The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
My Lords, this has been an excellent and informative debate. I join others in thanking my noble friend Lord Lansley for securing it, and for his very important contribution to it. However, it is slightly sobering to think that this issue was raised in the House of Lords as long ago as 1998, as the noble Lord, Lord Trees, said, and again in 2003, as the noble Baroness, Lady Walmsley, said. It is easy to write these reports but quite a different thing to act upon them.
I was struck by the comments of the noble Lord, Lord Rees of Ludlow, on longitude, and how that prize won in the 18th century by one of the great British entrepreneurs, John Harrison, transformed navigation. Prizes have a role to play, not just for the money but in raising the profile of issues and gaining public knowledge about what is going on. However, there is another issue here. We should not be afraid of money. If scientists working in British hospitals or universities are able to make money from winning a prize, or indeed from royalties or shared royalties for an invention, we should encourage that. I sometimes think that we are way off the pace compared with the culture in the US in that regard. My noble friend Lord Colwyn referred to reactive oxygen technology. That may well be one of the new technologies that could win a prize of this kind. Certainly, we should look at that technology very closely in our fight against infection.
I pause for a moment to try to imagine a world without antibiotics, before Alexander Fleming’s great discovery of penicillin in 1928. It is worth noting that he discovered penicillin in 1928, but its use was not commercialised until the mid-1940s, so the take-up of new inventions and innovations was not as fast then as we would have liked. In those days, even a minor infection following a wound caused by a thorn in the garden or a shaving cut could result in disastrous consequences. In that pre-antibiotic age, 40% of deaths were due to infections. The emergence of antibiotics changed all that. Today, the equivalent figure has fallen from 40% to 7%. Much of modern medicine, such as cancer treatment, and much of modern surgery, is possible only because of antibiotics. However, we have been wasteful with this precious resource. As my noble friend Lord Lansley pointed out, when Alexander Fleming won the Nobel Prize in 1945, he said in his acceptance speech that,
“the thoughtless person playing with penicillin treatment is morally responsible for the death of the man who succumbs to infection with the penicillin-resistant organism”.
He was, indeed, prophetic. As my noble friend Lord Selborne almost said, in the evolutionary race, bacteria have a huge advantage over human beings. Populations of bacteria can reproduce and double within four to 20 minutes in the right circumstances. Our profligate use of antibiotics in humans and animals has accelerated that evolutionary process.
Fleming was, of course, right in voicing his fears, because that is precisely what has happened today. In a post-antibiotic era, routine operations such as removing an appendix, inserting a pacemaker or a standard hip replacement could again be very hazardous. Childbirth, too, may once again threaten a woman’s life and child mortality could increase. As the noble Baroness, Lady Hayman, said, this problem could indeed set back all the successes that we have had in combating malaria.
The dilemma we face today is in two parts: a rise in antibiotic-resistant bacteria on the one hand; and the lack of new antibiotics coming on to the market on the other. In fact, we have not seen any truly new antibiotics for decades. This is in stark contrast to the rapid post-war development of new antibiotics. Already in the UK, we are seeing 5,000 deaths per year from sepsis, half of which are due to a resistant form of the bacteria. The numbers of infections complicated by AMR are expected to increase markedly over the next 20 years. If a widespread outbreak were to occur, we could expect around 200,000 people to be affected by a bacterial blood infection that could not be treated effectively with existing drugs. High numbers of deaths could also be expected from other forms of AMR. This is precisely why the Government asked my noble friend Lord O’Neill to conduct a review of the economic and social consequences of antimicrobial resistance. It is interesting to note that a senior, well-respected economist with particular expertise in emerging economies was chosen to conduct the review, as this issue goes beyond just a health problem. It is potentially a health, social and economic problem that threatens us on a global basis. In the Government’s risk register, AMR is a tier 1 risk, along with terrorism and a flu pandemic.
As the review has pointed out, antimicrobial resistance is not just a human health problem; it is of huge significance in the animal health, environment and agriculture sectors. It is only by tackling the problem in the round—a One Health approach—that we will make a difference globally. It is worth quoting from the foreword to the report of my noble friend Lord O’Neill, which states that,
“without policies to stop the worrying spread of AMR, today’s already large 700,000 deaths every year would become an extremely disturbing 10 million every year, more people than currently die from cancer. Indeed, even at the current rates, it is fair to assume that over one million people will have died from AMR since I started this Review in the summer of 2014 … The cost in terms of lost global production between now and 2050 would be an enormous 100 trillion USD if we do not take action”.
The review’s final report makes it clear that action is in part for nations to take in response to their particular circumstances, and that in other respects action will have to be taken globally. This mirrors the approach the UK has been taking towards AMR. As regards the Government’s response on a domestic level, the UK’s approach has been built around a five-year antimicrobial resistance strategy, first published in 2013. The report from my noble friend’s review has now given us the opportunity to reinvigorate and strengthen key elements of our existing strategy. New ambitions announced at the G7 leaders’ summit in May this year, and by our new Prime Minister at the G20 last week, are an example of the immediate effect of the review. Our aim now is to halve by 2020 the number of inappropriate antibiotic prescriptions within the NHS. We are also taking steps to halve the number of the healthcare-associated Gram-negative bloodstream infections, like E.coli, which pose the biggest threat to human health. This is not to say that the NHS has not made progress already on antibiotic prescribing. In fact, between April and December 2015, 2 million fewer prescriptions were dispensed compared with the same period in 2014. That is a reduction of a little over 7%. However, we have a long way to go and we know how difficult it is to change behaviour. More accurate diagnostics will clearly be a key part of this programme. As my noble friends Lord Colwyn, Lord Lansley and Lord Selborne said, the take-up of innovation is hugely important.
In response to the comments of the noble Lord, Lord Hunt, about the regulatory regime in a post-Brexit world, I say that the Brexit situation enables us to look again at our regulatory and licensing regime to see whether we can streamline it to make it quicker and less expensive than any other regulatory system in the world. Maybe in another debate we should come back on that in the context of life sciences more generally in a post-Brexit era.
The Government will additionally set an overall target for antibiotic use in livestock and fish farmed for food. The use of antibiotics as an aid to growth or a prophylactic against infectious disease is clearly highly undesirable. As the noble Lord, Lord Trees, said, we have largely ruled it out within the UK and Europe but in many parts of the world it is still a major problem.
Other recommendations in my noble friend’s review range from the issue of awareness-raising and behaviour change through to the question of how we might create the incentives to antimicrobial research and development that are so very much needed. Infectious disease has slipped down the priority list over the last 70 years and it is time that it came back to the top of the list. The Government will publish in the course of the next few days a full account of how they will address each of the recommendations in my noble friend’s review.
On the international dimension of the Government’s response to antimicrobial resistance, your Lordships will be well aware of the significant part that Dame Sally Davies, the Chief Medical Officer, has played—the noble Lord, Lord Rees, and other noble Lords drew attention to it—in raising the profile of AMR not only in this country but around the world. She has been and will continue to be a tireless champion, raising awareness of this huge threat to public health. The Government share her views fully. AMR has to be tackled on a global basis. In fact, in the last two years, the UK has played a central role in the WHO’s global action plan, which is largely mirrored by the World Organisation for Animal Health and the UN Food and Agriculture Organization. Each of these is important and each creates clear aspirations.
Our current focus is on the UN General Assembly high-level meeting next week to drive further international commitment and action to tackle AMR on a global scale. This objective will not be achieved easily or without perseverance. There is, however, good reason to believe that the effort and investment will bring real results. Indeed, the leaders’ communiqué from the G20 summit earlier this month acknowledged the threat that AMR poses to public health, growth and global economic stability, and committed to return to the subject next year. In the meantime, the leaders have asked international organisations with a particular interest, including the WHO and the OECD, to report back on options to address the serious shortfall in the number of new antibiotic and other drugs—a topic central to the analysis in my noble friend’s report. We are confident that the UN General Assembly high-level meeting on 21 September will not only raise awareness but pave the way for a positive declaration that will include a strong UN follow-up mechanism to monitor progress, locking in global commitments.
Our commitment will continue to allow us to provide support to low and middle-income countries. For example, our £265 million Fleming fund will support these countries to improve laboratory capacity and surveillance to tackle infectious disease. We are also working hard to promote research and innovation in antimicrobial resistance; for example, in fields of new diagnostics and vaccines. We have also committed £50 million towards setting up a global AMR research innovation fund to help countries tackle the threat.
The noble Baroness, Lady Hayman, asked a question on the Ross fund. The fund will provide £1 billion to develop, test and deliver a range of new products for infectious disease, such as malaria, Ebola and other neglected tropical diseases. The UK has invested over £200 million in product development, which has contributed to the launch of over 13 new vaccines, diagnostics and drugs in the last five years. This is a fourfold increase compared to the total global product development for the world’s most vulnerable between 1975 and 2000.
In conclusion, this is a hugely serious issue. AMR kills many people at the moment and could kill many millions more in the future. It also has huge economic consequences for the world. I will end by giving the last word to my noble friend Lord O’Neill, who has done so much to raise awareness of this great issue. I quote the last paragraph of his foreword to the latest report:
“Although AMR is a massive challenge, it is one that I believe is well within our ability to tackle effectively. The human and economic costs compel us to act: if we fail to do so, the brunt of these will be borne by our children and grandchildren, and felt most keenly in the poorest parts of the world”.