Antimicrobial Resistance

Greg Clark Excerpts

Wednesday 17th April 2024 Westminster Hall

[Will Quince (Colchester) (Con)]

I beg to move,

That this House has considered antimicrobial resistance.

It is a pleasure to serve under your chairmanship, Mr Dowd. Until November last year, I had the privilege of serving as Minister of State at the Department of Health and Social Care, alongside the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), who I am pleased to see here in Westminster Hall today. If I may say so, Mr Dowd, it was a pleasure to work alongside her.

My hon. Friend will know that the DHSC is a Department where, despite one’s best efforts, one spends a considerable amount of time firefighting and dealing reactively with issues. During my time in the DHSC, many pressing issues concerned me, some of which remain today, but one in particular scared me.

If I told the House that there was an issue that was so serious that it is a top World Health Organisation global health threat, that it sits on the UK’s national risk register and that it costs the NHS around £180 million a year, would we be surprised if I also said that most people were not aware of it? What about if I said that globally there were 4.95 million deaths associated with this issue and that 1.27 million of those deaths were directly attributed to it? What if I said that one in five of all those deaths were of children under the age of five? Or how about if I said that deaths in the UK related to this issue are estimated to stand at 12,000 per year, which is the equivalent of deaths from breast cancer? What if I told the House that 10 million people—I repeat that figure; 10 million—are predicted to die globally each year by 2050 because of this issue if urgent measures are not taken?

This debate is about antimicrobial resistance, or AMR. If we walked out into Parliament Square now and asked 100 people at random what “AMR” is, I wonder how many of them would know. For the reasons that I have just set out, we should be aware of AMR and concerned about it. We should be pushing our Government, Governments globally and the World Health Organisation to do more to highlight this top global health threat and to take steps to address it.

AMR occurs when bacteria, viruses, fungi and parasites no longer respond to antimicrobial medicines. As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become difficult or indeed impossible to treat, therefore increasing the risk of disease spread, severe illness, disability and—sadly—death. Although resistance is a natural phenomenon and not just a health issue, from a human healthcare perspective it is accelerated by inappropriate use of antimicrobial drugs, poor infection prevention and control practices, a lack of development of new antimicrobial drugs and insufficient global surveillance of infection rates.

As I have said, the World Health Organisation has declared AMR to be one of the top 10 global health threats, and it is also listed on the UK Government’s national risk register. In 2019, there were 4.95 million deaths associated with bacterial AMR across 204 countries, and 1.27 million of those were directly attributable, leading the WHO to declare it a top public health threat.

The OECD has found that one in five infections—I repeat: one in five infections—is now resistant to antibiotics, with the potential for that rate to double by 2035. In 2021, there were 53,985 serious antibiotic-resistant infections in England, which represented a rise of 2.2% from 2020. If left unchecked, resistance to third-line antimicrobials—the last-resort drugs for difficult-to-treat infections—could be 2.1 times higher by 2035. That means that health systems will be closer to running out of options to treat patients suffering from a range of illnesses such as pneumonia and bloodstream infections. Despite that—this is the really concerning part—no new class of antibiotics has been developed since the 1980s. Preserving and optimising our current antimicrobial arsenal is therefore not just urgent but paramount.

The consequences of AMR are huge. For urinary tract infections caused by E. coli, one in five cases exhibited reduced susceptibility to standard antibiotics. That is making it harder to effectively treat common infections. AMR also presents a threat to malaria control. Antimicrobial resistance is putting the gains of modern medicine at risk, because it makes surgical and medical procedures that are a normalised part of everyday life—such as caesarean sections, cancer chemotherapy and hip replacements—far more risky.

In addition to causing death and disability, AMR has significant economic costs. AMR creates the need for more expensive and intensive care, affects the productivity of patients or their caregivers through prolonged hospital stays and—I appreciate that this is a side issue—harms agricultural productivity. The World Bank estimates that AMR could result in $1 trillion of additional healthcare costs by 2050 and $1 trillion to $3.4 trillion of GDP losses per year by 2030.

Considering the huge risk that AMR poses to health security across the world, I do not believe that enough is being done globally to combat the current inevitability. Let me start by praising the UK Government for their action in this space, in particular the AMR five-year national action plan, or NAP, to contain and control AMR by 2040, which the NHS long-term plan details commitments to implement. I look forward to the update beyond 2024, which this period goes up to.

I could focus the rest of this speech on what more the UK could and arguably should be doing. We do need to see more on robust monitoring and surveillance. We need a significant public awareness campaign, greater investment in diagnostics, monitoring and screening—particularly in relation to rapid point-of-care testing—at local system level and, vitally, greater focus on infection prevention and management. However, I want to spend the rest of the time available to me focusing on international efforts and the role that the UK can play.

[Greg Clark (Tunbridge Wells) (Con)]

I am very grateful to my hon. Friend for bringing this very important matter to the Chamber. Before he moves to the international lens, will he reflect on the contribution that bacteriophages can make? Those are the subject of a report from the Select Committee on Science, Innovation and Technology. In effect, they are viruses that eat bacteria. In the UK at the moment, there is no approved manufacturing plant and therefore it is impossible to license phages for clinical use. A facility in Leamington Spa that was used as a Lighthouse lab could be repurposed for that. Does my hon. Friend agree with me that the Government might find that a useful way to address the very significant problem that he describes?

[Will Quince]

I thank my right hon. Friend for bringing that to my attention; it was not something that I was aware of. Given the gravity and seriousness of the situation that we face not just here in the United Kingdom but globally, I think that we need to look at all potential tools in the arsenal to tackle this issue, so I hope that the Minister has heard the case that my right hon. Friend has made very powerfully, and I would be happy to meet with him afterwards to find out more about it, because it sounds incredibly interesting.

My right hon. Friend is right—although I want to focus for some time on the international effort—the battle is not won here in the UK, we have far more to do, and the Department of Health and Social Care and NHS England have important roles to play. I know from first-hand experience, including when representing His Majesty’s Government at the World Health Assembly and the United Nations General Assembly when I was Minister of State, the global leadership that the UK shows through the World Health Organisation, especially in partnership with Sweden. During my time, I was proud to be able to announce an investment of £39 million into research through the global AMR innovation fund to help to tackle what is a silent pandemic. I understand that £24 million of that has been awarded to bolster the UK’s partnership with CARB-X, which is a global AMR research initiative that supports the continued early development of invaluable new antibiotics, vaccines, rapid diagnostics and new products that combat life-threatening, drug-resistant infections, as well as prevent death and disease across the world.

--- Later in debate ---

[Maria Caulfield]

The hon. Gentleman is absolutely right. I will touch on how much more we can do with screening to prevent some infections. This cannot just be about developing new antibiotics; it is about preventing infections and screening for them in a range of scenarios.

To touch on some of the high prevalence internationally, 89% of all antimicrobial resistance deaths occur in Africa and Asia, so we have responsibility to ensure that we help out in those countries that struggle most with the issue. We must continue to ensure that people around the world have access to the antibiotics they need, which is why the £40 million in innovative research through the global AMR innovation fund that my hon. Friend the Member for Colchester mentioned is so crucial. It enabled the development of a new antibiotic for drug-resistant gonorrhoea, the first in 30 years.

The hon. Member for Tiverton and Honiton (Richard Foord) touched on the role of water, which requires an international effort. Sanitation is often a leading cause of infection in other countries. That is why we are working hard with other countries and the WHO to improve water sanitation and hygiene to reduce infections occurring in the first place.

In 2022, we made a further £210 million commitment for the second phase of the Fleming Fund to strengthen our surveillance systems. As the hon. Member for Strangford (Jim Shannon) said, it is not just about treatment, but about picking up infections and trends and trying to prevent them in the first place. The Fleming Fund is having an impact. Since 2015, over 240 laboratories have been upgraded with state-of-the-art equipment, training and new systems, and over 75 national action plans on AMR have been developed in Africa and Asia to try to get the death toll from antibiotic resistance down. The Fleming Fund leverages UK expertise, with over 3,000 healthcare workers being trained in antimicrobial surveillance principles through a partnership with the NHS.

Looking ahead, we recognise the risks. We are not being complacent either domestically or internationally. Through the hard work of my hon. Friend the Member for Colchester, we have put some good building blocks in place, but we need to look to the future. Our next five-year antimicrobial resistance national action plan will be published later this year.

[Greg Clark]

I am grateful to the Minister for what she said about phages. She knows that UK science is world-leading, especially in this area. In Imperial College alone, there are 180 researchers working on AMR. One such researcher, Professor Jonathan Cook, has noted the real benefits of point-of-care testing and the fact that other countries, including the Netherlands, have managed to make a big impact. Can the Minister say whether we have plans to accelerate the availability of such testing in this country?

[Maria Caulfield]

My right hon. Friend makes a good point, which I will take away and follow up on. There are some really good examples in primary care where some testing is done. Primary care nurses particularly will do point-of-care testing to see whether someone’s infection will be sensitive to antibiotics or not. I believe there is more we can do in that space, both in primary and secondary care, so I am happy to write to him about how we can roll that out nationally. Importantly, that testing helps to maintain patients’ expectations. I cannot remember who, but someone said that people go along to GPs and expect to be given antibiotics. Point-of-care testing will be able to reassure them that they either do or do not need antibiotics and tell them which type is best suited to their type of infection. That is crucial.

Our plan will set out an ambitious programme of work, learning from covid-19 in testing, surveillance and treatment to prepare for infections of the future. I can reassure my hon. Friend the Member for Colchester that we will continue to collaborate internationally with organisations such as the WHO and use our soft power to help to support in particular African and Asian nations, which are suffering greatly from the mortality of antimicrobial resistance. This is a hidden pandemic that will have consequences for us all if we do not deal with it.

Question put and agreed to.