Antimicrobial resistance (AMR) poses a grave threat to health. Quite simply, if action is not taken to address this growing threat, we are told that modern medicine will be lost. By 2050 it is estimated that AMR will kill 10 million people per year, more than cancer and diabetes combined. Antimicrobial treatments make previously life threatening illnesses such as TB, pneumonia and malaria treatable; they enable surgery to be carried out safely; make childbirth far safer for both mother and baby; and protect cancer patients whilst their immune systems are weakened by chemotherapy. Without effective antimicrobial treatments, the risk of death from infectious disease becomes substantially higher, and weighing the risks of complications or death through infection against the benefits of proposed treatment will become increasingly challenging. We are seeing a rise of resistant infections across healthcare and even where these are not currently life threatening, they are causing serious harm for example sexually transmitted infections such as gonorrhoea and chlamydia.
Visible and active Government leadership needs to be restored to tackle AMR. We therefore urge the Prime Minister to work closely with her relevant ministers to raise the profile of AMR both at home and on the international stage. Given the severity of the threat, AMR needs to be firmly established as a ‘top five policy priority’ for the Government as a whole, and a dedicated budget should be made available to enable work in this area to make more rapid progress across all relevant departments.
No new classes of antibiotics have been discovered for decades. This is the result of market failure–pharmaceutical companies are concerned about the profitability of new antimicrobial drugs, and investment in their development has therefore been limited. Because of the need to protect new antibiotics from overuse in order to reduce the emergence of resistance, new approaches are required to encourage research and development in the public interest. Investment in basic scientific research is essential but so too is the investment by pharmaceutical companies in further development and bringing products to the market. Options to address this market failure include changes to patent law and changes to the ways that pharmaceutical companies are reimbursed for new antimicrobial medicines. We want to see tangible progress within six months on implementing practical policies to reverse the worrying exodus from this area of research and development and both government and industry should play their part in tackling this issue.
It is also essential to conserve the effectiveness of current antimicrobials by improving infection prevention, and by reducing inappropriate and unnecessary prescribing. We are supportive of public education campaigns to promote antibiotic stewardship. Improvements to date in prescribing practices are a step in the right direction but more needs to be done including to address unwarranted variation. This should be supported by rapid diagnostic tests, where these are recommended by NICE but in many cases there are already evidence-based decision support tools that are under-used.
Digital health tools for clinicians and policymakers have the potential to greatly increase the quality, safety, and cost effectiveness of clinical care and reduce the threat of antimicrobial resistance. The variation in uptake of best practice is unacceptable and there is good evidence of how this could be addressed. A single organisation should be given responsibility for co-ordinating clinical decision support systems across the NHS, and ensuring they prompt evidence based prescribing of antimicrobials, as well as other medicines.
There should also be a clear message about the value of vaccination programmes in preventing both primary and secondary infection; encouraging uptake also helps to reduce antimicrobial use and AMR.
Antibiotic use in farming is an important contributor to AMR and DEFRA must ensure that progress in reducing the use of antibiotics in animals is embedded and in some areas extended, including keeping targets under close review. Serious concerns remain about the prophylactic or metaphylactic use of antibiotics in animals, and the use of antibiotics of last resort that may as a result lose their effectiveness for humans more quickly. Strict controls on these practices are essential and attention must be paid to this following the UK’s departure from the EU. The Government must make a clear commitment that post-Brexit, any future trade deals will require any meat and dairy produce imported into the UK to meet at least the same standards relating to antibiotic use which apply to meat and dairy products produced in the EU.
The strategy should include commitments to establish safe discharge levels for human waste, agricultural waste and pharmaceutical manufacturing waste, and to introduce systems to monitor and enforce them.
We recognise that AMR is a global issue requiring co-ordinated international action, including on environmental contamination by antimicrobials. We expect the Government’s new strategy to give greater focus and emphasis to this area and we urge a clear commitment to provide global leadership.
Published: 22 October 2018