World Antibiotics Awareness Week

Julie Cooper Excerpts

Thursday 16th November 2017 Westminster Hall

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies. I thank the hon. Member for York Outer (Julian Sturdy) for securing this debate on a really important subject during the week when we are focusing attention on the value of antibiotics and the challenges of antimicrobial resistance.

We have heard some interesting contributions, and I think there is widespread agreement across the Chamber. To reiterate some of the problems, we all agree that antimicrobial resistance is arguably the biggest challenge facing our health system. It is worth taking a moment to reflect on how fantastic antibiotics have been. We take so much for granted. Alexander Fleming’s discovery of penicillin heralded a golden age in health. Penicillin was the first of many antibiotics; it alone has saved countless lives and was rightly hailed as a wonder drug. Wide-scale access to antibiotics changed the nature of medicine forever: wounds would heal and operating theatres became safe places where life-changing and, indeed, life-saving operations could be carried out without fear of deadly infection.

However, that was a long time ago and we now too often take antibiotics for granted. We have become blasé about their use. We have become careless and irresponsible. Too often at the first hint of an infection—a cough, a sneeze or a headache—GPs come under pressure from their patients to prescribe antibiotics. Too often antibiotics are the first port of call. Too often they are made available as a precaution. Through overuse and inappropriate use we have allowed the development of resistant bacteria on a global scale.

That is not just confined to their use on humans, as has been mentioned by several hon. Members. In fact, the use of antibiotics in animal husbandry is widespread and is not just to treat infection, nor even to protect against infection. Until relatively recently it was permissible for sub-therapeutic doses to be added to animal feed to promote growth. That practice was banned globally in only January of this year. Even without that, 44% of all antibiotics used in the UK are used on animals and often inevitably find their way into the food chain and domestic water supplies. Cat McLaughlin, chief advisor to the National Farmers Union on animal health and welfare, stated:

“Arbitrary restrictions on the use of antibiotics…could have a detrimental impact on animal and plant health.”

That might be all well and good; however, the scientific consensus is that if we fail to place restrictions on the use of antibiotics, there will be a catastrophic effect on human health.

It is worth stressing that, as we have heard, antimicrobial resistance is the cause of 700,000 deaths globally each year, and that figure is predicted to rise significantly, to horrific levels, by 2050. Here in England, 5,000 people die every year from infections that have developed resistance to antibiotics. We must not underestimate the full impact of antimicrobial resistance. Let us be absolutely clear: without resort to effective antibiotics, there will be no treatment for complex infections, no chemotherapy for cancer and no treatment for cystic fibrosis, heart transplants or joint replacements. I recently visited the microbiology laboratory at the Royal Blackburn Hospital in Lancashire and the consultant microbiologist I spoke with said, “If you take one thing from your visit here today let it be this: we are so close to being unable to perform even the most minor, the most simple, operations, and so close to being unable to treat commonplace infections.” She impressed on me the need for urgent action.

The World Health Organisation identified the need for co-ordinated global action back in 2011. I am pleased to say that the UK has been a leader in responding and that at the time it published the five-year antimicrobial strategy and commissioned the O’Neill report, which has already been mentioned. It is clear that our focus should be two-fold.

First and foremost, we must raise awareness of the danger of overuse and focus on the reduction of demand. There is a lot that we can and must do. I agree with other hon. Members that we must start with a public education programme to manage expectations and to highlight the issues of inappropriate use and too frequent use. We should increase the use of diagnostic testing so that only efficacious targeted antibiotics are used.

In both those areas we should look to community pharmacists to lead. Qualified pharmacists are well placed to provide antimicrobial stewardship. Every day 1.6 million visits are made to community pharmacies in the UK, which provides ample opportunity to advise the public on appropriate treatments for ailments, to ensure full awareness of remedies other than antibiotics that may in many cases be more appropriate. The Royal Pharmaceutical Society has offered to support its members to take on new and extended roles. Why not take it up on that offer? Why not make mandatory the roll-out of minor ailment schemes in community pharmacies? Why not support community pharmacists to carry out diagnostic testing to support GPs and other dispensing health professionals? Reducing the prescribing of antibiotics is not just the responsibility of GPs.

We must also regulate to reduce the amount of antibiotics used routinely on animals that are not sick. The National Office of Animal Health refutes the call for extended regulations and rejects the call to reduce antibiotic use in food products. However, we must act to promote a global reduction, because we are not talking about insignificant amounts of antibiotic use. Here in the UK, as I have mentioned, 44% of all antibiotic use is on animals. In the USA that figure is more than 70%. Many nations do not even record the figure and there is every reason to suppose that it is far higher. We must acknowledge that this is a global problem and play our part in identifying new incidences of antimicrobial resistance.

We must invest in research and development, promoting innovation to discover the next generation of antibiotics. At the moment, fewer than 100 scientists are working in the pharma industry to develop antibiotics, due mainly to a lack of adequate reimbursements. Not only would that ensure antibiotic protection for us in future, but investment in this sphere has the potential to make a significant contribution to the UK economy. We must see the challenges as opportunities.

The UK has an opportunity to be a world leader in life sciences and antibiotic development, but the reality is that, contrary to the O’Neill report’s recommendations, there has been insufficient progress, and incentives to promote this innovative work are not forthcoming. We should stop focusing on the cost of new antibiotics and focus on the cost of not developing them. The British Society for Antimicrobial Chemotherapy maintains that the UK has failed to address the issues in three main areas: education and public awareness; veterinary and agricultural use; and incentives for antibiotic discovery, research and development.

As we mark World Antibiotics Awareness Week, I ask the Minister to outline what steps the Government will take on three fronts. What steps will he take to reduce the inappropriate use of existing antibiotics in the treatment of human illness? What action will he take to regulate the use of antibiotics on healthy livestock? What action will he take to stimulate the research and development of new antibiotics? Will he demonstrate to us that the Department is determined to take this subject by the scruff of the neck? A world without antibiotics is unthinkable.