World Antibiotics Awareness Week

Julian Sturdy Excerpts

Thursday 16th November 2017 Westminster Hall

[Julian Sturdy (York Outer) (Con)]

I beg to move,

That this House has considered World Antibiotics Awareness Week.

It is a privilege to serve under your chairmanship, Mr Davies. Exactly one century ago, Ernest Rutherford split the atom and humanity entered the nuclear age. The groundbreaking discovery represented a momentous step forward for human progress, but at the same time it unleashed a challenge for those beyond the laboratory and academia—the avoidance of mutual assured destruction. As this debate is about World Antibiotics Awareness Week, some might wonder why I started with the splitting of the atom, but I believe that there is an equally strong argument for the aforementioned period to be referred to as the antibiotic age. It was 11 years after the splitting of the atom that Sir Alexander Fleming discovered penicillin, here in this very city of London.

No one can deny the profound impact of antibiotics on medicine, and their widespread use represents a watershed moment in our evolutionary story. However, as Fleming himself understood, shortly after making his discovery, giant leaps in scientific progress produced wholly new challenges. As antibiotics were readily available, it appeared that we had invented miracle drugs of sorts. The snag is that we now face the real and severe threat of antimicrobial resistance.

Across the globe this week, scientists and healthcare professionals are hosting a wide range of events to make antibiotic resistance a globally recognised health issue. I am delighted that we as parliamentarians are here today to represent the role that lawmakers and Governments will play in facing the challenge of antibiotic and antimicrobial resistance. The week is also intended to raise awareness of the need to preserve the power of antibiotics through appropriate use, to increase recognition that individuals, health and agricultural professionals, and Governments must play in tackling antibiotic resistance, and to encourage behavioural change and convey the message that simple actions can make a difference.

While the threat of antibiotic resistance is often considered a doomsday scenario—one might say a medical Armageddon—we must remember that that menace is all too deadly today. Currently, 700,000 people die each year from drug-resistant infections; the future threat is touted as being so severe and extreme, not because we are not living with the effects today but because of the truly appalling potential scale of the problem if we do not take co-ordinated action. If we do not act now, antimicrobial resistance will be responsible for 10 million deaths per year by 2050. That is more than the number of people worldwide who were killed by cancer in 2015. It is nearly impossible to put a number on the lives that have been saved by antibiotics; some sources put the figure at roughly 2 million, but it is entirely conceivable that we may arrive at a position where the balance tips, and antibiotics pose a greater threat than a remedy.

As I have said previously in this House, we run the risk of returning to a medical dark age, where routine operations such as hip operations cannot be carried out, and infections that are standard today become deadly. This week, the British Society for Antimicrobial Chemotherapy published a report on behalf of the all-party parliamentary group on antibiotics. The report, the briefing for which has been sent to all Members of the House, considers the AMR action plans and strategies set out by the World Health Organisation, the European Union and the UK, and asks, crucially: “Has the world lived up to the challenge?”

The overarching theme of the report is that future strategies to combat antibiotic resistance should incorporate specific, measurable, attainable, relevant and timely—SMART—targets. When the stakes are 10 million deaths each year within four decades, it is easy to become lost in the scale of response that that merits; but as is so often the case, a coherent and clear approach is our greatest weapon. I call on the Government to ensure that all steps are taken to counter AMR and explicitly to incorporate those SMART targets I listed. I believe there is much to be gained from making that standard practice and removing any doubt. I am sure that colleagues will be encouraged to read in the report that

“the UK has taken significant steps to meet the objectives of the EU Action Plan, which in turn satisfies the WHO Europe Strategic Action Plan.”

There are two aspects, however, where our country needs to up its game. First, we need to address education and public awareness, so it is entirely fitting that we meet today during World Antibiotic Awareness Week, an occasion aimed directly at bolstering an understanding of resistance and the threat it poses to humanity. We need to be forthright in promoting the “four rights” when consuming antibiotics: the right drug, the right dose, the right time and the right duration. A survey carried out across Europe in 2016 indicated that knowledge about AMR remains low, and antibiotic consumption has decreased by only 6% over the last seven years. To address that, the British Society for Antimicrobial Chemotherapy advocates the use of simple and clear language in all awareness-promoting material. There is a direct recommendation of

“monitoring the efficacy of education campaigns through online channels.”

Fleming himself was once quoted as saying that the best remedy for a common cold was a dram of whiskey.

[Patrick Grady (Glasgow North) (SNP)]

Hear, hear.

[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.

--- Later in debate ---

[Julian Sturdy]

I thank all hon. Members for their contributions and the Minister for his response. From speaking to him previously and from what he has said today, I know he understands the task ahead not only for us in the UK but globally. It is important to remember and to pay tribute to the work that has already been done, which was ably led by David Cameron and the O’Neill review—one of the most important reviews that was set out by the then Prime Minister.

We have a job to do in this House. I have attended packed Westminster Hall debates on issues such as cycling and bee health—I am not decrying those important issues; I do not want my inbox full of emails on that tonight—but if we are not getting hon. Members from all sides of the House in for a debate on something as important as antibiotic resistance that affects us all, all our constituents, our country and the globe, that is quite worrying. If all hon. Members take that away from this debate, that will be encouraging.

We are an immensely fortunate generation to have been born and to have grown up in the world of the antibiotic age. I look at this issue for the sake of future generations. I have an interest in that because I have young children, and I think the Minister has children of a similar age. When the next generation hit their 30s and 40s and begin to start families of their own, there is a real possibility that their children will be born into a world without antibiotics—a post-antibiotic age. That is quite terrifying. It is essential that the required steps are taken for that next generation.

If we get that right, no medals will be handed out. No statues will be erected in the streets. If the Minister becomes the Minister with responsibility for antibiotic resistance and succeeds in his pledges, he will not be immortalised in a statue in the centre of London. The world will continue as it is, and many will not even know the threat that faced them. If we stand by and do nothing, however, history will be extremely unkind to our generation. It is essential that we act. The UK is making great steps forward, but there is so much more to do and it has to be done on a global stage.

Question put and agreed to.

Resolved,

That this House has considered World Antibiotics Awareness Week.