Last year, a coalition of public health advocates released a report card grading the nation’s 25 biggest restaurant chains on their antibiotics policies. An astounding 20 of these chains earned “F” grades, usually for completely failing to address this issue. The newest report card shows that a number of restaurants have inched their way out of the basement, but the large majority of these companies appear to be completely ignoring antibiotics concerns.

Antibiotics provided to farm animals — primarily for growth-promotion — account for around 75% of all antibiotics sold in the U.S. each year. This practice has been linked, along with doctors who over-prescribe antibiotics to patients, to the development of drug-resistant pathogens that sicken some two million Americans — killing more than 20,000 — each year.

These 25 restaurant chains are each among the country’s largest buyers of beef and poultry. Advocates believe that if these companies were to demand antibiotic-free meat, they could help change farming practices to curb antibiotics overuse.

The good news in the latest report [PDF] from a coalition that includes the Natural Resources Defense Council, Food Animal Concerns Trust, and our colleagues at Consumers Union, is that the number of chains at least acknowledging the antibiotics issue has nearly doubled, from five in 2015 to nine this year.

Former “F” earners Papa John’s, Wendy’s, Subway, Taco Bell, and Pizza Hut, have all recently announced policy changes affecting at least some of their food supply.

Subway made the big leap from F to a solid B by laying out a roadmap to have 100% antibiotic-free meat by 2025. McDonald’s improved incrementally, from a C last year to a C+ by fulfilling its previously announced commitment to sourcing drug-free chicken in the U.S. The Golden Arches could have scored higher, but it has yet to announce any concrete plans to source antibiotic-free beef or pork.

Likewise, while Wendy’s, Taco Bell, Pizza Hut, and Papa John’s made the leap into the passing grades by at least eliminating antibiotics from some ingredients, they still have a long way to go. The two pizza chains committed to antibiotic-free chicken on pizza toppings, they have yet to agree to sourcing drug-free chicken wings, or to address their beef or pork ingredients. Similarly, Wendy’s policy change only addresses chicken, but not other meat ingredients.

One company actually slid out of the passing grades and back into the F zone; Dunkin’ Donuts, which actually relaxed its antibiotics policies since earning a C on the the 2015 report.

The previous DD policy prohibited all meat suppliers from practices like the routine use of antibiotics that are deemed medically-important to humans. But according to the report, in late 2015 Dunkin’ updated its policy from a prohibition to a recommendation, saying that “Suppliers should only administer antibiotics and antimicrobials to animals for the control and treatment of disease.”

A number of the F-earning chains — Dairy Queen, Denny’s, Jack in the Box, KFC, Sonic, Olive Garden, Starbucks — at least eked out some point on the report card for being transparent about their poor antibiotics policies.

These lowest scoring chains failed to earn a single point: Applebee’s Buffalo Wild Wings, Burger King, Chili’s, Domino’s, IHOP, and Little Caesars.

“The future effectiveness of antibiotics depends on making sure they are used only when necessary,” said Jean Halloran, Director of Food Policy Initiatives at Consumers Union, the advocacy arm of Consumer Reports. “By the end of 2016, Subway will join McDonald’s, Chipotle, and Panera in serving chicken raised without wasting these critical medications. It’s time for all fast food restaurants to do their part to protect public health by no longer serving meat and poultry from suppliers who misuse these vital drugs.”

Sasha Stashwick, Sr. Advocate for Food & Agriculture at the NRDC, says the new scorecard indicates from positive changes in the industry, but calls out KFC — whose corporate partners Pizza Hut and Taco Bell earned passing grades — for standing out “as a major laggard. Despite receiving a call to action last month from over 350,000 concerned consumers, the company is still failing to do its part to protect people from superbugs.”

“Antibiotic resistant infections already cause more than 23,000 deaths and up to $55 billion in costs each year and antibiotic misuse in animal agriculture threatens to drive these numbers even higher,” said Steven Roach, Food Safety Program Director of Food Animal Concerns Trust. “Even the CDC agrees that with the recent discovery of the latest colistin-resistant superbug, the end of the road for antibiotics is not far.”

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