Conclusions and recommendations
Priority and political leadership
1.Two of the Government’s key advisers on AMR have independently called for ‘more visible and active Government leadership’ on this issue. 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, drawing together the work of DHSC, DEFRA, DFID, the Foreign Office and BEIS. A dedicated budget should be made available to enable work in this area to make more rapid progress across all relevant departments. (Paragraph 24)
Pharmaceutical market failure
2.We expect to see tangible and rapid progress in this area within six months. Efforts to pilot the Government and industry’s current preferred option of an upfront payment scheme should not be delayed. Both government and industry should invest in this scheme. We recommend that other options to address market failure, including changes to patent law for antimicrobials and Lord O’Neill’s ‘play or pay’ proposals, should also be considered by Government. (Paragraph 37)
Antimicrobial use in healthcare
3.In order to preserve the effectiveness of current antimicrobial medicines for as long as possible, it is essential that they are prescribed appropriately. Improvements to date in prescribing practices are promising but need to continue. As UK prescribing levels are still approximately double that of the Netherlands, Sweden and the Baltic states, more challenging targets for primary care, and for rapid review and withdrawal of clinically unnecessary secondary care prescribing are needed. (Paragraph 49)
4.We welcome NICE’s development of evidence-based guidelines on antimicrobial prescribing, but we expect to see rapid and concerted action by NHS England to ensure that prescribing systems in all care settings make responsible prescribing of antimicrobials the default option. (Paragraph 52)
5.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. (Paragraph 53)
6.Encouraging the development of rapid diagnostic testing should be considered alongside the action to promote the development of new antimicrobials, but use of diagnostic tests should be based on NICE guidance. Where testing is clinically appropriate and recommended by NICE, action should be taken to address the perverse financial incentives which may discourage their use. (Paragraph 55)
Antimicrobial use in animals
7.Progress has been made in reducing the use of antibiotics in animals. DEFRA must ensure that this progress 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. It is essential that tight controls on these practices are introduced and maintained following the UK’s departure from the EU. (Paragraph 61)
8.We invite the Government to make a clear commitment that 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. (Paragraph 63)
Antimicrobials and the environment
9.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 little-understood but important area. 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. (Paragraph 71)
Published: 22 October 2018