Antibiotic-Resistant Bacterial Infections

Lord Crisp Excerpts

Wednesday 24th July 2013 Grand Committee

Asked by

[Lord Crisp]

To ask Her Majesty’s Government what is their assessment of the risks posed by antibiotic-resistant bacterial infections; and what plans they have to reduce such risks.

[Lord Crisp]

My Lords, first, I thank noble Lords who are taking part in this debate and say how much I look forward to their insights, which I know will come from very different perspectives. I suspect that there will be an enormous amount of agreement. I know that the Government are taking this matter extremely seriously and that, in the words used in my Question, they recognise the risks and are developing plans to reduce such risks. I hope that this debate will enable them to be even more bold and creative in their approach.

I will talk for a moment about that shared understanding, which I will put in very simple layman’s terms. No doubt others will expand on it. The first point is that antibiotics have been a great benefit to humanity in tackling everything from TB and pneumonias to sexually transmitted diseases and bacterial infections of all kinds—not just in this country of course but world wide, including in some of the poorest countries of the world. I happen to chair Sightsavers, which uses an enormous amount of antibiotics in dealing with trachoma in the poorest countries of the world.

Antibiotics are the basis of much modern practice. We assume now that we can tackle infections. Infamously, it was the American Surgeon General who said in 1968 that,

“the war against diseases has been won”.

Those words no doubt came back to haunt him. The problem is that the bacteria are fighting back, in large part due to misuse—people failing to complete courses of treatment and therefore to wipe out the infection. The bacteria did not know that the war was over; evolving and becoming drug resistant, the stronger ones survived. The result, as we know, is that globally we have multidrug-resistant TB, and infections that cannot be treated in countries as disparate and different as India and Israel. This has been known for a long time, and the problems coming forward have been known for a long time. It was the House of Lords Science and Technology Committee’s 7th report in 1998 that first drew attention to this. In the same year, the World Health Assembly raised it as a serious issue.

There has been considerable research over many years. I am indebted to one of the world’s experts, Professor Otto Cars of Uppsala University in Sweden, for setting out the evidence for me. It is compelling. Imagine a world without effective antibiotics. Our English Chief Medical Officer, Dame Sally Davies, said that if we do not take action, we may all be back in an almost 19th-century environment where infections kill us as a result of routine operations. We will not be able to do a lot of our cancer treatments or organ transplants.

It is not just the burden of disease that is at issue here but the economic impact. It has long been known to be significant, but new work coming forward from Professor Richard Smith of the London School of Hygiene and Tropical Medicine, and Professor Joanna Coast of the University of Birmingham, suggests that, when wider impacts are taken into account, the costs are even higher than anticipated. These economic arguments are extremely important in raising the issue up the world priority list. It is significant that the World Economic Forum sees antibiotic resistance as a major threat. There are other important issues around animals that I will not mention in this short debate. My noble friend Lord Trees will say something about them.

I congratulate the Chief Medical Officer on drawing this issue to the attention of the country and of the world in her 2011 annual report. I also congratulate the Government on supporting her to raise the matter at the World Health Assembly at the G8 summit and, I hope, at the UN in September. Her report sets out the issue in detail and notes that there are some drugs that are the last line of resistance, to which we should give special attention now. She and the experts who wrote Chapter 5 of her report drew attention to a number of solutions.

The first is new drugs, but at the moment there are few antibiotics manufacturers and few new antibiotics in the pipeline. Thanks to AstraZeneca, I understand more about the business model and the problems in dealing with drugs of last resort. The simple issue is that they are kept on the shelf; they are in reserve. It is important that we have them, but they do not get used very much and they do not lead to sales. Therefore, the economic model does not work. Even with the more common antibiotics that we use more regularly, we only use them for a short period as therapeutic drugs, not as long-term drugs that will produce a long-term income and therefore provide a return on the massive investment required for development.

AstraZeneca and many others argue that there is a need for very substantial changes to regulation to allow for shorter and easier development times, and even for antibiotics to be treated as a different category of drugs. They also point to the need for investment to secure development. This also makes the argument that vaccines are important in heading off disease. I well understand that not every new drug or vaccine is a significant advance, but there is enormous scope here for Government, and the public and private sectors, to work together to develop a new way of developing these drugs. My noble friend Lady Mar will say a bit more about vaccines in a moment.

Another aspect of the issue is the development and use of new diagnostics. If we can get people into treatment faster, we will be quicker to control the bacteria. At the moment it can be days before technicians know what strain they are dealing with.

The third and perhaps biggest point is about better stewardship and conserving what we have. This is even more difficult, but it is the basis for everything else. The CMO’s report describes good practice that will achieve this. There are 10 top tips for effective antibiotic prescribing that should be followed in this country. Imagine for a moment the situation in every country in the world; every clinic or village in China or India needs a battery of actions. There is a need for education professionals in those areas to have the equivalent of our 10 top tips, as well as for greater public awareness and education. That is no easy task. We should remember that many of us in our country do not take drugs in the way that we should. Also, in those countries we must tackle counterfeit medicines and restrict over-the-counter sales. We should also see changes to harmonise regulation. This is phenomenally difficult, but it is not enough to put our own house in order; we will be affected by what happens elsewhere in the world.

We need all these approaches combined: new drugs, new diagnostics, better practices and stewardship, action across the whole healthcare system and, indeed, across the whole world. Here I come to the point that I really want to talk to the Government about: this needs remarkable political effort. It is about reframing the issue and building political support, and I will be interested to hear what the Government have in mind.

I will make two points. First, this is an enormous threat. Indeed, you can galvanise people around the threat: it is real and it will impact in terms of illness and economy. However, it is also an opportunity. I am indebted to my friend and colleague Dr Ilona Kickbusch, and to Professor Cars, for pointing out that we should treat antibiotics as a global public good and that there is an alternative way of seeing this problem. It is about a vision of a world in which the peoples of the world really do in practice have a right to health and healthcare, something most nations have signed up to—many, like ours, since the UN declaration of 1948. In that world, nations develop, share and look after those things, such as antibiotics, which are a benefit to us all.

We have already seen how this can be done in tackling other threats such as global pandemics. Although there is always controversy about that, nevertheless great progress has been made in creating a network for surveillance and tackling issues. There is more to do. We have also seen it with the millennium development goals, working towards a vision where no woman dies as a result of pregnancy, although there is much more to do there as well. In other words, I am arguing for setting ourselves the goal of preserving antibiotics for the future as one of science’s great benefits for humanity, and for driving this forward politically and technically, in every way in which we can.

My second point is simply that the UK can play an extraordinarily important leadership role here. It is well respected in health. We have the credibility of having a health system which seeks to look after every person within it. We also have credibility because of the world-leading role that has been played in development; here I compliment both this Government and the previous one. We can be bold and ambitious in taking a lead. No nation is better placed to do so, with our connections in the Commonwealth, across the Atlantic, and in Europe. The key is to bring together a group of like-minded countries, as this and previous Governments have done on other things, starting with those who are already taking this seriously. We should set out a vision and pathway, and take on these issues step by step. The Chief Medical Officer has already started this, but it is important to add political weight and depth to her work. It is not just about health but about economics and foreign policy. It is a step in building a better world, where we have and share the means to offer better health to everyone.

I therefore look forward to hearing the Government’s response to these points, and to knowing how they will turn their undoubted commitment in this area into something even bigger and bolder. Will they seek to take a global lead on this? How will they do so? I also greatly look forward to hearing from other noble Lords.