Antibiotics: Research and Development

Daniel Zeichner Excerpts

Tuesday 26th April 2016 Westminster Hall

[Daniel Zeichner (Cambridge) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Evans. I congratulate the hon. Member for York Outer (Julian Sturdy) on securing this debate on an issue he has long championed. I became interested in the issue having listened to presentations by clinicians and scientists in my constituency. They made it absolutely clear that incentivising research into and the development of new antibiotics is essential not only for our generation but for future generations. Antimicrobial resistance and its consequences are happening now. The World Health Organisation has cautioned:

“A post-antibiotic era—in which common infections and minor injuries can kill—far from being an apocalyptic fantasy, is instead a very real possibility for the 21st Century.”

Last year, antimicrobial resistance was added to the Cabinet Office’s national risk register for civil emergencies. The Government rightly warned that without effective antibiotics, even minor surgery and routine operations could become high-risk procedures.

Long lead times for developing new medicines and the relatively low commercial returns on investments have unsurprisingly hampered investment in antibiotic development. In 2014, the Select Committee on Science and Technology highlighted the fact that only 22 new antibiotics have been launched since 2000. The Association of the British Pharmaceutical Industry—I thank it for its help in preparing for this debate—points out that whereas 18 large pharmaceutical companies were actively involved in antimicrobial research and development in the 1990s, that number had fallen to four by 2010.

To ensure that new antibiotics are developed, it seems that we need a new reimbursement system, as other Members have said. Unless the environment for companies to invest in antibiotic development becomes more attractive, the problem will continue to grow. Looking at the wider field of the development of new drugs, I fear that some indicators suggest we may be going in the wrong direction. In 2010, 6% of international clinical trials were based in the UK, but the figure now stands at a mere 2%.

There are a wide range of suggestions for what we might do, including altering the regulatory framework to incentivise innovation and developing new economic models, perhaps through innovative pricing and reimbursement mechanisms to incentivise more investment in researching new antimicrobials. There may be possibilities through the emergence of what is termed venture philanthropy, which is an exciting development for some of the big research charities.

It has to be said, however, that if there is not enough money in the system as a whole, it is hard to see a way forward. Some caution that whatever the accelerated access review brings, chronic funding shortages will continue to hamper innovation. If we add to that the changes in capital allowances that make other countries more attractive and the uncertainty over the replacement of the political fix known as the cancer drug fund, it is easy to become pessimistic.

The industry needs to think hard about the future. As the independent O’Neill review said:

“Big pharma…needs to look beyond short-term assessments of profit and loss, and act with ‘enlightened self-interest’ in tackling AMR, recognising that it has a long term commercial imperative to having effective antibiotics, as well as a moral one.”

The fact remains that the Government must position the UK as the most compelling global location to develop new treatments. Methods for doing that might include committing to, and funding, a reimbursed early access to medicines scheme; and ensuring that there are sufficient funds to continue funding some of the important schemes focused on innovation, such as the biomedical catalyst. Indeed, the World Health Organisation recommends that policy makers can help to tackle antimicrobial resistance by rewarding innovation and the development of new treatment options. A global innovation fund was one of the preliminary recommendations of the O’Neill review, and we await the final recommendations, which are due to be published this summer.

In addition to incentivising research and the development of new antibiotics to tackle antimicrobial resistance, as we have heard, the Government must focus on preventing the inappropriate prescription of antibiotics, which is causing resistance to spread. The Science and Technology Committee has said that the Government

“needs to set clear responsibilities at all levels of the NHS and veterinary medicine to achieve better stewardship of the antimicrobial drugs vital in modern medicine.”

Indeed, the National Institute for Health and Care Excellence has warned that more than 20% of prescriptions issued for antibiotics are likely to be unnecessary. That is about 10 million prescriptions.

Another problem that is contributing to growing antimicrobial resistance is the use of antibiotics in livestock production. Other European countries have already set targets for reducing the use of antibiotics in farming, but the UK Government have not. Considering that farm animals account for almost two thirds of antibiotics used in Europe, and about 40% of those used in the UK, it is hard to overestimate the significance of that in the increasing problem.

Antimicrobial resistance is a grave threat that is only going to grow and intensify. The Government must act now to tackle the barriers to the development of new antibiotics and make the environment for researching and developing new drugs less challenging. The alternative, to go back to a world without antibiotics where almost half of people in this country died of infection, must be avoided at all costs.