Drug-Resistant Infections

Lord Rees of Ludlow Excerpts

Thursday 15th September 2016 Lords Chamber

[Lord Rees of Ludlow (CB)]

My Lords, this timely debate is a chance to congratulate the noble Lord, Lord O’Neill, on the excellent series of reports that he has produced. We should surely also use this opportunity to acclaim Dame Sally Davies, the Chief Medical Officer, who espoused this cause early on and has probably done more than anyone else to raise ABR issues on the political agenda, not just in the UK but worldwide.

Antibiotic resistance is growing so fast that 700,000 people already die each year from untreatable infections. The pathogens such as typhoid which once succumbed swiftly to penicillin and other antibiotics now fight back; they are becoming killers again. Just this year, doctors have noted the emergence of resistance to colistin, which is the last line of defence against some very resistant bacteria. There is real worry that within a decade, transplants and even orthopaedic operations will become hazardous because of the intractable risk of infection, so ABR is a global threat that hangs over us. The O’Neill report emphasised that by 2050, 10 million lives a year and a cumulative $100 trillion of economic output might be at risk due to the rise of drug-resistant infections, unless we can develop new drugs and make more prudent use of what we have.

My comments will focus on avoiding the overuse of drugs. I have zero expertise in medicine—my scientific field is space research and astronomy—but I have become a small-time crusader for the AMR cause, for reasons that I will explain by offering a bit of history from 300 years ago.

In the 18th century, the most pressing scientific challenge was measuring time and determining longitude at sea. In 1714, the Government set up what was in a sense the first scientific quango: the Board of Longitude. The board established the first challenge prize: a reward of £20,000, a huge sum in those days, for the first person to devise a way to determine longitude, with specified precision. Famously, it was John Harrison, a working-class Yorkshireman and an outsider, who triumphed with his marine chronometer, an extraordinary high-tech artefact of its era.

In the 300 years since, this initiative has been emulated by many challenge prizes. One, for instance, was the stimulus for Lindbergh’s transatlantic flight. More recently, the American government agency DARPA has sponsored competitions for driverless vehicles and for robots that can do complex tasks in hazardous environments. The California-based XPRIZE foundation promotes privately sponsored prizes. It aims to revitalise,

“markets that are currently stuck due to existing failures or a commonly held belief that a solution is not possible”.

As the current Astronomer Royal, I thought that the tercentenary of the Longitude Prize was worth celebrating with a national prize to address a contemporary challenge. Government support was forthcoming and allowed a reward of £10 million. Nesta, which has established expertise in this area, agreed to oversee the administration of the prize and has done a splendid job.

What should the challenge be? There is no manifest number one problem, as there was in the 18th century. A committee I chaired came up with a list of six possible challenges. All were presented on BBC TV and in the press, after which there was a public vote. The most popular choice was a project to tackle antimicrobial resistance.

A well-designed prize must meet several criteria. It should engage many contestants and, ideally, unleash investment amounting to far more than the prize itself. It must not require huge facilities accessible only to big battalions. Success must require genuine breakthroughs but be credibly achievable within five years. It should be configured, as was the original Longitude Prize, so that intermediate steps towards the target may get a reward. For an individual, a university group or a small company, the prize money is a significant incentive; if a big company wins, the publicity is more important. Either way, all have a motive to participate.

Of course, £10 million is a trivial sum compared to what is needed for developing new drugs, but there are bite-sized challenges relevant to AMR where it is an appropriate incentive. The target our expert advisers chose was to devise cheap, accurate, rapid and easy-to-use point-of-care kits to test for bacterial infections. These kits might be a strip of sensitised paper or a lab on a chip combined with a smartphone app, and they must be capable of being used anywhere in the world to identify the nature of someone’s infection. This would reduce the overuse or misuse of antibiotics and thereby help ensure that the antibiotics we have now will be effective for longer. The O’Neill report argued that currently, more than half of prescriptions for antibiotics may be unnecessary or inappropriate and that developing a globally available test will be part of the solution to keeping these drugs viable for another generation.

The prize has attracted more than 150 registrations and remains open for more. Entries are whittled down by an expert panel. Many were clearly not credible, and some entrants are encouraged to team up with others. Entries have come from many countries, but to be eligible they must involve a UK company or institution and carry out manufacturing and/or design of the winning solution in the UK, or lab test or showcase the winning solution in the UK.

This year, incidentally, the Americans launched a challenge prize with similar goals and a similar scale of jackpot, although with a US focus. That prize will concentrate on the 18 identified bugs that pose special health threats in the US, but it is being co-ordinated with ours. The American prize has set a maximum time of 90 minutes for its test to be used and to give results, which is appropriate for use in out-patient and in-patient settings, including pharmacies. The Longitude Prize has set the time limit at only 30 minutes, as we are looking for a test that will work in the field, in all health settings, including where antibiotics can be bought over the counter.

Those of us involved in these prizes welcome the fact that the O’Neill report highlights the importance of rapid diagnostics. We hope the Longitude Prize will help to speed up existing work in this area and generate some novel ideas. Moreover, a feature of prizes is that they can attract public interest. Nesta has been working hard on this in the UK, even developing a computer game based on the principles of antibiotic resistance to illustrate the science.

If overprescription of antibiotics were the only problem, it would be challenge enough. But of course, it is already much worse than that, because in the US, China and many other countries, as the noble Lord, Lord Lansley, indicated, antibiotics are being used for animals in a prophylactic context. I gather that the EU is banning this, and we hope that that will be followed.

Finally, it is worth noting that this challenge is clearly one that must be tackled globally. It therefore tends, rather like climate change in a way, to slip down the agenda compared to more parochial issues. It is also rather like climate change in that, although it is important now, it is going to be even worse in the future, so the benefits of action will accrue even more to the next generation than to us. For that reason, in order to ensure it does not slip down the agenda, the public need to keep up the pressure. The O’Neill report included a global awareness campaign as one of its priorities, and I echo the view expressed already by the noble Lord, Lord Lansley, that the forthcoming UN meetings will offer a boost to this cause.