World Antibiotics Awareness Week

Patrick Grady Excerpts

Thursday 16th November 2017 Westminster Hall

[Julian Sturdy (York Outer) (Con)]

I beg to move,

That this House has considered World Antibiotics Awareness Week.

It is a privilege to serve under your chairmanship, Mr Davies. Exactly one century ago, Ernest Rutherford split the atom and humanity entered the nuclear age. The groundbreaking discovery represented a momentous step forward for human progress, but at the same time it unleashed a challenge for those beyond the laboratory and academia—the avoidance of mutual assured destruction. As this debate is about World Antibiotics Awareness Week, some might wonder why I started with the splitting of the atom, but I believe that there is an equally strong argument for the aforementioned period to be referred to as the antibiotic age. It was 11 years after the splitting of the atom that Sir Alexander Fleming discovered penicillin, here in this very city of London.

No one can deny the profound impact of antibiotics on medicine, and their widespread use represents a watershed moment in our evolutionary story. However, as Fleming himself understood, shortly after making his discovery, giant leaps in scientific progress produced wholly new challenges. As antibiotics were readily available, it appeared that we had invented miracle drugs of sorts. The snag is that we now face the real and severe threat of antimicrobial resistance.

Across the globe this week, scientists and healthcare professionals are hosting a wide range of events to make antibiotic resistance a globally recognised health issue. I am delighted that we as parliamentarians are here today to represent the role that lawmakers and Governments will play in facing the challenge of antibiotic and antimicrobial resistance. The week is also intended to raise awareness of the need to preserve the power of antibiotics through appropriate use, to increase recognition that individuals, health and agricultural professionals, and Governments must play in tackling antibiotic resistance, and to encourage behavioural change and convey the message that simple actions can make a difference.

While the threat of antibiotic resistance is often considered a doomsday scenario—one might say a medical Armageddon—we must remember that that menace is all too deadly today. Currently, 700,000 people die each year from drug-resistant infections; the future threat is touted as being so severe and extreme, not because we are not living with the effects today but because of the truly appalling potential scale of the problem if we do not take co-ordinated action. If we do not act now, antimicrobial resistance will be responsible for 10 million deaths per year by 2050. That is more than the number of people worldwide who were killed by cancer in 2015. It is nearly impossible to put a number on the lives that have been saved by antibiotics; some sources put the figure at roughly 2 million, but it is entirely conceivable that we may arrive at a position where the balance tips, and antibiotics pose a greater threat than a remedy.

As I have said previously in this House, we run the risk of returning to a medical dark age, where routine operations such as hip operations cannot be carried out, and infections that are standard today become deadly. This week, the British Society for Antimicrobial Chemotherapy published a report on behalf of the all-party parliamentary group on antibiotics. The report, the briefing for which has been sent to all Members of the House, considers the AMR action plans and strategies set out by the World Health Organisation, the European Union and the UK, and asks, crucially: “Has the world lived up to the challenge?”

The overarching theme of the report is that future strategies to combat antibiotic resistance should incorporate specific, measurable, attainable, relevant and timely—SMART—targets. When the stakes are 10 million deaths each year within four decades, it is easy to become lost in the scale of response that that merits; but as is so often the case, a coherent and clear approach is our greatest weapon. I call on the Government to ensure that all steps are taken to counter AMR and explicitly to incorporate those SMART targets I listed. I believe there is much to be gained from making that standard practice and removing any doubt. I am sure that colleagues will be encouraged to read in the report that

“the UK has taken significant steps to meet the objectives of the EU Action Plan, which in turn satisfies the WHO Europe Strategic Action Plan.”

There are two aspects, however, where our country needs to up its game. First, we need to address education and public awareness, so it is entirely fitting that we meet today during World Antibiotic Awareness Week, an occasion aimed directly at bolstering an understanding of resistance and the threat it poses to humanity. We need to be forthright in promoting the “four rights” when consuming antibiotics: the right drug, the right dose, the right time and the right duration. A survey carried out across Europe in 2016 indicated that knowledge about AMR remains low, and antibiotic consumption has decreased by only 6% over the last seven years. To address that, the British Society for Antimicrobial Chemotherapy advocates the use of simple and clear language in all awareness-promoting material. There is a direct recommendation of

“monitoring the efficacy of education campaigns through online channels.”

Fleming himself was once quoted as saying that the best remedy for a common cold was a dram of whiskey.

[Patrick Grady (Glasgow North) (SNP)]

Hear, hear.

[Julian Sturdy]

I know the Scottish Members would certainly agree with that. As Fleming said,

“it’s not very scientific—but it helps.”

We now need to make the message as clear as day: antibiotics are ineffective when taken unnecessarily and doing so bolsters resistance and endangers mankind.

The second area where significant progress can be made is on the incentives for antibiotic discovery, research and development. It should be noted that the antimicrobial challenge is as much economic as it is medical. We must find an alternative to the reimbursement model, whereby profitability of bringing new antibiotics to the marketplace is linked to volume of sales. That is because we are actually seeking to limit the use of such drugs to preserve their power; to use new drugs as a point of last resort, as it were. To use an analogy, it is almost like the fire service—we need it to be there and to be effective, but we do not want to use it. However, nobody would dispute the necessity of investment and funding for that key emergency service.

To overcome this task, it is essential that measures are taken to co-ordinate a review of progress in new drugs, alongside the activation of research and development by industry for new antibiotics and related products achieved by Innovative Medicines Initiative projects. On the economics, we need to seek innovative solutions, with the pricing conditions and “pull” measures needed for the long-term sustainability of new antibiotic development, so that they are promoted. An example of that is the compact initiative of the European Federation of Pharmaceutical Industries and Associations to promote a sustainable business model and adequate conditions for the introduction of effective new antibiotics.

The O’Neill review, published last year and described last week by a columnist from The Times as

“the best argued and most accessible”

report in his lifetime, was very clear on this matter. Lord O’Neill found that much more needed to be done to close the substantial gap in research and development funding between AMR and the best-funded areas of medical science. The report being launched this week quantifies this further, and states that $40 billion is needed over 10 years, representing about 0.05% of G20 countries’ current healthcare spend. I will not claim that that sum is insignificant, but it is certainly affordable given the magnitude of the threats we face.

For improvement on a global level, the report makes it clear that co-ordinated efforts must be made in the veterinary sector, where I am pleased that tangible progress has been made in the UK. Figures from the Countryside Alliance show that sales of livestock antibiotics across the sector have fallen by an average of 27%—their lowest levels since records began—which is a good start, because a failure to address AMR in livestock has fundamental implications for the treatment of human diseases. For that reason, mirrored co-operation between Government Departments is essential.

While I am delighted that we are joined by my hon. Friend the Under-Secretary of State for Health, this matter also encompasses the Department for Environment, Food and Rural Affairs, the Department for International Development and the Department for Exiting the European Union. We need a clear commitment from the Government that that co-operation is there and that an interdepartmental strategy is on the agenda. Beyond that, we require what Antibiotic Research UK describes as a “grand alliance” to come together, comprising the Government, the pharmaceutical industry, collective medical research charities and academics.

To reduce further the overall use of antibiotics in the veterinary sector, guidelines have been developed for prudent use. The EU road map also proposed the creation of an animal health legal framework, based on the principle that prevention is better than the cure. Take the example of colistin. In 2015, evidence emerged of colistin resistance with the potential for transfer and spread between bacterial species. In order to preserve colistin for human medicine and limit the spread of resistant genes, the European Medicines Agency imposed strict limitations on its use and recommended the withdrawal of marketing authorisations for all oral colistin in veterinary medical products. Professor Galloway, from the Royal College of Physicians and Surgeons of Glasgow, is calling for a full review of the use of antibiotics used in both animal husbandry and human clinical practices, and I believe the Government should actively consider that suggestion.

In the UK, some sectors have conclusively beaten the target set by the veterinary medicinal products directive. Such industries represent very clearly what we are aiming for with the SMART targets I referred to at the beginning of my speech. In many cases, progress has been made through voluntary schemes. I request that the Government look directly into specific sectors in order to investigate best practice and what we can learn from it.

However, we must go further as a global leader and recognise that this is an international challenge. Almost 80% of antibiotics used in the USA are not taken by people but used within the livestock sector, which I find astonishing. In India, people consume an average of 11 antibiotic tablets per year. Only today, data has been released showing that antibiotic resistance is growing in Europe. Progress that Britain makes will be quite simply irrelevant in the absence of a confident international stewardship programme.

The British Government must act as an example in their commitment to tackling resistance head-on globally and, while I recognise it is not in the specific gift of my hon. Friend the Under-Secretary of State for Health to dictate his published ministerial responsibilities, I believe it is timely explicitly to add antimicrobial resistance to those responsibilities. That symbolic act would send a clear message that Britain is committed to remaining at the forefront of the fight against antibiotic resistance.

--- Later in debate ---

[Patrick Grady (Glasgow North) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Davies. At relatively short notice I am standing in for my hon. Friend the Member for Linlithgow and East Falkirk (Martyn Day), who is not very well. I am not certain of the cause of his illness, but I am sure that if he is seeking advice, he will rightly be following the guidance of the theme of World Antibiotics Awareness Week, which states:

“Seek advice from a qualified healthcare professional before taking antibiotics”.

He will also be taking the advice, as I am sure will everyone else, of my hon. Friend the Member for Central Ayrshire (Dr Whitford), who has been impressing on us the importance of the flu jab. I can testify to the medicinal qualities of a hot toddy, from time to time, but in the careful context of appropriate medication with appropriate medical advice.

I congratulate the hon. Member for York Outer (Julian Sturdy) on securing this debate, which gives us an important opportunity to reflect on the issue of antimicrobial resistance and the importance of being aware of the challenges. It is a timely debate, taking place during the World Antibiotics Awareness Week. Any kind of awareness week has a number of important consequences. In this context, improving the understanding of the risks faced, which we have heard clearly from other hon. Members, is key, as is presenting an opportunity to take action in response to the challenges presented.

The challenge is very clear and came through in all the speeches. The right hon. Member for Chipping Barnet (Theresa Villiers) made it clear how difficult it is to overemphasise the scale of the challenge and the risk we face. Some 700,000 deaths a year are attributable to infections from superbugs that are resistant to antibiotics, and that figure is predicted, as we have heard, to rise to almost 10 million in total by 2050.

There are huge challenges in the livestock and veterinary sector as well. I was interested to hear that academics from the University of Glasgow in my constituency are among those taking the lead. I will say a wee bit more about what the university is doing shortly.

As the hon. Member for Stafford (Jeremy Lefroy) has said, the issue also has a big impact on developing countries, where people require access to medicines and the challenge of resistance is huge, and it threatens the progress made in health and tackling poverty. Being aware of the huge risks and then using that as a motivation to action is one of the key opportunities presented by awareness week.

I will reflect briefly on the Scottish Government’s actions. A large amount of health policy is devolved, but there are good examples and good practice on which we can reflect. In March the Scottish Government announced a £4.2 million research grant to investigate the prevention and control of healthcare-associated infections, as well as to research new ways of using existing antibiotics more effectively and efficiently. Some of that funding was provided to a consortium of researchers led, as I have said, by the University of Glasgow in my constituency, working with other Scottish universities to establish a new Scottish Healthcare Associated Infection Prevention Institute, which will conduct important research, bringing together a range of academics, researchers, practitioners and so on.

The Scottish Government have also established the Scottish antimicrobial resistance and healthcare-associated infections strategic framework for between 2016 and 2021. It has a number of aims to do with the containment of antimicrobial resistance; advancing scientific knowledge and innovation; improving efficiency, transparency and accountability; and improved workforce capability. That is important for all environments where healthcare is delivered, such as care homes, community pharmacies and primary care, and for everyone involved in the delivery of care.

There are a number of things we can all do at an individual level. There was a debate in March, I think on the broader issue of antimicrobial resistance, during which we were encouraged to become an antibiotic guardian. In fact, when the sitting was suspended for a Division in the House, many of us signed up online. The number of people signing up to that campaign continues to grow and this is another important opportunity to encourage others to do so. The Scottish Health Secretary, Shona Robison, has pledged to join the scheme and to encourage as many people as possible to do so in order to reach the target of 100,000 people becoming an antibiotic guardian.

This debate has shown that the Government have some challenges and opportunities. Are we ensuring that the right levels of investment are being channelled through the right Departments? The importance of joined-up government across Departments, including DEFRA, DFID and the NHS, has been made clear in this afternoon’s speeches. Towards the end of his remarks, the hon. Member for Stafford touched on the issue of a joined-up global response. There is a sense in some quarters that Brexit might represent some sort of retreat from the world stage. Yet the Government’s response to the O’Neill report in 2016 clearly stated that a global response, including “working closely with Europe”, is required. How do they see that relationship with European institutions in the context of Brexit? How can we be sure that the bonfire of red tape and regulation that so many Brexiteers have dreamed of for so many years will not weaken those efforts? We have already heard about the possibility of chlorine-washed chicken and so on coming into the United Kingdom as a result of potential trade deals with the United States. How can we make sure that meat that comes in as a result of new trade deals is not absolutely overloaded with antibiotics and other treatments that could lead to increased antimicrobial resistance?

In conclusion, this is a significant challenge and awareness is important. Awareness weeks, debates such as this, and the antibiotic guardian scheme play a very important role in tackling some of the challenges. I was interested to hear about the Swab and Send initiative and am keen to sign up to it. I can think of several dusty corners, not just in this Chamber but elsewhere in the Palace of Westminster, where who knows what might be discovered. I think that is a challenge to us all.

We know that there are models out there that can work. The hon. Gentleman spoke about a number of them and some of the many positive actions taken to tackle malaria, as well as the challenges that remain in closing the final gap. The other day I attended an interesting meeting between DFID officials and the all-party parliamentary group on vaccinations for all. We looked at the impact of the near eradication of polio and the challenges that will present for other schemes in the future. Some of the infrastructures that have been built up to deliver that historic achievement of the eradication of polio can perhaps be adapted to meet other healthcare challenges. I am not by any means an expert, but perhaps this is one of those areas.

It is clear from this debate that we can all play our part, and it is also important that the Government lead by example. Once again, I congratulate the hon. Member for York Outer on securing this debate and I look forward to the Government’s response.