Antibiotic consumer communication - clear of confounding?

Introduction

It’s not always easy for consumers to make sustainable choices at the grocery store. There are countless parameters to take into account, one of which being the use of antibiotics in food production. It is a complex issue where consumers often have limited knowledge. At the same time, the overuse of antibiotics in food production must be reduced. On this, more measures can be introduced within agriculture, the grocery trade and on the political level – but is it possible to also drive change through a consumer driven demand for food that is produced with a responsible use of antibiotics? Is there a way to guide customers to smarter antibiotic choices?

Very few studies have previously been conducted on the impact of the different types of communication towards consumers on antibiotics. Against this background, Axfoundation saw the need to investigate how consumers respond to information about the use of antibiotics in food production. This report summarizes the results of these consumer tests, conducted during 2021 2022 (full report in Swedish).

Overuse of antibiotics is a widespread problem in the food production industry. Approximately 70 percent of all antibiotics used worldwide are used in animal husbandry, with only 30 percent being used in human health care (Our World in Data, 2017). The overuse of antibiotics increases the risk of bacteria developing resistance. The medicine just isn’t as effective anymore. The result is an increased spread of bacterial resistance. This increasing antibiotic resistance is a global problem that the World Health Organization (WHO) classified as one of the ten biggest threats to human health. By 2050, it is estimated that 10 million people per year will have died from antibiotic resistant infections unless action is taken to counter the development of the issue (The Review on Antimicrobial Resistance, 2014). Efforts must be made in several areas, in collaboration between different actors – and awareness of the problem must increase among consumers. But how? Should this be carried out through antibiotic information on products – or are other measures required?

Axfoundation's survey shows that the antibiotic issue is complex and difficult to convey to customers at the time of purchase. We recommend that efforts to reduce the overuse of antibiotics are primarily aimed at producers and buyers. Tests also indicate, however, that efforts made to increase consumers' knowledge in advance of a purchase could have significantly more positive effects than information provided immediately in connection with a purchase. The study has only tested variants of longer information texts and not a “short message label”, which could be an interesting next step to study.

Axfoundation has adressed the antibiotic resistance issue since 2014 and has been the driving force behind the development of the Antibiotic Criteria – a voluntary list of criteria for antibiotics and animal husbandry that food companies use when setting requirements for their suppliers. Together with KSLA, Axfoundation also started the ‘Antibiotic Platform – from farm to fork’ to stimulate cooperation between more actors.

Amelie Silfverstolpe

Sustainable Innovation Lead,

Maria Lundesjö

Summary of the consumer tests

Sweden has shown that it is possible to radically reduce the use of antibiotics in animal husbandry while maintaining production and quality, but this is not enough to solve the problem. Antibiotic resistant bacteria know no national borders. Efforts must be made in several areas and in cooperation between different actors to speed up the work against antibiotic resistance.

Approximately 70 percent of all antibiotics used worldwide are used in animal husbandry, with only 30 percent being used in human healthcare (Our World in Data, 2017). Within the EU, Sweden leads the way, using only 10 15 percent, of the total antibiotics used in the country, for animal husbandry (SVA, 2019).

A consumer driven demand for food produced with responsible use of antibiotics could contribute to a reduced antibiotic treatment of animals. At present, however, it is difficult for consumers to find out if animals used for the production of a certain food product have been subject to antibiotic treatment. For example, no official labeling practice exists yet. Everything from ‘antibiotic free’ to ‘raised without antibiotics’ is currently used on labels.

Very few studies have been carried out on the impact of the different types of antibiotic information in relation to consumer choices in the food industry. Against this background, Axfoundation saw the need to investigate how consumers respond to information about the use of antibiotics in food production. Together with Coop and the Stockholm School of Economics, Axfoundation conducted three consumer tests during 2021 2022. The goal was to investigate the effects of communication towards consumers on the antibiotic treatment of food producing animals and to see which

message formulation resonated more. In order be able to test reactions to a short text label in a next step, we first wanted to investigate how consumers react to slightly longer informational

texts.

Tests showed that there are a number of challenges around informing consumers that a product has been produced with responsible antibiotic treatment. Such treatment means, for example, that antibiotics are only given to the animals that become ill, and not to an entire group of animals. One of the biggest challenges with this type of information is that, according to the tests, consumers choose meat where it is stated that no animals receive antibiotics at all – which has significant negative consequences for animal welfare, since sick animals must of course receive treatment.

Most consumers prefer that animals receive no antibiotics at all. This is problematic though since sick animals should be given antibiotics.

The tests also showed that if the information says that the meat was produced with responsible use of antibiotics, i.e. that sick animals have received antibiotics, then there is the potential to initiate a thought process in the recipient to wonder about things like "could the meat product I eat come from a sick animal?" or "am I ingesting antibiotics when I eat this"? In order to create genuinely positive consumer reactions to a process which means that only sick animals are given antibiotic treatment, more extensive information about this would probably be needed than what can be conveyed by a short text, what can fit on the packaging or what is possible to display as product information on an e commerce website.

What type of message works the best when one wants to inform customers that meat products are responsibly produced? To test this, the study examined reactions to different types of messages. The tests show that consumers look more positively upon information that indicates that responsible antibiotic treatment is good for animal health, compared to information that tells us about the benefits for humans. The tests also show that praise that is digitally mediated as part of the decision making process to the person who buys products that are produced with responsible antibiotic treatment of animals does not increase nor reduce the positive attitude towards a certain product, even though this can be perceived as an attempt to influence, which has a negative connotation with consumers.

Consumer tests also investigated whether the participants' prior knowledge of antibiotics and antibiotic treatment of animals affects their reactions to information regarding antibiotic use. The results show that the more antibiotic related knowledge that a participant has prior to the purchase, the more positive they are to product information that tells about animal husbandry where only sick animals receive treatment. Additionally, these consumers experience greater satisfaction with the purchase and have a more positive view of how responsible the merchant selling the product is. This part of the results thus suggests that

educational and informational efforts that can be made to increase consumers' knowledge about antibiotic treatment of animals in advance have more positive effects than brief information provided immediately in connection with a purchase, for example on a package or on an e commerce website. The more prior knowledge a consumer has about antibiotics, the more positive they are towards product information that tells them that only sick animals receive treatment.

The issue of antibiotic use in food production is complex. Our survey shows that it is difficult to clearly inform and influence a customer to make more antibiotic smart choices during the purchasing process. A short informational text is therefore not the whole solution. At the same time, it is beyond doubt that the global use of antibiotics must be drastically reduced. Our consumer tests show that customers prefer minimal use of antibiotics in food production –whilst we know that good animal welfare requires responsible use where sick animals receive antibiotics. This means that the responsibility for a reduced use of antibiotics rests partly on primary producers, but rests all the more heavily on food producers, wholesalers and the food trade supply chain, who need to set requirements and make the right choice at the point of purchase and offer consumers the best possible products.

“Our tests show that a description of responsible antibiotic use for consumers is not the simple solution many perhaps hoped for. The responsibility for a reduced antibiotic use should instead remain on primary producers as well as on purchasers who must choose to only buy responsibly produced products.”

Amelie Silfverstolpe, Axfoundation

Conclusions

The antibiotic issue is too complex a topic to be able to inform customers appropriately if only addressed at the moment they are purchasing a product.

Customers perceive that the less antibiotics used, the better, despite the fact that ‘no antibiotics’ is not the best option from an animal welfare perspective.

Animal welfare matters engages consumers more than the topic of their own health in relation to the use of antibiotics in food production.

3 practical measures

1. Wholesale purchasers should set requirements for suppliers when purchasing meat, dairy products and seafood. The Axfoundation Antibiotic Criteria is a voluntary list of antibiotic and animal husbandry criteria that food companies can use.

2. Collaborate with actors from different sectors to contribute to the transition. Together with KSLA, Axfoundation runs the ‘Antibiotic Platform – from farm to fork’ to stimulate collaboration.

3. Raise your own and others' level of knowledge on the topic through seminars and via tangible educational materials

Recommendations

Improving educational and informational efforts to generally increase consumers' knowledge about antibiotic treatment of animals can have more positive effects than information provided immediately in connection to a purchase.

Efforts to reduce the overuse of antibiotics in food production and animal husbandry should be aimed at primary producers, but also at purchasers at food producers, wholesalers and retail chains, as the issue is too complex to place the responsibility on customers at the time of purchase.

Avoid buying meat and animal products from primary producers and from countries where animal husbandry involves many animals being either given antibiotics for prevention or growth purposes or where animal husbandry is so substandard that many animals need to be given antibiotics.

Analysis and conclusions

An overarching conclusion from the studies is that there are several challenges to inform consumers about a procedure where antibiotics are only given to sick animals in the production of food products. The main challenge is that the most popular option among consumers means that no animals receive antibiotics at all. This alternative undeniably has disadvantages, for example that unnecessary suffering in animals occurs when you do not treat their treatable diseases. How then can it still be the option that consumers react most positively to?

The result can be interpreted in the light of a "disgust mechanism". It means that we humans are equipped with an evolution based warning system that reacts with negative emotions when there is a risk that something in our vicinity could infect us. Incorrectly neglecting a real threat can be extremely costly, so the warning system seems to have given us a sensitivity that means we react excessively negatively to signals of potential contagion, even when the risk is minimal. This is one explanation as to why many people find bodily fluids so disgusting. The spread of Covid 19 produced many examples of how this can be expressed, for example in the form of angry looks if you happened to cough in a public place. The warning system is thus so oversensitive that it can react negatively even to highly indirect, weak disease signals that refer to people's social behavior rather than the spread of infection per se.

Information that sick animals have received antibiotics thus has the potential to trigger a reasoning in the recipient that can mean that they question, for example, "could the meat product

I eat come from a sick animal?" or "am I ingesting antibiotics when I eat this"? This can, during later stages of the receiver's information processing process, make the attitude towards the product more negative.

The testing conducted in this study do not point to any specific information strategy for responsible antibiotic treatment to create positive reactions. Given the sensitive warning system, more extensive information is probably needed than can be conveyedby a short information text placed on packaging or as additional information on an e-commerce site, to create genuinely positive reactions to a procedure that involves only giving sick animals antibiotic treatment.

Information about antibiotic treatment must presumably be able to answer a number of questions that can easily arise as a result of consumers being made aware that animals can get sick and that they receive treatment. For example, questions about how many animals get sick in a typical production facility and how good antibiotics are at curing animal diseases. It may also include information on the possible health consequences of eating food from animals that have been sick but have been cured or have never been sick but still received antibiotics for preventive and growth promoting purposes.

Additional complexity in such information is created by the variation that exists in the treatment of disease, with or without antibiotics, for different animals (beef, chicken, pork, etc.) that are relevant for food production.

What goes through the mind of a recipient who is informed that only sick animals have been treated with antibiotics is difficult to say based on the consumers tests that have been carried out. Further studies would need to focus more on questions such

as: what conceptions can such information activate? What new notions can it create? And what consequences does this have for the recipient's view of food products produced with the current procedure as well as the view of the procedure itself?

The study carried out did not test how consumers would react to an ‘antibiotic smart choice’ style product label. Such tests could be a next step in a continued effort to find a way to guide consumers towards smarter antibiotic choices.

Axfoundation is an independent, non profit organization that innovates and accelerates practical solutions for a sustainable society. We believe in entrepreneurship as a force for change and in broad collaborations with relevant actors in society. Together with over 200 partners, we tackle practical issues related to the things we buy, the food we eat and the resources we use.

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About this report: The study was conducted by Axfoundation and Coop in collaboration with professor Magnus Söderlund at the Department of Marketing and Strategy at Stockholm School of Economics. This is a summary of the full report available in Swedish Design of tests, text and analysis: Magnus Söderlund together with Amelie Silfverstolpe, Maria Lundesjö, Maria Smith (Axfoundation). Editor: Linda Andersson, Axfoundation. Photo: iStock. Copyright: The use and distribution of material in this document is encouraged. The material may be copied, downloaded and printed, provided that Axfoundation is listed as the source and copyright holder and that the above named authors are mentioned for reference. Stockholm, september 2022 @Axfoundation