O’Neill Review

Kevin Hollinrake Excerpts

Tuesday 7th March 2017 Westminster Hall

[Mr Gary Streeter (in the Chair)]

Before I call Mr Hollinrake to move the motion, I shall let you know that eight colleagues are trying to catch my eye, in addition to the Front Benchers and the mover of the motion, so I will impose a voluntary time limit of four minutes on Back-Bench speeches. Please—I beg you—keep interventions to a minimum. We will see how it goes. I may have to impose a compulsory limit as we go along, but I hope not.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

I beg to move,

That this House has considered the O’Neill review into antibiotic resistance.

It is a pleasure to serve under your chairmanship, Mr Streeter. In advance of this debate, I penned an article for PoliticsHome titled, “Antibiotic resistance—the new Black Death?” As I was writing that headline, I could sense outraged people saying, “A typical politician grabbing a sensational headline to terrify the public once again,” but it reflects the devastating conclusions of the review on antimicrobial resistance, which involved some of the world’s leading scientists, academics and economists, including its chair, Lord O’Neill, the world-leading economist and former Treasury Minister.

The O’Neill review’s report states that bacteria are gradually becoming more resistant to antibiotics, and its most grim prediction is that 10 million lives will be lost globally every year by 2050. That is more than are lost to cancer and similar to the number of deaths caused in the 14th century by the black death, which killed some 75 million people between 1346 and 1353.

[John Howell (Henley) (Con)]

My hon. Friend cites 10 million deaths, but the effect will not be the same everywhere. Was he as shocked as I was to discover that the figure for Africa is more than 4 million? Does he think that more research should be done to ensure that the right resources are in the right places?

[Kevin Hollinrake]

My hon. Friend makes an excellent point. The key element of the fight against antimicrobial resistance is its global nature. We absolutely must not isolate ourselves from the rest of the world—we must collaborate—but we must take national action, too, and I will come on to that shortly.

That figure is of course a prediction—it could be lower, but it could also be higher. Predictions have been made about other contagions, such Ebola, Zika, HIV and Creutzfeldt-Jakob disease, and our scientists, academics and clinicians thankfully have managed to mitigate the worst effects and worst predictions for those diseases. But there are three reasons for us to be more alarmed this time: first, antimicrobial resistance is already happening; secondly, the problem is spreading rapidly and by all available means; and thirdly, research is not being carried out on anything like the scale required.

[Nick Herbert (Arundel and South Downs) (Con)]

A quarter of all the deaths that are predicted to happen as a result of drug resistance will be caused by tuberculosis, a disease that already kills 1.8 million people a year. Does my hon. Friend agree that research and development is essential if we are to develop a vaccine to prevent tuberculosis? No epidemic has ever been fully beaten without a vaccine.

[Kevin Hollinrake]

I absolutely agree. The difficulty is that due to the reward mechanisms in the system, such research and development is not happening. I will turn to that shortly.

This is not an apocalyptic prophecy. Antimicrobial resistance causes some 700,000 deaths globally and an estimated 12,000 deaths in the UK every year—similar to the number of people who lose their lives from breast cancer. Quite simply, if the bacteria that cause infections become resistant to antibiotics, people die. This issue is listed in the national risk register of civil emergencies, a five-year Government register, which states that an

“increasingly serious issue is the development and spread of”

antimicrobial resistance and points out that much of modern medicine will become unsafe. Minor surgery such as organ transplants, bowel surgery, cancer treatments and caesarean sections will become high risk—there will be more illness and more deaths.

Dame Sally Davies, our chief medical officer, pointed out that antibiotics have extended life by an average of 20 years—20 years of our lives may therefore be lost—and 40% of our population could die prematurely if this situation is not resolved. Operations would become unsafe due to the risk of infection during surgery or chemotherapy. Influenza pandemics would become much more serious. The national risk register states:

“The numbers of infections complicated by AMR are expected to increase markedly over the next 20 years. If a widespread outbreak were to occur, we could expect around 200,000 people to be affected by a bacterial blood infection that could not be treated effectively with existing drugs”.

[Mrs Theresa Villiers (Chipping Barnet) (Con)]

Does my hon. Friend agree that it is vital that we heed the O’Neill review’s recommendation that antimicrobial use in farming must reduce if we are to address the frightening consequences that he is outlining? In particular, we need to move away from intensive farming, which is reliant on the prophylactic use of antimicrobials.

[Kevin Hollinrake]

My right hon. Friend is right that bacteria can move from animals into humans, and the O’Neill review was clear that we need to take action in agriculture as well as our health services.

The national risk register states that we will be unable to treat some 200,000 people with existing drugs and

“around 80,000 of these people might die.”

That is a Government report.

[Julian Sturdy (York Outer) (Con)]

My hon. Friend is making a powerful argument. Is it not true that it takes about 15 years for a new antibiotic to get to the marketplace? Given the position that he has just laid out—deaths and resistance are happening already—that is quite frightening.

[Kevin Hollinrake]

My hon. Friend makes a very good point. We need to take action now because of the delays in producing new drugs.

[Mr Andrew Smith (Oxford East) (Lab)]

I congratulate the hon. Gentleman on securing this important debate. Is it not self-evident that the prevention of the occurrence and spread of infection must be in the first line of the battle against this problem, and screening people on admission to hospital to determine who might be resistant and carrying infections would be very useful?

[Kevin Hollinrake]

The right hon. Gentleman is right. Some 50% of prescriptions are needless, and diagnostics would mean that a lot of drugs were no longer prescribed.

We talk glibly about tens of thousands of deaths—Stalin once said, “One death is a tragedy; a million is a statistic” —but the reality is that these are our partners, our brothers, our sisters and our children, so we must act.

[Rebecca Pow (Taunton Deane) (Con)]

My hon. Friend is making a powerful point, but is not the key to find new antibiotics? Is he aware that several antibiotics originated from organisms in soil? That is how penicillin was found, and the first lead on a new antibiotic was recently found in soil. Does he agree that protecting our soil is key to our future? Given how much soil is being eroded and degraded, the Government should treat that as an important issue.

[Kevin Hollinrake]

My hon. Friend is a fantastic champion of the natural environment, and she makes a very good point.

The World Health Organisation has stated that antimicrobial resistance is

“one of the greatest challenges for public health”

and that the problem is increasing and we are

“fast running out of…options.”

Antibiotic resistance is just one form of antimicrobial resistance—others concern viral and fungal infections—but my focus is antibiotics, which the public more readily understand and should have real concerns about. Bacteria undergo an eternal battle for survival, and natural resistance occurs as a result of bacteria fighting that battle, but when we use antibiotics—particularly when we overuse them—that natural resistance accelerates significantly and becomes super-charged, and we end up with many more antibiotic-resistant bacteria.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate my hon. Friend on bringing the debate. He is right to highlight the scale of the challenge not just here but globally: it is difficult for countries to bring forward large-scale programmes to deal with the problem of antimicrobial resistance. Does he agree that, apart from inappropriate prescribing, one of the key issues in this country is people not always completing courses of antibiotics, which increases the challenges and problems of bacteria developing resistance?

[Kevin Hollinrake]

I defer to my hon. Friend’s in-depth knowledge in this area. I recognise my father’s habits in taking antibiotics when he felt a bit unwell—he had a little cupboard in the corner of his lounge. That is a problem, and that is why we need to improve the education on treatment of illnesses for which people are prescribed antibiotics.

The point about antibiotic resistance spreading is that it can be spread in so many ways: on aeroplanes; in our water; from contact with unwashed hands of people who carry bacteria resistance; coughing and sneezing; and from animals to humans. Some Members may have come across the excellent BBC Radio 4 drama “Resistance” —the first episode was aired on Friday and the second episode is this Friday—which talks about the transference from animals to humans. That means we must tackle this problem both in agriculture and in our health services.

Bacteria do not recognise national borders, so, as many hon. Members have already pointed out, this is a global problem. We would think that with those apocalyptic visions of the future we would be spending an awful lot of money on tackling this issue, but that is not the case. About $100 billion is spent every year on cancer research, but only about $5 billion is spent every year on tackling antimicrobial resistance. The reason for that is the commercial return that large pharmaceutical companies will get from bringing forward a new antibiotic to tackle this issue. Almost by definition, any new drug is held as a last line of defence, so there is not a significant commercial return for the pharmaceutical companies who we rely on for such new drugs. About $50 billion a year is spent on antibiotics but only about $5 billion a year is spent on patented antibiotics, which is equivalent to one cancer drug. It is a better commercial activity to be involved in cancer research and cancer drug development than in antimicrobial resistance. There has been a huge reduction in the number of pharmaceutical companies involved in research and development—in 1990 there were 18 and in 2010 there were only four—and no new classes of antibiotic drugs have been developed in the past 25 years.

Of course, the O’Neill review has studied that and come up with clear and compelling recommendations such as rapid diagnostic testing, which the right hon. Member for Oxford East (Mr Smith) referred to. Yesterday we had a Twitter debate, which was interesting, listening for an hour to people’s experiences. Many clinicians got involved in that particular Twittersphere, and we trended nationally at one point, which was certainly a new experience for me. One thing that came across was the pressure that clinicians were under to prescribe antibiotics to people who felt ill. Obviously, if we had diagnostics that could show people that they did not carry something that could be treated by an antibiotic, they would be much less likely to put that pressure on doctors.

[Maggie Throup (Erewash) (Con)]

My hon. Friend makes a good point about educating patients so that they appreciate that they do not have to come out of the GP surgery with a prescription in their hand if a diagnostic test can be carried out to prove that antibiotics will not work in their case.

[Kevin Hollinrake]

That is right. I had a test myself at a drop-in session in Portcullis House that showed me that I was not ill—I did not think I was ill, but they told me that I was not, which was reassuring. Again, we need to ensure that prescriptions are given when they will be effective. One other area that we do not seem to have control over at the moment is the online sale of antibiotics: whether through UK-based pharmacies or those based overseas, it is too easy to access drugs without a proper prescription.

The second key point that the O’Neill review highlights is the need for a global public awareness campaign so that people are aware of the issues. Again on Twitter yesterday, a student who had undertaken some analysis said that 80% of the people she had spoken to had no awareness of antibiotic resistance. We need a significant national and international effort to draw public attention to the problem. As people have already said, we need a reduction of usage in agriculture. That is clearly set out in the O’Neill review as one of the four main recommendations.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

The hon. Gentleman is making an important point about the dangers of antibiotic resistance. Does he agree that as well as not prescribing antibiotics for illnesses, it is important to recognise when there are alternatives that will reduce the use of antibiotics overall? For example, there is research being done at Newcastle University into using antiseptics for urinary diseases.

[Kevin Hollinrake]

Yes, what we need is a mixture of solutions. The UK by its own admission is mid-range across Europe in its use of antibiotics in agriculture. That is one thing, but we have been world leaders on this issue and for me mid-range is not where we need to be; we need to be at the forefront and world leaders in terms of best practice, whatever aspect of this issue we are dealing with.

There are four key recommendations in the O’Neill review’s 10 main recommendations. The last one is on market entry rewards to solve the problem of pharmas not investing in research and development, as well as a possible levy on drug companies that do not invest in research.

[Alex Chalk (Cheltenham) (Con)]

The World Health Organisation has made it clear, chillingly, that resistance to last resort antibiotics is present globally, so we have to act. Does my hon. Friend agree that we will not create vital new drugs until we align better the public health needs with the commercial incentives, and that Governments need to correct what is the most dangerous market failure in history?

[Kevin Hollinrake]

That is correct, and the review sets that out clearly. At the moment, if there is not a commercial return, it is difficult for pharmaceutical companies to invest in this field, although some are. For example, AstraZeneca recently sold its late-stage small molecule antibiotic business to Pfizer and so stepped out of research and development, but others, such as MSD, are still investing. It cannot be right that some companies are willing to invest—perhaps for altruistic purposes—when others are not. The O’Neill review discusses whether there should be a reimbursement or an insurance model, so that pharmaceutical companies can be sure that they will get a certain amount every year for drugs if they do develop them. It cannot be right that some contribute and some do not, so a levy for those that do not seems sensible to me. I do not think it should be left simply to big pharma to solve the problem.

The O’Neill review talks about a global AMR innovation fund—GAMRIF—to make funding available for smaller third sector organisations. Having Antibiotic Research UK, the world’s first charity in this field, in my constituency is how the issue was brought to my attention. It is doing fantastic research. From donations made by individuals, it has got hundreds of thousands of pounds that it is investing in “resistance breakers”, which is blending drugs together to repurpose existing antibiotics. That again is one of the recommendations in the report. Yes, big pharma, but we have also got to make some funding available to the smaller organisations, too.

[Mr George Osborne (Tatton) (Con)]

Will my hon. Friend give way?

[Kevin Hollinrake]

I am happy to give way my right hon. Friend, who has been a leader on this issue globally.

[Mr Osborne]

I congratulate my hon. Friend on highlighting this issue, and the wide range of Members here shows the degree of support across the House. He is now on the nub of the problem: there will not be an international levy unless Britain leads the argument internationally; no other country will do it. David Cameron established the review and Jim O’Neill has provided the answers. The British Government now need to double up their efforts and make sure that this is one of the major things we campaign for at the UN, the G20 and the like. We have made a good start and we have an extremely capable Minister, but now we need to finish the job.

[Kevin Hollinrake]

I am grateful for that intervention and for my right hon. Friend’s work on the issue in the past. He gives me an ideal opportunity to close my comments; I know you are keen to get other Members in to speak, Mr Streeter.

The UK is a world leader on this in both words and actions, but we need to do much more. The former Prime Minister—and the current Prime Minister, I am sure—and the former Chancellor of the Exchequer are leaders on this on the world stage and have drawn it to the world’s attention, as has Lord O’Neill. It is hugely important that we maintain that leadership. I look forward to hearing the thoughts of colleagues and the clear plans of Ministers for how we will act now to meet today’s challenge, because the fear is that tomorrow will be much worse than today.

[Mr Gary Streeter (in the Chair)]

I remind hon. Members of the voluntary four-minute time limit. There are about to be Divisions in the House.

--- Later in debate ---

[Kevin Hollinrake]

It is a pleasure to serve under your chairmanship, Mr Hollobone.

I thank the many colleagues who have contributed this afternoon to a very constructive debate; there has been a lot of consensus in this Chamber about what needs to be done. I also thank the Minister for her clear and comprehensive response to the many points that have been made; for the commitment she expressed at the end of her response, which is very reassuring; and, of course, for her great knowledge of this area.

It is quite clear from all the contributions that we have heard today that there is no one solution to this issue. There will have to be a holistic solution—a mix of solutions— across both the health and agriculture sectors; that point has been very clearly made this afternoon. That will also involve the different research laboratories that can contribute to this process. Obviously, the big pharmaceutical companies are a key element in making sure that we have the right remuneration mechanism for them and of course, our world-leading universities will also be involved, as well as other clinical institutions.

However, as I said earlier, the third sector is also important. Having the world’s first and only charity that specialises in combating antibiotic resistance in my constituency, I obviously feel honour-bound to support its fantastic activities. It is a collection of some of the UK’s top scientists. It has put an awful lot of work and money into this area, and its initial research has gone very well, using resistance breakers to repurpose antibiotics. Again, that is a key recommendation in the O’Neill review. As I say, the charity is making this progress and it is absolutely desperate to get the right kind of support. Any help we can give, in terms of pointing Antibiotic Research UK in the right direction to get the sources of funding it needs, would be useful. Its approach is innovative. It perhaps does not meet all the criteria that would normally be applied for this kind of research, but I absolutely believe that ANTRUK is certainly part of the short-term solution to this problem, if not the longer-term solution.

As others have already done, it is right that I thank Lord O’Neill for his tremendous work, as well as all the other people who contributed to his report. It is fair to say from what we have heard this afternoon that all the questions and answers are in the report; we just need to ensure that we execute well and follow through on the recommendations in the report.

As my right hon. Friend the Member for Tatton (Mr Osborne) said, leadership is a key part of this issue. We were very lucky with the former Prime Minister and the former Chancellor, who put it front and centre. They took global action and showed global leadership on it, which is critical. With leadership, all things are possible; there is no question about that. It is incredibly important that we continue to show that leadership in Parliament and Westminster.

It was tremendous to have so many contributions to this debate, not only from the Minister and former Ministers, who have so much knowledge of this area, but from those who have shown leadership at the highest possible level. It is great to see the UK front and centre, speaking out on this important issue on the world stage.

I thank you again, Mr Hollobone, for your time. It has been a pleasure to serve under your chairmanship and to contribute to this very important debate.

Question put and agreed to.

Resolved,

That this House has considered the O’Neill review into antibiotic resistance.