Westminster Hall debate on Antimicrobial Resistance - Apr 17

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 Jim Shannon 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.

4.42pm
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)

It is a pleasure to serve under your chairmanship,Will Quince thank my hon. Friend the Member for Colchester (Will Quince) for securing today's debate, for his contribution to the Department of Health and Social Care during his tenure as a Minister and, in particular, for his work on this issue.

This is a pivotal year for confronting antimicrobial resistance, because the emergence of resistant infections is relentless and, as my hon. Friend eloquently described, the pipeline for new antibiotics is running dry. The evidence is stark, not just domestically but globally: more than 1 million people die every year from infections that have become resistant to treatment. To put that number in context, that exceeds the number of people who die from HIV or malaria.

AMR is sometimes described as an ignored pandemic, but if we do not act, the cost of treating resistant infections could compare to having a pandemic such as covid-19 every five years. My hon. Friend is absolutely correct to say that, if we were to walk outside this place, many of the people we talked to would not understand what AMR is or appreciate the consequences of not dealing with it domestically or internationally. That is why we are committed to addressing antimicrobial resistance.

My hon. Friend is also right that in 2019 we published our vision for antimicrobial resistance to be contained and controlled by 2040, and that date looms ever closer. That vision recognises that it is a complex problem. There are three tiers to the way we are tackling it. First, we must lower the burden of infection in humans and—my hon. Friend touched on this slightly—in animals: if you do not get the bug, you will not need the drug.

Secondly, we must use antimicrobials only when they are absolutely needed, and we should use them correctly. That is also true for both people and animals, as I will touch on in a moment. Thirdly, we must develop new antibiotics or new technologies to treat these infections so that we have more tools in our armoury as resistance emerges.

We can all play our part. I make a public health plea to everyone: we all have a responsibility to finish courses of antibiotics prescribed to us—often, we do not finish our course, because we feel better and think there is no need to take the rest of it, but that is a key way of developing resistance—and not to self-medicate after keeping the strip, which is equally harmful. There are bad practices in other countries, but we all have a responsibility to take our antibiotics as prescribed, and not to self-medicate, should we have some antibiotics looming in our cupboards.
Richard Foord (Tiverton and Honiton) (LD)

I am grateful to the Minister for giving way and I pay tribute to the hon. Member for Colchester (Will Quince) for securing the debate. On a brilliant Radio 4 documentary called “Swimming in Superbugs”, Dr Anne Leonard of the University of Exeter Medical School talked about her Beach Bums project and said that people who use the sea are three times more likely to have antibiotic bacteria in their gut. Does the Minister agree that we should not import human sewage sludge to spread on farmland, given that we think traces of antibiotic resistance material might have ended up in the sea?

Maria Caulfield

That goes back to my first pillar of reducing and preventing infections in the first place. We need to do that domestically, but internationally we are also doing huge amounts of work in that space to improve water sanitation. With animal health, too, we have done a huge amount of work, in particular on antibiotic use in food. Among animals used in food production, the UK has reduced by 59% the amount of antibiotics going into the food chain, which has a knock-on effect.

We are also investing in innovation and capitalising on our world-leading science, including phage therapy, as my right hon. Friend the Member for Tunbridge Wells (Greg Clark) pointed out. I had not heard about the Leamington Spa facility, and I am interested to catch up with him after the debate to see what more can be done. The National Institute for Health and Care Research is investing almost £90 million in that type of research, so if there is potential to develop that further, we are always keen to hear it. Our plan is cross-sectional, a one health approach, recognising the links between the health of humans, animals and the environment, and the spread of resistance between them.

We have a national action plan, which is not limited to activity in the UK. We all know that infections do not respect borders. As my hon. Friend the Member for Colchester said, we are therefore working internationally and taking a lead in many elements of that across the Dame Sally Davies with our UK special envoy on antimicrobial resistance, Dame Sally Davies, spearheading some of the effort. On updating my hon. Friend on the action plan post 2024, we are working it up as we speak and hope to make an announcement soon. There is an ongoing piece of work to drive forward some of the changes across the three sectors.

We are doing our bit here and are leading internationally, but my hon. Friend also touched on what is happening in other countries. Low and middle-income countries have to be part of the change so that we can safeguard ourselves against antimicrobial resistance.

Jim Shannon

One of the groups that I speak to reminded me to mention—I quote—

“the need for Group B Strep screening in pregnant women during labour instead of using antibiotics for all routinely.”

The Minister is interested in that subject and has an opinion on it. Does she agree that this is a chance to raise awareness of that particular issue?
Maria Caulfield

The hon. Gentleman is absolutely right. I will touch on how much more we can do with screening to prevent some infections. This cannot just be about developing new antibiotics; it is about preventing infections and screening for them in a range of scenarios.

To touch on some of the high prevalence internationally, 89% of all antimicrobial resistance deaths occur in Africa and Asia, so we have responsibility to ensure that we help out in those countries that struggle most with the issue. We must continue to ensure that people around the world have access to the antibiotics they need, which is why the £40 million in innovative research through the global AMR innovation fund that my hon. Friend the Member for Colchester mentioned is so crucial. It enabled the development of a new antibiotic for drug-resistant gonorrhoea, the first in 30 years.

The hon. Member for Tiverton and Honiton (Richard Foord) touched on the role of water, which requires an international effort. Sanitation is often a leading cause of infection in other countries. That is why we are working hard with other countries and the WHO to improve water sanitation and hygiene to reduce infections occurring in the first place.

In 2022, we made a further £210 million commitment for the second phase of the Fleming Fund to strengthen our surveillance systems. As the hon. Member for Strangford (Jim Shannon) said, it is not just about treatment, but about picking up infections and trends and trying to prevent them in the first place. The Fleming Fund is having an impact. Since 2015, over 240 laboratories have been upgraded with state-of-the-art equipment, training and new systems, and over 75 national action plans on AMR have been developed in Africa and Asia to try to get the death toll from antibiotic resistance down. The Fleming Fund leverages UK expertise, with over 3,000 healthcare workers being trained in antimicrobial surveillance principles through a partnership with the NHS.

Looking ahead, we recognise the risks. We are not being complacent either domestically or internationally. Through the hard work of my hon. Friend the Member for Colchester, we have put some good building blocks in place, but we need to look to the future. Our next five-year antimicrobial resistance national action plan will be published later this year.

Greg Clark

I am grateful to the Minister for what she said about phages. She knows that UK science is world-leading, especially in this area. In Imperial College alone, there are 180 researchers working on AMR. One such researcher, Professor Jonathan Cook, has noted the real benefits of point-of-care testing and the fact that other countries, including the Netherlands, have managed to make a big impact. Can the Minister say whether we have plans to accelerate the availability of such testing in this country?

Maria Caulfield

My right hon. Friend makes a good point, which I will take away and follow up on. There are some really good examples in primary care where some testing is done. Primary care nurses particularly will do point-of-care testing to see whether someone's infection will be sensitive to antibiotics or not. I believe there is more we can do in that space, both in primary and secondary care, so I am happy to write to him about how we can roll that out nationally. Importantly, that testing helps to maintain patients' expectations. I cannot remember who, but someone said that people go along to GPs and expect to be given antibiotics. Point-of-care testing will be able to reassure them that they either do or do not need antibiotics and tell them which type is best suited to their type of infection. That is crucial.

Our plan will set out an ambitious programme of work, learning from covid-19 in testing, surveillance and treatment to prepare for infections of the future. I can reassure my hon. Friend the Member for Colchester that we will continue to collaborate internationally with organisations such as the WHO and use our soft power to help to support in particular African and Asian nations, which are suffering greatly from the mortality of antimicrobial resistance. This is a hidden pandemic that will have consequences for us all if we do not deal with it.

Question put and agreed to.