Antibiotics: Research and Development

George Freeman Excerpts

Tuesday 26th April 2016 Westminster Hall

[The Parliamentary Under-Secretary of State for Life Sciences (George Freeman)]

It is a great pleasure to serve under your chairmanship, Mr Evans. I believe we are expecting a vote, so my speech may be interrupted. I shall crack on, awaiting the bell.

I congratulate my hon. Friend the Member for York Outer (Julian Sturdy) on securing the debate and on the tenacity with which he has raised this issue in the House in recent years. It is a great opportunity to have this debate today, when so much is going on this week in London on international health leadership. My hon. Friend’s speech and the informed and constructive comments that he and others have made highlight how seriously this issue is taken throughout the House. Last Monday we had more than 60 Members of Parliament in this Chamber. The fact that we have a dozen today does not suggest that there is any less interest; many Members are tied up in other debates. I know that Members from all parties are concerned about this issue.

The debate is timely, because it coincides with a two-day international summit on antimicrobial resistance convened by the Wellcome Trust in London, which brings together a global gathering of scientists and policy makers to explore key areas for action. I thank the Wellcome Trust and pay tribute to it for its leadership. In so many areas of public policy, it has put its money and expertise to work for us. I also pay tribute to Jim O’Neill and his team, as others have done, for their work on the issue.

I will set out the context of the debate, as a number of other hon. Members have done. Antibiotics play a crucial role not just in human health but in animal health and welfare—my hon. Friend is a doughty campaigner for agricultural causes—and so are of great strategic interest in the wider field of biosecurity. We have seen the impact of diseases in domestic and agricultural poultry and in some of our tree species, and we are trying to view this issue in the wider global context of biosecurity from infectious diseases.

[Jim Shannon]

There have been some marvellous steps forward in addressing the use of antibiotics on poultry, as I indicated in my speech. Many people are trying to move that forward. If we take steps forward with poultry and other animals, we can transfer that work to humans too.

[George Freeman]

The hon. Gentleman makes an excellent point. As ever, Belfast University and the Northern Ireland life sciences cluster are doing good work in agriculture and in the medical space.

For the reasons that I outlined, the growth of resistance presents a genuine strategic global threat, which, as hon. Members from throughout the House have gratifyingly acknowledged, the Government have taken a strategic grip of. Globally, some 700,000 people will die this year because of antimicrobial resistance. In Europe, the healthcare and societal costs of resistance are estimated to be of the order of €1.5 billion per annum. That translates into a verifiable and measurable cost to the NHS of £180 million, but it may well be an awful lot more. Meanwhile, we face an antibiotic discovery void. The golden age of discovery ended in the 1980s. We have had very few new antibiotics since then and no new class since 1987.

I had a 15-year career in the sector and spent one chunk of it starting, financing and managing a small anti-infectives company that was spun out of Hammersmith and Imperial College and used some phenomenally powerful technology to look at the genetics of how microbes reproduce. We spent a lot of money on some elegant science, but we did not produce a new anti-infective. The truth is that these bugs are very difficult targets in biomedicine. It is difficult to go after the cell wall of Gram-positive and Gram-negative bacteria. Their ability to reproduce and develop resistance to drugs—they are moving targets, as it were—makes it particularly difficult to design effective drugs for them.

The good news—if I may put it that way—is that we can do things that will make and are making a real difference. The chief medical officer outlined the scale of the issue and its implications for public health in her 2013 annual report. She called for urgent action at a national and international level. The UK responded by publishing our five-year antimicrobial resistance strategy, the core aims of which were to improve understanding of resistance, to ensure that existing medicines remain effective and to stimulate the development of new antibiotics, diagnostics and therapies. Three years on, we have made considerable progress. We have put the building blocks for success in place, including better data, guidance and a strengthened framework—

--- Later in debate ---

[Mr Philip Hollobone in the Chair]

[George Freeman]

I leave Mr Evans for five minutes and he transforms into you, Mr Hollobone. I am grateful for the opportunity to serve under your chairmanship.

We are three years into our strategy and we have put building blocks in place, including better data and guidance and a strengthened framework for antimicrobial stewardship. I want to highlight one or two areas of progress. The first is surveillance. The UK has one of the most comprehensive surveillance systems in the world. We collect baseline data from which antibiotic prescribing and trends in antibiotic resistance can be monitored, and we are continuing to improve those data so that we can identify problems early and take action.

Alongside that, we have published outcome measures against which the UK will assess progress, and we have produced a range of tools and guidance to support best practice on antibiotic stewardship. We have introduced incentives for the NHS to improve the prescribing of antibiotics and the quality of data, which will be supported and enhanced by a set of AMR indicators that will provide NHS teams with local data on infections, resistance rates and prescribing, so they can set their own ambitions to take action and drive improvement locally.

Of course, it is simply not possible to look at the challenge presented by AMR without examining it from a global perspective. AMR is a global problem and no one country can tackle it alone. The UK has played and continues to play a major part, if not the major part, in raising awareness and pushing forward international commitment and action, as several colleagues throughout the House have acknowledged. We sponsored the World Health Organisation’s 2015 global action plan on AMR, we created the £265 million Fleming fund specifically to help poorer countries tackle drug resistance, and we are promoting work on AMR through the G7, the G20 and the United Nations.

The other, perhaps obvious point to make is that there is no single solution to antimicrobial resistance. We must prevent infection, conserve the antibiotics we have, develop new diagnostics and promote the development of new drugs. The UK’s strategic approach rests on those pillars, and they resonate across the world.

I turn briefly to the Jim O’Neill review. It is widely recognised that the systems on which drug discovery and development currently depend cannot and will not deliver the new antibiotics the world needs. Hon. Members have made that point clearly. That is why my right hon. Friend the Prime Minister established the independent review. It has run for two years and has made a comprehensive and highly informed assessment of the AMR challenge. Hon. Members will have seen some of the authoritative and readable papers the review team has published, setting out its thinking on a number of key areas, stimulating debate here and globally, and paving the way for the final report, which we all await and which is due to be published next month.

Not surprisingly, research and development has received much attention from Lord O’Neill’s team. It featured particularly in their paper on AMR and the antibiotic pipeline, which appeared in May 2015. That paper argued for the establishment of a global payer fund and an innovation fund to boost funding for blue-sky research into antibiotic drugs and diagnostics. Elsewhere in their publications, the review team identify some of the neglected areas of research that they believe such a fund could help address.

The Government’s response to the review team’s work will rightly follow the publication of its final report, which we eagerly anticipate. In line with our manifesto commitment to take forward the review team’s recommendations, that response will be positive, ambitious and timely, building on what we have already achieved. We do not intend to delay in a sector that needs urgent action.

One reason why the review team published their series of thematic papers was to stimulate international debate. The value of that approach was made very clear when the President of China came to the UK in the autumn, which led to agreement on a joint UK-China innovation fund modelled on the very proposal that Lord O’Neill set out. We have committed £50 million to that fund and are now in discussion with the Chinese on how it can be taken forward. We hope at the end of it not only to have increased financial collaboration in antimicrobial research and development, but to have brought together the best research teams from industry and academia in the search for practical solutions.

The review explored how the disincentive to antibiotic research and development presented by the absence of a viable commercial market could be tackled. Hon. Members will know that, as I have painfully experienced in the industry, there is an irony in the anti-infectives field. If a new class of anti-infectives is developed, they will tend to be used as a last line of defence, so the level of usage is quite low and patent protection is often not as significant as is required or justified by other drug discoveries. The fundamentals are not the same with anti-infective drug discovery, which is one reason why the standard model does not work as well as in other areas.

The Government are convinced of the need to look again at how we fund antibiotic development, based on Lord O’Neill’s groundbreaking work. It seems clear from that work and other studies that a global solution will be needed, although I cannot, of course, pre-empt what Lord O’Neill will recommend.

Inevitably, global solutions take some time to come to fruition, and for that reason my officials have had meetings with a number of pharmaceutical companies, including AstraZeneca, to discuss alternative approaches to reimbursement. They include the insurance model and a number of others that have been widely discussed. Progress is being made and the discussions are continuing. We do not intend to allow the potential delay in global discussions to get in the way of this country taking all the steps it can to facilitate our leadership in this space.

Meanwhile, Government investment in antimicrobial-related research here in the UK continues to grow. The Medical Research Council funds an AMR research funders forum, which we established to co-ordinate research across different funding bodies. The forum has set up a number of AMR-themed research programmes, and its members have together allocated some £36 million to them. Themes include resistant bacteria and how they interact with their hosts, and projects to speed up the development of therapies and diagnostics. At the applied end of the spectrum, the National Institute for Health Research is funding health protection research units at Oxford and at Imperial College. An NIHR research call has led to the allocation of around £15 million in support of some 16 projects.

I want to reinforce the point made by my hon. Friend the Member for York Outer and others about the important role of charities—not just the Wellcome Trust, which leads, but in the sector in general. In my reform of the life science space, I have made a clear offer to charities to come to the top table as we set out the policy and reform landscape. Medical research charities in the UK now invest £1.4 billion in research every year, which puts them at the top table alongside the biggest pharma companies. I am determined to ensure that they have a voice in policy setting to reflect their increasing voice in the research landscape. We are especially fortunate in this country to have the Wellcome Trust, whose work this week is timely.

My hon. Friend referred to the Antibiotic Research UK charity, which has been set up in his constituency. It is very encouraging to hear about that initiative and its work and ambition. He has had meetings about it with the Minister with responsibility for public health, my hon. Friend the Member for Battersea (Jane Ellison), and with the Prime Minister, and is being typically diligent in ensuring that its existence and profile are raised. He knows that I cannot pre-empt the outcome of the O’Neill report, but it is incredibly encouraging to see a charity coming forward in this space. We look forward to continuing to work with that charity and others in our response to the O’Neill report.

Antibiotic Research UK is, understandably, enthusiastic about what it has to offer. My hon. Friend the Member for York Outer and other hon. Members will understand that the NIHR does not award research money by particular therapeutic area. There are good reasons for that, which I will not go into in the few moments I have left. We fund the infrastructure and are open to research bids, and I encourage that charity and others to put bids together in conjunction with industry. We stand ready to support them. I have no doubt that when we respond to the O’Neill report we will look at how we can do more to encourage and support those bids.

In the time remaining, I want to deal with some of the questions that have been asked. My hon. Friend asked whether I would meet Antibiotic Research UK. I would be delighted to do that. It would probably be sensible to do so with my hon. Friend the public health Minister after publication of the O’Neill report, but I am happy to meet them before that.

My hon. Friend made a point about the foreign aid budget. He and other observers will have noticed that in the autumn statement we announced yet more funding from the prosperity fund to go into global public health. Whether in relation to vaccines or anti-infectives, we are determined to ensure that our international development spend addresses global public health issues, and we are harnessing UK science to that end.

My hon. Friend made a point about Sweden. We are trying to strike a balance between global leadership and supporting global collaboration. My position on that, as on wider EU affairs, is that I am ambitious for the UK life sciences sector, ambitious for life sciences in Europe and ambitious for the European single market in a global race for investment. We need every collaboration network we can get.

My hon. Friend the Member for Erewash (Maggie Throup) mentioned diagnostics, and she was absolutely right. She brings to the debate her experience and professional background. Diagnostics are key, and there is some very exciting work in that field. It is fair to say that the diagnostics sector is probably ahead of the therapeutic sector on this one.

The hon. Member for Poplar and Limehouse (Jim Fitzpatrick) asked about the Ross fund, as did a number of other hon. Members. It is good to hear the level of support for the fund, which is aimed at developing, testing and delivering a range of new products, including vaccines, drugs and diagnostics, to help combat the most serious infections in low-income countries. My right hon. Friend the Chancellor of the Exchequer announced the Ross fund with added detail in January, with a portfolio of projects and programmes led by DFID and the Department of Health. The hon. Gentleman asked which Department is responsible for that, and I can confirm that it is the Department of Health through the health research budget and portfolio, for which I am responsible.

Time is against me, but I want to deal with the point made by the hon. Member for Cambridge (Daniel Zeichner) about clinical trials. As a result of an awful lot of hard work across the Department, led by the chief medical officer and the NIHR, we are turning the corner on trials—we got recruitment to trials in the NIHR clinical trials network up from 200,000 to 600,000 last year. We are starting to see an increase in the number of first-in-human trials globally, which is an indicator of cutting-edge clinical science, and we have reduced the rate of time to first patient recruitment. We are never complacent—there is more to do—but we are turning the corner on global trial recruitment.

I believe that 2016 is set to be a critical year for the AMR challenge. The O’Neill report is shortly to land, as is my accelerated access review. We have secured a historic science budget for capital and revenue and a series of initiatives in global public health. We are well placed to convene and pull together that international leadership and ensure that British science is leading in what is ultimately, and needs to be, a global endeavour. I look forward to Lord O’Neill’s report and to working with colleagues across Government to implement it as speedily as we can to ensure that the momentum is maintained. I want this country to lead in what must ultimately be a global effort to find models to ensure that we bring all our science to bear to generate new diagnostics and new treatments. We must prevent the appalling situation, which a number of us have discussed today, of antimicrobial resistance becoming one of the great scourges of the 21st century.