Autism: Diagnosis Targets

Lord Trees Excerpts

Tuesday 16th May 2023 Lords Chamber

[Lord Markham (Con)]

First, each ICB now has to have a lead for autism and learning difficulties. The noble Baroness is correct that there are some disparities— I am sure that she is aware of the two ICBs which have restricted their services quite significantly, although, thankfully, they are now rowing back on that. We need to make sure that we are on top of all of them. As the noble Baroness is aware, I and other Ministers are taking a personal interest in this. Clearly, there is a lot of work to be done.

[Lord Trees (CB)]

My Lords, what are the Government doing? Are they supporting research to find out the causes of this apparent huge increase in autism which we have seen in recent years?

[Lord Markham (Con)]

There are a couple of factors. Obviously, the strains and stresses of Covid have brought a lot of these things out into the open. It is good that people are becoming much more aware. My experience dates back 20 years when no one had even really heard of Asperger’s, so it is good that we are aware of it today. It is also good that many more people are now diagnosed with it.

Animal Diseases: Future Pandemics

Lord Trees Excerpts

Wednesday 21st July 2021 Lords Chamber

Asked by

[Lord Trees]

To ask Her Majesty’s Government what assessment they have made of the proportion of infectious diseases in people that originate in animals; and what plans they have to adopt a “One Health” approach to prepare for future pandemics.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]]

My Lords, zoonotic diseases comprise approximately 75% of all newly identified infectious diseases and 60% of existing ones. The UK has world-leading “one health” expertise already enhancing the detection, investigation and management of zoonotic diseases. We must continue to weave this approach into the fabric of domestic and global architecture. Through our G7 presidency and ambitious initiatives, such as the centre for pandemic preparedness, we will further strengthen our “one health” capability.

[Lord Trees (CB)]

I thank the Minister for his Answer. I shall press him for more specifics. Given the huge cost of zoonotic pandemics—Covid-19 has been estimated to cost the UK £340 billion—what plans have Her Majesty’s Government been considering to improve animal health, public health and environmental health systems which are critical in the prevention of spillover infections from animals to humans in the UK and abroad?

[Lord Bethell (Con) [V]]

My Lords, there is a very large number of initiatives. I emphasise our international efforts to reverse the underlying causes of spillover infections from animals to humans, including biodiversity loss and the risk from the illegal wildlife trade. Using the UK’s G7 presidency, we have committed to doing more by establishing the International Zoonoses Community of Experts, by creating the centre for pandemic preparedness and conducting a one health intelligence scoping study to ensure that the systems work better together to identify future threats.

Covid-19 Update

Lord Trees Excerpts

Tuesday 15th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I absolutely forgive my noble friend because that is an extremely sensible question. I take it on board completely. The endgame is to end a contagious disease that has exponential growth. As she knows, R is currently between 1.2 and 1.4. If it goes unchecked, this disease will spread pretty much through the whole population. The vaccine is excellent at keeping people out of hospital, but not everyone. It is excellent at preventing deaths, but not for everyone. It is good at stopping the disease, but only half of the disease. We must get enough vaccine out there so that the disease will not run through the entire population and lead to the deaths of thousands, tens of thousands, or more. That is the endgame of this project.

[Lord Trees (CB)]

My Lords, will the Minister confirm that the Covid cases reported daily in the media are not clinical cases? They are not sick people but positive results of the PCR test. Given that the PCR test is incredibly sensitive and can detect tiny numbers of virus particles, what proportion of positive tests is likely to develop clinical disease?

[Lord Bethell (Con)]

My Lords, the PCR test is very sensitive. Most people who take the test are presenting a symptom, so a very high proportion of those positives are people who have the disease when they take it. Of course, there are many who have the disease and do not take a test at all, so there is more disease in the population than accounted for in the positive tests. There is a very small proportion of people who might have shreds of the virus from a previous infection who then test positive, but it is thought that that proportion is very small.

Covid-19: Great Barrington Declaration

Lord Trees Excerpts

Tuesday 13th October 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Lord makes a very good point. Although I have not had legal advice on this, I feel sure that he is on the right track. The great protection would condemn anyone with asthma or a learning difficulty, in old age, or with any major disability or immune challenge to be locked up while society turns its back. That is not a decision that this Government are prepared to make.

[Lord Trees (CB)]

My Lords, an exit from the pandemic will be achieved only when an appropriate level of population immunity is achieved, either by natural infection or vaccination. Given that the Government’s strategy is to rely on vaccination to deliver population immunity, what estimates and advice are Her Majesty’s Government receiving about the realistic timeframe, from now, in which an efficacious vaccine will have been given to sufficient numbers of people to establish that population immunity?

[Lord Bethell (Con)]

The noble Lord is entirely right in his analysis. The briefings from the Vaccine Taskforce to the Prime Minister are encouraging. One of the striking things about the updates is not only the promising nature of the Oxford vaccine, which is progressing very well, but the substantial pipeline of a dozen or more other vaccines that are coming through. Six of those have already been contracted by the Vaccine Taskforce on four different vaccine platforms. I am afraid that I cannot provide a firm schedule as such things are not in the gift of Ministers, but I am informed that progress is substantial.

Health: Tick-borne Encephalitis

Lord Trees Excerpts

Tuesday 5th November 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Lord is right to raise this issue. We have been making sure that action is taken quickly. Tick bite avoidance is a key message in this area and is the same for TBEV as for Lyme disease. PHE has worked with local authorities and key stakeholders in the relevant areas, informing them about TBE and the tick toolkit documents and guidance, so that they can remind the public, their staff and visitors to be tick aware. Specific awareness campaigns will come forward in spring 2020. The material for these will include information on Lyme disease and TBE. In addition, there will be research programmes on TBE, to ensure that we in the UK are as aware as we can be about it. To be clear, there has been only one probable case of TBE infection diagnosed —a European visitor bitten by a tick in the UK. At the moment, this is a very low risk to anyone in the UK and a low risk to those in the areas.

[Lord Trees (CB)]

My Lords, I do not want to be alarmist but the discovery of tick-borne encephalitis virus in the UK is worrying. The tick vectors of this viral infection are widespread throughout the UK and are maintained on a variety of animal hosts, including wild deer, which are now extremely common in lowland as well as upland areas. The number of clinical cases in Europe has been steadily increasing and, while it is true that something like two-thirds of cases are non-clinical, as many as up to 10% of those affected may suffer severe neurological sequelae, especially children and—noble Lords may like to know—the elderly. I ask the noble Lord: will the Government reintroduce the mandatory tick treatment of pets imported into the UK under the pet travel scheme? Is the noble Lord satisfied that we are doing all we can in the UK, in terms of research and preventive actions with regard to biosecurity, to safeguard animal and human health in this era of climate change and globalisation?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for that question, although I generally identify as a noble Baroness. We are continuing surveillance studies for TBEV in ticks and wildlife, and we plan to monitor its prevalence, distribution, maintenance and spread in the UK to ensure oversight of the situation. We have based our understanding of the risk assessment on recent experience in the Netherlands, where TBEV was recently identified. The estimated risk there of Lyme disease from a tick bite is 1:50, while the estimated risk of TBEV from a tick bite is 1:500,000. As regards us doing enough work, we have a national contingency plan written to deal with vector-borne diseases and understanding the effect of climate change, which gives us a sense of the challenges that we face.

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.

Drug-Resistant Infections

Lord Trees Excerpts

Thursday 15th September 2016 Lords Chamber

[Lord Trees (CB)]

My Lords, I join others in congratulating the noble Lord, Lord Lansley, on securing this debate, which, I dare to suggest, in terms of the significance of the global problem that we are discussing, is one of the most important that we have had in this House for some time.

I begin with a quotation:

“This enquiry has been an alarming experience, which leaves us convinced that resistance to antibiotics and other anti-infective agents constitutes a major threat to public health, and ought to be recognised as such more widely than it is at present”.

That is not a quote from the O’Neill report; it is the opening statement of the summary of recommendations from the seventh report of the House of Lords Science and Technology Committee, published in 1998 and entitled Resistance to Antibiotics and Other Antimicrobial Agents. The inquiry was chaired by my friend, mentor and fellow vet Lord Soulsby of Swaffham Prior, who retired from the House at Christmas. The report went on to make a number of recommendations that have an uncanny similarity to the ones we are now considering in the O’Neill report. Such is the nature of human progress; it takes us a while to become convinced of emerging threats.

I wholeheartedly welcome the O’Neill report, and the political support that it received from the last Prime Minister deserves commendation. In common with other noble Lords, I also congratulate Dame Sally Davies on her championing of this important issue. If antimicrobial resistance was a serious problem in 1998, its significance has increased enormously since, especially as a result of globalisation and a dramatic increase in the large-scale movement of people.

I shall focus my remarks in this debate on the veterinary aspects of this issue and focus particularly on bacterial resistance to antibiotics—which I shall refer to as “antibiotic resistance”—which is a problem in human health, as we are hearing, that is relevant to antibiotic use in animals. In that context, I should point out that the estimates of the costs that have been quoted already, provided by the consultants to the O’Neill commission, in terms of human life and in financial terms—10 million deaths per year by 2050 and a cost of US $100 trillion, truly shocking figures—refer to antimicrobial resistance. That is to say, they include such problems as resistance to protozoa, malaria, viruses such as HIV, as well as bacteria such as the human tubercle bacillus, all of which are huge causes of human morbidity and mortality, but there is no connection with chemotherapy in animals.

None the less, there are undoubtedly substantial human health problems which relate to bacteria which also affect animals and where animal usage has been implicated as a source of resistant strains. These particularly involve bacteria associated with gastro-enteric infections and the environment, such as E. coli, campylobacter and MRSA.

As the O’Neill commission laid out, the solutions to this problem involve reductions in drug usage, the development of new therapeutic and diagnostic agents and vaccines and the application of a global approach. I shall deal with those issues in that order and, as I said, mainly from a veterinary aspect.

First, I assure the House that, with respect to the UK and the EU, the veterinary bodies take the issue of antibiotic resistance very seriously. There are numerous high-level initiatives to reduce antibiotic usage in animals and to ensure their responsible use when necessary for animal health and welfare. In the UK and the EU, antibiotics are available only on prescription, and I assure the noble Lord, Lord Lansley, that the use of any antibiotics for growth promotion has been banned in Europe and the UK since 2006. Certain antibiotics critical for human use are still in veterinary use, such as fluoroquinolones and third and fourth-generation cephalosporins, and they are receiving particular attention from the veterinary community.

The Veterinary Medicines Directorate of Defra, the British Veterinary Association and its subdivisions, the British Small Animal Veterinary Association and the British Equine Veterinary Association, the National Office of Animal Health and an organisation called RUMA—the Responsible Use of Medicines in Agriculture Alliance—as well as industry organisations, have all been active in recent years in promoting the responsible use of antibiotics and in promoting and introducing measures accurately to record and reduce their usage. Indeed, the Royal College of Veterinary Surgeons has incorporated in its guide to professional conduct a professional obligation on vets to use responsibly all antimicrobials, so it could be a matter which triggers a professional disciplinary offence.

The British Poultry Council, which represents 90% of the poultry meat industry, established an antibiotics stewardship programme in 2011, which introduced a voluntary ban on cephalosporins in 2012, and is committed to reduce fluoroquinolone use and cease all use of colistin in British poultry, which two noble Lords have mentioned. It reported a 44% drop in total antimicrobial usage between 2012 and 2015, despite a 5% increase in poultry meat production.

All those measures are to be commended, and the total usage of antibiotics in the UK in animals is substantially less than that in humans. Progress shows what can be done, but we cannot be complacent, and more needs to be done, as I shall discuss. Suffice it to say that total antibiotic usage in animals in the UK is now close to the 50 milligram per kilogram target suggested in the O’Neill report. The veterinary profession is committed to continue these trends in the interests of public health while at the same time balancing the legitimate need to protect animal health, welfare and food production.

There is an urgent need in veterinary as well as human medicine to develop better diagnostics and better vaccines for infectious diseases, as the O’Neill commission urged and several noble Lords have said. These have the potential substantially to reduce the use of antibiotics. For example, the burgeoning aquaculture industry, particularly salmon farming, has made a remarkable reduction in antibacterial usage in the UK. Despite a huge increase in productivity from about 60 million tonnes in 1993 to 180 million tonnes in 2014, antibiotic usage in the sector is now very low. It is about one to two tonnes per year, which may sound quite a lot, but I assure your Lordships that it is small compared to the 419 tonnes total in all animals in the UK and 531 tonnes in humans—those are the 2013 figures. That progress in aquaculture has been achieved mainly by the development of vaccines and other management processes.

That is what is happening in the UK and Europe, but to reduce antibiotic resistance by reducing and controlling usage it is essential that action takes place on a global scale. There are no restrictions on antibiotic usage in animals or humans in many parts of the world, including in areas where there may be particularly high densities of human and animal populations and very high levels of contact between the two. Resistant strains which arise by natural selection in animals or humans due to uncontrolled use of antibiotics anywhere in the world can arrive in the UK within hours. About 60 million people per year travel through Heathrow airport alone, each carrying millions of microbes on two legs, many of which may have been acquired only hours previously. The O’Neill commission rightly emphasised this fact, even in the title of its report, Tackling Drug-Resistant Infections Globally. Whatever we do here in the UK—already a lot is being done in both the medical and veterinary worlds, but we need to do more—will be rendered ineffectual because of global human traffic, and we will not eliminate health risks anywhere unless we can secure concerted global action to address that.

At the same time as encouraging responsible use of antibiotics, there is an urgent need to discover and develop new antibiotics and new ways to combat bacterial infections. These may be by innovative therapeutic techniques, and the UK’s vibrant and creative scientific and commercial sector is at the cutting edge of these developments. A number of exciting developments are badly in need of support. That may initially come from traditional research grant sources—I commend the initiatives that have recently been announced. Other developments may require creating appropriate financial incentives for investment. A major problem with antibiotics, as with many other therapeutics, is that relatively small amounts of drugs are used only occasionally on only a small proportion of the population. The market sizes are not such as to provide the incentives for industry to respond. Industry is very successful in responding when there are market rewards consistent with the high cost of developing and registering therapeutic drugs. The O’Neill report rightly comments on that and makes a number of exciting and creative suggestions on how to mobilise the creativity of industry by creating artificial marketing opportunities.

In addition to therapeutic agents, we must do more to stimulate research on vaccine development. Earlier, I illustrated how important that can be in terms of aquaculture. There are challenges there with respect to some of the bacteria involved, but in general we have been extremely successful in science in developing vaccines to bacteria, and I am optimistic that solutions will be found and that vaccination will substantially reduce the need to use therapeutic interactions.

Lastly, management systems are hugely important; I do not have time to discuss them in any detail, but we need more research into improved management, particularly in animal husbandry systems.

In conclusion, I welcome the debate and the attention that the subject is receiving. Although only a proportion of the problems of antimicrobial resistance in humans is related to animal usage, there is a very high level of awareness in the veterinary community about this problem and a commitment to the responsible use of antibiotics and a reduction in the usage. The magnitude of this problem globally merits much more investment in research and development of vaccines, antibiotics, innovative therapies and new diagnostics, as well as improved management systems. Above all, the uncontrolled use of antibiotics, like climate change, is an issue that must be tackled globally.

Lyme Disease

Lord Trees Excerpts

Thursday 22nd October 2015 Grand Committee

[Lord Trees (CB)]

My Lords, I too thank the noble Lord, Lord Greaves, for bringing forward this timely debate. As someone who for much of their professional life has researched and taught on tick-borne diseases, I never imagined that I would be speaking on this subject in your Lordships’ House, but I would say that my students might have preferred it had my lectures been limited to four minutes, as are today’s contributions. I may be the only person here who has actually been to Lyme. During a road trip down the eastern seaboard of the US some years ago, I dragged my wife on a detour to visit the lovely New England village of Lyme in Connecticut with white clapboard houses. It is where, in the 1970s, the first outbreak of the disease was thoroughly investigated, which led to the discovery of the causal organism and much of the characterisation of the disease. However, the first important point to appreciate is that this is not a new disease. The characteristic skin lesion was first described as far back as 1909.

Looking at the data from Public Health England, it is not clear whether there has been a big change in incidence, but there is certainly a big increase in concern. There is certainly some evidence of increased distribution and abundance of the tick vector, Ixodes ricinus, and in recent years we have seen an increase in the number of wild animal hosts, particularly deer and game birds, both of which are extremely good hosts for ticks. There is also an increase in human contact with ticks, not only in rural areas but also in peri-urban and suburban areas.

As I say, it is well known that deer are excellent hosts for the tick. Like the noble Lord, Lord Patel, I live in Perthshire and I regularly have to pick ticks off myself that I contract in the garden, which is frequently visited by deer. But—this is an important point—the ticks are almost always at the larval stage; they are tiny, pinhead-sized larvae which do not transmit Lyme disease. It is during the larger nymphal and adult stages when the disease is transmitted, and these ticks are much less abundant than the larvae.

There are risks, but I would like to make the point that it would be a tragedy if people were dissuaded from enjoying the great benefits of the outdoors for fear of Lyme disease. Having said that, there is no doubt that it is a severe and debilitating disease if it is not diagnosed and treated early. In the absence of a vaccine for humans, I suggest that the key to controlling it, as has been said by a number of noble Lords, is to ensure that GPs are aware of the threat and are thus able to instigate early diagnosis and treatment.

It is a fact that in western medicine GP training in zoonotic infections and parasitic diseases is very limited. That is for understandable reasons, and I am fully aware of the pressures on curriculum time in our undergraduate medical courses. None the less, what are the Government doing to encourage awareness among GPs of tick-borne infections? This is of course a matter for continuing professional development but there is also a role for the state, which bears the costs of undiagnosed and misdiagnosed cases that lead to severe and chronic disease.

Lyme disease is a good example of the “one health” concept, which recognises the connectivity between human and animal health, and indeed plant and environmental health. It is a concept embraced well by vets but, I suggest, is understood much less by our hard-pressed GPs. Pathogens do not recognise differences between humans and animals. With regard to zoonotic infections, those infections specifically transmitted between animals and humans and vice versa, such as the agent of Lyme disease, we need to ensure that our GPs are adequately aware of the hazards. That way we can prevent serious illness in people and reduce burdens on the hard-pressed NHS.

Antibiotic-Resistant Bacterial Infections

Lord Trees Excerpts

Wednesday 24th July 2013 Grand Committee

[Lord Trees]

My Lords, I thank my noble friend Lord Crisp for initiating this important debate and draw attention to my various veterinary interests that are listed in the register. As some noble Lords have observed, this topic was the subject of a report in 1998 by the Science and Technology Select Committee of this House, chaired by the noble Lord, Lord Soulsby of Swaffham Prior. It was an important issue then and it is now even more important. A number of reasons have been eloquently articulated. I will point to three recent issues that have drawn attention to its importance.

The first is the Chief Medical Officer’s report, published earlier this year, in which she chose infectious disease and drug resistance as the principal theme. Secondly, she suggested that the subject should be put on the National Risk Register for the UK. Thirdly, in June the UK hosted the G8 summit, and there was a separate meeting of science Ministers—the first such meeting at a G8—at which the Ministers singled out resistance to antimicrobial antibiotics as one of humanity’s most pressing concerns.

Today I will highlight two aspects of the subject. There are many more, including the drug pipeline, which was talked about by several noble Lords. I will focus on the role that the veterinary profession is playing in addressing the issue, which it takes very seriously; and on the global dimension of the threat.

The resistance of bacteria to antibiotics—I will refer to this as antimicrobial resistance—involves a complex interplay of interactions between different bacteria, hosts and antibiotics. Some bacteria exclusively infect animals. Resistance has developed in some strains, which is likely to be associated with the use of antibiotics in animals, and where the consequences will be confined to animals. Equally, some bacteria are unique to humans. A few of them have developed resistance, which, again, is likely to have its causes and consequences principally with humans.

Of course, some bacteria—so-called zoonotic bacteria —infect both humans and animals. The causes of their resistance, and the consequences of it, can affect both animals and humans. Those bacteria can move not only from animals to humans but from humans to animals. The picture is further complicated by the fact there are, as has been well described, antibiotic-resistant bacteria in wildlife and in the environment. There is a flux and flow of resistant bacteria and the genes that confer resistance within the biosphere.

As the Chief Medical Officer acknowledged in her report, and as was stated in a response by Department of Health Minister Dr Poulter to a Question from Glyn Davies in the other place on 27 February 2013, it is the use of antimicrobials in human rather than veterinary medicine that is the main driving force for antimicrobial-resistant human infections. Notwithstanding that, there are many organisations, in my profession particularly, that are working very hard to ensure the responsible and prudent use of antibiotics in animals.

Antibiotics have not been allowed as growth promoters in animals anywhere in Europe since 2006. In the UK, antibiotics are available only on prescription from a veterinary surgeon. The British Veterinary Association and the Federation of Veterinarians of Europe have worked very hard to promote the responsible use of antibiotics and have produced publicity and information, as has the Responsible Use of Medicines in Agriculture Alliance. My own college, the Royal College of Veterinary Surgeons, the governing body, has it embedded in its own professional code of conduct that:

“Veterinary surgeons who prescribe … medicines must do so responsibly”.

The consequence is that a vet could be struck off for irresponsible use.

We must continue to do all that we can to manage the prudent use of antibiotics in humans and animals in Britain and Europe. The forthcoming national cross-governmental strategy for antimicrobial resistance, which involves not only the Department of Health and the Chief Medical Officer but Defra and the Chief Veterinary Officer, is an excellent initiative which will define a coherent plan to address this problem.

However, this brings me to my second major point. The reality is that this is a global problem of massive scale, particularly in China and elsewhere in Asia. We must recognise that, whatever we do about the domestic use of antibiotics, the greatest threats will arise from overseas. This is a consequence of a number of factors. One is the gross use and, one might say, misuse of antibiotics in animals and humans. For example, in 2007, China produced 210,000 tonnes of antibiotics, of which about 100,000 tonnes were used in animals. Adjusting pro rata for the human population, that is 20 times the amount of antibiotics for animals than we used on animals in the UK at that time.

Many antibiotics are available over the counter in India, Asia and elsewhere, not exclusively on prescription. This leads to their misuse, the underdosing or curtailment of dosing regimes, both of which are factors in inducing antimicrobial resistance—as, of course, is the close contact of humans and animals in many of these settings in developing countries. All these factors contribute to high rates of antimicrobial resistance. Again, in China, in a survey of hospital infections in 2009, more than 60% of staphylococcus aureus infections were methicillin resistant—that is, MRSA—compared with less than 2% in UK hospitals.

This alarming genesis of antimicrobial resistance is coupled with the massive and rapid movement of people throughout the world. Just like pathogens themselves, such as the SARS virus and avian influenza, can move, antimicrobial-resistant bacteria can evolve in distant lands and arrive here in the UK within days if not hours. This is the downside to globalisation. When globalisation comes in the door, biosecurity goes out of the window.

We need to harness the economic gains from globalisation. We all think that it is a good thing, which brings economic gains. However, I suggest to the Government that perhaps we need to consider ways in which some of those economic gains of globalisation might be devoted to research in this area, to improving surveillance, to researching and developing rapid and effective detection and diagnostic technologies, and to helping us work with our colleagues overseas to mitigate the global threat of antimicrobial resistance. The good news is that the global nature of this problem is now being recognised. Now we need imaginative measures to counter that threat.