Antibiotics: Research and Development

Justin Madders Excerpts

Tuesday 26th April 2016 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Evans. I congratulate the hon. Member for York Outer (Julian Sturdy) on securing this extremely important debate, and on the knowledgeable and measured way in which he introduced it. I also commend his ongoing efforts to bring antibiotic resistance to the House’s attention since his election in 2010. As he said, he secured a Westminster Hall debate in October 2014 in which he called for co-ordinated action to be taken to tackle this issue. Today’s debate offers a valuable opportunity to take stock of progress since then, and to redouble our efforts to ensure that the right conditions are created to incentivise the development of the next generation of antibiotics.

The hon. Gentleman rightly said that something as minor as a grazed knee could claim lives. It is difficult to comprehend how that could happen, but there is a real risk that incidents of that sort will become commonplace in future. He cited the staggering statistic that of the 20 pharmaceutical companies that were originally developing antibiotics, only four are now in operation. He highlighted the tension between the need to encourage innovation and the financial uncertainty in this area of research. He also gave some interesting facts about regional variance in antibiotic prescription, about which I would like to learn more after the debate.

It was a pleasure, as always, to hear from my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick). He discussed tuberculosis from the perspective of both a member of the all-party group on global tuberculosis and the representative of a constituency that historically had severe problems with TB. He highlighted the increasing incidence of drug-resistant TB, and raised important questions that I look forward to hearing the Minister answer.

The hon. Member for Erewash (Maggie Throup) discussed the obstacles to the development of new antibiotics and the issue of inappropriate prescribing. She made a fair analogy with road deaths, as did my hon. Friend the Member for Poplar and Limehouse. The hon. Member for Strangford (Jim Shannon) made a valuable contribution. He was right to acknowledge and encourage the political leadership that is needed on this issue. He also made an important point about the side effects from treatments.

It was good to hear from my hon. Friend the Member for Cambridge (Daniel Zeichner), who brought a great deal of knowledge from his constituency and revealed the alarming statistic that the UK has gone from having 6% of the world’s clinical trials in 2010 to just 2% today. He echoed Jim O’Neill’s comments about pharmaceutical companies needing to look beyond the short term; I think we would all agree that that is an important challenge that we face. He also stated clearly that he believes that more should be done to encourage research and development in this country. We have been a leader for many years, and it would be a real shame if that position was under threat.

The debate is timely, as the Government-commissioned review on antimicrobial resistance is due to report next month. I pay tribute to the huge amount of work that Jim O’Neill and his team have undertaken. I hope that the conclusions of the review will lead to the far-reaching changes that we know are necessary, both in this country and around the world. Antibiotic resistance has been described by the World Health Organisation as the

“single greatest challenge in infectious diseases today, threatening rich and poor countries alike.”

The hon. Member for York Outer referred to the future as a nightmare scenario, and the WHO has also said that if we fail to act on antimicrobial resistance, by 2050 an additional 10 million lives will be lost each year to drug-resistant strains of malaria, HIV, TB and certain bacterial infections, at a cost to the world economy of $100 trillion.

As Dame Sally Davies set out in the foreword to the “UK Five Year Antimicrobial Resistance Strategy 2013-2018”:

“The harsh reality is that infections are increasingly developing that cannot be treated. The rapid spread of multi-drug resistant (MDR) bacteria means that we could be close to reaching a point where we may not be able to prevent or treat everyday infections or diseases.”

Despite that, so far, drug-resistant bacteria have not had anything near sufficient attention in terms of medical research.

It is easy to forget that it was less than 100 years ago that Alexander Fleming discovered penicillin after a piece of mould contaminated a petri dish at St Mary’s hospital, and it was not until the 1940s that the true era of antibiotics began. Despite an exponential increase in the use of antibiotics and an increasing awareness of the threat posed by antimicrobial resistance, since the year 2000 just five new classes of antibiotics have been discovered, most of which are ineffective against a number of resistant strains of bacteria, including Gram-negative bacteria.

We need to take a wide variety of steps to get to grips with the problem, including, of course, looking at how we address the long-term decline of the pipeline for new antibiotics through incentivising research and development, which I will come to shortly. We must also improve our focus on disease prevention, improving surveillance over drug resistance and tackling unnecessary antibiotic consumption. I will briefly address each of those matters in turn.

First, disease prevention, particularly in hospitals and care environments, is vital if we are to tackle antimicrobial resistance. Around 300,000 people a year get an infection while being cared for by the NHS in England—that is one in every 16 people treated by the NHS. As the Royal Society for Public Health said,

“it is alarming that the very place you would expect public health to be a high priority remains a breeding ground for life threatening infections.”

Despite improvements in recent years, the rate of healthcare-acquired infection in England has remained stubbornly high, while checks on compliance with hand hygiene best practice can only be described as inadequate. On 13 January, hand hygiene was the subject of a Westminster Hall debate, to which I responded on behalf of the Opposition. Will the Minister set out what additional steps have been taken since then to improve hygiene in all care settings? There is still a lot we can do to deny superbugs such as MRSA the opportunity to spread.

Secondly, we need to tackle surveillance blind spots in all parts of the world. As Jim O’Neill made clear,

“if we can’t measure the growing problem of drug resistance, we can’t manage it.”

We know that the technology exists to combine rapid diagnostics with data sharing, but we need to build consensus on precisely how that will take place. I would welcome any comments from the Minister on the steps being taken to improve surveillance, both in the NHS and internationally.

Thirdly, as the Science and Technology Committee found in July 2014, there is an urgent need to tackle unnecessary antibiotic consumption in healthcare and in farming, which is one of the key causes of antibiotic resistance. The Chair of the Select Committee at the time, Andrew Miller—my predecessor as MP for Ellesmere Port and Neston—called on the Government to take

“decisive and urgent action to prevent antibiotics from being given to people and animals who do not need them.”

Nearly two years on from that report, there is little evidence that such decisive and urgent action has taken place, or that all the Committee’s recommendations have been implemented. When the Minister responds, will he update us on what steps have been taken to reduce the unnecessary use of antibiotics? Although at the time of the report the Committee welcomed the launch of the O’Neill review by the Prime Minister, it cautioned against using that as an excuse or a reason to delay any progress. I hope the Minister will assure us that that has not happened.

The need to

“stimulate the development of new antibiotics, rapid diagnostics and novel therapies”

was one of the three strategic aims set out in the chief medical officer’s September 2013 report on the five-year antimicrobial resistance strategy. It was also one of the key recommendations of the Science and Technology Committee report. Although I welcome the renewed focus that today’s debate brings, I fear we are no closer to a solution than we were two and a half years ago. The barriers that existed to the development of new drugs have still not been addressed. I hope that today’s debate, and the final report of Jim O’Neill’s review, will provide the catalyst needed for meaningful action finally to be taken. As the hon. Member for York Outer said, a firm timetable from the Minister would be helpful.

The key issue is that in other medical fields, once a new drug is developed that significantly improves on previously available drugs, it quickly becomes the standard first choice for patients once it comes to market. However, as we have heard, a new antibiotic might not become the first choice until there was resistance to previous generations of drugs. Indeed, health officials logically seek to limit prescribing a new antibiotic drug, with the goal of delaying resistance for as long as possible. By the time that a new antibiotic becomes the standard line of care, many years or even decades are likely to have elapsed, bringing it near to or beyond the end of its patent life. If a company has spent tens of millions of pounds on its development, that would leave it unable to generate sufficient revenue and to come close to recouping its original investment. As the hon. Gentleman said, from that perspective, the system is certainly broken.

In the review, “Securing New Drugs for Future Generations: The Pipeline of Antibiotics”, Jim O’Neill suggests a number of interventions to tackle the systematic issues that prevent the development of new antibiotics. He says that those interventions, which require political leadership at a global level, have the potential radically to overhaul the antibiotics pipeline. Will the Minister assure us that the Government will do everything they can to secure an international consensus? We have been told by report after report over the past decade how important tackling antimicrobial resistance is. I am sure Members from all parties will agree that it is time we started to put those findings into action. If the Government do the right thing and take action, they will have our full support.

Members have talked about the challenges, which are on a par with climate change, global terrorism and various other apocalyptic scenarios. It is a sad fact that generally our constituents talk about these issues only when they become everyday concerns. If that happens with antimicrobial resistance, we will have failed. We are all committed to ensuring that that does not happen; we certainly have a duty to do so.