Antibiotic-Resistant Bacterial Infections

Lord Trees Excerpts

Wednesday 24th July 2013 Grand Committee

[Lord Trees]

My Lords, I thank my noble friend Lord Crisp for initiating this important debate and draw attention to my various veterinary interests that are listed in the register. As some noble Lords have observed, this topic was the subject of a report in 1998 by the Science and Technology Select Committee of this House, chaired by the noble Lord, Lord Soulsby of Swaffham Prior. It was an important issue then and it is now even more important. A number of reasons have been eloquently articulated. I will point to three recent issues that have drawn attention to its importance.

The first is the Chief Medical Officer’s report, published earlier this year, in which she chose infectious disease and drug resistance as the principal theme. Secondly, she suggested that the subject should be put on the National Risk Register for the UK. Thirdly, in June the UK hosted the G8 summit, and there was a separate meeting of science Ministers—the first such meeting at a G8—at which the Ministers singled out resistance to antimicrobial antibiotics as one of humanity’s most pressing concerns.

Today I will highlight two aspects of the subject. There are many more, including the drug pipeline, which was talked about by several noble Lords. I will focus on the role that the veterinary profession is playing in addressing the issue, which it takes very seriously; and on the global dimension of the threat.

The resistance of bacteria to antibiotics—I will refer to this as antimicrobial resistance—involves a complex interplay of interactions between different bacteria, hosts and antibiotics. Some bacteria exclusively infect animals. Resistance has developed in some strains, which is likely to be associated with the use of antibiotics in animals, and where the consequences will be confined to animals. Equally, some bacteria are unique to humans. A few of them have developed resistance, which, again, is likely to have its causes and consequences principally with humans.

Of course, some bacteria—so-called zoonotic bacteria —infect both humans and animals. The causes of their resistance, and the consequences of it, can affect both animals and humans. Those bacteria can move not only from animals to humans but from humans to animals. The picture is further complicated by the fact there are, as has been well described, antibiotic-resistant bacteria in wildlife and in the environment. There is a flux and flow of resistant bacteria and the genes that confer resistance within the biosphere.

As the Chief Medical Officer acknowledged in her report, and as was stated in a response by Department of Health Minister Dr Poulter to a Question from Glyn Davies in the other place on 27 February 2013, it is the use of antimicrobials in human rather than veterinary medicine that is the main driving force for antimicrobial-resistant human infections. Notwithstanding that, there are many organisations, in my profession particularly, that are working very hard to ensure the responsible and prudent use of antibiotics in animals.

Antibiotics have not been allowed as growth promoters in animals anywhere in Europe since 2006. In the UK, antibiotics are available only on prescription from a veterinary surgeon. The British Veterinary Association and the Federation of Veterinarians of Europe have worked very hard to promote the responsible use of antibiotics and have produced publicity and information, as has the Responsible Use of Medicines in Agriculture Alliance. My own college, the Royal College of Veterinary Surgeons, the governing body, has it embedded in its own professional code of conduct that:

“Veterinary surgeons who prescribe … medicines must do so responsibly”.

The consequence is that a vet could be struck off for irresponsible use.

We must continue to do all that we can to manage the prudent use of antibiotics in humans and animals in Britain and Europe. The forthcoming national cross-governmental strategy for antimicrobial resistance, which involves not only the Department of Health and the Chief Medical Officer but Defra and the Chief Veterinary Officer, is an excellent initiative which will define a coherent plan to address this problem.

However, this brings me to my second major point. The reality is that this is a global problem of massive scale, particularly in China and elsewhere in Asia. We must recognise that, whatever we do about the domestic use of antibiotics, the greatest threats will arise from overseas. This is a consequence of a number of factors. One is the gross use and, one might say, misuse of antibiotics in animals and humans. For example, in 2007, China produced 210,000 tonnes of antibiotics, of which about 100,000 tonnes were used in animals. Adjusting pro rata for the human population, that is 20 times the amount of antibiotics for animals than we used on animals in the UK at that time.

Many antibiotics are available over the counter in India, Asia and elsewhere, not exclusively on prescription. This leads to their misuse, the underdosing or curtailment of dosing regimes, both of which are factors in inducing antimicrobial resistance—as, of course, is the close contact of humans and animals in many of these settings in developing countries. All these factors contribute to high rates of antimicrobial resistance. Again, in China, in a survey of hospital infections in 2009, more than 60% of staphylococcus aureus infections were methicillin resistant—that is, MRSA—compared with less than 2% in UK hospitals.

This alarming genesis of antimicrobial resistance is coupled with the massive and rapid movement of people throughout the world. Just like pathogens themselves, such as the SARS virus and avian influenza, can move, antimicrobial-resistant bacteria can evolve in distant lands and arrive here in the UK within days if not hours. This is the downside to globalisation. When globalisation comes in the door, biosecurity goes out of the window.

We need to harness the economic gains from globalisation. We all think that it is a good thing, which brings economic gains. However, I suggest to the Government that perhaps we need to consider ways in which some of those economic gains of globalisation might be devoted to research in this area, to improving surveillance, to researching and developing rapid and effective detection and diagnostic technologies, and to helping us work with our colleagues overseas to mitigate the global threat of antimicrobial resistance. The good news is that the global nature of this problem is now being recognised. Now we need imaginative measures to counter that threat.