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Julian Sturdy (York Outer) (Con)
I am delighted to have been given the opportunity to host a vital debate on antibiotic resistance. As ever, Mr Chope, it is a pleasure to serve under your chairmanship.
Many people will be aware that the 20th century discovery of antimicrobial drugs, a class of medicine that includes antivirals, antimalarials and antibiotics, such as penicillin, is among the greatest medical breakthroughs of our time. However, we have failed to heed the warnings of such people as Alexander Fleming, who, when collecting his part of the Nobel peace prize in 1945, warned:
“there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant”.
There has never been any doubt about the link between the misuse of antibiotics and resistance to them, but despite this antibiotics have been misused and, as a consequence, we now face the prospect of losing modern medicine as we know it. If people take a moment to think about the consequences, they will find them frankly horrifying.
In 2013, the chief medical officer, Professor Dame Sally Davies, told Parliament of an horrific scenario, where people going for simple operations in 20 years’ time could die of routine infections because
“we have run out of antibiotics”.
To some, this scenario may still seem too far in the future to warrant any immediate action, but for me the clock started ticking on this issue a long time ago. Yet we are no further forward.
In 20 years’ time, my children will be in their late 20s. Parents and families around the country will all want their children, and the next generation after that, to have the medical guarantees that we have the luxury of being afforded today, so inaction is simply not an option.
Antibiotic resistance is already changing clinical practices in this country, For example, in recent years complication rates for prostate biopsy, which carries a risk of septicaemia, have increased from less than 1% in 1996 to nearly 4% in 2005. Due to this, doctors are now carrying out the biopsy in a different way, changing clinical practice.
The rise of antibiotic resistance is widely seen by organisations such as the European Food Safety Authority and the World Health Organisation as a consequence of the use and overuse of antibiotics in both veterinary and human medicine. However, in this debate I will focus on the continuing overuse of antibiotics in human medicine, where considerable improvements could still be made in many countries.
Mr David Davis (Haltemprice and Howden) (Con)
I congratulate my hon. Friend on securing a debate about one of the great threats to modern civilization: the prospective failure of antibiotics. Since he is not going to focus on agriculture, might I ask whether he agrees that, because some 50% of antibiotics are used in agriculture in this country, and 80% in the United States, if we are to take an international lead, as the Prime Minister would wish us to, we have to clean up our own act at home, in the way that the Dutch have in agriculture?
Julian Sturdy
I agree. Although I was only going to touch on that matter briefly, that does not mean that I do not recognise the impact on resistance from use of antibiotics in veterinary medicine. My right hon. Friend is right to mention the problems relating to resistance in the US, especially because the way that veterinary antibiotics are used there is quite frightening. In the UK and Europe, we use antibiotics differently. The Dutch are the example in that regard, and we have to learn from that. If we continue to misuse antibiotics, whether in human medicine or in the veterinary industry, resistance is bound to happen and that is bound to cause a problem, so we have to tackle it on both sides, although I want to focus on the human medicine side.
Jeremy Lefroy (Stafford) (Con)
My hon. Friend mentioned malaria and the treatments against it that have been discovered. He may know that, through misuse of the latest generation of artemisinin-based antimalarials, resistance to those is already coming up through Thailand and Burma and will possibly, eventually, get to sub-Saharan Africa, with devastating consequences, as was the case with previous antimalarials.
Julian Sturdy
My hon. Friend is right. I was going to touch on that. Multi-resistance is widespread around the world. He mentions antimalarials, but resistance is also apparent in relation to tuberculosis and there is emerging resistance to the antibiotics of last resort—the so called super antibiotics—the carbapenems, which are not licensed for use in farm animals on the veterinary side. That resistance is causing real concern.
Returning to the livestock sector for a minute, there is a tendency among some sections of the intensive livestock industry, and even some Governments, to dismiss almost entirely the contribution to resistance by veterinary use of antibiotics. This is a dangerous path to take, because although antibiotic use in farm animals may not be the main driver of resistance in humans, it is a still an important contributor, and we must recognise that.
Glyn Davies (Montgomeryshire) (Con)
Before my hon. Friend moves away from the agricultural sector, let me say that, in a long previous life as a livestock farmer, one of my earliest experiences was of the most amazingly casual approach to the use of antibiotics. If we are going to change the mindset in the agricultural industry, we have to bring on board the unions that advise farmers and get the people running agriculture onside in recognising the danger of this, because an awful lot of individual operators just do not accept the dangers and risks.
Julian Sturdy
I agree entirely with my hon. Friend. I said earlier that we must tackle misuse in the livestock sector, as well as misuse in human medicine; we must tackle misuse across the world. Regarding food security and imported food, antibiotics are misused throughout the world in the livestock sector.
It is worth putting on the record that in the UK we have some of the best animal welfare standards in the world, but we do not misuse antibiotics to any extent in the food chain, as is seen in the US. Such misuse has to be stopped and action has to be taken on that.
For far too long antibiotics have been used as if they were a bottomless pit of cure-all miracle treatments. Some 30 years ago, the battle against infectious diseases appeared to have been won, at least in the developed world. The old drugs could handle whatever bugs came along, which meant there was no market for new ones. That is why, since the year 2000, just five new classes of antibiotics have been discovered, and most of these are ineffective against the increasingly significant problem posed by gram-negative bacteria, which are also difficult to detect. The fact is that misuse, over-prescription and poor diagnostics have driven an environment that favours the proliferation of resistant strains of bacteria, rendering once vital medicines obsolete.
Mr Iain McKenzie (Inverclyde) (Lab)
I congratulate the hon. Gentleman on securing this important debate. What does he think about the growing pressures on GPs from their patients to prescribe antibiotics, which causes over-prescription?
Julian Sturdy
The hon. Gentleman makes a valid point. I hope that, through this debate and beyond, we can get the message out there that the misuse of antibiotics is potentially the greatest threat to mankind that we have seen, and in doing so, I hope that the pressures on GPs will start to subside. He is absolutely right. GPs in my constituency tell me that as soon as some people get a common cold or a sore throat they are breaking down the door, asking for antibiotics. Sometimes it is difficult for GPs to resist those calls. If we are going to secure our long-term future in the medical industry, those calls have to be resisted and that is where it has to start.
If we look at deaths related to MRSA, which is a bacterial infection resistant to a number of popular antibiotics, mortality rates rose steadily in the UK from 1993 onwards to peak at more than 2,000 in 2007. Bacteria and parasites are already developing resistance to front-line antimicrobials, which are over-prescribed and under-regulated, leading to 25,000 people dying each year in Europe from infections that doctors were unable to treat with the drugs available to them. Those statistics, however, are just from the developed world; the misuse of antibiotics is a much more serious problem in lesser developed countries, as my hon. Friend the Member for Stafford (Jeremy Lefroy) said. Hotspots of antimalarial-resistant parasites are springing up in south-east Asia, as are cases of extreme drug-resistant tuberculosis in South Africa and other parts of the African continent. Those are among the many examples that illustrate the urgent nature of this health problem.
In an increasingly interconnected world, an infection that emerges in Delhi today will have an impact in London tomorrow. More needs to be done on a scientific level to develop new antibiotics and to improve diagnostics, but science alone will not solve the problem. Pharmas, which is the collective term for pharmaceutical companies —I put on record that I was a farmer, not a pharma—need to be incentivised to develop new antimicrobials. As with other resources, antibiotic effectiveness can be used up. The eventual loss of current antibiotics is sadly inevitable, but, depending on the actions taken now, it can happen at a much slower pace.
While there are many examples of misuse in lesser developed countries, I want to look specifically at the case of India, as the challenges associated with controlling antibiotic resistance there are many and multifaceted. India has a problem with the overuse and underuse of antibiotics. The underuse is mainly due to the lack of prescriptions. For example, prescriptions were not presented for one fifth of the antibiotics purchased recently in Delhi. However, in 2005-06, a large proportion of infant and childhood deaths from pneumonia would not have occurred if the children had been properly treated with antibiotics. On the overuse, patients with coughs and colds are often prescribed antibiotics, which wastes their effectiveness. As I said, many continue to purchase antibiotics without a prescription.
India has emerged as the world’s largest consumer of antibiotics, with a 62% increase over the past decade. They consume an average of 11 antibiotic tablets a person a year—that is five days of antibiotics for every person in the country. Additionally, the use of last resort drugs such as carbapenems has gone up significantly. That is due to the enzyme known as NDM-1, which makes bacteria resistant to a broad range of antibiotics, including the antibiotics of the carbapenem family. Bacteria that produce carbapenemases are often referred to in the media as superbugs, because the infections they cause are difficult to treat. In India, 50% of all superbugs are resistant to all known antibiotics. The only exception to that is colistin, but that is because the antibiotic, which was introduced in 1959, is considered toxic.
In India, it is commonplace for someone with a sore throat to go to the chemist and choose the antibiotic they want to use. From there, many people will go to a clinic and are given their chosen antibiotics intravenously to treat the sore throat. Usually, the full dose is not administered. That is a horrendous example of the misuse of antibiotics and simply cannot be allowed to continue. Over-the-counter regulation needs to be tightened in lesser developed countries and people need to be better educated on the problems associated with misuse.
On funding and bringing new drugs to the marketplace, when pharmaceutical companies are deciding where to direct their research and development money, they naturally assess the market for a drug candidate. They have an incentive to target diseases that affect developed countries, because they can afford to pay. The pharmas also have an incentive to make drugs that many people take, and take regularly for a long time, such as statins and antidepressants, which leads to enormous under-investment in certain kinds of diseases and certain categories of drugs. Diseases that mostly affect poor people in poor countries are not a research priority, because it is unlikely that those markets will ever provide a decent return. That problem can still be seen with antimicrobials. Again, the trouble is the business model. If a drug company invented a powerful new antibiotic, Governments would not want it to be widely prescribed, because the goal would be to delay resistance. Public health officials would, appropriately, try to limit sales of the drug as much as possible. That makes for good public health policy, but a bad investment prospect.
As we all know, pharmaceutical companies form a major part of how the problem can be addressed, but we have to keep regulation in mind. By that, I mean the ability to identify infected patients quickly and cost-effectively and, indeed, to identify whether antimicrobials are needed at all. Failure on that is a root cause of the blanket drug usage we are seeing around the world. Surveys in the UK have shown that many doctors, as the hon. Member for Inverclyde (Mr McKenzie) said, still prescribe antibiotics far more often than necessary, and they are often under intense pressure to do so. A significant number of patients fail to complete a full course of antibiotics, and I hold my hands up and say that I have done that, as I am sure have many other Members. As resistance becomes more commonplace, it increases the chances that the initial antibiotic prescribed will be ineffective. As a result, resistance to antibiotics, such as carbapenems, has grown from five patients in 2006 to 600 in 2013.
While improved diagnostics would increase the effectiveness of the antimicrobials already available, the need to develop more sophisticated drugs that can keep pace with resistance is critical. The development of new drugs, however, will only come when pharmaceutical companies invest once again in antibiotics. That will occur only when those companies know they can recoup their investment costs. Of the 18 to 20 pharmaceutical companies that were the main suppliers of new antibiotics 20 years ago, just four persist in the field. Ultimately, given the choice between making an antibiotic that a person might take for two weeks once in a lifetime or developing an antidepressant that a person would take every day for the rest of their life, pharmas will naturally opt for the latter. It is thought that we need some 200 new antibiotics to cope with the growing problem. However, pharmas are clearly wary of funding this type of investment if the scope for use afterwards is limited.
I originally believed that the best way to tackle the problem would be for the Government to agree a decent unit price for antibiotics. However, it is likely that pharmas would not trust the Government—of whatever colour or combination—to deliver on that promise, so the best option could be to let the market handle the unit price, meaning that Government would stop restraining the price of antibiotics and allow them to increase to entice pharmas to invest. The more I have researched the topic, however, the more convinced I have become that that idea would not succeed. Introducing a targeted antimicrobial and selling it for the price of a cancer drug is likely to be impossible, because this is a market where people are used to getting antibiotics for next to nothing. Why would they suddenly start paying such high prices? As a result, the best solution may be incentives. The key would be to reward companies for creating substantial public health benefits, and the simplest way to do that would be to offer cash prizes for new drugs. For example, the Government would make a payment to the company, and the company would in exchange give up the right to sell the product. That would ensure the pharmaceutical company would be paid, and it would avoid all the expenses of trying to push a new product, as touched on in a report by the Select Committee on Science and Technology.
Additionally, Governments could use the approach that worked with vaccines and new pre-purchase antimicrobial drugs for a set number of years. Such pre-purchasing agreements would mean that the health care system becomes responsible for the proper usage and surveillance of antimicrobials. Currently, no Government grants are aimed at antibiotic discovery, but I welcome the independent review into antimicrobial resistance that the Prime Minister announced in July. I also welcome the brilliant news that the public recently voted to focus the new Longitude prize on antibiotics. The money will go to whoever can develop a rapid bacterial infection diagnosis test within five years. Announcements such as that ensure that antimicrobial resistance is kept in the news and on people’s minds.
Another way to ensure progress is to set up a global organisation that focuses solely on antimicrobial resistance. The World Health Organisation is now devoting considerable time to the problem, but it only produced its first global report in April this year. We are entering a perfect storm with no global organisation or global pharmas tackling the issue head on. Ultimately, a global network needs to be created to fund global antibiotic discovery. In addition, we need to ensure that people are aware of the problem and how it can be solved. Only with the public’s interest can we rally enough support to ensure antimicrobial resistance stays at the top of the political agenda, which will ensure that action is finally taken.
Overall, the purpose of today’s debate is to raise the profile of the devastating threat of antimicrobial resistance and hopefully to strike a chord across the House. Solving the problem will not be easy and will take considerable time. However, if we do not act now, things will only get worse. Many people in positions of authority in the medical profession consider antimicrobial resistance to be one of the biggest threats to mankind and I agree with that assessment. Therefore, I would like to outline a three-step plan to the Minister, which is essential to tackle the problem head on.
First, I have always believed that an in-depth report is needed into antimicrobial resistance. As such, I am extremely pleased by the Prime Minister’s announcement in July that a report will be carried out by the renowned economist Jim O’Neill. The report will look at the increase in drug-related strains of bacteria; market failure, which is crucial; and the overuse of antibiotics globally. Secondly, a global network needs to be created to fund global antibiotic discovery. Finally, the Government must step up and support small companies that invest in antibiotic discovery. As the Prime Minister said in July, the UK should be proud to lead the way in tackling antibiotic resistance, but we must ensure that the rest of world keeps pace. All Governments have a responsibility to tackle the problem and only with full co-operation across the world can we make a real impact.
We live in a globalised world, and 70% of the bacteria in it have developed resistance to antibiotics. We have been through a golden age of discovery and have sadly become complacent. We cannot become the generation that squanders that golden legacy. As the director of the Wellcome Trust, Jeremy Farrar, said:
“We are sleepwalking back into a time where something as simple as a grazed knee will start to claim lives.”
The golden age of medicine could well be behind us. It is time to step up to the plate as politicians and take decisions which might not bear fruit in the short term and might not secure votes in forthcoming elections, but can help to secure the golden age of medical discovery that we in this room have had the fortune to benefit from. We must ensure that it is not squandered for future generations.
Mr Iain McKenzie (Inverclyde) (Lab)
It is again a pleasure to serve under your chairmanship, Mr Chope. I congratulate the hon. Member for York Outer (Julian Sturdy) on securing this debate on an important and alarming subject: infections becoming increasingly resistant to antibiotics.
Without doubt, antibiotics revolutionised health care around the world, and penicillin has saved tens of millions of lives since its discovery. However, the life-saving role of antibiotics is threatened by the emergence of antibiotic-resistant superbugs. At the G8 Science Ministers’ meeting in 2013, antibiotic resistance was highlighted as one of the top threats facing humanity today, and the World Health Organisation has highlighted the difficulty in tackling the global spread of resistance. Its report suggested that no single factor or isolated intervention would prove successful in reducing the threat of antibiotic-resistant superbugs. We are only too aware that antibiotic resistance is rising. Worryingly, multi-drug-resistant tuberculosis is on the increase around the world. Only a couple of drugs still work against it, and even they may soon stop working. In 2011, over 25,000 people in the EU died of antibiotic-resistant bacterial infections. That growing resistance raises the spectre of a return to the pre-antibiotic world, when many diseases were cured—or not—just by the body’s own defence mechanisms and the passage of time.
Antibiotics were designed to kill or block the growth of bacteria, so why have they stopped working? There would seem to be several reasons, one of which, as we have heard, is certainly overexposure. Overexposure to antibiotics promotes resistance in bacteria by favouring mutations with antibiotic resistance, which can be passed from one species of bacterium to another. The reason why bacteria develop resistance so quickly is that they multiply incredibly quickly. Some bacteria can double in population every 20 minutes, meaning that mutations can emerge quickly and nullify drugs.
We are now warned that a crisis situation is developing around the world. We have not had a new class of antibiotics for decades, so growing resistance is disturbing, but it is not only antibiotics that are losing the battle against resistance. Resistance also applies to antivirals. Why? As I have said, the more a particular antibiotic is used, the greater the chance that bacteria will develop a resistance to it. As we have heard from the hon. Member for York Outer, Sir Alexander Fleming foresaw that danger way back in 1945, when he said:
“It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them…The time may come when penicillin can be bought by anyone in the shops.”
That now happens in some countries. He continued:
“Then there is a danger that…man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”
We are adding to the problem by overuse, inappropriate use, not finishing the course of the antibiotic, and a lack of basic hygiene. All contribute to the ineffectiveness of antibiotics. Experts are concerned that we are reaching a point at which some previously manageable infections will become untreatable with antibiotics. The superbug MRSA is now resistant to so many drugs that it is already hard to treat, though outbreaks have been heavily reduced by people taking simple hygienic precautions. Recently, there have been reports of cases of difficult-to-treat sexually transmitted diseases; antibiotics normally used to manage the infection are again proving ineffective. Similarly, as I have said, we are seeing cases of multi-drug-resistant tuberculosis throughout the world. WHO says that 150,000 deaths a year are caused by multi-drug-resistant TB.
Given the recent outbreak of Ebola, we are only too aware that increased international travel means that people infected in one country can spread the infection to another country very quickly. Experts say that the danger posed by growing resistance to antibiotics should be ranked alongside terrorism on a list of threats to the nation. They described resistance to antibiotics as a “ticking time bomb”. The implication is that routine operations could become deadly in only 20 years if we lose the ability to fight infection, returning us to the medicine of the 1930s or before:
“If we don’t take action, then we may all be back in an almost 19th Century environment where infections kill us as a result of routine operations. We won’t be able to do a lot of our cancer treatments or organ transplants.”
If pharmaceutical companies do not develop new antibiotics within a matter of decades, we risk losing the war against microbes. Standard surgical procedures would become riskier, as would treatments that suppress the immune system, such as chemotherapy or organ transplant.
We can take steps right now. As I said, basic hygiene has reduced MRSA infection rates by up to 80%. The use of condoms can of course prevent STDs as well as HIV. We can reduce antibiotic use, and advise doctors to be frugal in their prescribing to help avoid resistance developing. We can educate people about hygiene and unnecessary antibiotic use. Pharmaceutical companies can produce new antibiotics and develop degradable antibiotics that do not persist in the environment. We are looking at developing new vaccines as well. Vaccines for MRSA should be ready within a decade. Finally, we need joined-up thinking and new approaches.
The rise in antibiotic-resistant bacteria is a global problem that requires international action to reverse. Developing new antibiotics and vaccines, however, is very expensive. To take a drug from discovery to market is estimated to cost about £700 million. Cost will always be a major factor in the development of new antibiotics, which is why Governments must somehow find a way to incentivise research and development in the area, because if companies do not develop new antibiotics, the future is unthinkable, with previously preventable infections claiming the lives of many.
Sir George Young (North West Hampshire) (Con)
It is a pleasure to follow the hon. Member for Inverclyde (Mr McKenzie), who set out clearly the problems of antibiotic resistance. I compliment my hon. Friend the Member for York Outer (Julian Sturdy) on his choice of subject and on how he developed the argument and presented the case, ending with a three-point action plan, which I hope that the Minister will be able to smile on when she responds to the debate.
Over the recess, I read Dame Sally Davies’s book, “The Drugs Don’t Work”, which was published last year. It is concise and understandable by a layman, but deeply alarming, particularly as it comes from the country’s chief medical officer. She warned that antibiotic resistance should be treated as seriously as terrorism when we rank threats against this country. The hon. Gentleman and my hon. Friend set out the problems as the risks of antibiotic resistance become greater because of over-prescription and overuse. At the moment we are all preoccupied with Ebola, which is a virus and not a bacterium, but many lower-profile cases of new strains of antibiotic-resistant bacteria are being introduced into NHS hospitals as a result of the admission of patients who have recently arrived from overseas.
As my hon. Friend the Member for York Outer said, if we do not raise our game against the superbugs, the chief medical officer warns that a cut finger could lead to a festering death. Each year across Europe, some 25,000 people die from drug-resistant-bacterial infections. As he said, the new antibiotic-resistant threat is from the less well known, so-called gram-negative bacteria, which have names such as Klebsiella, Pseudomonas and Acinetobacter. In many parts of the world, those bacteria are either untreatable or only treatable by a toxic antibiotic called colistin, which was discovered in the 1940s. Its use carries huge risks, as my hon. Friend said, because of its toxicity. The new strains of gram-negative bacteria create severe clinical problems for patients in intensive care units or other critical care units, such as oncology or transplant. The highly antibiotic-resistant bacteria affect very sick patients, who are found in intensive care and other high-risk units. Some of those bacteria lead to death rates of 50%.
Again as my hon. Friend said, no new gram-negative antibiotics are at an advanced stage in the drug discovery pipeline, so the historical approach of relying on the pharmaceutical industry to come up with a solution will not come to our rescue this time. He explained why we have a classic case of market failure. The business case against developing antibiotics is powerful. It can take 10 years and cost more than £1 billion to bring a new drug to market and, because those bacteria evolve fast and rapidly become resistant to new antibiotics, the research needs to be ongoing. Even if a successful drug is developed, a course of antibiotics might only last a week, so the revenue potential of any new drug is relatively low. My hon. Friend contrasted that with investment in statins, for example, which a patient may take for the rest of his or her life without developing resistance, so in a sense the question of where to put the money is a no-brainer. As a result, AstraZeneca is scaling back research into antibiotics and Roche has issued warnings about the terms of trade.
There is some good news. The severity and acuity of the problem is beginning to be recognised. WHO published a document highlighting the problem in April, and President Obama signed the Generating Antibiotics Incentives Now legislation. As both the previous speakers said, we await Jim O’Neill’s report next spring on why the industry has failed to deliver any new antibiotics. It is not clear, however, how the market failure can be addressed without Government intervention of some sort —my hon. Friend the Member for York Outer outlined a number of possible solutions. It would be helpful if the Minister could confirm that she has an open mind about changing the terms of trade with the pharmaceutical industry, if that proves to be the only way forward.
I am interested in the subject because I have in my constituency a firm called Bioquell, which manufactures equipment and provides specialist services that eradicate micro-organisms—bacteria, viruses and fungi. Its new Pod product comprises single-patient rooms that can be rapidly deployed in hospitals. Crudely put, they can turn a “Nightingale” ward into US-style single rooms. The single-patient room Pod product is generating interest from hospitals around the world worried about Ebola.
As became clear in one of our exchanges on Monday following the statement by the Secretary of State for Health, hospital structures throughout the world vary. Most intensive care units in France and the USA comprise single-patient rooms, whereas most ICUs in the UK comprise open, multi-bed units, which are often linked to high infection rates. We therefore need to have tools available to combat the threat from antibiotic-resistant organisms, which differ from country to country.
At the moment, Bioquell is involved in the decontamination of health care facilities around the world that have housed Ebola patients. Those include three hospitals in the United States, as well as hospitals in the UK, France and Holland. Recently, 20 of the company’s single-patient room Pods have been deployed in the middle east to help a hospital combat the spread of viruses. A small technology company from Andover—this ties in with my hon. Friend’s third point—is therefore leading specialist decontamination work in Europe and the US, helping to combat Ebola through the provision of safe single rooms.
I ask the Minister for an assurance that the contribution companies such as Bioquell can make will not be overlooked. The NHS is sometimes slow to adopt new technology, but when it faces substantial capacity and cost pressures due to an ageing population, the adoption of new technology must form a key part of the solution to those ever-growing pressures.
We rightly celebrate our knowledge-based economy. My hon. Friend the Minister’s Department has done much to export life sciences, to encourage med-tech industries and to generate export earnings. In return, however, the Government must support British innovation in the NHS. It is unrealistic to expect companies to be successful at exporting if they do not have a robust domestic market.
I end with the point my hon. Friend made about public interest. I hope the debate he has initiated will begin to drive the issue up the agenda, and bring home to the public and, I suspect, many of our colleagues the real threat antibiotic-resistant bacteria pose to the NHS. I do not think our colleagues appreciate that, with these new strains of bacteria, the NHS faces a major challenge, with high associated death rates, and no effective antibiotics exist. Unchecked, these bacteria will limit the ability of the NHS to provide many of the life-saving procedures we all take for granted, and the costs to the NHS will increase substantially. That means there must be a positive response to Jim O’Neill and active engagement with companies at the cutting edge of research in this field so that we can begin the fight back against these antibiotic-resistant bacteria.
Mr Christopher Chope (in the Chair)
Order. Before I call Jim Shannon, may I say that the winding-up speeches will start at 3.40 pm? Three hon. Members wish to make a contribution, and I hope that can be borne in mind.
Jim Shannon (Strangford) (DUP)
It is a pleasure to serve under your chairmanship, Mr Chope. It is always nice to speak on health issues in this hall. It is also nice to see the Minister in her place—we seem to be here regularly discussing health issues—and I look forward to her response.
First, I thank the hon. Member for York Outer (Julian Sturdy) for bringing this issue forward for discussion and for his introduction. The issue is of the utmost importance, and, despite the warnings about it, some people still want to bury their head in the sand like the ostrich—“If you put your head in the sand, the car won’t run you down.” Antibiotic resistance is a serious issue but, for some reason, some people—perhaps many people —are under the illusion that if we do not talk about it, it will not happen. However, it is happening right now, and we should all be extremely worried about it. That is why the debate is important. Indeed, the hon. Gentleman and the hon. Member for Inverclyde (Mr McKenzie) both mentioned the example of the grazed knee—in the past, it was not an issue, but it could be in the future, and people could end up dying from it.
Antibiotic resistance is the ability of a germ to prevent an antibiotic from working against it, and it is a global problem. It is also part of the reason why, in recent years, we have been warned over and over again to take antibiotics only when absolutely necessary. That is a serious issue, which we must address. Although we cannot become resistant to antibiotics themselves, because they are designed to target germs not cells, antibiotic resistance is a major health problem, and we already face the reality of having fewer choices of effective drugs with which to treat basic illnesses.
Some 70% of the world’s bacteria have developed resistance to antibiotics. Unfortunately, we are now in the position of considering drugs of last resort. Before we are at the stage when only one antibiotic is left that can do the business, we need to think ahead. Other Members have talked about the pharmaceutical industry and the development of new drugs, and that is important. The more a drug is used to treat germs, the more resistance they develop. For example, just a few years after penicillin was developed, resistance to it was found in Staphylococcus aureus, in the skin. After years of heavy use, several species of bacteria are now resistant to penicillin. However, the biggest problem facing us is the development of multi-resistant germs, which are resistant to a large range of antibiotics. As they begin to develop, effective treatments become difficult. In that respect, I declare an interest as a type 2 diabetic. Every year, I am eligible for a flu jab to help me combat colds and flu. Some years it does, but some years it does not—I am not quite sure why—but, again, that shows there is resistance to the jab used to deal with flu and the cold bugs out there.
We have been advised to follow some simple instructions to try to prevent germs from becoming immune to our medicines. The advice includes getting antibiotics only when absolutely necessary, and it falls to our GPs to know when that is. Other advice includes washing our hands regularly, finishing a course of antibiotics as advised and ensuring that antibiotics are taken only by the person they have been prescribed for. Finally—I hope the Minister can give us some indication of what is being done on this—GPs should not prescribe antibiotics for colds and flu, because they are caused by viruses, not bacteria. Sometimes GPs need to have a better focus on what is best. Do people always need an antibiotic, or do they need something different?
Mr Gregory Campbell (East Londonderry) (DUP)
Does my hon. Friend agree that we require an educational process—from the Government, to GPs, to pharmaceutical companies and to the wider public—to ensure that we do not face an Ebola-type position, where we are trying to play catch-up and the end result is many deaths?
Jim Shannon
I thank my hon. Friend for his intervention. As always, he succinctly puts the issue into perspective. We are all aware of Ebola, although we are not talking about it today. The question is how we resist such bacteria.
When it comes to viruses and bacteria, most of the pieces of advice I mentioned are simple enough for us to follow. However, the two most important, which involve access to drugs, relate to doctors, and my hon. Friend referred to that. Undoubtedly, we need to encourage greater awareness through media campaigns and posters in doctors’ surgeries, and by educating our children and young people. This is all about knowledge and awareness.
The findings from the World Health Organisation are quite disturbing. In May 2014, it warned that we should expect “many more deaths” because dishing out too many antibiotics
“will make even scratches deadly”.
That is the point many people are making. Over the years, antibiotics have been used properly to extend our lives, but now we are at grave risk of turning the clock back on medicine, with the World Health Organisation claiming that antibiotic resistance has the potential to be worse than the AIDS epidemic of the 1980s, which was responsible for 25 million deaths worldwide.
The importance of necessary prescriptions cannot be underestimated. In England last year, 41.7 million prescriptions were written out, up from 37.2 million in 2006. The World Health Organisation looked at data from 114 countries on seven major types of bacteria, and the results showed that we have reason to be most concerned about the bacteria that cause pneumonia, urinary tract infections, skin infections, diarrhoea and gonorrhoea—the hon. Member for Inverclyde referred to sexually transmitted diseases.
As people become infected by resistant superbugs, they are likely to need to remain in hospital for longer than would normally be required. That may also result in their being moved to intensive care. Both those things cost the NHS money, which is simply not an option in this economic climate.
Medicine is amazing, and we are blessed to have the NHS, which is so efficient and helpful. What has been achieved over the last 100 years is astounding. However, our generation has come to rely on tablets. We are all busy, and with work and families it is not always practical to take time off, but the convenience of taking a tablet to reduce our recovery time is beginning to have adverse effects. Unfortunately, while bacteria were getting smarter, we were loading ourselves up with antibiotics. If one did not work we got another one, and if that did not work we got yet another. Now bacteria are outsmarting us, and there are few new antibiotics in the pipeline.
Although we bear responsibility for our own health, and must ensure that when prescribed an antibiotic we take it properly, much of the responsibility lies with general practitioners. They must prescribe such drugs only when absolutely necessary, and they must prescribe broad-spectrum antibiotics suitably, making sure that the selection, dosage and duration are correct. That is a clear role for the GP to play. It is vital to review and renew our campaign to research and assess microbiological data, with the aim of preventing any more bacteria from becoming resistant to antibiotics. Perhaps in that way we will find a way to reverse their immunity, and ensure that the drugs that we are using are not those of last resort.
Jeremy Lefroy (Stafford) (Con)
I congratulate my hon. Friend the Member for York Outer (Julian Sturdy) on taking the lead in the debate, and in the House previously. I congratulate, too, hon. Members from all parties, on setting out the issues clearly.
I want to concentrate on the second action point set out by my hon. Friend—a global network. I shall take malaria as an example—I declare an interest as chair of the all-party group on malaria and neglected tropical diseases—and will speak about what happened when resistance to malaria drugs spread around the world in the 1980s and 1990s. The drug that was most effective until then for the standard treatment of malaria was chloroquine. Quinine was of course a last resort, but chloroquine was used by most people. Resistance cropped up, initially in south-east Asia, spreading throughout sub-Saharan Africa, until there was little that most people who caught malaria could do, besides hoping it would be effective. In many cases it was not.
A new class of drugs was discovered, based on artemisinin, and a network called Medicines for Malaria Venture was set up. The previous Government were instrumental in setting up and supporting it, and the present Government have continued substantial support for it. As a result, even in 2008 there was a reasonable antimalarial drug pipeline. A couple of days ago in this place I had the pleasure of launching our group’s 2014 report, which had some helpful financial support from the Medicines for Malaria Venture. The pipeline has grown substantially in the six years since 2008. It has been remarkable to see not only that drugs have been coming through the pipeline, but that four of the six most commonly effective antimalarials at present have resulted from the venture. That is an example of what can be done by a multinational network, with Britain taking the lead. I urge the Minister to consider such an approach for antibiotics.
The chief medical officer, among others, has rightly referred to antibiotic resistance as a threat equivalent to the threat from terrorism. We see our work in international development as a means to combat many of the sources of terrorism. Unemployment around the world is a breeding ground for people who want to peddle violent and hateful dogmas. Where people have no jobs, ISIL uses that as an excuse to commit terrible acts. Terrorism is a threat, and so is antibiotic resistance. The problem is a global one, and relates to the global public good. Dealing with it would help the poorest in the world more than anyone else, and we could easily justify using overseas development assistance funding from the Department for International Development, alongside commercial and public health service funding, to fund a network such as the one I described. I urge the Minister to take as broad as possible an approach when she considers what sources of funding could be used to confront the threat. It cannot be exaggerated.
Zac Goldsmith (Richmond Park) (Con)
I am thrilled that despite my breaking two rules in a short time when I walked into the Chamber you are still allowing me to speak in the debate, Mr Chope. It is a pleasure to follow all the speeches, which have covered virtually all the angles. I am grateful to my hon. Friend the Member for York Outer (Julian Sturdy) for securing the debate, and for the speech he made.
There is a depressing but nevertheless welcome consensus that we are losing our antibiotics to resistance, and effectively losing modern medicine as we know it. Notwithstanding the threat of Ebola it is hard to imagine a bigger health threat. The World Health Organisation has described antibiotic resistance as a bigger crisis than the AIDS crisis of the 1980s. If we lose antibiotics we risk the return of a time when basic operations will be deadly. I used to wonder what it would take to wake up the British establishment to that appalling threat. For years virtually nothing seemed to be done to combat the extraordinary phenomenon of antibiotic resistance. I thought, naively, perhaps, that once the health establishment blew the whistle, everyone else would fall into line and, fortunately, the health establishment has been blowing the whistle very loudly. We have heard various quotations today of the apocalyptic language of the chief medical officer, Dame Sally Davies. I think she has even used the term “apocalypse”. She has said that if we do not take action, deaths will go up and up, and modern medicine will be lost.
That is of course already beginning to happen. It is not a futuristic scenario. In 2006 there were just five cases in which patients failed to respond even to last-resort antibiotics in this country. Last year the number was 600. I know that there has been some action and I do not mean to disparage that. In March last year the Cabinet Office confirmed that it would examine the question of resistance as a national security issue. In September of that year it released an outline UK five-year antimicrobial resistance strategy. The Government have since set up a high-level steering group, chaired by Dr Felicity Harvey, the director general, public health, to implement the strategy once it is released, which I think will be later this year. All that is good news, and it is possible that the strategy will match the urgency of the situation. However, I am afraid that there are worrying signs that it will not.
Yes, there will be renewed efforts to develop new drugs, which is crucial. I was thrilled to hear the Prime Minister’s response to a question on the subject, during Prime Minister’s questions, when he briefly outlined the Government’s commitment to supporting the development of new drugs. That is obviously a prerequisite to solving the problem. There is nothing in the pipeline at all, and, as existing drugs become ineffective, we clearly must hope for new developments and do all that we can to facilitate them. There will also be renewed efforts to limit the inappropriate use of antibiotics in human medicine. That subject has been covered and I shall not dwell on it today. However, so far, successive Governments, including the present one, have resolutely avoided confronting a part of the problem that is not only huge but avoidable.
It is worth repeating that from day one, when Alexander Fleming accepted his part of the Nobel prize, he issued a dire warning. We have heard the quotation and I will not repeat it. The simple reality is that we have completely ignored that warning, more or less from the day he issued it. Instead of treasuring that miracle cure, we have squandered it—not just in hospitals but on intensive farms, and not just to treat sick animals but to keep animals alive in conditions where they otherwise would struggle simply to survive. That is not just a niche concern; 50% or thereabouts of the antibiotics that we use in this country are used on farms and it is even more in the United States and some other countries. Overall use per animal on UK farms is 18% higher today than it was a decade ago. That is disproportionately true of those antibiotics that are critical to human health.
Graham Stringer (Blackley and Broughton) (Lab)
The hon. Gentleman is making an important point: since tetracycline and penicillin-based antibiotics have been banned as growth promoters for farm animals, the use of tetracyclines has up gone tenfold and the use of penicillins has gone up fivefold. This is not a party political point: there is something that the Government can do immediately about that situation, which is to monitor and study it with a view to reducing the excessive use of antibiotics on farms.
Zac Goldsmith
I absolutely agree with the hon. Gentleman, and will come on to that briefly—I am going to try to keep my remarks short. That is exactly the point. Many people felt that the ban on the use of growth promoters back in—actually, I forget the year, but I think it was 15 years ago, although I may have got that wrong and am happy to be corrected—
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
It was in 2006.
Zac Goldsmith
It was eight years ago, then. Many people felt that ban heralded the beginning of the phase out of the routine prophylactic use of antibiotics on farms, but, as the hon. Gentleman just pointed out, use has continued to increase across the board and disproportionately with regard to those antibiotics that are critically important. Given that the antibiotics used in veterinary and human medicine are closely related it is impossible to believe that that increase has not contributed to antibiotic resistance and the transfer of resistant bacteria from animals to humans.
The problem is that the industry has dug its heels in and contested the link. We have been told that there is no proof, but we know that resistant bacteria can be passed to humans on food, through the environment, directly via raw meat and so on. Some strains of resistant bacteria can mix with human strains and pass on resistant genes. For example, E. coli in animals is different from E. coli in humans, but we know that resistance can be and is transferred between animals and humans.
The industry also says that levels of resistance on intensive farms are no different from those on extensive farms, but two reports from the Department for Environment, Food and Rural Affairs have shown that resistance is 10 times lower on organic farms. The industry says there is no problem because antibiotics have to be prescribed by vets and everything is handled responsibly, but more often than not it is the feed mills that place orders for antibiotics rather than the farmers themselves. Finally, we are told that the use of antibiotics is necessary for the provision of cheap food. Perhaps that is the case, but that food will feel a hell of lot less cheap if the cost that society has to pay is the loss of modern medicine.
A briefing has been sent out to a number of MPs by the industry body RUMA—the Responsible Use of Medicines in Agriculture Alliance—saying:
“Fluoroquinolones are rarely used in poultry in the UK.”
RUMA has stated that as fact in response to the points that I and others have raised today. But on 8 September, a few days before that briefing was released, I met representatives of the Veterinary Medicines Directorate, who told me that the British Poultry Council has so far refused to provide any kind of data on antibiotic use at all. How the industry body RUMA can make such a bold and plain statement is beyond me—I suspect it is simply nonsense.
The experts take a different view from that of the industry. Sir Liam Donaldson, chief medical officer before Dame Sally Davies, went so far as to say that
“every inappropriate or unnecessary use on animals or agriculture is potentially signing a death warrant for a future patient.”
The European Food Safety Authority said last year that it is a
“high priority to decrease the total antimicrobial use in animal production in the EU.”
The Minister’s predecessor, my hon. Friend the Member for Broxtowe (Anna Soubry), told me after a debate on the same subject last year:
“Routine prophylactic use of antibiotics in both humans and animals is not acceptable practice”
and that she would be writing to DEFRA
“to ensure that existing veterinary guidance makes that very clear.”
I do not doubt the commitment of the chief medical officer—I am a wild fan of hers, as I know many hon. Members here are. I have not read her book yet, but I will do; I have read much of her writing. I have also met Dr Felicity Harvey and seen the seriousness with which she takes the issue. But so far, at least, DEFRA seems to be dragging its feet. There has been no sense of urgency in any of the meetings I have had, and any response I have had from DEFRA has been far more likely to mirror the industry line than anything the experts have said. The body language of DEFRA as a Department is almost completely defensive.
Thanks to the Netherlands and other countries we no longer have any excuse to stall. The Netherlands has seen a 50% reduction in livestock antibiotic use and expects a 70% reduction by 2015. It has phased out almost completely the use in agriculture of critically important antibiotics. There has been similar action in Denmark, Norway and Sweden. As I understand it, even the US, the land of agribusiness—it is where it was invented—has banned the use of fluoroquinolones in poultry.
The UK has no such targets or aspirations, and it is time that changed. We need to stop hearing excuses about lack of data that the industry has not provided and require those data to be collected. That is a prerequisite, as the hon. Member for Blackley and Broughton (Graham Stringer) said earlier. If the five-year strategy is to be taken seriously when it is eventually produced, it must provide a pathway to ending the routine prophylactic use of antibiotics on farms. That is now a black and white issue. In addition, the strategy must provide a pathway to an eventual ban—ideally, sooner rather than later—on the use on farms of antibiotics that are critically important to humans. Those two measures are the least we can expect from the five-year plan if we are to have any hope at all of combating a threat that the World Health Organisation has compared to the threat of AIDS.
Mr Jamie Reed (Copeland) (Lab)
It is a pleasure to serve under your chairmanship, Mr Chope. I also extend my thanks to the hon. Member for York Outer (Julian Sturdy) for securing this critical debate. He has done a great deal of work on raising the profile of antimicrobial resistance since he entered this place in 2010. Like him, and every other Member who has spoken today, I understand the issues at stake if we do not do everything within our power to tackle this threat. As well as being a shadow Health Minister, I am also chair of the all-party parliamentary group on antibiotics, which is co-chaired by the hon. Member for Richmond Park (Zac Goldsmith), who has just made a superb contribution to the debate. The hon. Member for York Outer did an excellent job in setting out the scale of the challenge that we face today.
The APPG on antibiotics was formed in June 2013 specifically to raise the profile of antibiotic resistance. Through working with key stakeholders and experts on the issue, we hope to build a cross-party consensus on tackling the threat of AMR. Before moving on, I want to praise the work of Professor Laura Piddock and the British Society for Antimicrobial Chemotherapy. That organisation works tirelessly to highlight the threat of antibiotic resistance; without it, the APPG might not even exist.
In the foreword to the document “UK Five Year Antimicrobial Resistance Strategy 2013 to 2018”, Dame Sally Davies gave a concise explanation of the scale of the challenge that we currently face:
“There are few public health issues of greater importance than antimicrobial resistance…in terms of impact on society. This problem is not restricted to the UK. It concerns the entire world and requires action at local, national and global level. AMR cannot be eradicated but a multi-disciplinary approach involving a wide range of partners will limit the risk of AMR and minimise its impact for health, now and in the future.
The harsh reality is that infections are increasingly developing that cannot be treated. The rapid spread of multi-drug resistant bacteria means that we could be close to reaching a point where we may not be able to prevent or treat everyday infections or diseases.”
Her sentiments and judgment have been echoed by scientist after scientist and medical professional after medical professional. Dame Sally Davies must be commended on her commitment and work on this issue—I am pleased so many hon. Members have recognised that today—and her leadership should be applauded. The Government must take heed of what she says and take the actions she recommends.
A report published on 10 October by Public Health England, “English surveillance programme for antimicrobial utilisation and resistance”, highlights that the problem is already real now and, as Members have observed today, is getting worse. Antibiotic prescriptions are rising—they increased by 6% in the past three years alone. At the same time, resistant bacterial infections are also on the rise. Resistant E. coli infections have risen by 12% since 2010. Dr Susan Hopkins of Public Health England told the BBC recently:
“We know that less than 1% of bacteria are extremely multi-drug resistant at the moment…But in countries like India they are approaching 10% to 20% of individuals they are not able to treat effectively with the antibiotics.”
The threat is real and we all agree that something must be done; inaction cannot be tolerated.
The Science and Technology Committee published its report, “Ensuring access to working antimicrobials”, on 7 July. At Health questions on 15 July, responding to the hon. Member for York Outer, the Minister said that the Government would publish their response to that report in September. We are now into October, so I hope she will explain when that response will be ready.
Government action is overdue. With that in mind, I would be grateful if the Minister would update Members on the progress made towards the three strategic aims and the seven key areas for future action as prescribed in the chief medical officer’s report on the five-year antimicrobial resistance strategy. The three aims were to improve the knowledge and understanding of AMR, to conserve and steward the effectiveness of existing treatments and to stimulate the development of new antibiotics, diagnostics and novel therapies. Will she explain how the findings by Public Health England on increasing antibiotic usage and increasing proliferation of resistant bacteria square with the first of those strategic aims? According to the five-year plan, the aims were informed by the 2011 European Union AMR strategic report, so we should recognise that we are already behind the curve.
The Government seem no closer on the third aim, the development of new antibiotics, although I recognise that that is a difficult problem to solve. The Science and Technology Committee report states that
“the Government needs to work with researchers, investors, small and medium sized enterprises, large pharmaceutical companies and other Governments to urgently identify appropriate economic models that might encourage the development of new antimicrobials.”
Since the Prime Minister’s announcement of the commission to review the situation we have heard nothing further from the Government. I hope that the Minister will be able to give assurances that the review, which will clearly take some years, will not be simply a substitute for any action that could be taken immediately and that, in giving those assurances, she will explain what action the Government are taking in the meantime and what discussions they—or officials, critically—have had with the stakeholder groups highlighted by the Committee’s report.
It is clear that this is an international issue that requires work across Governments. We warmly welcome the G8’s commitment to tackling it, but it is clear that more needs to be done. It cannot be solved simply by eight countries acting by themselves; wider engagement is needed. Will the Minister therefore update Members present on discussions with counterparts throughout the world and the actions that are being taken internationally?
Finally, I want to question the Minister on the pressures on primary care. One often-cited solution to over-prescription of antibiotics is to administer them only if a patient’s condition worsens. While that is a sensible approach that, where clinically appropriate, reserves antibiotics for the most serious cases, in reality the pressure on GPs means that that is not always a credible or deliverable solution.
At present 13 million people wait more than one week to see their GP. During that time, symptoms could worsen and antibiotics could be the only treatment available to people when they are seen. If they had been seen earlier, however, alternative clinical options might have been available to them. Relieving the pressure on primary care must form part of the toolkit that should be employed to tackle AMR, yet it seems that, at the moment, the Government have no response.
The tackling of antibiotic resistance is incredibly important. The CMO has said that the threat posed by AMR is on a par with international terrorism and the Government’s wishes and rhetoric must be backed up with action. That is the settled will of the Chamber and I am sure that it is also that of all 648 sitting Members of Parliament. Where the Government do the right thing, they will have the full support of the Opposition without question. This is too important to be subjected to the banalities of party politics, so let us get on with it.
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
I thank all Members who have contributed to what has been an extremely good debate. I thank my hon. Friend the hon. Member for York Outer (Julian Sturdy), who led the debate and gave a thoughtful speech. I will try to respond to as many points as possible.
I will not spend much time on the scale of the threat, as many Members eloquently have outlined that. It was brought home to me clearly when, together with my noble Friend Lord De Mauley, on behalf of the Department for Environment, Food and Rural Affairs, and the chief medical officer, I represented the Government at a World Health Organisation conference in The Hague earlier this year. The conference started with a young woman talking to us. Essentially, she was dying: she had been through pretty much every stage of antibiotics available and all had failed. That brought home powerfully what we are talking about now and what Professor Dame Sally Davies has been writing about for some years. The case has been made by other Members and I will not dwell on it. This is an extremely serious global public health threat.
The Government have a “one-health” approach, working together across human and animal health with DEFRA. My hon. Friend the Member for Richmond Park (Zac Goldsmith) made some detailed points that I will probably ask DEFRA colleagues to respond to in more detail. We will be able to respond to some of them, and some will be encapsulated in the strategy, which will be published alongside an implementation plan. Virtually all the points made in today’s debate will be covered, as well as many additional points, in that publication; I will talk to Dr Felicity Harvey and the CMO to ensure that.
In the time available, I will try to outline what the Government have done to date and give Members reassurance that we are not complacent and that we recognise the scale of the threat. In response to questions raised by some Members, we are not waiting for a grand global strategy to try to take action ourselves; we already have many things in hand, because, as Members have said, time is running out.
In September 2013, we published the UK’s first five-year AMR strategy, taking the one-health approach that I have outlined to address the human, animal, food and environmental aspects of AMR, and set up the high-level steering group, to which some Members have referred, to oversee the delivery of that strategy and, importantly, to deliver metrics to assess progress and develop the implementation plan so that our progress can be judged. In June 2014, the steering group published the measures. Broadly speaking, they look at areas such as trends and resistance; antibiotic usage; the quality of antibiotic stewardship; public attitudes, knowledge and awareness; and changes in public and professional behaviour. All of those were touched on in the debate. I confirm to the shadow Minister that the Government published their response to the Health Committee’s report on 12 September.
The first annual progress report will be published later this year, alongside an associated implementation plan, which will pick up many of the points made in more detail. However, let me highlight some of the actions to date. I am delighted that the chief medical officer, Professor Dame Sally Davies, received so many plaudits from Members in the Chamber. I, too, have read her book, which is short but very alarming, and it brings home in graphic detail the scale of the problem we face—it certainly helped to focus my mind. She has led a global campaign of which the UK is right at the forefront.
The adoption in May 2014 of the World Health Assembly resolution on AMR, which was co-sponsored by the UK, was a major step forward. It provided a mandate for the World Health Organisation to develop a global action plan to tackle AMR by 2015. We are actively contributing to support the delivery of that global action plan.
The international nature of the problem was highlighted by many Members. India was mentioned by my hon. Friend the Member for York Outer and other Members, and I confirm that the recently produced Chennai declaration has begun to tighten up on over-the-counter use, so we are beginning to see significant action. India also supported a World Health Assembly resolution on this matter. However, sitting the table and hearing the different contributions at the conference at The Hague certainly brought home to me the fact that there are differing attitudes across the world. It will be a big task to get some countries to where they need to be and we certainly need to lead by example, which is a point that has been well made.
One of the things that we can do in supporting the work at a global level is building capacity and capability. As with so many problems of our developed world, we cannot afford to wait for everyone to go through the same cycle of development, discovery and identification of problems; we need to try to share our understanding. Public Health England is piloting a laboratory-twinning initiative, where high-income Commonwealth nations are working with low and middle-income countries to build up AMR education, training and surveillance capability, rather than waiting for them to develop their own.
The drugs pipeline is a huge issue, which was explained well and in some detail by my hon. Friend the Member for York Outer. That is an area in which we need rapid and concerted international action to stimulate the development of new antibiotics. The O’Neill review, which was commissioned by the Prime Minister in July, was mentioned. It is an independent review looking at the economic issues that cause this problem, and will make recommendations on what collective action can be taken by Governments globally. I confirm to my right hon. Friend the Member for North West Hampshire (Sir George Young) and others that that review will investigate solutions such as pricing and the introduction of incentives. The review is independent, so that team can think what they want—that is what they are tasked with—and we want them to come back with solutions to a problem that we know requires innovation. The interim report is due next summer, with the final report the year after that.
The faster adoption of new ideas was touched on, in particular those brought forward by small suppliers—Bioquell was mentioned. That is integral to the brief of the new Minister with responsibility for life sciences, my hon. Friend the Member for Mid Norfolk (George Freeman), who was recently given a joint appointment to the Department of Health and the Department for Business, Innovation and Skills to look at how we can accelerate the rate of innovation, because, as we know, we must not lose time on this.
Members were concerned to know whether, in the meantime, pending the O’Neill review, work was under way, and I can confirm that it is. Quite a lot of work is going on with the pharmaceutical industry. The industry is working with Chatham House and the Big Innovation Centre to explore issues about the pipeline and to look at possible options to stimulate antibiotic development. We expect the outputs of those initiatives to be published later this year, and they will feed into the independent O’Neill review. Other work is under way, some of which involves making public assistance available to smaller companies where they need it, but I can confirm that the pharmaceutical and biotech industries are fully engaged, as we need them to be, in exploring the issue and working together on the all-important research agenda.
Much of the focus for that research is diagnostics. We have commissioned work to improve our ability to diagnose infections quickly and increase the take-up and routine use of point-of-care diagnostics. That means being able to diagnose much more quickly—at the point of care—without the delay in having to send things away for study, and so on. The more quickly we can diagnose, the more quickly we can use appropriate medication. The Select Committee certainly pressed us on that when we gave evidence and we are aware that it wants us to take action on that issue. That is very closely linked to the work on improving prescribing, which is a key strand of efforts to reduce the overuse of broad spectrum antibiotics. Easy, cheap and accurate diagnoses will enable us to tailor patient treatment much more speedily and improve clinical outcomes, which is obviously a win-win.
Hon. Members have mentioned the award of the £10 million Longitude prize, which happened on the evening between the first and second days of the Hague conference, so it could not have been more appropriate and it was great news that came through while we were all there. It was fantastic on two counts: first, that money will go towards developing a new diagnostic for AMR, on which we expect further details to be announced shortly; and secondly, it felt like a great leap forward for public recognition and public engagement on the issue. That announcement was integral to a popular science programme on television—it was not just done by the scientific community; there was full public engagement, so I am really delighted about that and we have to build on it.
On research, hon. Members will be interested to know that the Medical Research Council is leading an AMR Funders’ Forum to improve the co-ordination of research relevant to all those different aspects of antibiotic resistance. In addition, there are two new National Institute for Health Research, or NIHR, health protection research units—I apologise for all the acronyms—with a focus on AMR and health care-associated infection. They were established in April at Imperial college London and at Oxford university, and they are in the process of agreeing their initial two-year work programmes, so more research is going on in those establishments.
In addition to important work to galvanise international action and stimulate drug development, we are trying to put in place the infrastructure and tools needed to improve infection prevention and control, and diagnosis and prescribing, in order to prevent the development and spread of AMR. That requires thinking about the problem in an entirely different way, because this problem is unique. The scale has been outlined by other people, but because of some unique aspects, we need to do things in a different way, and we are very aware of that.
Infection prevention is, of course, better than treatment, so we are refocusing attention on what more we can do to improve our ability to prevent infections and reduce reliance on antibiotics. To reduce the risk of importing very resistant infections from countries where the prevalence is higher—some of those countries have been mentioned—measures such as screening on admission to hospitals are now recommended and will be taken up.
Improving infection prevention includes work with NICE—the National Institute for Health and Care Excellence—and others to develop clinical guidance, best practice information and resources. We are also strengthening the code of practice on the prevention and control of infections to clarify for providers the measures they need to take to ensure effective infection prevention and, importantly, antimicrobial stewardship. That is being complemented by NHS England looking at the best ways to use levers on commissioning in the NHS and how it can establish local patient safety fellows to champion and help to embed best practice. On the animal side, DEFRA has provided guidance to assist with farm health planning. Work is under way to explore how we can make better use of vaccines and alternative treatments to reduce reliance on antibiotics and minimise the opportunity for resistant strains to develop.
I turn to the recent survey, the English Surveillance Programme for Antimicrobial Utilisation and Resistance —to which the shadow Minister nobly referred; it is quite a mouthful—or ESPAUR. That report from Public Health England was grim reading. It certainly made it clear that we have a long way to go in this regard, and it provided data that showed the enormous variability in the levels of prescribing across the health care system in England. It showed us some areas with extremely high prescribing rates, which often had the highest resistance rates. Although that report was tough reading, it was commissioned precisely because we did not really have a baseline report. We now have that, and it is a really important set of baseline information, from which we can go forward and help to improve practice.
Zac Goldsmith
Data are rigorously collected in relation to the resistance and use of antibiotics in human medicine, but they are hardly collected at all in relation to farm use. My understanding is that the whole system is entirely voluntary, and as a consequence, there are virtually no data at all. Is that an area where, at the very least, the Minister’s Department could pull rank on DEFRA and require the collection of data, so that we can have a meaningful discussion, because at the moment DEFRA does not seem inclined to pursue the matter with any great vigour?
Jane Ellison
I have already noted my hon. Friend’s concern about that, and I will bring it to the attention of my colleagues in DEFRA and ask them to give a detailed response. Although I had noted it as an area of concern, as I say, we work very closely together on this issue, which is why the UK, I think uniquely, sent two Ministers—one from agriculture and one from human health—to conference in The Hague.
To go back to GPs, we need to get to the bottom of why we have such variation around the country and why there is so much inappropriate use. That work is going on. There are some initiatives to support the optimisation of prescribing—essentially trying to give doctors more tools to enhance their professional skills. One of those is called TARGET—Treat Antibiotics Responsibly, Guidance, Education, Tools—and is being promoted by the Royal College of General Practitioners. Work is under way to develop this area and include it in health care training curricula. We have also developed new antibiotic prescribing measures for both primary and secondary care to try and help drive down that variability.
I think we can do more as MPs—all of us, in all our routine conversations with health and wellbeing boards, GPs and clinical commissioning groups, and with our local trust chief executives. This should be a standard question on our agenda for those meetings. That would really help, because I know, as a Government Minister, and I think we all know as MPs, that when we are aware that someone is going to ask us a tough question, we go away and start thinking about whether we have a good answer, so there is a lot more that we can all do to drive it at that routine level. There is only so much that the Government nationally can do to influence local GPs.
I want to reassure Members, however, that European antibiotic awareness day is on 18 November, and it would be a great moment for all of us to talk to our local health care professionals. I would be delighted if hon. Members here today, who are so interested in the subject, would work with me in putting together something in writing to all colleagues, with great questions to ask their local health care system. I would be delighted to do that and I can facilitate it. It would include posters for GPs’ surgeries as well as encouraging the public and professionals to become antibiotic guardians and to make pledges to undertake individual action in our effort to preserve antibiotics. Some members of the public are beginning to understand the scale of the challenge, but we are certainly not there yet, and I think Parliament has a role in trying to make that clear.
As a result of the work to date in the first year of the Government’s strategy, we have significantly better data and information, which we can use to inform the development of effective interventions. We have begun to define the scale of the problem much more, and I have outlined the action that we are trying to take in an international context to make sure that the spread of AMR is taken seriously across the world.
As I have mentioned, I will report all the points made in today’s debate both to the chief medical officer and to our cross-party high-level steering group to ensure that we have picked them up in the imminent publication. If there are any points that are not picked up, I will come back to hon. Members on them individually, but I want to reassure the House on the matter. I thank my hon. Friend the Member for York Outer for calling this debate and, indeed, the House for such a well-attended and thoughtful discussion. Everything we can do in this House to highlight the scale of the problem and the urgency of tackling it is very welcome, and I thank all hon. Members for their contribution today.
Mr Christopher Chope (in the Chair)
We now move on to a short debate on connectivity to Leeds Bradford international airport. I call Stuart Andrew.