Antimicrobial Resistance

Will Quince Excerpts

Wednesday 17th April 2024 Westminster Hall

[Peter Dowd (in the Chair)]

I call Will Quince to move the motion and then I will call the Minister to respond. There will not be an opportunity for the Member in charge to wind up, as is the convention for 30-minute debates.

[Will Quince (Colchester) (Con)]

I beg to move,

That this House has considered antimicrobial resistance.

It is a pleasure to serve under your chairmanship, Mr Dowd. Until November last year, I had the privilege of serving as Minister of State at the Department of Health and Social Care, alongside the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), who I am pleased to see here in Westminster Hall today. If I may say so, Mr Dowd, it was a pleasure to work alongside her.

My hon. Friend will know that the DHSC is a Department where, despite one’s best efforts, one spends a considerable amount of time firefighting and dealing reactively with issues. During my time in the DHSC, many pressing issues concerned me, some of which remain today, but one in particular scared me.

If I told the House that there was an issue that was so serious that it is a top World Health Organisation global health threat, that it sits on the UK’s national risk register and that it costs the NHS around £180 million a year, would we be surprised if I also said that most people were not aware of it? What about if I said that globally there were 4.95 million deaths associated with this issue and that 1.27 million of those deaths were directly attributed to it? What if I said that one in five of all those deaths were of children under the age of five? Or how about if I said that deaths in the UK related to this issue are estimated to stand at 12,000 per year, which is the equivalent of deaths from breast cancer? What if I told the House that 10 million people—I repeat that figure; 10 million—are predicted to die globally each year by 2050 because of this issue if urgent measures are not taken?

This debate is about antimicrobial resistance, or AMR. If we walked out into Parliament Square now and asked 100 people at random what “AMR” is, I wonder how many of them would know. For the reasons that I have just set out, we should be aware of AMR and concerned about it. We should be pushing our Government, Governments globally and the World Health Organisation to do more to highlight this top global health threat and to take steps to address it.

AMR occurs when bacteria, viruses, fungi and parasites no longer respond to antimicrobial medicines. As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become difficult or indeed impossible to treat, therefore increasing the risk of disease spread, severe illness, disability and—sadly—death. Although resistance is a natural phenomenon and not just a health issue, from a human healthcare perspective it is accelerated by inappropriate use of antimicrobial drugs, poor infection prevention and control practices, a lack of development of new antimicrobial drugs and insufficient global surveillance of infection rates.

As I have said, the World Health Organisation has declared AMR to be one of the top 10 global health threats, and it is also listed on the UK Government’s national risk register. In 2019, there were 4.95 million deaths associated with bacterial AMR across 204 countries, and 1.27 million of those were directly attributable, leading the WHO to declare it a top public health threat.

The OECD has found that one in five infections—I repeat: one in five infections—is now resistant to antibiotics, with the potential for that rate to double by 2035. In 2021, there were 53,985 serious antibiotic-resistant infections in England, which represented a rise of 2.2% from 2020. If left unchecked, resistance to third-line antimicrobials—the last-resort drugs for difficult-to-treat infections—could be 2.1 times higher by 2035. That means that health systems will be closer to running out of options to treat patients suffering from a range of illnesses such as pneumonia and bloodstream infections. Despite that—this is the really concerning part—no new class of antibiotics has been developed since the 1980s. Preserving and optimising our current antimicrobial arsenal is therefore not just urgent but paramount.

The consequences of AMR are huge. For urinary tract infections caused by E. coli, one in five cases exhibited reduced susceptibility to standard antibiotics. That is making it harder to effectively treat common infections. AMR also presents a threat to malaria control. Antimicrobial resistance is putting the gains of modern medicine at risk, because it makes surgical and medical procedures that are a normalised part of everyday life—such as caesarean sections, cancer chemotherapy and hip replacements—far more risky.

In addition to causing death and disability, AMR has significant economic costs. AMR creates the need for more expensive and intensive care, affects the productivity of patients or their caregivers through prolonged hospital stays and—I appreciate that this is a side issue—harms agricultural productivity. The World Bank estimates that AMR could result in $1 trillion of additional healthcare costs by 2050 and $1 trillion to $3.4 trillion of GDP losses per year by 2030.

Considering the huge risk that AMR poses to health security across the world, I do not believe that enough is being done globally to combat the current inevitability. Let me start by praising the UK Government for their action in this space, in particular the AMR five-year national action plan, or NAP, to contain and control AMR by 2040, which the NHS long-term plan details commitments to implement. I look forward to the update beyond 2024, which this period goes up to.

I could focus the rest of this speech on what more the UK could and arguably should be doing. We do need to see more on robust monitoring and surveillance. We need a significant public awareness campaign, greater investment in diagnostics, monitoring and screening—particularly in relation to rapid point-of-care testing—at local system level and, vitally, greater focus on infection prevention and management. However, I want to spend the rest of the time available to me focusing on international efforts and the role that the UK can play.

[Greg Clark (Tunbridge Wells) (Con)]

I am very grateful to my hon. Friend for bringing this very important matter to the Chamber. Before he moves to the international lens, will he reflect on the contribution that bacteriophages can make? Those are the subject of a report from the Select Committee on Science, Innovation and Technology. In effect, they are viruses that eat bacteria. In the UK at the moment, there is no approved manufacturing plant and therefore it is impossible to license phages for clinical use. A facility in Leamington Spa that was used as a Lighthouse lab could be repurposed for that. Does my hon. Friend agree with me that the Government might find that a useful way to address the very significant problem that he describes?

[Will Quince]

I thank my right hon. Friend for bringing that to my attention; it was not something that I was aware of. Given the gravity and seriousness of the situation that we face not just here in the United Kingdom but globally, I think that we need to look at all potential tools in the arsenal to tackle this issue, so I hope that the Minister has heard the case that my right hon. Friend has made very powerfully, and I would be happy to meet with him afterwards to find out more about it, because it sounds incredibly interesting.

My right hon. Friend is right—although I want to focus for some time on the international effort—the battle is not won here in the UK, we have far more to do, and the Department of Health and Social Care and NHS England have important roles to play. I know from first-hand experience, including when representing His Majesty’s Government at the World Health Assembly and the United Nations General Assembly when I was Minister of State, the global leadership that the UK shows through the World Health Organisation, especially in partnership with Sweden. During my time, I was proud to be able to announce an investment of £39 million into research through the global AMR innovation fund to help to tackle what is a silent pandemic. I understand that £24 million of that has been awarded to bolster the UK’s partnership with CARB-X, which is a global AMR research initiative that supports the continued early development of invaluable new antibiotics, vaccines, rapid diagnostics and new products that combat life-threatening, drug-resistant infections, as well as prevent death and disease across the world.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for bringing the debate forward. The issue has been in my mind for some time, and I have a number of questions about antibiotic use, which, as I understand from the stats and from questions to the Department and Ministers, has been increasing greatly. Does the hon. Member agree that during covid a standard was set whereby many GPs and out-of-hours practices had to prescribe antibiotics without seeing patients? We need to return to the prescription of antibiotics after an examination that determines whether they are absolutely necessary. We cannot keep on giving them out willy-nilly; we have to do it under strict control.

[Will Quince]

The hon. Gentleman makes a valuable point; he is absolutely right that we need to readdress our approach to antibiotics. Yes, there is a role for clinicians in that. A 10-minute slot is not a lot of time to diagnose. Lots of people will go to see their doctor and the first thing they will say is, “I have an infection; I need antibiotics.” That may not be the case, and we have to trust clinicians. The Government’s new Pharmacy First initiative, which pharmacists take seriously, has strict controls and surveillance around the use of antibiotics; the UK Government and the Department of Health and Social Care take that incredibly seriously.

The hon. Gentleman is absolutely right to allude to the fact—and this is what worries me—that, in many countries around the world, antibiotics are available off the shelf, in the same way that paracetamol or ibuprofen are. I will not name the country, but I spoke to the Health Secretary of a particular country in Africa, who said that people routinely keep antibiotics in their medicine cupboard at home; if they feel unwell, they will take a few. That causes huge problems. We need an enormous awareness campaign and education piece around antibiotics, because their use may be harming us all in the medium to long term.

I also want to touch on the Government’s Newton fund, which has supported more than 70 research teams to conduct crucial research on strategic areas, including AMR. Through the brilliant Fleming Fund, the Government have invested £265 million to support countries around the globe to generate, share and use data on AMR. I am proud that that is the world’s single largest aid investment in AMR surveillance. I also must not fail to mention the role played by Dame Sally Davies, who is the UK’s special envoy on antimicrobial resistance. At the WHA and the UN General Assembly, I saw at first hand Dame Sally’s global leadership and how widely respected she is on the world stage on this issue. We are very lucky to have her.

Internationally, there is movement. I welcome the landmark 2015 WHO global action plan on AMR, which was followed in 2016 by the historic UN declaration on AMR and, more recently, the one health global leaders group on AMR, founded just a handful of years ago to provide leadership and maintain political momentum on the issue. But I believe the issue is so serious that more urgent and immediate action needs to be taken. As I said to the hon. Member for Strangford (Jim Shannon), we know there are countries where antibiotics are routinely kept in cupboards and medicine drawers at home and taken when people feel unwell. We know there are countries where antibiotics can be purchased over the counter or online without seeing a doctor or physician. My question to the Minister is what action could and should we be taking?

I think we need a significant domestic and international awareness and understanding campaign on AMR. We need the Governments in our respective nations to understand the risks of failure. We need the public to understand the impact on them and their families, and the urgency of the situation: we want them to be the ones calling for action. We need to do more to promote appropriate and adequate global surveillance for AMR to detect and strengthen our knowledge and evidential base. Incidentally, doing that will also help with identifying potential future pandemics, so there is a dual benefit.

We need to work towards an international agreement on common evidence-based goals, and support other countries to deliver against them. We have to use our official development assistance—our overseas aid budget —to help reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures. To the best of our ability, we need to use the UK’s political positions on international platforms and our soft power, including our ODA spend, and of course the formidable Dame Sally Davies and our UK expertise, to continue to provide global leadership on AMR. I hope the Minister will commit to supporting and continuing to fund the work of the World Health Organisation on AMR.

I hope that in the short time available to me—I appreciate that it was shorter because I was racing to get here in time following the votes—I have been able to set out why antimicrobial resistance is the issue that concerned me most when I was Minister of State at the Department of Health and Social Care and why it continues to concern me on my glide path out of politics. I genuinely think it should greatly concern us all. I hope the Minister and future Ministers will continue to keep the issue front of mind and treat tackling it with the urgency and seriousness it deserves.