Biosecurity and Infectious Diseases

Baroness Murphy Excerpts

Thursday 18th January 2024 Lords Chamber

[Baroness Murphy (CB)]

My Lords, the House has not seen much of me this last year, because last year I was one of the 100,000 people to be admitted to hospital in the UK with cellulitis, going on to septicaemia, which then progressed very rapidly to sepsis. I owe my life, or at least my legs, to flucloxacillin. So I thought I would talk about antimicrobial resistance today. I am perfectly well now, by the way, so no worries for the future.

First, antimicrobial resistance in humans is due to inappropriate or excessive prescribing by doctors, of whom I am one, not just in the UK but worldwide. Some 58,000 people in England were reported to the UK Health Security Agency—probably an underestimate, of course—to have had a resistant infection in 2022; that was a rise of 4% in a single year. With Klebsiella pneumoniae, for example, which is a very common cause of sepsis in this country, 30% of the bug’s subtypes are now resistant.

Pre-pandemic, there was a very healthy drop in prescriptions, which was due to doctors’ efforts to reduce the number of inappropriate antibiotic prescriptions, which are usually given out for very mild virus disorders, of course. But this has not been maintained after the Covid pandemic; in fact, they are on the rise again, and we need another big effort. What are the Government doing? I realise that I am asking for some Department of Health wisdom here, as well as the Minister’s own.

The second issue, of course, is, as we have heard from everybody, the global impact of antibiotic resistance, which is brought by travellers from abroad. At the moment, Asian and Asian British ethnic groups have almost double the proportion of antibiotic resistant infections—35%—compared with only 19% in white British ethnic groups. This is probably because of antibiotic overuse in south-east Asia.

I was sceptical about this—I thought it could not be happening that quickly—but recently an elegant study looked at subtypes of enterobacteria causing dysentery that are currently found in India and Pakistan, and you can map the progress of the subtypes cropping up all over the UK, so it is due to international travel. The Hospital for Tropical Diseases recently reported 92 travellers arriving in Britain from south Asia and Nigeria with enteric fever caused by salmonella and found that 30% were multiple drug resistant.

Globally, the financial costs of resistant strains of malaria, HIV and TB are directly related to poor prescribing and inadequate courses of treatment. In this age of global travel, as we have heard from others, the transmission of resistant strains of tropical diseases is of increasing importance. The ill-educated beliefs of patients impact very much on doctors’ prescribing habits. We know that GPs who do not prescribe antibiotics tend to be less highly rated and less popular. In Romania, Greece and Hungary most people buy their antibiotics over the counter and there is very little control indeed. In Cyprus, Estonia, Italy and Spain, most patients get antibiotics left over from previous courses—and I bet there is not anyone in this House who has not done the same. We use antibiotics from last year if we think we have something that we need to use them for. We need a real effort to reduce these.

Finally, I want to mention the issue of antibiotics in livestock. The noble Baroness, Lady Bennett, has brough the issue of fish farming to our attention because it is one area where we are not making progress. I thank the noble Lord, Lord Trees, for his brilliant personal briefing on this. We are making good progress on tackling resistance in animals by the improvement of their environments so they do not get infections in the first place, the control of veterinary medicines and the excellent work done by vets in the UK. However, as we have heard, that is not necessarily the case in other countries. We have achieved a 42% reduction in fluoroquinolones and reductions in other important drugs, such as cephalosporins, that are important to human beings.

So we are making good progress. We probably do not need to make it statutory by banning things; it is always better to do it with the co-operation of the agencies, individual professionals and farmers involved. However, we need to make greater progress on antimicrobial resistance. I know the Government were negotiating with the pharmaceutical industry to see what could be done. Can the Minister tell us how far have we got on our project there?