Antimicrobial Resistance

Baroness Sheehan Excerpts

Thursday 8th March 2018 Grand Committee

[Baroness Sheehan (LD)]

My Lords, I add my thanks to the noble Baroness, Lady Greengross, for introducing this debate on such an important matter.

The seriousness of this issue was stated starkly by the Chief Medical Officer, Professor Dame Sally Davies, who said that if we do not act, it is possible that we will return to 40% of the population dying prematurely from infections that we cannot treat. The sad fact is that overuse and misuse of antibiotics and other antimicrobials in humans, animals, including farmed fish, and crops have been major contributors to an acceleration in the emergence of drug-resistant strains of bacteria, viruses, parasites and fungi. The noble Baroness, Lady Masham, referred very powerfully to the role that better diagnostics can play in enabling us to use antimicrobials with circumspection. I concur with her completely.

When the review on AMR, led by the noble Lord, Lord O’Neill, was published in May 2016, it generated a much-needed urgent focus on the issue, leading to a commitment to act by world leaders at the high-level meeting of the UN General Assembly on AMR in September 2016. Countries reaffirmed their commitment to develop national action plans on AMR, building on the blueprint developed in 2015 by the World Health Organization, the FAO and the World Organisation for Animal Health.

The fact is that common and life-threatening infections such as pneumonia and gonorrhoea, and post-operative infections, as well as HIV, TB and malaria, are increasingly becoming untreatable. Very worrying is the fact that cases of completely untreatable gonorrhoea have been recorded in the last year in developed countries.

I shall concentrate the rest of my remarks on international development, which is the brief on which I speak for my party, the Liberal Democrats. TB is a disease that kills 1.8 million people a year. My noble friend Lady Suttie has already spoken passionately about the rise of multidrug-resistant TB globally. Last August I was in Liberia and, courtesy of RESULTS UK, I visited a clinic where patients with multidrug-resistant TB were being treated. As my noble friend Lady Suttie said, the treatment is complex, very costly and toxic. It can last from six to 30 months and can consist of more than 14,000 pills and daily injections for six months. What was clear to me was that the patients I met were the lucky ones and that many more in the community potentially carried MDR-TB because the resources to carry out comprehensive tracing were just not there.

What is urgently needed is a vaccine for TB. Prevention would obviate the need for treatment with antibiotics and give us a chance to eradicate the disease. However, the development of vaccines is a lengthy process, so recent progress is at risk unless vital investment is provided with a long-term commitment to give developers—in particular, product development partnerships—the confidence to plan for the future with certainty. I fully echo the words of the noble Lord, Lord Colwyn, on that. The UN high-level meeting on TB this September offers a rare chance to turn the tide against TB and I hope the Government will take the opportunity to drive the vaccine agenda forward.

Malaria is another long-time scourge of the developing world and now the problem is compounded by the discovery of drug-resistant mosquitoes in Myanmar, Thailand, Lao PDR, Vietnam and Cambodia. I draw the Minister’s attention to the extremely dangerous situation that exists in the Rohingya camps in Bangladesh, as identified by the Malaria Consortium—I declare that I am a trustee of that organisation. The monsoon rains are due next month and these, coupled with the combination of poor sanitation and emergency, substandard housing, will provide perfect breeding conditions for malaria-transmitting mosquitoes. The danger to the refugees is obvious, but what also needs to be considered in the mix is that the refugees have come from Myanmar, where malaria resistant to artemisinin-based antimalarials has been detected, including in the nearby Sagaing region. The native population of Cox’s Bazar in Bangladesh is highly vulnerable to malaria because the people have not been exposed to the disease recently. We can see the dangers inherent in that situation. We cannot risk the further spread of drug-resistant malaria and I ask the Minister to relay these concerns as a matter of urgency to the appropriate personnel. DfID is well placed to take action as a world leader in the fight against malaria and is already in place, combating diphtheria and cholera in the camps.

Prevention is always better and cheaper than cure. In its March 2016 report on limiting the spread of drug resistance, the AMR Review Board estimated that improved water and sanitation in middle-income countries could reduce the volume of antibiotics used to treat diarrhoea by at least 60%. We need to apply common sense and ensure that good housekeeping takes precedence over popping a pill. The availability of antimicrobials is shifting action away from prevention and the good practice of investing in basic sanitation infrastructure.

Previous speakers have spoken about market failures. We see that investment in developing new antibiotics has gone into reverse. We need new ways of stimulating innovation and to do that we must find a way to delink the cost of research and development from the price and volume of sales. How will the Government ensure that new antibiotics and other innovations are affordable to the NHS and health systems around the world? In the same vein, will the Minister comment on the progress of the UK and China Global AMR Research Innovation Fund?

To conclude, considering that we are in a global space where it is easy to spread AMR infections through trade and travel, and that resistance has been observed in terrestrial and aquatic environments, where wind and currents take them out of our control, we begin to see the scale of the problem we face. The fact is that we know what we have to do. Political will and leadership is what is needed now.