Antimicrobial Resistance

Baroness Suttie Excerpts

Thursday 8th March 2018 Grand Committee

[Baroness Suttie (LD)]

My Lords, I, too, thank the noble Baroness, Lady Greengross, for securing this extremely important and timely debate. I begin by declaring an interest as vice-chair of the APPG on Global Tuberculosis, and I refer noble Lords to my interests as set out in the register and my work with the Global TB Caucus. I will, perhaps not surprisingly, concentrate my remarks this afternoon on tuberculosis and multidrug-resistant TB.

The review on AMR by the noble Lord, Lord O’Neill, estimated that one-third of all AMR-associated deaths are currently caused by drug-resistant TB. In 2016, an estimated 600,000 people developed drug-resistant TB. While rates are going down gradually, drug-resistant TB rates continue to rise in some parts of the world. This situation is particularly true in Europe, which has seen the fastest growing rates of multidrug-resistant TB of any world region. Although it has the lowest TB incidence, it has the highest rates of MDR TB. Of the almost 300,000 cases of TB in Europe last year, more than 120,000 were drug-resistant. I should say at this point that this is the European region as defined by the World Health Organization, which includes the central Asian countries of the former Soviet Union. In other words, well over one-third of all TB cases in Europe last year were drug-resistant.

Of the 30 countries identified as having the highest rates of drug-resistant TB, nine are in the European region and the countries of the former Soviet Union. The reasons for the particularly high levels of TB and MDR TB in the countries of the former Soviet Union are complex: steep economic decline and the sharp rise in poverty in the 1990s, when the Soviet Union collapsed; the disintegration of the Soviet healthcare system; an HIV epidemic; very high prison populations and dilapidated prison facilities; and the excessive hospitalisation of patients who are no longer infectious as they have been taking their medication. In addition, since independence, many of these countries have seen significant deregulation of pharmaceutical provision and the ready availability of antibiotics to buy in privatised kiosks, often without a doctor’s prescription, throughout the cities of the former Soviet Union. In some countries, there are also difficulties in securing newer drugs available to treat MDR TB, from which patients could greatly benefit.

With the Global TB Caucus I have been visiting many of these countries over the past 18 months to try to raise awareness of multidrug-resistant TB and its causes among parliamentarians in the countries of the former Soviet Union, to encourage them to set up parliamentary groups like APPGs in their own Parliaments and to work with civil society organisations and their health ministries to take action against drug-resistant forms of TB. Clearly, the APPG in this department has very similar aims.

The noble Lord, Lord O’Neill, in his review of AMR, recommended as a first intervention that there should be a global public awareness campaign. Will the Minister say how successful he thinks this public awareness campaign has been up until now, and what further measures the Government intend to take to achieve this goal? Drug-resistant strains of TB are more expensive to treat because of the cost of medicines, the length of treatment and the amount of additional support required by each patient to manage side effects. I have spoken to many patients with drug-resistant TB in Ukraine and central Asian countries, as well as here in the UK, and they have told me of the difficulties of swallowing up to 20 pills a day, along with painful injections and the side effects to their mental and physical health of having to cope with such a harsh regimen, often for a period of 18 months or more. Considerable support networks are required to ensure that patients continue with their treatment and, clearly, not continuing with the treatment adds to the risk of developing a form of TB which is even more drug-resistant.

There have been relatively few advances in finding new treatments which work more effectively and more quickly against drug-resistant TB, which leads me to my second question to the Minister. What measures do the Government intend to take to incentivise the production of new and more effective antibiotics for TB, and multidrug-resistant TB in particular? The Global TB Caucus estimates that $1 trillion will be lost to the global economy between 2015 and 2030 if no major steps are taken. Increases in rates of MDR TB can put a massive strain on healthcare systems and national economies. KPMG predicts that Europe could be due to lose nearly 0.02% of its economy between 2015 and 2050 due to MDR TB alone should urgent action not be taken.

In autumn this year the United Nations will hold a high-level meeting on TB. This represents a significant opportunity to adopt a concerted international effort to tackle multidrug-resistant TB. Will the Minister say what preparations the Government are currently making to prepare for this high-level meeting?

I will end with a quote from the review by the noble Lord, Lord O’Neill:

“The burden of TB is too great, and the need for new treatments too urgent, for it not to be a central consideration in the role and objectives of a global intervention to support antibiotic development”.