Antibiotics: Research and Development

Jim Shannon Excerpts

Tuesday 26th April 2016 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to be called to speak to speak in this debate, Mr Evans. I congratulate the hon. Member for York Outer (Julian Sturdy) on securing this debate on an increasingly important issue that we are more aware of today than ever before. He set out a comprehensive scene, which has been most helpful. He covered many of the issues involved, which will probably take away from other contributions, but he added to the debate, and that is the important thing.

The discovery of antibiotics revolutionised healthcare, allowing for the effective treatment of illnesses, including TB, that had previously been commonplace and frequently deadly. The hon. Member for Poplar and Limehouse (Jim Fitzpatrick) referred to the increase in TB in his constituency, which I am aware of because of events that have taken place here in Westminster. The incidence of TB in the United Kingdom has risen sharply in certain areas, and there is a tie-in between how we address TB and HIV. It is important that we look at the bigger picture.

Pathogens have evolved to resist new drugs. Resistance has increasingly become a problem as the pace at which new antibiotics are discovered has slowed and antibiotic use, including misuse and overuse, has risen. Antimicrobial resistance presents arguably the most serious threat to global health security and is threatening to undo major gains in the control of infectious diseases. If it is left unaddressed, 300 million people will die prematurely because of AMR by 2050 and the world’s GDP will be 2% to 3.5% lower. This year, the World Health Organisation and the G20 are considering AMR, providing the UK Government with an opportunity to build on the leadership they have shown to date. The UK Government prioritised tackling drug resistance in their aid strategy published last November. They also created the related Ross fund, which they are to be congratulated on. In addition, they brought the issue to the attention of the international community by commissioning the independent review on AMR in 2014.

The Ross fund is a commitment to spend £1 billion over the next five years on research and development on infectious disease, including £315 million to fight AMR. It is jointly administered by the Department of Health and the Department for International Development. Will the Minister give us some indication of how those Departments are working together to achieve the goals set? Commitments under the Ross fund are yet to be detailed. The all-party group played an instrumental role in securing the Conservative party’s manifesto pledge to create the fund. Given the urgency of tackling the TB epidemic, it is important that TB is prioritised within the Ross fund. Will the Minister tell us— I am sure he will—how that will happen? Although the Government’s steps are welcome, we must ask when the funding provided through the Ross fund will be allocated, because many of us are keen to see that happen. The hon. Member for York Outer also asked that question. Investment in TB diagnostics, drugs and vaccines through the fund is critical, and we need to see where the money is being spent and what the feedback is.

TB is the world’s leading infectious killer, killing some 1.5 million people every year, or 4,000 every day. TB is the biggest killer of people with HIV, as I mentioned earlier with reference to London. As the only drug-resistant infections spread through the air, multi-drug-resistant and extensively drug-resistant TB pose a serious threat to global health security. When we think about what is happening in London with TB and HIV, we should also think about what is happening in other parts of the world, where greater numbers are affected and there could be even more deaths.

Multi-drug-resistant TB—MDR-TB—is resistant to certain drugs. It can take more than 4,000 pills over a period of six months to cure someone with TB, and the drugs are often associated with severe side effects that can make treatment unbearable. As a result, patients often do not finish treatment, which increases the likelihood of drug resistance. I do not know whether any research is happening into how to make the drugs more palatable, if that is possible.

As well as treatment failure, inferior treatment and infection with resistant strains are drivers of MDR-TB. The number of cases of drug-resistant TB is increasing. There were nearly half a million new cases of MDR-TB last year and almost 200,000 deaths. One quarter of MDR-TB cases are in the WHO European region. MDR-TB requires patients to take a course of drugs over an 18 to 24-month period, including eight months of daily intravenous injections. That would be quite hard for anybody. Fewer than half of people who start treatment successfully complete the course due to the unbearable side effects, which can include permanent deafness. We have to be aware of not only what is done to treat people medically but the side effects.

The treatment of MDR-TB can cost 450 times the amount usually required to treat TB. In the UK, treatment of MDR-TB costs about £70,000, which is quite a lot of money, but if it addresses the issue, it has to be done. Due to stigma, lack of access to services and poor understanding, 3 million people—more than a third of those who fall ill with TB each year—fail to be diagnosed. MDR-TB already accounts for one third of the 700,000 annual deaths from AMR, and if it is left unaddressed, an additional 2.59 million people will die each year from the disease by 2050. It is imperative that TB is included in the AMR review’s recommendations to be published this year and considered in any international negotiations that follow. The G20 and the WHO will consider AMR this year.

I will finish with one more point—I am conscious of the suggested time for speeches, Mr Evans, but it is important that Members hear this. Although there may be a natural inclination to focus on the impact of increasing resistance to antibiotics on people, there is great work happening within the livestock industry, and particularly the poultry industry. The British Poultry Council has managed to achieve some encouraging results with its antibiotic stewardship scheme. It is the first UK livestock industry to pioneer a data collection mechanism to record antibiotic usage, which covers 90% of production across the chicken, turkey and duck sectors. It is important to record that since the scheme began monitoring overall use, it has demonstrated an encouraging downward trend. Between 2012 and 2015 production increased by 5%, with UK poultry meat accounting for 44% of total UK meat production. The total quantity of antibiotics used by scheme members in the same period decreased by 44%. In 2012, the scheme introduced a voluntary ban on the use of third and fourth-generation cephalosporins and a commitment to reduce the use of fluoroquinolone antibiotics. In 2016, the scheme made a further commitment not to use colistin.

Those encouraging results within the poultry industry should be recognised and encouraged, but as we have seen, when it comes to antibiotics for people, we need to wake up to the issue sooner rather than later. We need the Government to commit to delivering on the Ross fund and to continuing to look for further ways in which they can help address this issue.

--- Later in debate ---

[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—