of Chipotle, Panera, Chick-fil-A, Noodles & Co, McDonald’s, Subway and others, we may reach a point where the federal government is less gun shy about taking action.

In January 2015, we launched a campaign to convince McDonald’s to stop the purchase of meat raised with the routine use of antibiotics. Organizing on-the-ground and online, we elevated the voices of potential and existing McDonald’s customers in calling for reform.

In an exciting campaign win, on March 4th McDonald’s announced that it will phase out the purchase of chicken raised with medically-important antibiotics in its U.S. restaurants within two years. This commitment is a win for public health. The restaurant buys more chicken than beef, and requiring the phase-out of these drugs will lead major chicken producers to reform their practices. Our strategy worked: according to McDonald’s, their decision was made in response to consumer demand for meat raised without antibiotics. “We listened to our customers,” said Marion Gross, senior vice president of McDonald's North American supply chain, when announcing the change.

In April 2015 we launched our next phase, calling on Subway, with more restaurants than any other chain in the U.S., to commit to serve meat raised without antibiotics. Subway responded to the widespread consumer demand we demonstrated with an announcement in October that the sandwich chain would serve all meat raised without antibiotics within ten years. Subway’s announcement is in many ways bigger than McDonald’s was, due to their sheer size and because the commitment is for all meats.

23USDA. 2009. The transformation of U.S. livestock agriculture: scale, efficiency, and risks. Electronic information bulletin no. 43. www.ers.usda.gov/Publications/EIB43.   24 Pew Charitable Trusts, “Denmark’s Ban on Growth Promoting Antibiotics in Food Animals,” February 24 2010, downloaded 6/27/201425 Central Veterinary Institute et al, MARAN 2013: Monitoring of Antimicrobial Resistance and Antibiotic Usage in Animals in the Netherlands in 2012; June 2013 p 7, downloaded from http://www.nieuweoogst.nu/scripts/edoris/edoris.dll?tem=LTO_PDF_VIEW&doc_id=67602de , downloaded July 7 201426 Rick Young, “The Trouble with Antibiotics,” PBS Frontline, 14 October 2014 http://www.pbs.org/wgbh/pages/frontline/trouble-with-antibiotics/.

Moving forward, in order to continue to build on this momentum, and move the meat industry to stop their practice of raising animals with the routine use of antibiotics, we need other large, national restaurant chains to follow the example of McDonald’s and Subway, starting with KFC.

Goal & Target

The overall goal of this campaign is to convince five major chains to commit to serve meat raised without the routine use of antibiotics by the end of 2016, starting with KFC. Taco Bell committed on chicken in April and Wendy’s made a similar commitment in August. So we have two down, three more to go. Although we’re focusing the majority of our efforts on KFC, other targets include Applebee’s, Burger King, Pizza Hut, Panda Express, Olive Garden, In-N-Out in the Southwest, Bojangles’ in the Southeast, and Culver’s in the Midwest. Plus we will urge McDonald’s to set a policy for their other meats.

Strategy

We’re moving the marketplace. We have momentum. Our strategy largely will remain consistent across the brands, but it’s worth noting that with the wins, we may have the opportunities to use the threat of a full-blown campaign to move some others in the marketplace.

Generally, there are two main concerns that may hold potential targets back from committing to meat raised without antibiotics—worries over lack of supply and the backlash from the Ag industry.

In order to tackle both concerns, we’ll maximize our visibility so it’s clear to our targets that switching to meat raised without antibiotics is what consumers want. Both McDonald’s and Subway were able to use their market leverage to force suppliers to adapt. Also some major meat producers recently made commitments on their own to transition away from overusing antibiotics across the meat industry—namely Perdue and Tyson Foods—so it’s entirely possible.

The different brands will have different vulnerabilities, which will lead to some strategic tweaks from brand to brand, but what follows is true of most:

Brands care about their own customer base, and we will work to show that existing customers care about this policy.

Brands are very aware of their competitors, and we will use the fact that McDonald’s, Chick-fil-A, Subway and others are out of in front of them on the antibiotics issue.

Nearly all brands will be influenced by doctors and health professionals simply because they make such great messengers and are validators of all that we say.

Some brands are seeing dips in profits, sales, growth, etc. These brands are likely more vulnerable than others that are oxen strong. But that said, a strong brand may be vulnerable because they fear a dip in sales.

Finally, all brands, other than arguably Cracker Barrel, care about winning over youth. Thus Millennials matter.

We will campaign on one national target at a time to focus all of our field power in one spot. We will also leave open the possibility of targeting regional brands, depending on the prevalence of the brand in the region and our field capacity to run a successful campaign. Possible regional targets this fall include In-N-Out (they have committed but haven’t put out a timeline yet) BoJangles’, and Culver’s.

KFC is the main national target. The strategy is pressure and the brand fits into all the considerations laid out above. Although it’s a pressure strategy, it’s important to note that we do not want to villainize KFC, the real opposition is the meat industry.

If KFC commits to a strong antibiotics policy it could have a major impact on the U.S. chicken industry.

KFC is part of one of the largest fast food conglomerates in the business, the Yum! Brands, which also includes Taco Bell and Pizza Hut. Both Taco Bell and Pizza Hut have made antibiotics commitments on chicken recently, although Pizza Hut’s is only for part of its supply chain. We can point to that progress to push KFC forward.

KFC is starting to feel the heat after our steady drumbeat of grassroots pressure and series of coordinated events throughout the summer. The company has said that it’s considering changes to its antibiotics policy, but that it isn’t ready to commit. We may be close to seeing a major change from KFC, so it’s critical that we keep up the visibility and consumer pressure.

KFC Background:- KFC total U.S. locations 4,370, total U.S. sales $4.2 billion (FY 14).27 - KFC’s reported suppliers include Koch Foods, Pilgrim’s Pride, and Case Farms, all of which do

not have meaningful antibiotics policies. If KFC commits to a strong antibiotics policy it could have a major impact on the U.S. chicken industry.

- KFC has more locations in the U.S. than any other fried chicken chain, so if they commit it will set an example for other fried chicken restaurants28

- KFC is part of one of the world’s largest restaurant conglomerates, the Yum! Brands, which also includes Taco Bell and Pizza Hut.29

- In April Taco Bell committed to stop serving chicken raised on antibiotics important to human medicine starting March 2017. Pizza Hut made a similar commitment in May, but only for chicken used as pizza toppings, not for the rest of its chicken products. KFC is now the only company under Yum! Brands that has not taken any steps forward on antibiotics.

- KFC is based in Louisville, KY, also home of Papa John’s, which announced an antibiotics commitment for chicken in December which goes into effect starting this summer30.

- According to KFC’s own data three out of five Millennials have never tried KFC. KFC is revamping its image, coming out with catchy and clever ads with a new Colonel Sanders31 to attract Millennials’ business. It has also started to focus on what it considers traditional, higher quality cooking.

- KFC needs to compete with Chick-Fil-A, a chain that’s already committed to meat raised without antibiotics and which recently stole KFC’s title as the highest grossing fried chicken chain in the U.S. 32

- KFC has had problems with antibiotics in the past. In December 2012 an investigative news television program in China found that farms supplying KFC were playing loose with antibiotics laws and using the life-saving medicines excessively. Said David Novak, then-CEO of Yum

27 http://nrn.com/top-100/kfc28 http://nrn.com/top-100/kfc29 http://www.yum.com/company/30 http://ir.papajohns.com/releasedetail.cfm?releaseid=94728531 Candice Choi, “KFC executive says chain going through ‘re-Colonelization’,” Associated Press, 17 February 201632 Vanessa Wong, “Chick-fil-A stole KFC’s chicken crown with a fraction of the stores,” Yahoo! Finance 31 March 2014.

Brands: “the onslaught of negative media coverage was longer lasting and more impactful than we ever imagined.” 33

- KFC’s parent company recently said that its “position on antibiotics is currently being reviewed to determine the viability for our suppliers to go beyond the FDA guidelines for antibiotic usage.”34

Messaging background info

What’s the problem?Millions of Americans are getting sick, and 23,000 die every year from antibiotic resistant infections. Yet factory farms are giving a daily dose of antibiotics to their livestock and poultry. This overuse of our life saving medicines is putting everyone’s health at risk, and if we don’t act soon we could face a world in which antibiotics stop working.

Key Facts to use/highlight

• According to the CDC, every year 2 million Americans are infected by antibiotic-resistant bacteria, and 23,000 die.

• 70% of antibiotics sold in the United States are for use on livestock, not humans, and the drugs are often given to animals that aren’t even sick.

• According to the World Health Organization: "Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill."

• The Centers for Disease Control and Prevention has said that “Much of the antibiotic use in animals is unnecessary and inappropriate and makes everyone less safe.”

• A recent study commissioned by the United Kingdom found that unless action is taken, antibiotic resistant infections will kill more people worldwide in 2050 than cancer does today. (http://amr-review.org/)

• In a poll released by U.S. PIRG and Consumer Reports, 93 percent of doctors said they were concerned about the practice of using antibiotics on healthy animals for growth promotion and disease prevention.

• 85 percent of doctors said that in the last year, one or more of their patients had a presumed or confirmed case of a drug-resistant infection.

• We have built a coalition of over 35,000 doctors and other members of the medical community.

• Restaurants like Chipotle have stopped purchasing meat raised with antibiotics (https://chipotle.com/food-with-integrity#saying-no-to-drugs), and others such as Chick-fil-A have made a commitment to stop doing so (http://www.chick-fil-a.com/Antibiotic-free). Subway, with more restaurants than any other chain in the U.S., also recently made a commitment to transition away from all meat raised on antibiotics.

33 Jonathan Maze, “Antibiotics Give Yum A Headache,” Restaurant Finance Monitor, 18 July 2013.34 Jere Downs, “Antibiotics in KFC chicken ‘being reviewed’,” Louisville Courier Journal, 9 August 2016.

• Within 2 months of the McDonald’s commitment, Tyson Foods, a major supplier of chicken to the golden arches, announced a similar policy for their birds.i

• Regional chain In-N-Out recently committed to move away from beef raised with antibiotics important to human medicine, but has not yet put out a concrete timeline to do so35.

• Tyson Foods recently introduced a new line of pork raised without antibiotics36. Perdue announced that 2/3 of their chickens are now produced without antibiotics37.

How does the problem affect people?We rely on antibiotics to treat everything from simple infections like strep throat, to more serious and life threatening illnesses like pneumonia. And they are losing their effectiveness. The ability to effectively treat infections is a cornerstone of modern medicine, routine procedures and lifesaving operations could become high risk propositions without effective antibiotics.

Facts• According to the CDC, every year 2 million Americans are infected by antibiotic-resistant bacteria, and 23,000 die.

What’s the solution?The World Health Organization talked about action from major stakeholders. We’re asking major players in the restaurant industry to take action. Panera Bread and Chipotle have been the leaders, with Chick-fil-A not far behind. Thanks in part to our efforts, McDonald’s made a commitment, as did Subway. Now we need more stakeholders to follow. And as we make progress, market pressure will force more and more large farms to stop the overuse of antibiotics. Is change possible?Due to consumer concerns, restaurants are moving to serve meat not raised on antibiotics. With consumer pressure, more will follow.

Why is our group or plan the right one?National chains are spread out throughout the country. We have canvass offices throughout the country that can mobilize consumers nationwide.

Consumer and grassroots pressure is what has worked with McDonald’s and Subway. Bringing that type of pressure to bear is our forte. Finally, the medical community is a critical validator of our position, and is the right messenger for the public. Through our canvass, we’ve organized over 35,000 health professionals.

What can the audience do?Join us in calling on major restaurant chains to take action.

Why is this urgent?Millions are already getting sick, and the medical community agrees that if we don’t act soon the problem is only going to get worse.

35 Lisa Baertlein, “Activists press In-N-Out on antibiotic policy amid superbug worries,” Reuters, 24 February 2016. 36

37

How great will this be if we do this?!!How stupid would we look, as a society, if we took a miracle of modern medicine and squandered it by using it to produce a slightly cheaper burger? Solving this problem would help avert a global health crisis, and to ensure the effectiveness of antibiotics for generations to come.

Key Messaging Principle- Avoid the term “antibiotic-free.” It’s not what we’re actually asking of these restaurants and it

opens up an attack line for the meat industry (the “sick animals need antibiotics” argument highlighted above). Acceptable shorthand:

o Meat raised without routine antibiotics—this is the most accurate.o Meat raised without antibiotics o Meat not raised on antibiotics

Lay of the Land

AlliesOur key coalition partners are Natural Resources Defense Council (NRDC), Consumers Union, PEW Charitable Trusts, Friends of the Earth, Center for Food Safety, the “Food Babe,” the Center for Science in the Public Interest, GWU Antibiotic Resistance Action Center. Most of these partners have all helped prevail upon McDonald’s and Subway to act.

Potential AlliesDoctors and doctor groups are key validators. A U.S. PIRG and Consumer Reports poll found that 93 percent of doctors said they were concerned about the practice of using antibiotics on healthy animals for growth promotion and disease prevention. Doctors, nurses, and other health professionals have an obvious stake in keeping antibiotics effective, and on our electronic petition, we’ll have a checkbox that new members or petition-signers can check to indicate that they are health professionals who support our campaign. Our non-canvass campaign staff will follow up with these health professionals from there to get them more involved.

Farmers are to an extent an ally, but really they’re important insofar as having some of them on our side helps deflect criticism and prevent the story from devolving into public health vs. farms.

“Case for” the Field:Major chains tend to have restaurants throughout the U.S. With staff on the ground all across the country, we can match up with those chains reasonably well. Additionally, all brands care about their image, and our work on the ground threatens their image (even when we do it politely and not in a hostile way, holding events outside a store is threatening to them). Finally, it gets us something to have social media with clever memes, but when the social media amplifies real people doing real organizing in multiple locations around the country, the targets then realize that they need to do something. In sum, the more staff and volunteers on the ground engaging the public, the more visible the campaign will be and the more likely that more restaurants will commit.

The main field resources on this campaign will include campus chapters, canvass offices, and state directors across the country.

Powerbuilding:

1. Building our brand with the public - The visibility strategy of the campaign not only elevates the issue but also gets our name out on

college campuses, communities, and the media.

2. Developing coalition and VIP relationships- Health professionals are the main group we’ll work to develop relationships with. They are key

validators not just for the antibiotics issue, but for all of our public health campaigns. We’ll keep health professionals involved by developing an action network to reach out to them with a constant stream of updates and opportunities to take part in the campaign.

- We’re also working with national advocacy groups like the Natural Resources Defense Council, Friends of the Earth, and the Pew Charitable trusts.

- Major public health organizations like the American Academy of Pediatrics have a stake in the issue and could be an important ally to work with.

3. Raising small donor money - Canvassing on the corporate antibiotics campaign has had a high average. People respond well at

the door and can see the change they make with our high profile victories.

Top tier tactics

Photo petitions (Goal: 100 or more per campus): It is critical to the visibility and therefore success of this campaign to get a lot of photo petitions and make them as viral and visible as possible. We also want to demonstrate that people who frequent fast food chains that don’t serve meat raised with routine antibiotics (ex McDonald’s or Chick-fil-A) and millennials are more likely to visit some of our targets if they make the switch. Instead of generating a steady stream of photo petitions as we’ve done in the past, we’re going to concentrate the photo petitioning during times where other events are happening that we can use to build the visibility. For example, on September 20th our coalition partners are releasing the Chain Reaction Report that grades major restaurant chains based on their antibiotics policies. KFC will likely receive a failing grade for its antibiotics policy (or lack thereof). We’ll hold photo petitioning events after the release to call attention to it. The next two big pushes will be around Halloween and in mid-November during Antibiotics Awareness Week.

- Make creative props to use during photo petitioning o Ex. Have people take photo petitions with a face cut out of Colonel Sanders. o Ex. Design a big bucket of chicken

- Collect photo petitions outside of the target franchise (KFC)- Collect photo petitions outside of local fast food restaurants that serve meat raised

without routine antibiotics (Chick-fil-A, Chipotle, Panera Bread, Subway)

Doctor/Medical professional organizing (30 actions): We need to continue to activate and mobilize health professionals to call for an end to the overuse of antibiotics in large scale farms that contributes to antibiotic resistance. We sent a campaign endorsement letter to KFC signed by over thirty Kentucky health professionals in July and the company responded directly to us for the first time. In addition to being influential with our marketplace targets, health professionals give our campaign more credibility over the long term.

- VIP campaign endorsements (10 endorsements per campus): Recruit VIP doctors and other health professionals to sign our letter endorsing the campaign to move the marketplace away from overusing antibiotics. VIPs can be heads of departments at local hospitals, like the Director of Antimicrobial Stewardship, or chairs of public health

departments on campuses or medical schools. Make sure you database endorsements in contact organizer (ask your organizer to do this).

- Health professional Halloween events (20 photos) 10/25: Organize Halloween focused photo petitioning events in front of local hospitals. The main tactic is getting photo petitions that show health professional support for moving the marketplace, with a clever Halloween angle. The secondary ask would be to sign the health professional endorsement letter.

o Start set up early, best to try and recruit a hospital to let us hold the event inside of the hospital. A good place to start is to reach out to the Antimicrobial Stewardship Department for help in setting up the event.

o We’ll use the photo petitions over social media and direct the attention at KFC.

Earned Media (3 hits per campus): We’ll organize media events geared toward highlighting our public health message, and to demonstrate the consumer demand for meat raised without routine antibiotics. If you are in a state with a state director, you need to coordinate with them on all media work.

- October (1 media hit): Organize radio talk show forum with a public health VIP on campus, using Halloween as a good hook.

o Doing radio talk shows will help build our organizational profile in the community, and it is good visibility for the campaign. We’ll have a responsible farmer and a doctor with us on the show to hit all sides of the issue, while focusing heavily on our public health message.

- November (2 media hits): November 14-20th is Antibiotics Awareness Week, a global initiative held by the World Health Organization to call attention to the need to preserve antibiotics. As part of that week, we’ll organize events to highlight local farmers who are raising animals without misusing antibiotics. The events will be stand up press conferences where we’ll recruit a doctor or VIP public health professional to present a local farmer with the antibiotics stewardship award.

Tier two tactics

Activist Phone Calls (200 calls): Demonstrating a steady stream of calls into KFC shows strong grassroots support for adopting a no routine antibiotics policy. After we flooded customer service with calls this summer KFC started to interact with us more, which shows that we’re getting their attention. We need to keep their phones ringing. Every person that comes in for an intern info session or chapter meeting should call KFC headquarters and say “My name is ____, I’m in ___city and I urge KFC to commit to serving chicken raised without routine use of antibiotics.” That way KFC will hear from hundreds, if not thousands, of people all over the country.

Opinion Media (20 submitted, 5 LTE’s printed): Generate letters to the editor in local papers to build visibility for the campaign. The program team will provide template letters, and Matt Wellington can review any letter written in response to a story (which is the best kind of letter).

Be opportunistic, if you read an article that you think you should respond to email Matt at mwellington@pirg.org to get it proofed.

Farmer endorsements (10 endorsements): Organizers will identify farms/farmers in state who sell meat/animal products without the routine use of antibiotics and have them sign onto a general letter about responsible farming and consumer demand. Focus on larger farms rather than small ones to emphasize that larger farms don’t need to overuse antibiotics.

Tier three tactics

Social media thunderclap (overall goal reach 500,000 people): This issue is hot right now, and we need to build on that momentum to make it even more visible. During Antibiotics Awareness Week (Novemeber 14-20th) we’ll put together a twitter thunderclap calling attention to how KFC and other restaurants can help stop the overuse of antibiotics in the meat industry. The key is volume, we need a lot of people to sign onto it, but we also need people with huge twitter followings.

Victims of antibiotic resistance personal stories: Victims of resistant infections can send a powerful message about how critical of a public health problem we face without effective antibiotics, and why restaurants should take action. We’ll gather stories of resistance from these victims and share those via social media, and potentially use them for a media release as well. General rule of thumb here is to ask everyone, use personal networks and also ask health professionals who endorse our campaign if they’re comfortable referring people to us. Email stories to Matt Wellington, mwellington@pirg.org

Restaurant organizing: Restaurant owners that choose to serve meat raised without routine antibiotics can be powerful allies on our campaign. They can use their pulpit to help build the visibility of the campaign. This fall we’re going to ask responsible restaurant owners to allow us to take video testimonies of their customers, asking why they eat there and why it’s important to them that the meat is raised without routine antibiotics. We’ll use the testimonies over social media.

Key Dates

September

Week ending 9/23

- Photo petitioning events—the week of the UN general assembly and the release of a report from our coalition partners.

October

Week ending 10/28

- Health professional Halloween events at local hospitals

i http://www.npr.org/sections/thesalt/2015/04/28/402736017/tyson-foods-to-stop-giving-chickens-human-used-antibiotics and http://www.chicagotribune.com/business/ct-mcdonalds-antibiotics-0305-biz-20150304-story.html

- Radio show with the medical pro or public health VIP

November

Week 14th-20th: Antibiotics Awareness Week

- Big push for letters to the editor - The Antibiotics Stewardship Award event: A stand up media event with a local doctor

and farmer, ideally at the farm if it makes sense for the TV stations.