Antimicrobial Resistance

Kevin Hollinrake Excerpts

Tuesday 7th December 2021 Westminster Hall

[Sir Gary Streeter (in the Chair)]

Before we begin our next debate, I remind Members that they are expected to wear face coverings when they are not speaking in the debate. That is in line with current Government guidance and that of the House of Commons Commission. I remind Members that they are asked by the House to have a covid lateral flow test twice a week if coming on to the parliamentary estate. That can be done either at the testing centre in the House or at home. Please also give each other and members of staff space when seated, and when entering and leaving the room.

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

I beg to move,

That this House has considered the health impacts of increasing levels of antimicrobial resistance.

It is a pleasure to serve under your chairmanship again, Sir Gary. Mark Twain once said:

“I am an old man and have known a great many troubles, but most of them never happened.”

This is not a trouble that will not happen. This trouble is happening now; this trouble will get much worse. The UK Health Security Agency chief medical adviser, Dr Susan Hopkins, said that antimicrobial resistance, or AMR, was “a hidden pandemic” and that it was important that

“we do not come out of COVID-19 and enter into another crisis.”

What I fear most is that, as Warren Buffet once said:

“What we learn from history is that people don’t learn from history.”

There can be no excuse this time if we do not prepare well for a future pandemic of AMR.

This is not the first time I have raised the issue in the House, and it will not be the last, because AMR is simply too important to ignore. Antibiotics are one of the most powerful tools in healthcare, underpinning every aspect of modern medicine. We need them not just when we are poorly at home with an infection but when we are going through significant life-changing procedures such as chemotherapy and hip replacements. Antibiotics work by killing bacteria but, in the same way that the covid-19 virus can mutate and evolve, so can bacteria, developing resistance to antibiotics.

Right now, this year, about 700,000 people will die from antibiotic resistance infections across the world. It is estimated that by 2050, AMR could claim as many as 10 million lives a year. It is not a hypothetical or vague threat that is happening elsewhere; it is happening in the UK, is getting worse and will get much more so. Professor Jennifer Rohn of University College London has said:

“AMR has very much not gone away, and in the long term the consequences of AMR will be far more destructive.”

The latest report from the English surveillance programme for antimicrobial utilisation and resistance found that antibiotic resistance increased by 4.9% between 2016 and 2020. That means that one in five people with a bloodstream infection in 2020 had one that was antibiotic resistant—a serious, potentially life-threatening situation.

I want to tell you about a mother named Helen. Helen experienced resistant infections in 2013 and 2018, which caused her a great deal of anxiety and pain. She was to experience a third resistant infection shortly after giving birth. When her baby was just six weeks old, Helen developed mastitis, an infection of the breast tissue. She soon developed flu-like symptoms, and a GP prescribed her an oral antibiotic. The infection was resistant and two days later it was getting worse, and she could barely hold her baby. She started vomiting and was sent to A&E, where she was kept on heavy-duty intravenous antibiotics for two nights. Luckily, the sepsis was caught early and she recovered, but it could have been a very different story. Sepsis causes 48,000 deaths in the UK every year, many of them due to resistant infections.

AMR is the next pandemic. It is a hidden pandemic, but that does not mean that we can treat it any less seriously than covid-19. We must have the right plan in place. First, we need a strong system for monitoring the impact of rising AMR here in the UK. I welcome the fact that the Government have been looking into recording AMR or antibiotic resistance as a cause of death on death certificates and I had a welcome update from the Minister on where we are with those proposals. However, it is surprising that not many parliamentarians are focused on the problem, given its context and scale. It is good to see my fellow parliamentarians here today who are taking an interest, but until we have a proper register and until more parliamentarians are made aware of the issue through their constituents, I do not think the levels will be sufficiently high to raise awareness as often as we need in Parliament to make sure we take the matter forward and take action against it. Secondly, we need to support only the appropriate use and prescription of existing antibiotics. Thirdly, we need to ensure that we incentivise the development and research of new antimicrobials and antibiotics.

We need to take a one-health approach across all three issues that recognises the link between resistance and use in humans, animals, agriculture and the environment. The Government’s five-year national action plan on AMR set out the steps we need to take, but we are now just about halfway through and have yet to see any clear update on progress. The UK has been a trailblazer on AMR, but that lack of reporting is not where we need to be. We must be at the forefront of taking domestic action, not least because we are trying to maintain our leadership position as an example for other countries.

It was pleasing to see that the UK made AMR a centrepiece of our G7 presidency. We are long-standing global leaders in AMR and this is hugely important work, but we cannot afford to let our attention drop from what we can also do here and at home. The Minister and I shared many conversations on this matter as Back Benchers and I know she is very focused on and aware of the context, particularly in diagnostics, which I will talk about shortly. Will she consider introducing annual reports for all the partners on the actions in both this plan and in the next five-year action plan?

As has already been mentioned, one of the biggest issues facing us is the fact that there is not enough research and development of new antimicrobials. I would be interested to see what metrics of success we can use to judge the outcomes of the National Institute for Health and Care Excellence’s AMR project, formerly called the pilot, which is trialling a new model for valuing and paying for antibiotics. This is a world-leading, first-of-its-kind subscription-style payment model that will help incentivise companies to develop new drugs needed to tackle resistant infections and is supported by NICE.

The reasons we need a new model are complex. Bacteria naturally evolve to become resistant to certain drugs, but that evolution is happening faster than new medicines are reaching healthcare systems. That is partly because developing antibiotics is a long, complex and risky process, with many products failing along the way. At the end of that process, we do not have a viable commercial market for the new products. That is the key problem and that is because antibiotics are not like other medicines. Often, we want to reserve the new antibiotics for the patients who really need them, meaning the new products could just sit unused on the shelf. In that scenario, the cost of development could way exceed the return, undermining future research. The commercial model for developing antibiotics is broken.

I pay tribute to the UK’s leadership in introducing the AMR project in the first place. I know it is the result of many years of work by the Government, NHS, NICE and the industry sector, but we cannot afford that leadership and drive to slacken off now, because the price is simply too high if we do not succeed. As the Minister knows, the pilot looks at only two antibiotics and, as yet, there are no concrete plans to evolve into a new permanent model for all new antibiotics that come after them. Even though we are world leaders, we must urgently start thinking about the next steps and that must be built into the next action plan. The next steps must consider how we evolve the pilot and implement its learnings at scale and pace. Will the Minister comment on what conversations she has had with NHS England and NICE about how best to do this and what the timeframe might be?

We must also remember that the world is watching the world-leading AMR pilot. NICE has always been regarded as the gold standard and its actions have always carried weight, but now it is running one of only two pilots in the world considering this issue. It is therefore important not only that we get the project right, but that we also get right how we talk about what happened, the results and, indeed, what went wrong. Given that the goal is to incentivise private research and development, I urge the Minister to work with industry on that communication to ensure we are all aligned on the successes and learnings.

In 2019, in their five-year national action plan, the Government committed to reducing hospital-acquired infections by 2024 and halving gram-negative bloodstream infections in the NHS long-term plan. However, there is increasing concern that the covid-19 pandemic will have pushed those targets into the background. I would welcome the Minister’s comment on that issue, too.

As a final action point, in his landmark report, Lord O’Neill describes diagnostics as the most important of his 10 commandments to tackle AMR. The launch of the community diagnostic hubs represents an important opportunity to combat an increased incidence of AMR through accurate and targeted prescription. However, we need to tackle the false economy of simply prescribing antibiotics because they are cheaper than a diagnostic test.

I know other Members want to come in, so I will close by recognising those who do tireless work on this issue and with whom I work closely. First, Antibiotic Research UK or ANTRUK, which is in my constituency, is the world’s first charity specialising in antimicrobial research and education. It provides vital research and support services for patients impacted by resistant infection. Secondly, the British Society of Antimicrobial Chemotherapy provides the secretariat to the all-party parliamentary group on antibiotics, of which I am a member. Without its efforts, the efforts of the Minister and her team and the work of many others, we would not have achieved so much in our fight to stop the next pandemic, but that must be our challenge, to make sure that this time we prepare properly for a pandemic that absolutely will happen if we do not put the right steps in place.

[Sir Gary Streeter (in the Chair)]

Before I call Theresa Villiers, we are expecting three Divisions in the House in a moment. When we get to that point, Members should perhaps think about adjusting their diaries, because it will be 25 to 35 minutes before we come back.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

You are most kind, Sir Gary; thank you very much. I am not sure about the pure gold, but I will certainly do my best to make my contribution to the debate. I congratulate and thank the hon. Member for Thirsk and Malton (Kevin Hollinrake). He is not only an hon. Member but my friend, and has been for all the time we have been together in the House. We have spoken on many issues together, so I am pleased that he has brought this subject forward.

I have an interest in this issue, probably because of my constituency. I will start with a comment from back home. This is not only a UK-wide issue but a global issue. As Northern Ireland’s chief medical officer, Dr Michael McBride, said:

“As certain antibiotics lose their ability to kill particular strains of microbe, and if we cannot develop new drugs that can beat those bugs, then by the year 2050 we can expect about 10 million deaths per year, worldwide, from drug-resistant infections.”

If that does not shock hon. Members or sound horrific, it should. If hon. Members thought the covid-19 pandemic was their worst nightmare, with all its repercussions and problems and horribleness, I suggest that this debate has the potential to be their even worse nightmare. Will I be here in 2050? It is highly unlikely, but many others will be, so we should ensure that what we do today will be sufficient to protect those of tomorrow—my children, my grandchildren and, whenever they come, my great-grandchildren.

The rise in antibiotic-resistant infections is of real concern: England saw 90,000 hospital admissions because of such infections in 2019-20 alone. There is a real problem, and we need to act now, as right hon. and hon. Members have said. There is a rising tide of antibiotic-resistant infections. We have to do something.

I declare an interest as a member of the Ulster Farmers’ Union. I have acknowledged on the record the need for investment in agriculture in the effort to tackle antimicrobial resistance from every angle. The Ulster Famers’ Union said:

“As a farming industry, we are committed to playing our part in reducing antibiotic usage and resistance. Significant progress has already been made in the pig and poultry sectors, which have seen their usage fall by over 50% and 80% respectively. Historically, those working with cattle are smaller users of antibiotics but there are improvements that can be made.”

I welcome that commitment from not only the Ulster Farmers’ Union but the National Farmers Union here on the mainland; it is a joint operation. We should support the clear commitment by the farmers unions to do these things and take this action.

[Kevin Hollinrake]

The hon. Gentleman is making a very good speech, and he makes a good point about the pig sector. I am sure he will be aware that the reduction in antibiotic use in the pig sector has not affected yields at all, which demonstrates that things can be done more sustainably, and can be better for the environment, without affecting the economics of farming.

[Jim Shannon]

The hon. Gentleman is absolutely right. The farmers unions welcome these things because, first, they are the right things to do, and secondly, because they do not affect the profitability of the sector or the industry. We need to try to reinforce that.

My constituency has only two or three pig units—one is fairly big, by the way—but a big poultry sector, which has made significant moves towards those things. I live right in the middle of a farm. All my neighbours are dairymen or have beef cattle or some sheep, and they told me that they are careful about what antibiotics they give their animals because that is the right thing to do. Who led the way on net zero targets from the farming sector? The National Farmers Union. It did not have to be coaxed to do that; it was happy to do it. Those are some good things.

It is clear that the farming community is stepping up to the mark and that we in this House need to do more. We need to get the message out that antibiotics are a last line of defence. We must allow our bodies to do their work against viral infections, which antibiotics cannot hope to address. I do not take antibiotics often, but I had to in 2019 because I got a bad infection, and those worked well to clear up my chest infection. Researchers at the University of Limerick found that GPs often felt pressurised into prescribing antibiotics, particularly for fee-paying patients in both in and out-of-hours situations, despite being aware that antibiotics were inappropriate for treating non-bacterial infections. Can the Minister provide an idea of what GPs and consultants do in relation to that and why it is important to get that right and not to be pressurised into giving those out?

GPs need our support and a clear message needs to be sent. We need to ensure that the message is simple: that it is a matter of life and death. Antibiotics are the last of our steps to take and only if we hold them as sacred will we ensure they can still work effectively and save lives. At the end of the day, that is all we want.

--- Later in debate ---

[Kevin Hollinrake]

I thank my hon. Friend the Minister. As I said earlier, she has always been a passionate champion of this subject, long before she was an excellent Health Minister. AMR is quite an esoteric issue. Most hon. Members, as we can tell from the attendance, are not particularly concerned about or aware of the problem. I was only made aware of the issue because a charity in my constituency, Antibiotic Research UK, or ANTRUK, drew my attention to it. It acted as an adviser to a Radio 4 programme called “Resistance”, which is well worth listening to. There are about four or five series, and it is a dramatisation where an antibiotic-resistant bug wipes out over 99% of the planet’s population.

That is the potential for how devastating AMR could be, so it is absolutely critical that we get this right. For me, it is down to the three D’s—drugs, diagnostics and data. I wonder how concerned we all would have been about covid, particularly early on in the crisis, had we not seen the data behind it. For most of us, it did not really directly affect us, so the data is crucial. I know that it can be challenging to determine exactly what somebody has died from in the case of a resistant infection, but it is critical that we establish a framework so that there is more concern among parliamentarians, the media and constituents, which leads to parliamentary concern, and constituents can come to our surgeries and say, “We are very concerned about this, because we have had a catastrophic personal incident ourselves.”

I thank hon. Members for their contributions. There were few of them, but this is a hugely important issue, and I really am grateful to hon. Members for coming here and speaking about it today.

Question put and agreed to.

Resolved,

That this House has considered health impacts of increasing antimicrobial resistance.