Kevin Hollinrake (Thirsk and Malton) (Con) I beg to move, That this
House has considered the health impacts of increasing levels of
antimicrobial resistance. It is a pleasure to serve under your
chairmanship again, Sir Gary. Mark Twain once said: “I am an old
man and have known a great many troubles, but most of them never
happened.” This is not a trouble that will not happen. This trouble
is happening now; this trouble will get much worse. The UK
Health...Request free trial
(Thirsk and Malton)
(Con)
I beg to move,
That this House has considered the health impacts of increasing
levels of antimicrobial resistance.
It is a pleasure to serve under your chairmanship again, Sir
Gary. Mark Twain once said:
“I am an old man and have known a great many troubles, but most
of them never happened.”
This is not a trouble that will not happen. This trouble is
happening now; this trouble will get much worse. The UK Health
Security Agency chief medical adviser, Dr Susan Hopkins, said
that antimicrobial resistance, or AMR, was “a hidden pandemic”
and that it was important that
“we do not come out of COVID-19 and enter into another
crisis.”
What I fear most is that, as Warren Buffet once said:
“What we learn from history is that people don’t learn from
history.”
There can be no excuse this time if we do not prepare well for a
future pandemic of AMR.
This is not the first time I have raised the issue in the House,
and it will not be the last, because AMR is simply too important
to ignore. Antibiotics are one of the most powerful tools in
healthcare, underpinning every aspect of modern medicine. We need
them not just when we are poorly at home with an infection but
when we are going through significant life-changing procedures
such as chemotherapy and hip replacements. Antibiotics work by
killing bacteria but, in the same way that the covid-19 virus can
mutate and evolve, so can bacteria, developing resistance to
antibiotics.
Right now, this year, about 700,000 people will die from
antibiotic resistance infections across the world. It is
estimated that by 2050, AMR could claim as many as 10 million
lives a year. It is not a hypothetical or vague threat that is
happening elsewhere; it is happening in the UK, is getting worse
and will get much more so. Professor Jennifer Rohn of University
College London has said:
“AMR has very much not gone away, and in the long term the
consequences of AMR will be far more destructive.”
The latest report from the English surveillance programme for
antimicrobial utilisation and resistance found that antibiotic
resistance increased by 4.9% between 2016 and 2020. That means
that one in five people with a bloodstream infection in 2020 had
one that was antibiotic resistant—a serious, potentially
life-threatening situation.
I want to tell you about a mother named Helen. Helen experienced
resistant infections in 2013 and 2018, which caused her a great
deal of anxiety and pain. She was to experience a third resistant
infection shortly after giving birth. When her baby was just six
weeks old, Helen developed mastitis, an infection of the breast
tissue. She soon developed flu-like symptoms, and a GP prescribed
her an oral antibiotic. The infection was resistant and two days
later it was getting worse, and she could barely hold her baby.
She started vomiting and was sent to A&E, where she was kept
on heavy-duty intravenous antibiotics for two nights. Luckily,
the sepsis was caught early and she recovered, but it could have
been a very different story. Sepsis causes 48,000 deaths in the
UK every year, many of them due to resistant infections.
AMR is the next pandemic. It is a hidden pandemic, but that does
not mean that we can treat it any less seriously than covid-19.
We must have the right plan in place. First, we need a strong
system for monitoring the impact of rising AMR here in the UK. I
welcome the fact that the Government have been looking into
recording AMR or antibiotic resistance as a cause of death on
death certificates and I had a welcome update from the Minister
on where we are with those proposals. However, it is surprising
that not many parliamentarians are focused on the problem, given
its context and scale. It is good to see my fellow
parliamentarians here today who are taking an interest, but until
we have a proper register and until more parliamentarians are
made aware of the issue through their constituents, I do not
think the levels will be sufficiently high to raise awareness as
often as we need in Parliament to make sure we take the matter
forward and take action against it. Secondly, we need to support
only the appropriate use and prescription of existing
antibiotics. Thirdly, we need to ensure that we incentivise the
development and research of new antimicrobials and
antibiotics.
We need to take a one-health approach across all three issues
that recognises the link between resistance and use in humans,
animals, agriculture and the environment. The Government’s
five-year national action plan on AMR set out the steps we need
to take, but we are now just about halfway through and have yet
to see any clear update on progress. The UK has been a
trailblazer on AMR, but that lack of reporting is not where we
need to be. We must be at the forefront of taking domestic
action, not least because we are trying to maintain our
leadership position as an example for other countries.
It was pleasing to see that the UK made AMR a centrepiece of our
G7 presidency. We are long-standing global leaders in AMR and
this is hugely important work, but we cannot afford to let our
attention drop from what we can also do here and at home. The
Minister and I shared many conversations on this matter as Back
Benchers and I know she is very focused on and aware of the
context, particularly in diagnostics, which I will talk about
shortly. Will she consider introducing annual reports for all the
partners on the actions in both this plan and in the next
five-year action plan?
As has already been mentioned, one of the biggest issues facing
us is the fact that there is not enough research and development
of new antimicrobials. I would be interested to see what metrics
of success we can use to judge the outcomes of the National
Institute for Health and Care Excellence’s AMR project, formerly
called the pilot, which is trialling a new model for valuing and
paying for antibiotics. This is a world-leading,
first-of-its-kind subscription-style payment model that will help
incentivise companies to develop new drugs needed to tackle
resistant infections and is supported by NICE.
The reasons we need a new model are complex. Bacteria naturally
evolve to become resistant to certain drugs, but that evolution
is happening faster than new medicines are reaching healthcare
systems. That is partly because developing antibiotics is a long,
complex and risky process, with many products failing along the
way. At the end of that process, we do not have a viable
commercial market for the new products. That is the key problem
and that is because antibiotics are not like other medicines.
Often, we want to reserve the new antibiotics for the patients
who really need them, meaning the new products could just sit
unused on the shelf. In that scenario, the cost of development
could way exceed the return, undermining future research. The
commercial model for developing antibiotics is broken.
I pay tribute to the UK’s leadership in introducing the AMR
project in the first place. I know it is the result of many years
of work by the Government, NHS, NICE and the industry sector, but
we cannot afford that leadership and drive to slacken off now,
because the price is simply too high if we do not succeed. As the
Minister knows, the pilot looks at only two antibiotics and, as
yet, there are no concrete plans to evolve into a new permanent
model for all new antibiotics that come after them. Even though
we are world leaders, we must urgently start thinking about the
next steps and that must be built into the next action plan. The
next steps must consider how we evolve the pilot and implement
its learnings at scale and pace. Will the Minister comment on
what conversations she has had with NHS England and NICE about
how best to do this and what the timeframe might be?
We must also remember that the world is watching the
world-leading AMR pilot. NICE has always been regarded as the
gold standard and its actions have always carried weight, but now
it is running one of only two pilots in the world considering
this issue. It is therefore important not only that we get the
project right, but that we also get right how we talk about what
happened, the results and, indeed, what went wrong. Given that
the goal is to incentivise private research and development, I
urge the Minister to work with industry on that communication to
ensure we are all aligned on the successes and learnings.
In 2019, in their five-year national action plan, the Government
committed to reducing hospital-acquired infections by 2024 and
halving gram-negative bloodstream infections in the NHS long-term
plan. However, there is increasing concern that the covid-19
pandemic will have pushed those targets into the background. I
would welcome the Minister’s comment on that issue, too.
As a final action point, in his landmark report, Lord O’Neill
describes diagnostics as the most important of his 10
commandments to tackle AMR. The launch of the community
diagnostic hubs represents an important opportunity to combat an
increased incidence of AMR through accurate and targeted
prescription. However, we need to tackle the false economy of
simply prescribing antibiotics because they are cheaper than a
diagnostic test.
I know other Members want to come in, so I will close by
recognising those who do tireless work on this issue and with
whom I work closely. First, Antibiotic Research UK or ANTRUK,
which is in my constituency, is the world’s first charity
specialising in antimicrobial research and education. It provides
vital research and support services for patients impacted by
resistant infection. Secondly, the British Society of
Antimicrobial Chemotherapy provides the secretariat to the
all-party parliamentary group on antibiotics, of which I am a
member. Without its efforts, the efforts of the Minister and her
team and the work of many others, we would not have achieved so
much in our fight to stop the next pandemic, but that must be our
challenge, to make sure that this time we prepare properly for a
pandemic that absolutely will happen if we do not put the right
steps in place.
(in the Chair)
Before I call , we are expecting three
Divisions in the House in a moment. When we get to that point,
Members should perhaps think about adjusting their diaries,
because it will be 25 to 35 minutes before we come back.
16:44:00
(Chipping Barnet)
(Con)
It is a pleasure to serve under your chairmanship, Sir Gary, and
to follow my hon. Friend the Member for Thirsk and Malton (), whose track record on
this important issue is second to none. I warmly congratulate him
on securing more time in this Chamber on this important
issue.
“Before Alexander Fleming discovered penicillin in 1928, an
infection from a simple cut could mean the end of life. Nearly
100 years later, the antibiotic safety blanket we live our lives
with is being pulled from us.”
That is a quote from the former chief medical officer, , on the threat posed by
antimicrobial resistance. She and many others have spoken out in
apocalyptic terms about the catastrophe ahead of us if we do not
stem the tide of infections resistant to treatment with
antibiotics, as my hon. Friend has so articulately put it.
(in the Chair)
Order.
16:45:00
Sitting suspended for Divisions in the House.
17:10:00
On resuming—
(in the Chair)
We will get under way. I know is not here, but I am sure she
will pick up the pace of the debate when she returns. The debate
may now continue until 5.55 pm.
I started my speech by referring to the remarks of the former
chief medical officer, and I was about to say that she is
entirely right to have spoken out on this issue. It is not just
some millennium-bug anxiety about something that might or might
not happen in the future, because people are already dying. Every
year, an estimated 50,000 people die from drug-resistant
infections, and that number will grow massively unless we deal
with the problem.
During lockdown, many of us will have viewed the video of Bill
Gates’s warning about a global virus pandemic, which was made
years before it actually happened. If action is not taken now on
a global scale to deal with AMR, people will look back on Dame
Sally’s predictions in the same way. They will say that leading
scientists highlighted the potential return to the days when
routine surgery, childbirth, a cut in the arm or even an insect
bite could give rise to a serious risk of death, and they will
ask why we did not act. The good news is that a great deal of
action is under way. The O’Neill report, commissioned by , was groundbreaking. It was
highly influential around the world, and 135 countries have
finalised action plans on tackling AMR.
This year, it is very welcome that the UK Government have been
using their G7 presidency to try to deliver more tangible
progress, as they did last time they held the presidency, in
2013. However, the fact is that developing new antibiotics is
massively expensive. The attempt to do so has already forced a
number of smaller firms into insolvency and caused some bigger
companies to exit their research and development programmes in
this area. The fact is that many hundreds of millions of pounds
can be pumped into R&D, with no return on that investment
whatever if a project turns out to be unsuccessful.
The high failure rates of antibiotic development apparently leave
just 40 antibiotics in clinical trials globally. The problem is
compounded by the fact that if a new antibiotic is successfully
discovered, we want to use it as sparingly as possible, keeping
it for serious conditions and to head off potentially worsening
AMR problems in the future. That creates even more problems with
the risk-return ratio. There is therefore an urgent need for
policy reforms to create market conditions that enable
sustainable investment in antibiotic innovation, including
properly valuing and paying for new antibiotics.
It is very encouraging that the industry has set up a £1 billion
investment fund to try to bridge the funding gaps, particularly
for smaller biotech companies, that will have a strong focus on
drugs that could have the maximum impact in securing and
safeguarding public health. Also welcome is the AMR project,
which we have already heard about from my hon. Friend the Member
for Thirsk and Malton. The project, launched by the UK
Government, NICE and NHS, is trialling a new subscription-style
model for antibiotics. Under the model, payment is based on the
product’s overall value to the NHS, rather than on just counting
the pills dished out to patients. Two medicines have been
selected, and contracts are expected to commence in April
2022.
It is very welcome that the project has continued despite the
pandemic, but we now need to press ahead with wider
implementation in order to cover more research and bring in the
devolved nations, so that we have a whole-country approach. We
need the project to get beyond the pilot stage, and we need to
learn from it to ensure that a sustainable solution is put in
place for new antibiotics that reflects their long term value to
society as a whole.
In conclusion, I very much welcome the leading role that the UK
Government have taken on this issue on the world stage. However,
if we are to succeed in addressing this great challenge of our
time, there is still a lot of work to be done. For example, we
need to increase public understanding of the dangers of
over-prescribing or misusing antibiotics. We must also tackle the
overuse of antibiotics in farming. I do not see that as a
domestic problem with our sector—we have strict rules to prevent
that from happening in UK farming—but we need to use our trade
and foreign policy to raise standards on antibiotics use in
agriculture all around the world.
Above all, the Government need to be bold and ambitious in
putting in place a long-term market solution that changes how we
pay for antibiotics, so that we can reward and incentivise the
scientific research that can save us from the nightmare we face:
a return to Victorian medical outcomes, where 40% of our
population have their lives cruelly cut short by infections we
cannot treat. I look forward to hearing from the Minister what
action the Government are going to take to drive this crucial
issue forward.
17:16:00
(York Outer) (Con)
It is a pleasure not only to serve under your chairmanship, Sir
Gary, but to speak in this important debate. I warmly thank my
hon. Friend the Member for Thirsk and Malton () for having secured it. I
share his view on the priority of keeping the Government’s focus
on this very important subject: as a co-chair with my hon. Friend
of the all-party parliamentary group on antibiotics, I urge the
Minister to reflect very carefully on the suggestions my hon.
Friend has made and that continue to be made in this debate. I
also want to highlight a few other important points that we need
to consider.
First, the Government need to carefully assess how covid has
impacted on the global and national antibiotic resistance
challenge. Unsurprisingly, the once-in-a-century scale of the
pandemic has generated concerns that the increased prescribing of
antibiotics worldwide on the back of covid will amplify the
problems of growing resistance. The scale of the virus disaster
and the variety of global health systems has led to a huge,
unco-ordinated and large-scale use of different antibiotics, and
we need to know how the nature of the AMR threat has evolved as a
result.
The covid experience and the size of the Government’s response
also offer lessons for the AMR debate by indicating that, when
necessary, we can rise to the challenge and assign huge resources
to protect the public. The costs involved in developing the new
drugs needed to beat the resistance are enormous, as has already
been touched on in this debate, but arguably our perspective on
that has shifted somewhat when we consider the scale of the
fiscal firepower deployed against the covid virus—some £378
billion in this country alone, as of October’s Budget.
Given the potential of AMR to equal or surpass what covid has
done, as my hon. Friend the Member for Thirsk and Malton
mentioned, with the very plausible prediction of 10 million dead
annually across the world by 2050, it seems reasonable to
increase our national financial commitment now. With a much more
significant—but still relatively small—investment, we can really
make a difference. As has already been mentioned during this
debate, and as the Association of the British Pharmaceutical
Industry has called for, raising the £10 million cap for the
Government’s AMR project subscription trial could be one such
investment.
The Government should also explore whether they can build more
laboratory capacity in middle income countries and the developing
world, as part of our public health and wider aid strategies. The
lack of significant medical microbiological facilities in such
nations is a significant factor in the mistaken prescribing of
antibiotics that fuels the growth of AMR around the world. These
labs are necessary to generate the guidance on which antibiotics
best fit which disease.
The source of the deficiency is an absence of quality, accredited
training and the lack of medical microbiological biomedical
scientists, producing a situation in which under-informed
prescribing practices simply spread resistance. Building that
capacity would be a helpful addition to the UK public health and
aid policy, because, as the pandemic has shown, disease mutations
that develop abroad do not stay there for long.
Growing antibiotic resistance in lower income countries is both a
disaster for them and a serious threat to lives in this country.
I urge the Department of Health and Social Care to engage closely
on this aspect of the problem and listen to calls, such as those
from the British Society for Antimicrobial Chemotherapy, for the
creation of a global antimicrobial stewardship accreditation
scheme to ensure co-operation across health and research systems
and to generalise global good practice. Ministers should
constantly remember the need to address the challenge of
resistance across Government—I mean making sure that other
Government Departments know the impact that AMR has.
I want to touch on one example of that. At the APPG on
antibiotics, we recently connected scientific researchers at the
University of Exeter with Ministers at the Department for
Environment, Food and Rural Affairs, so they could share the case
for amending the Environment Bill so that it took account of the
issue of antimicrobial residues in water and sewage. I understand
DEFRA’s decision that although it should not adopt the specific
University of Exeter recommendations, it will continue to listen
to this research work, including through the new shared outcomes
fund pilot project on AMR surveillance, which is in the
Environment Act 2021, but we need to see a level of engagement
across the board, from all Departments. A Government assessment
of whether a further statutory basis is needed to step up action
on AMR should be welcomed.
I finish on this brief point, Sir Gary. Many of us in the Chamber
now have sat here before, talking about AMR. We are constantly
raising the same arguments and the same points, but we really
need to spread that message wider. The biggest disappointment is
that it is the same few Members raising the same points: the
subject does not seem to be getting the political traction it
needs. Given where we have been with covid, that might be
slightly understandable, but we have to remember, as my hon.
Friend the Member for Thirsk and Malton said: if we take our eye
off the ball, AMR has the potential to be a much larger pandemic
than we have ever seen before.
(in the Chair)
The winding-up speeches will begin at 5.32 pm. We are now going
to have seven and half minutes of pure gold from .
17:24:00
(Strangford) (DUP)
You are most kind, Sir Gary; thank you very much. I am not sure
about the pure gold, but I will certainly do my best to make my
contribution to the debate. I congratulate and thank the hon.
Member for Thirsk and Malton (). He is not only an hon.
Member but my friend, and has been for all the time we have been
together in the House. We have spoken on many issues together, so
I am pleased that he has brought this subject forward.
I have an interest in this issue, probably because of my
constituency. I will start with a comment from back home. This is
not only a UK-wide issue but a global issue. As Northern
Ireland’s chief medical officer, Dr Michael McBride, said:
“As certain antibiotics lose their ability to kill particular
strains of microbe, and if we cannot develop new drugs that can
beat those bugs, then by the year 2050 we can expect about 10
million deaths per year, worldwide, from drug-resistant
infections.”
If that does not shock hon. Members or sound horrific, it should.
If hon. Members thought the covid-19 pandemic was their worst
nightmare, with all its repercussions and problems and
horribleness, I suggest that this debate has the potential to be
their even worse nightmare. Will I be here in 2050? It is highly
unlikely, but many others will be, so we should ensure that what
we do today will be sufficient to protect those of tomorrow—my
children, my grandchildren and, whenever they come, my
great-grandchildren.
The rise in antibiotic-resistant infections is of real concern:
England saw 90,000 hospital admissions because of such infections
in 2019-20 alone. There is a real problem, and we need to act
now, as right hon. and hon. Members have said. There is a rising
tide of antibiotic-resistant infections. We have to do
something.
I declare an interest as a member of the Ulster Farmers’ Union. I
have acknowledged on the record the need for investment in
agriculture in the effort to tackle antimicrobial resistance from
every angle. The Ulster Famers’ Union said:
“As a farming industry, we are committed to playing our part in
reducing antibiotic usage and resistance. Significant progress
has already been made in the pig and poultry sectors, which have
seen their usage fall by over 50% and 80% respectively.
Historically, those working with cattle are smaller users of
antibiotics but there are improvements that can be made.”
I welcome that commitment from not only the Ulster Farmers’ Union
but the National Farmers Union here on the mainland; it is a
joint operation. We should support the clear commitment by the
farmers unions to do these things and take this action.
The hon. Gentleman is making a very good speech, and he makes a
good point about the pig sector. I am sure he will be aware that
the reduction in antibiotic use in the pig sector has not
affected yields at all, which demonstrates that things can be
done more sustainably, and can be better for the environment,
without affecting the economics of farming.
The hon. Gentleman is absolutely right. The farmers unions
welcome these things because, first, they are the right things to
do, and secondly, because they do not affect the profitability of
the sector or the industry. We need to try to reinforce that.
My constituency has only two or three pig units—one is fairly
big, by the way—but a big poultry sector, which has made
significant moves towards those things. I live right in the
middle of a farm. All my neighbours are dairymen or have beef
cattle or some sheep, and they told me that they are careful
about what antibiotics they give their animals because that is
the right thing to do. Who led the way on net zero targets from
the farming sector? The National Farmers Union. It did not have
to be coaxed to do that; it was happy to do it. Those are some
good things.
It is clear that the farming community is stepping up to the mark
and that we in this House need to do more. We need to get the
message out that antibiotics are a last line of defence. We must
allow our bodies to do their work against viral infections, which
antibiotics cannot hope to address. I do not take antibiotics
often, but I had to in 2019 because I got a bad infection, and
those worked well to clear up my chest infection. Researchers at
the University of Limerick found that GPs often felt pressurised
into prescribing antibiotics, particularly for fee-paying
patients in both in and out-of-hours situations, despite being
aware that antibiotics were inappropriate for treating
non-bacterial infections. Can the Minister provide an idea of
what GPs and consultants do in relation to that and why it is
important to get that right and not to be pressurised into giving
those out?
GPs need our support and a clear message needs to be sent. We
need to ensure that the message is simple: that it is a matter of
life and death. Antibiotics are the last of our steps to take and
only if we hold them as sacred will we ensure they can still work
effectively and save lives. At the end of the day, that is all we
want.
17:30:00
Ms Anum Qaisar (Airdrie and Shotts) (SNP)
It is a pleasure to serve under your chairmanship, Sir Gary. I
thank the hon. Member for Thirsk and Malton () for securing this
important debate. He spoke passionately about this important
issue and I thank him for all his work to highlight it. I also
thank him for telling us Helen’s story. Very often, when we stand
in this Chamber, we forget that we are speaking about real
people, so I thank him for sharing that with us.
The right hon. Member for Chipping Barnet () made a reasoned
contribution and I completely agree with her that action needs to
be taken on a global scale. We cannot just look at isolated
countries, one by one. The hon. Member for York Outer () made a thought-provoking
contribution when he spoke about the awareness required and that
we need more political traction, not just by having debates but
ensuring that more Members of Parliament are aware of the matter.
I also thank the hon. Member for Strangford (), who, as we say, is everyone’s friend. His
contribution was pure gold and he made important points about the
support that GPs should be getting, and that taking antibiotics
is the last step.
Antimicrobial treatments are among the most powerful tools in
healthcare and have helped save millions of lives, as has been
said. They are one of the most important medical discoveries in
history, adding an average of 20 years to a person’s life
expectancy. Yet the growing resistance to antimicrobial
treatments poses a threat to our collective health. In Scotland,
for example, an estimated 1,312 bloodstream infections were
caused by antibiotic-resistant bacteria last year. That number is
likely to grow, with drugs becoming less effective over time, and
research into new antibiotics is simply not keeping up with the
speed at which microbes are developing resistance. In the long
term, that poses a threat to our health services. As the World
Health Organisation noted, antimicrobial resistance is a serious
threat that is no longer a prediction for the future. It is
happening now in every region and has the potential to affect
anyone, of any age and in any country.
Much of that antimicrobial resistance is caused by the overuse of
antibiotics and more emphasis must be placed on ensuring that
antibiotics are not overused in treatments. In the UK, for
example, only 10% of those suffering from a sore throat actually
require antibiotics, yet they are prescribed in 60% of cases when
patients seek treatment. Part of the problem is a lack of
awareness of antimicrobial resistance. We can help raise
awareness through initiatives such as World Antimicrobial
Awareness Week in November and the APPG’s work, as mentioned by
the hon. Member for York Outer. In Scotland, the antimicrobial
resistance and healthcare associated infection strategy group
leads the domestic approach to tackling the misuse of
antimicrobials, with a plan published every five years. We are
gradually seeing a reduction in the use of antibiotics in
Scotland, but as has been said, this is a global problem that
requires global action.
Greater global action is also required on the use of antibiotics
in animal feed. Currently, many farmers feed their livestock
antibiotics to prevent potential infections. That practice may
pose a problem because it allows bacteria to build up immunity to
antibiotics, potentially reducing their overall effectiveness,
and that then may pose a risk to humans in cases where those
antibiotic-resistant bacteria jump from an animal to a person. To
prevent that from happening, the European Union prohibits the
import of animal products where antibiotics have been used to
promote growth; currently, the UK Government have taken no such
action. When negotiating trade deals, the Scottish Trade
Minister, , noted that the UK failed
to include measures to prevent antimicrobial resistance in its
trade deal with Japan.
In conclusion, antimicrobial agents are a miracle of modern
medicine. However, their effectiveness is under threat. Although
the UK has made progress in combating microbial resistance, I
have spoken to relevant organisations working in the field, and
the feedback that they gave me was that more action will be
needed in the long term. I ask the Minister, and the UK
Government, if they will consider increasing the level of funding
to help reduce the threat of antimicrobial resistance. I look
forward to hearing how she plans to ensure that the general
public are more aware of this situation. Without drastic action
being taken, it threatens to be the next pandemic-in-waiting.
17:36:00
(Bristol South) (Lab)
It is a pleasure to serve under your chairmanship, Sir Gary. I
congratulate the hon. Member for Thirsk and Malton () on bringing this very
timely debate to Westminster Hall. It is timely because if we do
not learn from the situation that we are in, we will end up in a
very bad place; it is with that in mind that I give my
remarks.
This is a really unusual subject; I have not been involved in a
debate on it before, but it is one on which there is so much
agreement. We have a problem, we have evidence of a problem, we
agree that we have a problem, we have solutions that we generally
agree on and we are genuinely world leaders. I think the
Government sometimes bandy around the fact that we are world
leaders when we are not; but we are genuinely world leaders in
this area, and that is something to be proud of. We have some
fantastic people in this country. However, why is the situation
not improving? What more needs to be done, and, crucially, has
enough been done in recent years? How do we know what has been
done? As the hon. Member for York Outer () said, why is there not
greater interest and political pressure on this subject?
It was 2013 when described this as a
“catastrophic threat”.
She said:
“If we don’t act now, any one of us could go into hospital in 20
years for minor surgery and die because of an ordinary infection
that can’t be treated by antibiotics. And routine operations like
hip replacements or organ transplants could be deadly because of
the risk of infection.”
It was in 2014 that the estimated figure of 10 million people
dying as a result of AMR by 2050 was mooted. I was working in the
health service when that discussion was being had, back in
2013-14. I vividly remember the concern of specialists,
particularly colleagues in pharmaceuticals, about that, and the
actions that were being taken to support clinical practice to
make sure that did not happen. However, I do not think that most
people walking the streets are aware of the catastrophic
prediction made then.
We have a problem—we agree on the problem—and we know the causes
of the problem: inappropriate use of antimicrobial drugs in
healthcare; poor infection prevention and control practices; use
of antimicrobial drugs in agriculture, and accelerated spreads of
AMR infections through global trade and travel. Additionally, as
the right hon. Member for Chipping Barnet () and other hon. Members
have said, there are limited numbers of new drugs available to
replace those that become ineffective. The former Prime Minister,
, launched a review in 2014,
and the list of 10 recommendations was published in 2016. In
2017, the cost of global action was estimated at $40 billion.
That is an eyewatering sum, but when compared with what is being
described as the incalculable cost of covid, which reaches
trillions of dollars, that $40 billion estimate starts to look
quite small. Others have indicated that in reality the cost of
this could be unimaginable to most of us.
There was an excellent debate in Westminster Hall on 26 April
2016, in which my hon. Friend the Member for Ellesmere Port and
Neston () addressed the hon. Member
for Mid Norfolk (), who is also an expert in
this area. My hon. Friend said:
“Although I welcome the renewed focus that today’s debate brings,
I fear we are no closer to a solution than we were two and a half
years ago.”—[Official Report, 26 April 2016; Vol. 608, c.
540WH.]
I think there is concern in the Chamber that that remains the
case today.
The Government have targets, although they are not terribly
specific. Many are for the period 2021 to 2025—for example, being
able to
“report on the percentage of prescriptions supported by a
diagnostic test…by 2024.”
On the eve of 2022, I expect the Minister to be able to outline
how meeting those commitments is going. The hon. Member for
Thirsk and Malton made some helpful suggestions for what we
should be measuring, how we should be measuring it and how that
should be reported, which I am sure the Minister will
address.
On animal use, which the hon. Member for Strangford () highlighted, the investment required by farmers was
yet to be formally evaluated in 2019, so it would be useful to
know whether the Minister has evaluated that cost. It would also
be helpful to have an understanding of how we are collaborating
with our European neighbours, now that we have left the European
Union, because we know that collaboration is really important,
particularly in the agricultural industry.
We should be prepared, and we should certainly be on track, but I
fear we are not, so the crucial issue is: what do we need to do?
I pay tribute to , our special envoy on
AMR, and her work to highlight this issue, which, as she has said
in the last year, is a silent pandemic. As she has told us, covid
needs to be a wake-up call to the warnings that she has issued
over the years. I have listened to her speak on this issue, as
has another all-party group, and she has recently used quite a
vivid image to describe the situation: covid is like putting a
lobster into boiling water, but AMR is like a lobster in cold
water. It is a silent pandemic.
One of the issues is that fewer adults know about this. I
absolutely agree, and I think that is also true of Members of
Parliament. We need to learn from covid, including about things
such as altering behaviour, washing our hands and access to
water. We also need to support those on the frontline much
better, including through clinical direction, to help them in the
way that they need in order to treat patients.
(in the Chair)
I call the Minister. Please remember to leave two or three
minutes for to respond.
17:43:00
The Parliamentary Under-Secretary of State for Health and Social
Care ()
It is a pleasure to serve under your chairmanship, Sir Gary. I
thank my hon. Friend the Member for Thirsk and Malton () 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, , 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 (). 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.
17:51:00
I thank my hon. Friend the Minister. As I said earlier, she has
always been a passionate champion of this subject, long before
she was an excellent Health Minister. AMR is quite an esoteric
issue. Most hon. Members, as we can tell from the attendance, are
not particularly concerned about or aware of the problem. I was
only made aware of the issue because a charity in my
constituency, Antibiotic Research UK, or ANTRUK, drew my
attention to it. It acted as an adviser to a Radio 4 programme
called “Resistance”, which is well worth listening to. There are
about four or five series, and it is a dramatisation where an
antibiotic-resistant bug wipes out over 99% of the planet’s
population.
That is the potential for how devastating AMR could be, so it is
absolutely critical that we get this right. For me, it is down to
the three D’s—drugs, diagnostics and data. I wonder how concerned
we all would have been about covid, particularly early on in the
crisis, had we not seen the data behind it. For most of us, it
did not really directly affect us, so the data is crucial. I know
that it can be challenging to determine exactly what somebody has
died from in the case of a resistant infection, but it is
critical that we establish a framework so that there is more
concern among parliamentarians, the media and constituents, which
leads to parliamentary concern, and constituents can come to our
surgeries and say, “We are very concerned about this, because we
have had a catastrophic personal incident ourselves.”
I thank hon. Members for their contributions. There were few of
them, but this is a hugely important issue, and I really am
grateful to hon. Members for coming here and speaking about it
today.
Question put and agreed to.
Resolved,
That this House has considered health impacts of increasing
antimicrobial resistance.
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