Antibiotic-Resistant Bacterial Infections

Countess of Mar Excerpts

Wednesday 24th July 2013 Grand Committee

[The Countess of Mar]

My Lords, I am grateful to my noble friend Lord Crisp for enabling us to debate this important subject today. I draw the Committee’s attention to my interests in the register, and I am also a member of the All-Party Parliamentary Group on Antibiotics.

We have been given warnings of the dire effect of the overuse of antibiotics that results in antibiotic resistance for many years. In 2011 Dr Margaret Chan, director of the World Health Organisation, warned:

“The implications go beyond a resurgence of deadly infections to threaten many other life-saving and life-prolonging interventions, like cancer treatments”—

which my noble friend mentioned—

“surgical operations, and organ transplantations”.

As both Dr Chan and the Chief Medical Officer have stated, the R&D for new antimicrobials has practically run dry.

Noble Lords have given graphic examples of the cost of antibiotic resistance. I will try to look ahead and inject a glimmer of hope into the current gloomy scenario, and expand a little on what my noble friend Lord Crisp proposed. If modern medicine is to progress, the infrastructure of academic and industrial antibiotic research discovery and development needs to be rebuilt. We know that the current estimates for one new drug to reach the market range from $100 million to $10 billion, with antibiotics at the lower end of that scale. For 20 new classes to reach the market, the costs are phenomenal.

What can be done? There needs to be an overarching framework within which the very best knowledge is brought together. The key to progress will be the development of well informed guidelines and information to help current and future research activities to focus on well funded innovation. Because the problem is potentially so huge and widespread, there is a need for a global initiative as well as a UK one. For the global initiative, it has been suggested that something along the lines of the post-war Marshall plan, which helped to rebuild Europe, might provide the beginning of a solution. This would have to be paid for at a continental level—for example, by the European Union, the USA and Asian countries.

Antibiotic Discovery UK is a network of leading academic researchers and universities, together with SMEs, that have a common goal of revitalising antibiotic research in the UK. It has recently circulated to the Medical Research Council, the Biotechnology and Biological Sciences Research Council, the Engineering and Physical Sciences Research Council and the National Institute for Health Research a proposal for a cross-research council antibiotic research programme—CRCA for short—modelled on the Farr Institute and the MRC’s AIDS-directed programme of 1987, with the aim of conducting fundamental and developmental research into antibiotics for the prevention and treatment of bacterial infections. The programme plans to include work on basic bacteriology, antibiotic resistance, epidemiology, chemistry, drug design and drug evaluation. The CRCA would add to existing investment by research councils and charitable bodies. It believes that its programme would further enhance the UK’s international reputation and that it would provide a significant stimulus to the UK economy, and in particular to the pharmaceutical sector.

Members of Antibiotic Discovery UK point out that the UK is home to a wide range of outstanding scientists with innovative medical, biological and physical science skills. The CRCA programme would link at least eight universities across the UK and would foster strong links with industry as well as international co-operation. They acknowledge that this is an ambitious proposal but I believe that, if we are to crack this problem, a programme such as this is vital.

A multi-pronged approach such as that proposed by Antibiotic Discovery UK would include antibiotic discovery and development by discovering new molecules, mining past leads and exploiting natural products. It would improve researchers’ understanding of pharmacokinetics so that new combinations of drugs could be developed such as those currently used to treat TB and HIV. This would enhance antibiotic stewardship and research into antibiotic resistance through surveillance, diagnostics, epidemiology and mechanisms of resistance.

There is a clear need better to engage and fund academics alongside industrial partnerships to help to deal with this threat, but no one academic group or single institutional centre has the capacity or the capability to make significant inroads. There is great strength in numbers. Best practice and knowledge can be shared between academics and industry within the network, and innovation can flourish. There is a need for multi-institutional centres of excellence to tackle well validated targets such as cell wall biosynthesis, protein biosynthesis and DNA replication, as they offer multiple targets to hit. We now know that therapy should avoid hitting single targets, which will only result in the further speedy emergence of resistance.

On the subject of novel treatments for antibiotic-resistant conditions, I was interested to read that Professor Tony Maxwell of the John Innes Centre, together with a European consortium of researchers, is researching a compound derived from the South African toothbrush tree which inactivates a drug target for tuberculosis in a previously unseen way. Miracles come from all sorts of places.

The situation is not hopeless, but we need to ensure that researchers are encouraged to work together and that they are adequately funded. This matter is too important to be left to industry alone to deal with.

As I have a few minutes in hand, I will read to noble Lords the e-mail that we have all received today from Sue Davie, the chief executive of the Meningitis Trust. She says:

“I understand you are participating in a Speaker debate on ‘antibiotic resistant bacterial infections’ this afternoon. In light of the announcement today that the JCVI will not be recommending the Meningitis B vaccine, we would be grateful if you could raise the following issues, on behalf of Meningitis Trust/Meningitis UK … We welcome the Chief Medical Officer’s focus on antibiotic resistant bacterial infections and the efforts the government is making on this issue ... It is accepted that one of the best ways of limiting the rise of antimicrobial resistance is to properly use the interventions we do have available to combat infectious diseases—an excellent example of these are vaccines ... Can Earl Howe comment on the interim position statement of the Joint Committee on Vaccination and Immunisation (the independent body which advises the Government on vaccination) which has said that a vaccine which could prevent meningitis B disease will not be made available in the UK? … Meningitis is a disease with a very rapid onset, its symptoms are vague and unspecific. When a case is suspected the medical personnel need to flood the systems of these babies and children with antibiotics ... Kind Regards, Sue Davie”.

There is nothing worse than seeing a baby who lost their limbs because they had meningitis B and were not reached in time with antibiotics. Can the Minister give me a response on that?