World Antibiotics Awareness Week

David Drew Excerpts

Thursday 16th November 2017 Westminster Hall

[Julian Sturdy]

I know the Scottish Members would certainly agree with that. As Fleming said,

“it’s not very scientific—but it helps.”

We now need to make the message as clear as day: antibiotics are ineffective when taken unnecessarily and doing so bolsters resistance and endangers mankind.

The second area where significant progress can be made is on the incentives for antibiotic discovery, research and development. It should be noted that the antimicrobial challenge is as much economic as it is medical. We must find an alternative to the reimbursement model, whereby profitability of bringing new antibiotics to the marketplace is linked to volume of sales. That is because we are actually seeking to limit the use of such drugs to preserve their power; to use new drugs as a point of last resort, as it were. To use an analogy, it is almost like the fire service—we need it to be there and to be effective, but we do not want to use it. However, nobody would dispute the necessity of investment and funding for that key emergency service.

To overcome this task, it is essential that measures are taken to co-ordinate a review of progress in new drugs, alongside the activation of research and development by industry for new antibiotics and related products achieved by Innovative Medicines Initiative projects. On the economics, we need to seek innovative solutions, with the pricing conditions and “pull” measures needed for the long-term sustainability of new antibiotic development, so that they are promoted. An example of that is the compact initiative of the European Federation of Pharmaceutical Industries and Associations to promote a sustainable business model and adequate conditions for the introduction of effective new antibiotics.

The O’Neill review, published last year and described last week by a columnist from The Times as

“the best argued and most accessible”

report in his lifetime, was very clear on this matter. Lord O’Neill found that much more needed to be done to close the substantial gap in research and development funding between AMR and the best-funded areas of medical science. The report being launched this week quantifies this further, and states that $40 billion is needed over 10 years, representing about 0.05% of G20 countries’ current healthcare spend. I will not claim that that sum is insignificant, but it is certainly affordable given the magnitude of the threats we face.

For improvement on a global level, the report makes it clear that co-ordinated efforts must be made in the veterinary sector, where I am pleased that tangible progress has been made in the UK. Figures from the Countryside Alliance show that sales of livestock antibiotics across the sector have fallen by an average of 27%—their lowest levels since records began—which is a good start, because a failure to address AMR in livestock has fundamental implications for the treatment of human diseases. For that reason, mirrored co-operation between Government Departments is essential.

While I am delighted that we are joined by my hon. Friend the Under-Secretary of State for Health, this matter also encompasses the Department for Environment, Food and Rural Affairs, the Department for International Development and the Department for Exiting the European Union. We need a clear commitment from the Government that that co-operation is there and that an interdepartmental strategy is on the agenda. Beyond that, we require what Antibiotic Research UK describes as a “grand alliance” to come together, comprising the Government, the pharmaceutical industry, collective medical research charities and academics.

To reduce further the overall use of antibiotics in the veterinary sector, guidelines have been developed for prudent use. The EU road map also proposed the creation of an animal health legal framework, based on the principle that prevention is better than the cure. Take the example of colistin. In 2015, evidence emerged of colistin resistance with the potential for transfer and spread between bacterial species. In order to preserve colistin for human medicine and limit the spread of resistant genes, the European Medicines Agency imposed strict limitations on its use and recommended the withdrawal of marketing authorisations for all oral colistin in veterinary medical products. Professor Galloway, from the Royal College of Physicians and Surgeons of Glasgow, is calling for a full review of the use of antibiotics used in both animal husbandry and human clinical practices, and I believe the Government should actively consider that suggestion.

In the UK, some sectors have conclusively beaten the target set by the veterinary medicinal products directive. Such industries represent very clearly what we are aiming for with the SMART targets I referred to at the beginning of my speech. In many cases, progress has been made through voluntary schemes. I request that the Government look directly into specific sectors in order to investigate best practice and what we can learn from it.

However, we must go further as a global leader and recognise that this is an international challenge. Almost 80% of antibiotics used in the USA are not taken by people but used within the livestock sector, which I find astonishing. In India, people consume an average of 11 antibiotic tablets per year. Only today, data has been released showing that antibiotic resistance is growing in Europe. Progress that Britain makes will be quite simply irrelevant in the absence of a confident international stewardship programme.

The British Government must act as an example in their commitment to tackling resistance head-on globally and, while I recognise it is not in the specific gift of my hon. Friend the Under-Secretary of State for Health to dictate his published ministerial responsibilities, I believe it is timely explicitly to add antimicrobial resistance to those responsibilities. That symbolic act would send a clear message that Britain is committed to remaining at the forefront of the fight against antibiotic resistance.

[Dr David Drew (Stroud) (Lab/Co-op)]

I share the hon. Gentleman’s concern about the problems with antibiotics, which we see with farm animals. However, there is also now a problem over supply, due to the increased concentration of the pharmaceutical industry—there are new mergers coming along as we talk. Does he think that that is worthy of proper investigation? Those companies can turn the supply on, but they can also turn it off, which can also be life threatening.

[Julian Sturdy]

The hon. Gentleman makes a fair point. As I said, we have to encourage new antibiotic discovery. In our current system, the big pharmaceutical companies have been reluctant to come forward and put that money in, because the financial model just does not work.

However, encouragingly, we are now seeing smaller companies and spin-outs—from science departments within medical departments within universities—looking specifically at antibiotic discovery. There is something to be said about that, and again we have to look closely at it, because it could be used to our advantage. I encourage the Government to look at that, I encourage all Members who have a university in their patch to talk to them and I encourage those who have any of these small companies to visit and talk to them. It is incumbent on us all as parliamentarians to go out there and promote what is happening on our doorstep.

There is no doubt about it: the big pharmaceutical companies are finding it very difficult to promote new antibiotics. It takes 15 years for a new antibiotic to come to the marketplace from the start of the process of discovery. Companies have to make a huge investment. If that investment leads to a drug that is not actually used, because we are using it as a point of last resort, the financial model as it currently sits just does not stack up. That is something we have to address.

The discovery and development of antibiotics should not be seen as a curse. However, we must recognise that responsible steps now need to be taken to ensure that they persist and that we keep resistance firmly locked down. The antibiotic age can remain a golden one, and our collaborative actions can prevent a fall into what has been described by many as a medical abyss without antibiotics.

In the antibiotic age, we are all on the same side. This is not about politics or what the UK can do; it is about global action. That cannot translate into a lack of zeal and an absence of the will to win. I very much look forward to hearing what the Minister has to say. The UK Government have made great steps forward. The O’Neill report was a great start, but we have to continue that, and we have to be world leaders in this. We have a great opportunity to do that, if not for our generation, for future generations.