Antimicrobial Resistance

Maggie Throup Excerpts

Tuesday 7th December 2021 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maggie Throup)]

It is a pleasure to serve under your chairmanship, Sir Gary. I thank my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) for bringing forward today’s debate, and all hon. Members for their thoughtful contributions. As has been made clear in this debate, antimicrobial resistance is undoubtedly one of the most significant global health challenges that we face today. The covid-19 pandemic has illustrated the substantial impact that major outbreaks of disease can have on society, endangering lives and disrupting public services and the economy. The threat of AMR is no different.

Last year, in England alone, there were over 55,000 cases of resistant infections and more than 2,000 estimated deaths. Across Europe, hospital infections caused by resistant bacteria add £1 billion to hospital treatment and societal costs. In addition, the emergence of multi and extremely drug-resistant strains of infectious diseases threatens to undo years of global effort to tackle them. For example, there are now strains of tuberculosis that are resistant to almost all lines of treatment. TB deaths have increased for the first time in a decade and global targets are no longer on track. As other hon. Members have said, without working antibiotics, routine surgery such as caesarean sections or hip replacements could become too dangerous to perform, and cancer chemotherapy could become prohibitively high risk. As my hon. Friend highlighted, the threat of AMR also extends beyond human health. The implications of AMR for animals and crops threaten food security and trade. It is predicted that the global cost of AMR could amount to $100 trillion without action.

So what are the UK Government doing to tackle this risk? As Members have referenced, in January 2019 the Government set out the UK’s vision to contain and control AMR by 2040. That vision is supported by a five-year national action plan across the spectrum of human and animal health, agriculture, the environment and food. We are halfway through implementing our five-year action plan and have made considerable progress. We are committed to reducing the need for antimicrobials by lowering the burden of infection in our communities, in the NHS, on farms and in the environment—if you don’t get the bug, you don’t get the drug.

We have also taken a series of steps to ensure the appropriate use of antimicrobials, where they are needed, in both humans and animals. Antibiotic use in farmed animals has decreased by 52% since 2014, with a decrease of 79% in sales of veterinary antibiotics that are most critical for human health. Among European nations with a significant livestock farming industry, the UK has the lowest use of antibiotics, and antibiotic consumption by humans reduced by 6.6% between 2016 and 2019.

No new class of antibiotic has been developed since 1987, and the market for antimicrobials is broken, as my hon. Friend the Member for Thirsk and Malton said. To address that, we are testing a new Netflix-style subscription model for antibiotics—a world first. The economic model and evaluation reports for the two antimicrobials in the project have been completed, and the reports are currently undergoing consultation with registered stakeholders, including drug manufacturers. We hope that the first payments under the new model will be made in 2022, and I can reassure my hon. Friend the Member for Thirsk and Malton that we will incorporate the learnings from the pilot project in any new framework for the purchase of antimicrobials in the future.

We maintain a formal dialogue with industry through the joint Government and industry working group on AMR. The group, which has members from the Association of the British Pharmaceutical Industry, the National Institute for Health and Care Excellence and NHS England and Improvement, last met in October 2021, and the next meeting will take place in spring 2022.

I wholeheartedly agree with the point raised by my hon. Friend the Member for Thirsk and Malton on the importance of reporting. That is why a range of annual reports are already published by our partners across Government and their agencies, highlighting progress against the ambitions of the national action plan. The most recent of these, the “English surveillance programme for antimicrobial utilisation and resistance report 2020 to 2021”, was published on 17 November 2021. The report includes national data on human antibiotic prescribing, resistance, antimicrobial stewardship implementation, and awareness activities. The UK Health Security Agency also publishes data on antibiotic prescribing at practice level, and quarterly on the web platform Fingertips.

My hon. Friend the Member for Thirsk and Malton asked for an update on the national action plan ambitions. I will start by exercising caution on the figures in the light of covid-19. In England, however, we have seen an 11.2% decrease since 2019 in healthcare-associated gram-negative engagement. In response to my hon. Friend’s question about death certificate recording, it is important to acknowledge the difficulty faced by medical practitioners in distinguishing whether the cause of death of a patient with a resistant infection was due to the resistance itself, the infection or another cause. However, we will work with professional bodies to enhance the likelihood of AMR being accurately recorded where it can be determined that a resistant organism is responsible for an infection that caused or contributed to death.

Additionally, the Office for National Statistics upgraded its death recording software in January 2020 in order to support codes for AMR and allow analysis of mentions of AMR in death certificate data. We are not only taking action at home but continue to take a global lead in the world’s collective fight against AMR. The UK is committed to pushing the AMR agenda forward through multilateral forums, including as a signatory to the United Nations’ Call to Action. I am delighted that the UK’s special envoy, Professor Dame Sally Davies, represents the UK on the UN Global Leaders Group on Antimicrobial Resistance in order to advocate and advise on AMR globally.

Under the UK’s G7 presidency this year, we have secured ambitious commitments on AMR to balance innovation, access and stewardship for antimicrobials. G7 Health Ministers have agreed to strengthen the resilience of antibiotic supply chains and, with the G7 Climate and Environment Ministers, they will develop sustainable, clean and green solutions for antibiotic manufacturing. The G7 Health and Finance Ministers are working together to strengthen antibiotic development to ensure that there is a sustainable pipeline of new and equitably accessible antimicrobials in the making and building of the UK’s subscription model.

Finally, in recognition of the global effort required to tackle AMR, the UK invests significantly to improve global knowledge, surveillance and understanding of AMR—an issue raised by my hon. Friend the Member for York Outer (Julian Sturdy). The Department of Health and Social Care invests significantly in tackling AMR where the burden is highest, including through the Fleming fund, which improves laboratory capacity for surveillance of AMR, and the global AMR innovation fund, which funds innovative science in neglected areas of AMR R&D. Both of these projects are UK aid funded and are primarily for the benefit of people living in low and middle-income countries.

We also invest UK aid on research into new drugs, vaccines and diagnostics, as well as capacity building, technical expertise and support to relevant programmes, such as strengthening healthcare systems and improving infection prevention and control. Again, I want to thank my hon. Friend for bringing this incredibly important matter to the Chamber and for providing the opportunity to emphasise the necessity of collective domestic and international action if we are to effectively solve the very serious threat that AMR poses to us all.