Antimicrobial Resistance

Lord Trees Excerpts

Thursday 2nd May 2019 Lords Chamber

[Lord Trees (CB)]

My Lords, I too am grateful to the noble Lord, Lord Lansley, for securing this debate. Like him, I commend the new national action plan on tackling antimicrobial resistance. There is no doubt that antimicrobial resistance—that is resistance to microbes—is a major global challenge. The O’Neill commission’s final report in 2016 warned that, if unchecked, by 2050 AMR could lead to 10 million deaths and a $100 million cost to the economy globally. That has been referred to earlier. There is no question that antimicrobial resistance is a truly major issue.

These figures are frequently used in the introduction to discussion of antibiotic resistance. That is the resistance of bacteria to particular drugs. I emphasise, perhaps needlessly, that while all bacteria are microbes, not all microbes are bacteria. This is significant when considering drugs, which are often specific. As a veterinary scientist and in the context of the involvement of animals in this issue, I will focus on antibiotic resistance. I declare my interests as a long-standing member of the BVA and a former president of the Royal College of Veterinary Surgeons.

The first point is that the AMR figures that headline my contribution, quoted in the O’Neill report, include the consequences of drug resistance in malaria and in viruses, notably HIV and the human tubercle bacillus. These are undoubtedly major causes of mortality in humans globally, but in none of them is there a connection to drug use in animals. I make this point not to diminish the problem of AMR, nor that of antibiotic resistance, but it is important when addressing this problem to accurately distinguish its component parts in order to rationally tackle it.

Having clarified that, and excluding the above three infections, the resistance of some bacteria to antibiotics is still a substantial problem in human medicine. While it is generally accepted that this is primarily a result of the use of antibiotics in humans, there is undoubtedly some connection to the use of antibiotics in animals. These situations particularly involve food-borne infections transmissible between humans and animals, such as E. coli, campylobacter—which is the biggest cause of food poisoning in the UK, usually non-fatal but debilitating—and salmonella. They also involve some other directly transmissible infections, to which those who work with or keep animals may be particularly exposed, such as MRSA.

There is still much uncertainty, in many of these situations, about the extent of the flow of resistant bacteria between animals and humans, and indeed the environment, and its direction—because we must remember this is bidirectional. We badly need more research on this, but molecular typing methods are increasingly helping to elucidate these questions. There have been some important results recently from several groups using molecular characterisation, which have shown that bacterial populations of E. coli and salmonella in animals and humans may remain more distinct than hitherto suspected.

Notwithstanding this, the veterinary profession and livestock industries have taken the issue of antibiotic resistance very seriously, and have made huge progress in reducing or restricting antibiotic usage in animals—I am talking about Europe and the UK particularly—to safeguard human health, while maintaining animal health and welfare, and livestock productivity. There has been a concerted effort by animal industry bodies—particularly in fish farming, but also the poultry and pig industries, to be fair to them—and the British Veterinary Association, the British Small Animal Veterinary Association, the British Equine Veterinary Association, the Responsible Use of Medicines Agriculture Alliance and the National Office of Animal Health. These bodies have variously produced literature, information, posters, training courses and toolkits, and have set voluntary targets and restrictions.

This has all been strongly supported and monitored by the Veterinary Medicines Directorate and the Royal College of Veterinary Surgeons, which introduced guidance some time ago in its Code of Professional Conduct requiring veterinary surgeons to be responsible in their use of medicines and antibiotics. For the avoidance of doubt, I make it clear that the use of antibiotics in animals for growth promotion has been banned in Europe since 2006, and antibiotics are available only by prescription from a veterinary surgeon for animals under their care.

The remarkable progress in reducing and restricting antibiotic use in the UK is documented by the latest UK One Health Report, published in January this year. This shows that, between 2013 and 2017, there was a 40% reduction in the use of antibiotics in food-producing animals, achieving below the 2018 target advocated by the O’Neill commission report. This translates to a reduction of antibiotics in animal use to 282 tonnes, and of so-called high-priority critically important antibiotics, as defined for human use, to 2.2 tonnes. In the same year, 2017, the corresponding figures in humans were 491 tonnes for all antibiotics and 17.1 tonnes for critically important antibiotics.

But we must not be complacent. Further voluntary targets were agreed in 2017 for reducing antibiotic use in eight key livestock sectors. Those targets variously include reduced use, particularly of high-priority critically important antibiotics; improved monitoring and data collection; and knowledge-exchange initiatives.

As has previously been said, the issue of antibiotic resistance is global. While good progress is being made in the UK, there is still uncontrolled use of antibiotics in both humans and animals in many countries. In an age of globalisation, the global movement of humans, who carry millions of bacteria with them every time they go anywhere, as well as of animal products, will continue to introduce antibiotic-resistant bacterial strains into the UK no matter what we do here, as was stressed by the O’Neill report. United, coherent global action is required and the UK has been a strong leader in that respect. The importation of resistant bacteria is of particular concern post-Brexit. Like several speakers in today’s debate, the BVA and others have called for rigorous standards requiring the responsible use of antimicrobials on farms to be incorporated into future trade deals, with certain conditions put in about minimal antibiotic usage. This is a particular issue with regard to the US, for example, to which the noble Lord, Lord Crathorne, alluded. I assure him that I do not defend the scale or purposes of antibiotic use in animals that we see in the US. Can the Minister assure the House that the threat of importing antibiotic-resistant bacteria on meat products will be carefully considered in negotiating future trade deals?

The new UK five-year action plan sets out ambitious measures nationally and internationally in both human and animal usage to tackle AMR. In animals, a target is set to reduce antibiotic use by 25% between 2016 and 2020, with new objectives set beyond that for the next five years. In the longer term, and in addition to the reduction and restriction of antibiotic use, it is essential that we seek better ways of dealing with bacterial infections to avoid drug use, such as improved hygiene, biosecurity and other measures, particularly the development of vaccines—that has been mentioned, so I shall not emphasise it further. Vaccines against endemic disease are particularly needed. The Government are to be congratulated on mentioning the importance of endemic diseases in their Health and Harmony policy statement in 2018.

Will Her Majesty’s Government consider making available financial support under the public money for public goods agenda that we see in the Health and Harmony document and in the coming Agriculture Bill for measures that will reduce the development and spread of antibiotic resistance?

I, too, pay tribute to the efforts of the Chief Medical Officer, Dame Sally Davies, and the O’Neill commission, which have been hugely important in galvanising national and international attention on this subject.