Antimicrobial Resistance

Lord O'Shaughnessy Excerpts

Thursday 8th March 2018 Grand Committee

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O’Shaughnessy) (Con)]

My Lords, I first thank the noble Baroness, Lady Greengross, and congratulate her on securing this debate on an incredibly important topic, which definitely performs above the graveyard slot it has been given on a Thursday afternoon. It has been a very useful and informative debate, and a good opportunity for us all to reflect on an important—indeed, vital—area of medicine and health, not least because it highlights the potential risks we face as humankind in dealing with this issue, but also to set out some of the things that are being done to deal with it. It is also worth our taking the opportunity to thank my noble friend Lord O’Neill, who is not here. In so many ways, the work that he has done has set the tone for the work that we are all doing together now. I will not rehearse the risks that have been set out very clearly by others, but I think a word the noble Baroness, Lady Greengross, used was “unprecedented”, which is the scale of what we face if we do not get this right.

I thought it would be useful to rehearse a little of the action that the Government have been taking over the last few years—if nothing else, to emphasise the seriousness with which we take the issue. Noble Lords will know that the Chief Medical Officer used her annual report in 2013 to highlight the risk of antimicrobial resistance. Later that year, a five-year antimicrobial resistance strategy across human and animal health was published. Following that, my noble friend Lord O’Neill was asked to forward a globally facing independent review, which was published in 2016. That report produced the truly alarming figure we have heard of 10 million extra deaths a year, with a potential economic impact of $100 trillion. A very powerful point was made by the noble Baroness, Lady Suttie, namely that up to one-third of those statistics is driven by drug-resistant TB. I did not realise that until she said so. It is truly alarming, hence the focus on TB in this debate. AMR was also added to the national security risk assessment in 2015 as a tier 1 risk for our country: that is how important it is.

As for what the UK’s strategy includes, we have an acronym of the three Ps: prevent infection occurring in the first place; protect the antibiotics we have through good antimicrobial stewardship; and promote the development of new drugs, which, as noble Lords have said, is incredibly important.

On prevention, the noble Baroness, Lady Greengross, mentioned urinary tract infections. They are a huge driver of both the use of antibiotics and the development of antimicrobial resistance. There are very interesting, and very simple, things going on such as the good use of catheters, which can have a profound effect both on infection occurring in the first place and the knock-on impact on the benefit of the antibiotics that we still have now. All this work is underpinned by our world-leading R&D base in this country.

The Government’s response to the review by the noble Lord, Lord O’Neill, set out new ambitions, including halving healthcare-associated gram-negative bloodstream infections and inappropriate antibiotic prescribing by 2021. We welcomed the emphasis in the review on the use of diagnostic tests, which was brought to the fore by the noble Baroness, Lady Masham, in her speech.

I do not know whether noble Lords had a chance to see it, but only last week Public Health England published details of the modelling work it has done to look at inappropriate prescribing. The work found that, using a conservative approach, around 20% of current antibiotic prescribing is inappropriate, and therefore the ambition should be to reduce that by 10% from a 2016 baseline. Between 2012 and 2016, we had already reduced our use of antibiotics by 5%. Clearly, though, to some extent that was the low-hanging fruit, and now we need to take on the more difficult areas. In doing so—I think back to debates we have had about wound care and sepsis—we must never forget that these drugs are vital. Although we want to reduce inappropriate prescriptions, we also have to make sure that people who need them are not being restricted access to them. It is not just about gram-negative bloodstream infections but other health-acquired infections. I was sorry to hear the story of my noble friend Lord Colwyn’s brother. That shows the horrible impact that can happen.

I have talked mainly about humans but, as other noble Lords have pointed out, we also need to set an ambition to reduce antibiotic use in livestock and fish farmed for food. The good news is that we have met our ambition two years early: sales of antibiotics for use in food-producing animals dropped by 27%. In answer to the noble Lord, Lord Hunt, that is good progress. Perhaps it is an answer to the noble Baroness, Lady Suttie, about whether awareness campaigns work: it is evidence that they do. New sector-specific targets were published in October 2017 and we will be reporting against them in the months to come.

As all noble Lords pointed out, AMR is ultimately a global issue. This Government helped to secure the UN declaration on AMR in September 2016. We are committed to working not just with the global health community but with the finance community to create a system that rewards companies that develop new, successful antibiotics and, critically, make them available to all who need them.

Noble Lords will, I hope, know that the UK has been a leading advocate at the G20 for the piloting and rollout of global solutions that incentivise new antibiotic development. We continue to promote the need for global action. Noble Lords will also be aware that our Chief Medical Officer is a driving force in these efforts; she really is a wonderful and zealous advocate of this agenda. They will also know that she is totally unbending in her desire to keep this at the top of the global agenda.

AMR is embedded in all relevant strategies, particularly the sustainable development goals agenda. I also want to point out that the UK has helped to create the Fleming Fund, which is a £265 million commitment over five years, as a development project dedicated to AMR globally. It focuses on increasing capacity and capability for diagnosis and surveillance of AMR in low and middle-income countries. The noble Baroness, Lady Sheehan, made a very important point that the people who are most likely to suffer from the consequences of AMR, although spread across the world, are focused on those communities that are likely to be the poorest.

Noble Lords have asked about that incentivisation and pulling through the new drugs. There is the £50 million Global AMR Innovation Fund, which looks to develop neglected areas. The noble Baroness, Lady Sheehan, asked about China; a new partnership is soon to be launched on that although I do not have details now. When I do, I will certainly write to her. In the UK, we are channelling investment through the National Institute for Health Research, Research Councils, Innovate UK and so on to attract high-quality research proposals. As the noble Baroness, Lady Greengross, said, there is some cause for cautious optimism on drug development in this area. Not only do we need to get the drugs developed but we need to find ways to pull them through. My noble friend Lord Colwyn talked about the accelerated access pathway; that could be one route by which these drugs come through.

I want to spend a little time talking about vaccination, because it has been mentioned by all noble Lords. I absolutely agree that it is an important part of reducing the need for antimicrobials and a key weapon in slowing down antimicrobial resistance. We have a world-class vaccination service that reduces the overall burden of disease in this country. Uptake is among the best in the world: about 90% of the population get childhood vaccines, for example. However, it is fair to say that we need to do better, not only in making sure—in this era of fake news—that rumours and false information about the dangers from vaccines are firmly rebutted, but in using every opportunity and channel we have to promote the uptake of vaccines in families and other groups. That is something that the health family, as we sometimes describe it, is working on, to better understand local variation; there is huge variation from area to area, as pointed out by the noble Baroness, Lady Greengross.

It is worth saying that, from an R&D perspective, we have a great strength in this country in the development of vaccines. It was a major focus of the life sciences industrial strategy. Research Councils have just invested just over £9 million in five new vaccine networks, and the Government have invested £100 million in focusing on vaccines of epidemic potential. A lot is being done but, as noble Lords have pointed out, the task is growing because antimicrobial resistance is growing.

Specifically on pneumococcal immunisation, our expert group—the Joint Committee on Immunisation and Vaccination, as noble Lords will know—has been consulting on its advice on the number of doses. It would not be appropriate for me to pre-empt that decision at this stage. My honourable friend in the other place, the Minister for Public Health and Primary Care, will, of course, give its advice due consideration, but I will pass on the concerns that have been expressed in this debate about that, so that they understand—as we do—that there is deep concern about any dilution of our vaccination programme.

I want to quickly deal with the issues I have not dealt with. My noble friend Lord Colwyn asked whether the AAP will focus on antimicrobials. It will suggest a new suite of products in April. I have tried to leave the expert group to it; it will come to us, but that is certainly a route forward, and I would be happy to meet with the company that he mentioned to talk about its work.

The noble Baroness, Lady Suttie, asked about the UN high-level meeting, which marks an important moment to secure a political commitment to TB control. She will be pleased to know that the Government are engaging closely with the WHO and taking a lead on that. There is some benefit coming from raising awareness, but clearly there is more to do to ensure that the UK is fully engaged. On the development of new anti-TB drugs, DfID is contributing to the Global Alliance for TB Drug Development, which I hope is to some extent a reassurance that we are playing our part.

I should congratulate the noble Baroness, Lady Masham, who is a woman of many firsts. She led the first debate on the issue of MRSA in the House. We have made some really good progress on controlling MRSA and C.diff in hospitals but, of course, that is the only part of controlling infection. We are making some progress and better diagnostic techniques now exist. She also asked about the diagnosis of TB. I made a fascinating visit to a Find & Treat service in Camden which was doing on-street work. Unfortunately, it is one of only a few services of this kind, and we certainly need to do more of that sort of work.

Finally, the noble Baroness, Lady Sheehan, asked about the Rohingya community. I am not familiar with those issues, but I shall certainly take her concerns to DfID and I understand the seriousness of them.

The final and very major point to make is to ask how we break the link between price and the cost of drug development, which was raised by the noble Lord, Lord Hunt, and the noble Baroness, Lady Sheehan. The truth is that this is not an issue that faces drug development in this area alone; it concerns drug development in every area, as drugs and medicine become more stratified. The answer lies in partnership but, to be honest, we do not yet have the model for doing that. However, we are developing it, and we have a good relationship with industry to help us to do that.

In conclusion, once again I thank the noble Baroness for initiating this fantastic debate and all noble Lords for their contributions. I think that we are making good progress, but there is a long way to go. The lodestar here is Sweden, which has succeeded in reducing antibiotic use by 40%, although it has taken the country 20 years to do that. We are a few years down the track in the process, and I hope that we can learn from Sweden and others to accelerate our progress. I finish by wishing to make sure that noble Lords understand that keeping antibiotics working lies at the heart of the Government’s strategy, and our job is to keep the issue at the forefront of everyone’s mind.

Committee adjourned at 5.52 pm.