Antimicrobial Resistance

Baroness Greengross Excerpts

Thursday 8th March 2018 Grand Committee

Asked by

[Baroness Greengross]

To ask Her Majesty’s Government what assessment they have made of the risks of antimicrobial resistance.

[Baroness Greengross (CB)]

My Lords, I declare an interest as the CEO of the International Longevity Centre-UK, which has done quite a lot of work on the issues that we are discussing. Antimicrobial resistance poses an unprecedented threat to human health. As bacteria become resistant to antibiotics, even minor infections have the potential to become serious and indeed fatal. The rise of drug-resistant infections is estimated to account for around 700,000 deaths per year worldwide, with 50,000 of those deaths occurring within Europe and the United States.

I am sure that noble Lords will be familiar with the review of the noble Lord, Lord O’Neill, on antimicrobial resistance, published in 2016, which projected that by 2050 global mortalities due to this could reach 10 million a year and cost the global economy £66 trillion in lost productivity. The Chief Medical Officer, Dame Sally Davies, has also shared her concerns that the recent era of material mortality improvement will give way to many years of material mortality worsening if drug-resistant infections continue to develop at current rates. Willis Towers Watson’s head of mortality and longevity has calculated that a “plausible” worst-case scenario for the development of antimicrobial resistance will,

“largely zeroise or even negate”,

the longevity improvements made since the mid-20th century.

Fortunately, there have been some developments in the global effort to reduce the spread of AMR. The Access to Medicine Foundation’s 2018 Antimicrobial Resistance Benchmark report found that nine life sciences companies are active in antimicrobial resistance surveillance programmes covering 147 countries between them. There are also currently 28 antibiotics for high-priority pathogens in late-stage development. However, in other areas there is cause for concern as progress seems to have stalled.

A freedom of information request issued to Public Health England in 2017 found that prescriptions of colistin, the last line of defence in antibiotic treatment, rose by 40% between 2014 and 2015, from 346,000 doses to 485,000. Antimicrobial resistance was common in the more than 1 million urinary tract infections caused by bacteria identified in NHS laboratories in 2016. Some progress was observed in reducing rates of prescribing in secondary care in 2015, but there has not been a sustained reduction in total antibiotic prescribing in this care setting. While antibiotic prescribing reduced by 5% overall between 2012 and 2016, when measured as defined daily doses per 1,000 inhabitants per day, significant regional variation in antibiotic use continues to occur.

Unfortunately, there is also significant regional variation in the uptake of a crucial means of preventing the spread of antimicrobial resistance—I am talking about vaccination. The review by the noble Lord, Lord O’Neill, noted that vaccine programmes can reduce antibiotic consumption by preventing secondary infections and that, in addition, they often save society more than 10 times their original cost by protecting against vaccine-preventable diseases.

A study conducted jointly by the Department of Health and Social Care, the Norwegian Institute of Public Health and the South African directorate of health estimated that universal coverage with pneumococcal conjugate vaccine could avert up to 11.4 million days of antibiotic therapy annually worldwide in children younger than five years of age. A separate study published in the Journal of Clinical Infectious Diseases and Practice found that the introduction of a universal influenza immunisation programme for everyone aged six months and over in Ontario in the year 2000 resulted in a 64% decrease in influenza-associated respiratory disease antibiotic prescriptions relative to other regions.

However, despite the demonstrable impact of vaccination on antibiotic prescription, there is significant regional variation in immunisation uptake rates. Uptake targets set by the Department of Health and Social Care are sadly being missed. Between September and December 2017 flu vaccine uptake among GP patients aged 65 and over varied from a high of 74% in Greater Manchester to only 64.9% in London. Between September 2016 and August 2017 shingles vaccine coverage in the routine cohort—those aged 70—declined 13.5% since the start of the programme to 48.3%. I can speak personally about that vaccine. With shingles about to descend into my eye, it was so quick in getting rid of it. It was extraordinary and I am very wedded to this.

The coverage rate for the infant pneumococcal vaccination programme is now sadly below the 95% national target adopted by the Department of Health and Social Care. Given that the coverage level in the UK is already falling, it is worrying that the Government might deprioritise pneumococcal immunisation following a recent proposal to remove a dose of the vaccine from the infant pneumococcal immunisation programme. This advice has recently been consulted on, so it is to be hoped that in the interests of public health, the Government will consider the views of stakeholders closely, including the potential impact of a reduced schedule on antimicrobial resistance before making any policy decisions. The Government could also consider how they can ensure that the NHS benefits from future vaccines targeted at preventing hospital-acquired infections such as MRSA and C. difficile, which are of particular relevance to AMR. The Government should consider how tackling AMR can be incorporated into decision-making processes about the introduction of vaccination programmes.

Finally, given that the Civil Contingencies Secretariat 2017 national risk register categorises antimicrobial resistance and climate change as long-term trends that pose severe risks to the UK, I would urge that each of us should approach the problem of antimicrobial resistance with the same urgency and vigour as the threat posed by climate change.