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House of Commons Hansard
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Antibiotics: Research and Development
26 April 2016
Volume 608

[Mr Nigel Evans in the Chair]

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I beg to move,

That this House has considered incentivising research and development of new antibiotics.

It is a pleasure to serve under your chairmanship for the first time in this hall, Mr Evans. I am delighted to have secured the opportunity once again to introduce a debate on the increasingly urgent issue of antibiotic resistance. I first debated this issue back in October 2014, when I discussed the wide-ranging causes of antimicrobial resistance—AMR—and our urgent need to address the problem head-on.

Today, I will focus on the most pressing elements of the issue: the need to incentivise more research and development of new antibiotics so that we have new drugs coming on stream to meet our future needs. Before I discuss the development of a new funding model for antibiotics, I will briefly explain exactly why AMR is such a pressing issue. This is far from being a problem only for the future; it came as a shock when, before my last debate, doctors in my constituency told me that patients were already experiencing the devastating effects of AMR. Across the country, we are seeing an increasing number of patients in intensive care units who have resistant infections, meaning that there is no effective treatment available. Antimicrobial-resistant infections already kill some 50,000 people every year across Europe and north America, but sadly the reality of AMR today is nothing compared with the nightmarish scenario of the future. The initial paper of Lord O’Neill’s AMR review concluded that

“a continued rise in resistance by 2050 would lead to 10 million people dying every year”.

That is more than the number of people who will die of cancer, and it is double the number of people who will die of cholera, diabetes, diarrhoea, measles, tetanus and road traffic accidents combined. Some might say that AMR is the biggest threat to mankind.

We have also been warned that the secondary health effects of AMR could result in a return to the dark ages of medicine. Our national health service and other modern health systems across the world rely heavily on antibiotics. When surgery is undertaken, for example, patients are given antibiotics to reduce the risk of infection. In a world in which antibiotics do not work, surgery will become far more dangerous. Many routine procedures, such as hip operations, will become too risky for many elderly patients, depriving them of their mobility and their active lives. Cancer treatments such as chemotherapy supress patients’ immune systems, making them more susceptible to infections. Without effective antibiotics to prevent those infections, such life-saving treatment could no longer be an option. As Jeremy Farrar, a director of the Wellcome Trust, said:

“We are sleepwalking back into a time where something as simple as a grazed knee…will start to claim lives.”

Thankfully, medical opinion is, in the vast majority of cases, that the looming global crisis can be avoided if we take action, but it must be taken sooner rather than later. It is encouraging that there have been numerous positive developments since this topic was last debated in Westminster Hall. The £20-million Fleming fund was announced in March 2015, and it will support the delivery of action plans for AMR laboratory surveillance across the world, with a particular focus on low-income countries. Just before the 2015 general election, I was delighted that the Conservative party manifesto said:

“Antibiotic resistance is a major health risk so we will continue to lead the global fight against it, taking forward the recommendations of the independent review launched by the Prime Minister”.

I promise that that will be my last reference to party politics, because this issue has the support and attention of every party in this House. AMR is such a huge issue that it transcends party politics.

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I thank the hon. Gentleman for securing this debate on an important subject. Before he completely passes on from party politics—I agree that this issue cuts across all party politics—does he agree that the nature of antibiotics, and the fact that we want to use them as little as possible when they are discovered or invented, drives against the free market system, in which new products and services are used as much as possible? For that reason, the Government and the public sector must take action, because to be effective, antibiotics should be used not as much as possible but as little as possible.

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I agree with the hon. Lady’s last comments. She is right that antibiotics must be used as a last resort, which is why, as I will say, the current funding model for antibiotic research is broken, and why we have to correct it.

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I take the point raised by the hon. Member for Newcastle upon Tyne Central (Chi Onwurah), with which my hon. Friend the Member for York Outer (Julian Sturdy) has just agreed. This is also about having the right diagnostic tests to ensure that people who need antibiotics receive them while ensuring that they are no longer handed out like sweets.

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My hon. Friend is right. Later in my speech, I will discuss the model of how antibiotics are used across the country. It is chilling how antibiotics are used in different parts of the country. Testing to find out resistance to certain antibiotics is also important before any antibiotics needed are used. It is not just a matter of how we bring new antibiotics to market, which can take 15 years; it is also about how we protect our existing armoury of antibiotics to buy us time for those new antibiotics to reach the market.

The £1 billion Ross fund was announced by the Chancellor in the spending review of November 2015. Some £350 million will be spent fighting AMR by strengthening surveillance of drug resistance and laboratory capacity in developing countries, and by delivering the new global AMR innovation fund with China. In January 2016, at the World Economic Forum in Davos, 85 major pharmaceutical and biotech companies agreed to the declaration on combating antibiotic resistance, which demonstrates the industry’s willingness to take up the challenge. Earlier this month, the Chancellor addressed the issue once again by highlighting the importance of AMR at the International Monetary Fund in Washington DC. He confirmed what the industry has long been telling us: that the reimbursement models for antibiotics are broken. I entirely agree that a global overhaul is required, and I will focus on that issue today.

Lord O’Neill has also backed proposals to change the way we develop new antibiotics for the marketplace. We all look forward to the AMR review publishing its final set of recommendations in the months ahead, and the Minister might be able to give us a firmer timescale for that review. In my previous debate on antibiotic resistance, I raised the key issues at stake in the growing challenge of this continuing problem. We know that using antibiotics inappropriately increases resistance and the risk associated with routine treatments. In the last debate on the subject, I mentioned that in India, many prescriptions are purchased over the counter to treat a wide variety of unsuitable illnesses, often with no professional diagnosis. Such practices compound the problem. However, it is greatly encouraging that many countries around the world have now woken up to the impending disaster that we could face if we simply do nothing.

As a consequence, things are starting to move forward, which must be seen as positive. However, the central challenge of getting new antibiotics on stream remains. As the Chancellor said earlier this month and as we have heard, the current funding model is no longer fit for purpose. The O’Neill report makes it clear that it typically takes about 15 years for an antibiotic to go from the initial research stage to final delivery to the marketplace. For that to happen, a large amount of money is required up front to fund the project, at a stage when the company has absolutely no idea whether the drug will succeed. Astonishingly, only about 2% of products, or one in 50 proposed new antibiotics, successfully make it to the marketplace. In the vast majority of cases, large sums of money are invested with no financial return whatever.

Although to a certain extent that is true of the manufacture of all new drugs, the problem is far worse for antibiotics. Conditions such as cancer or diabetes often closely follow demographic trends, so new drugs are also used as the medication of choice for cancer or diabetes, as they are more effective than the older prescriptions. In the case of antibiotics, however, generic products can treat infections as well as new drugs for far less money, except where there is resistance. Furthermore, in the attempt to slow the development of resistance, new antibiotics are often held back and are prescribed only when everything else has failed. That is the right thing to do. The market for new antibiotics is therefore limited to a small section of patients, as new drugs are used only when existing drugs are no longer effective. They will be required as a first-line treatment only many years after their introduction, by which time their exclusive patents have often expired.

That may explain why so many pharmaceutical companies have, sadly, exited the market over the years. Of the 20 pharmaceutical companies that were the main suppliers of new antibiotics back in the 1990s, only four remain. Furthermore, only five new classes of antibiotics have been discovered in the last 15 years. Sadly, some companies are waiting for resistance to rise before they even explore the viability of investing in a new product, which is clearly not in the best interest of patient health and wellbeing, or of the future of health care as we know it. Under the current funding model, the profitability of any new drug depends entirely on how many units are sold. As discussed, that is not suitable for the development of new antibiotics. Incentivising the increased use of antibiotics only increases resistance in patients, which can have devastating consequences.

The O’Neill review therefore proposes the creation of a more predictable marketplace that will sustain commercial investment in antibiotic research and development. A key proposal that has the full support of many pharmaceutical companies is for profitability to be de-linked from volume of sales for new antibiotics. That would guarantee developers an acceptable return on their investment when they produce a new antibiotic that fulfils an unmet clinical need. That is especially important when volume would not be sufficient to make the product commercially viable, despite its value to the NHS. A de-linked model also has the added benefit of eliminating any incentive to oversell antibiotics needlessly as cure-all miracle drugs, which, sadly, still occurs.

Before being elected as a Member of this House, as many know, I was a farmer—a farmer who produces food, not a pharma who is part of the prescription sector—so I do not pretend to know exactly what model is right for our national health service. However, it seems to me that an insurance-based approach that shares financial risk is certainly worth the Government’s consideration. Providing developers of the most important antibiotics with a fixed fee would remove the current financial uncertainty from the marketplace. It would also limit financial uncertainty for the NHS: if there were an outbreak of an infection requiring the antibiotic, the costs would be capped at an agreeable level.

I understand that AstraZeneca and the Association of the British Pharmaceutical Industry have been working closely with the Department of Health to develop such a model. We must continue to encourage innovation while doing what we can to remove the financial uncertainty of developing key new antibiotics. At the same time, it is essential that any new funding model provides the best possible value to the taxpayer. There should be no additional support in areas that are already adequately supported by the marketplace.

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I thank the hon. Gentleman for being generous in giving way a second time, and for making an excellent summary of the case. Although the state—the national health service—should share the risk, does that not mean that it should also share the benefits and returns? As the economist Mariana Mazzucato sets out in “The Entrepreneurial State”, where the state invests, particularly in services such as this one, there should perhaps be a return to us as well, so that the upside as well as the downside is shared.

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I do not disagree at all. There must be a return, in the first place, for the companies looking to develop drugs, or they will not come forward. Delivering new antibiotics must be viable. At the same time, it is absolutely right that if the Government, the NHS or, ultimately, the taxpayer invests in those drugs, they also must see the benefit and the return. When we talk about risk, we are talking about shared risk, and if we are talking about shared risk, we should be talking about shared return.

I hope to receive the Minister’s undertaking that he will continue to work closely with companies such as AstraZeneca and with the Association of the British Pharmaceutical Industry to develop a model that supports innovation and removes financial uncertainty. The industry has asked for a clear timetable of action on the development of a new funding model, as it is essential that we turn our positive words into meaningful change.

However, it is worth saying that pharmaceutical companies do not have a monopoly on innovation, and they alone cannot solve the colossal problem of AMR. Within our rich medical marketplace across the country, there are a range of other organisations that are well positioned to offer invaluable assistance in this exciting area of discovery. In fact, the O’Neill review makes it clear that the research and development of antibiotics must be opened up, offering new opportunities for small and medium-sized enterprises, academic research teams and not-for-profit entities to compete with established players in the market.

I am proud to say that one such charity is based in my constituency: Antibiotic Research UK, or ANTRUK, is the first charity in the world set up to tackle the challenge of the scarcity of new antibiotics to treat resistant bacterial infections. Some of the country’s leading scientific and clinical experts form part of this team, and they all share the same concern about the slow progress made in combating AMR, as well as a passion for taking practical steps to take up the challenge.

The charity has three key missions: first, to develop a new antibiotic therapy by the early 2020s; secondly, to educate both practitioners and the public alike about the threat of AMR; and thirdly, to provide support to patients with antibiotic-resistant infection. In less than two years, ANTRUK has raised over £400,000, and it is working towards a programme of developing antibiotic resistance breakers. This technique reverses the resistance and extends the life of existing antibiotics. ANTRUK believes that is the best hope of finding a way of breaking AMR in the short term. Basically, it is a way of buying us more time to develop new antibiotic drugs.

Charities such as ANTRUK are ideally placed to work with both the Government and large pharmaceutical companies in finding a solution to AMR. However, to maximise its effectiveness, ANTRUK needs our support. Despite being a new player in the industry, it is already demonstrating the innovative ways in which it can help to inform public policy on AMR, an issue touched on earlier in an intervention.

In co-operation with an analytic database company, ANTRUK has published a heat map of England that shows how the number of antibiotic prescriptions varies across the country. I am happy to show this map to interested Members. The results are absolutely fascinating. The research demonstrates that the number of antibiotic prescriptions being given is rising at an alarming rate in some of the most hard-pressed areas of England. The key findings are that there is a widening gap in antibiotic prescription. For example, doctors in London prescribe 20% less antibiotics than doctors in the north, and doctors in the most hard-pressed coastal towns in Lincolnshire, Norfolk and Essex are prescribing the most. In Clacton-on-Sea, the number of antibiotic prescriptions by doctors is almost double the national average. Furthermore, doctors prescribe almost 60% more antibiotics in December than they do in August. At first glance, that might not seem surprising, but many illnesses treated by antibiotics are not seasonal in nature. Is this another example of the potential misuse of antibiotics? On a positive note, it appears that the number of prescriptions peaked at 3.4 million in 2012 and has since dropped by more than 5%.

Such research is absolutely vital in the fight against AMR. It demonstrates how charities can complement the vital work of Government and the large pharmaceutical companies. Consequently, I would be most grateful to the Minister if he would agree to meet me and a delegation from ANTRUK to discuss how the Government can assist it with its mission to combat AMR. A key request is for a relatively small amount of funding from the £12 billion foreign aid budget to assist ANTRUK’s work, which could have a revolutionary impact across the world, particularly in developing countries.

I have already had one such meeting with the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), who has responsibility for public health, along with my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake), who is also my neighbour. Sadly, he could not attend today’s debate. That meeting proved to be immensely helpful, and I hope that the Minister will agree that charities, and not just the large pharmaceutical companies, have a key role to play in the fight against AMR.

Ultimately, antibiotics are often woefully undervalued, in the sense that their price often bears no resemblance to their overall value to society. Since Dame Sally Davies published her report on the threat of AMR back in 2013, there has been an unprecedented focus on the need to change how we tackle the threat of resistance. However, this concern and the widespread discussion of the topic need to be translated into action if we are to tackle the problem head-on.

Antibiotics are the fire department of our health service, and they need a better funding model. We do not pay our firefighters only when they put out a fire; nor do we think that it is a poor return on our investment when they are not in action. Instead, we ensure that we have a well-funded fire service in place at all times, to protect us in our hour of need. It is a service that we all take for granted, and exactly the same is true of our use of antibiotics.

It is probably fair to say that whoever discovers the cure for cancer will go down in history, but the pioneer who prevents a return to the dark ages of medicine through a new antibiotic discovery will probably be forgotten. Nevertheless, the clock is now ticking, and producing positive noises without taking action is simply not an option. I hope the Minister will agree to publish a clear timetable on reforming the antibiotic funding model, and I also ask him to meet me and representatives of ANTRUK, who I know have so much to offer in furthering the process of making our next great discoveries.

I hope that the Minister will work with Departments across Government to give due consideration to the idea of allowing a greater proportion of our generous foreign aid budget to be used in this vital area of study. We have the potential to be world leaders in this field. I have heard, as other Members probably have, reports that Sweden is exploring options for changing its funding model. We must not let Sweden steal a march on us.

It was British innovation that ushered in the golden era of medical discovery. Without action, we risk squandering that legacy for future generations, who may not have the benefit of antibiotics as we know them today. It is absolutely right that global action is required to solve what is ultimately a global problem, as drug-resistant bacteria do not recognise national boundaries. We have the opportunity to safeguard the future of medicine as we know it. To achieve that goal, we must both set the standard and rise to the challenge, and hopefully the rest of the world will follow us.

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Did I see four people standing just now? Good. I intend to call those making the winding-up speeches from 3.30 pm. If everybody else could keep to about seven minutes for their speeches, that would mean everybody would get a fair share of time.

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It is a pleasure to see you in the Chair, Mr Evans, and I certainly hope to follow your request without any difficulty; I do not expect to speak for too long.

I congratulate the hon. Member for York Outer (Julian Sturdy) on securing this debate and on his comprehensive introductory speech. As a former firefighter myself, I had to chuckle a little bit about his fire analogy. Also, in the main Chamber now, new clause 20 of the Policing and Crime Bill, which deals with the role of the fire brigade under police and crime commissioners, is being debated. So there is a little bit of continuity between the two Chambers in that regard.

I also speak as a member of the all-party group on global tuberculosis and because my previous constituency of Poplar and Canning Town had the highest TB rate in the UK and one of the highest TB rates in the world, despite being situated in central London. I congratulate Barts Health NHS Trust, which includes the Royal London hospital, as well as the local authorities of Tower Hamlets and Newham, on the work that they have done in tackling that problem and the efforts that they are making to address these issues.

I am very grateful to Dan Sharp, the policy adviser for the all-party group on global TB, for the briefing that he has sent me; I will quote from it extensively. The first quote is from Dr Margaret Chan, the director general of the World Health Organisation:

“antimicrobial resistance is a crisis that must be managed with the utmost urgency. As the world enters the ambitious new era of sustainable development, we cannot allow hard-won gains for health to be eroded by the failure of our mainstay medicines.”

The report goes on to congratulate the Government on the lead they have taken, as referred to by the hon. Gentleman. It states:

“The UK Government prioritised tackling drug-resistance within its aid strategy, published last November, and created the related Ross Fund. In addition, it brought the issue to the attention of the international community by commissioning the independent Review on AMR in 2014”,

as mentioned by the hon. Gentleman. The report continues:

“The Ross Fund is a commitment to spend £1 billion over the next five years on research and development...including £315 million to fight AMR.”

As the hon. Gentleman mentioned, the Prime Minister appointed Lord O’Neill to lead a review, and its recommendations are expected next month. The Chancellor highlighted the issue of AMR in a speech to the IMF. He said:

“Unless we take global action, antimicrobial resistance will become an even greater threat to mankind than cancer is”.

TB, as we know, is the leading infectious killer. It kills 1.5 million people in a single year—4,000 every day—and is the biggest killer of people with HIV. I met Dr Chan in Brazil in November last year at the UN World Health Organisation second world summit on road crashes; road crashes kill 1.25 million people a year. The Government are committed to sustainable development goals 3.6 and 11.2. It is to their credit that they are leading on TB also.

The number of cases of drug-resistant TB is increasing, with nearly 500,000 new cases last year, and almost 200,000 deaths. Multi-drug-resistant TB already accounts for one third of the 700,000 annual deaths from AMR. The all-party group produced a report last year entitled “The price of a pandemic: Counting the cost of MDR-TB”, which called for several measures: a pooled research development challenge fund to support innovative approaches such as the Médecins sans Frontières 3P proposal to incentivise the pharmaceutical sector, as mentioned by the hon. Gentleman; and investment in basic research to address key gaps that remain in our fundamental understanding of the biology of the TB bacterium.

I have questions for the Minister. When will funding provided through the Ross fund be allocated? Investment in TB diagnostics, drugs and vaccines through the fund is critical, as he knows. Which Department is ultimately responsible for the commitments pledged through the Ross fund, given that the remit is cross-departmental? I assume from the Minister’s presence here today that his Department will lead.

The Government recognise the serious threat posed by TB within the frame of AMR. In addition to the Ross fund, the Government’s aid strategy included the creation of a global challenges fund. Will that be used to address AMR? Can the Minister provide further details on that? Finally, what discussions have the Government had with pharmaceutical companies on addressing the challenge of AMR? I note the request by the hon. Member for York Outer to lead a delegation of pharmaceutical companies that he is associated with. What does the Minister say about that?

The Government have provided a positive lead on this matter, and more information will be reassuring. I look forward to hearing the Minister’s comments and those of the shadow Minister, my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders), and of the Scottish National party spokesperson, the hon. Member for Glasgow North West (Carol Monaghan), in response to contributions to the debate.

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It is a pleasure to serve under your chairmanship, Mr Evans. Like my hon. Friend the Member for York Outer (Julian Sturdy), I have also held a debate—an Adjournment debate—on the subject of AMR to look at the use of antibiotics in primary care. The UK, as we all know, is the envy of the world when it comes to research and development into new drugs and new drug technology. Antibiotics have been widely used to treat infections for more than 60 years. Without doubt they have saved many millions of lives, as my hon. Friend said. I doubt whether there is any hon. Member who has not taken antibiotics at some time in their life. It is extensive use that has created the problem that we have today.

Although new infectious diseases have been discovered nearly every year over the past 30 years, very few new antibiotics have been developed in that time. This means that the existing pool of antibiotics are used to treat more and more infections. My hon. Friend the Member for York Outer has eloquently outlined the problems in developing new antibiotics, but one of the consequences of their widespread availability and the relatively low cost of the current antibiotics is the extensive inappropriate prescribing of the drugs for conditions on which they will have no effect. That adds to the increasing resistance to these life-saving drugs.

In preparing for the debate today, I found out that treatment-resistant bacteria are responsible for approximately 25,000 deaths across Europe each year—similar to the number of deaths from road accidents. The “National Risk Register of Civil Emergencies” estimates that a widespread outbreak of a bacterial blood infection could affect 200,000 people in the UK, and if this could not be treated effectively with our existing drugs, approximately 40% of those affected could die: 80,000 people.

There is an urgent need for action to slow the spread of antimicrobial resistance. My hon. Friend the Member for York Outer referred to buying time to allow for the development of new antibiotics to catch up with need. I talked about the number of deaths due to road traffic accidents. We have seen widespread campaigns for road safety, and we need more campaigns to highlight the dangers of the overuse of antibiotics.

In the UK, 74% of antibiotics are prescribed in a primary care setting, and a staggering 97% of patients who ask for antibiotics are prescribed them whether they need them or not. Studies have shown that antibiotic resistance rates are strongly related to use in primary care. They have also shown that more than half of the antibiotics used in primary care are for respiratory tract infections, most of which are either viral in nature or self-limiting.

As this debate indicates, one method of tackling antimicrobial resistance is by incentivising research and the development of new antimicrobials. My hon. Friend made an excellent case for that. That obviously takes time and a huge amount of financial investment. We should also look at the role that diagnostics can play. Diagnostic tests can often be carried out rapidly, giving results in minutes. This allows immediate diagnosis and treatment choices. Such tests also prevent the need for over-prescribing and ensure that patients have the right drugs at the right time.

A couple of years ago, the chief medical officer described the threat of antimicrobial resistance as being

“just as important and deadly as climate change and international terrorism.”

On that basis, and taking all the evidence into consideration, it is vital that the Government do whatever they can to tackle this major threat. If I may be so bold, I will suggest to the Minister that in addition to measures such as incentivising research and development of new antimicrobials, the Government should consider improving access to diagnostic tests in primary care, and focusing research and development funding on diagnostics as well as on drug development.

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It is a pleasure to be called to speak to speak in this debate, Mr Evans. I congratulate the hon. Member for York Outer (Julian Sturdy) on securing this debate on an increasingly important issue that we are more aware of today than ever before. He set out a comprehensive scene, which has been most helpful. He covered many of the issues involved, which will probably take away from other contributions, but he added to the debate, and that is the important thing.

The discovery of antibiotics revolutionised healthcare, allowing for the effective treatment of illnesses, including TB, that had previously been commonplace and frequently deadly. The hon. Member for Poplar and Limehouse (Jim Fitzpatrick) referred to the increase in TB in his constituency, which I am aware of because of events that have taken place here in Westminster. The incidence of TB in the United Kingdom has risen sharply in certain areas, and there is a tie-in between how we address TB and HIV. It is important that we look at the bigger picture.

Pathogens have evolved to resist new drugs. Resistance has increasingly become a problem as the pace at which new antibiotics are discovered has slowed and antibiotic use, including misuse and overuse, has risen. Antimicrobial resistance presents arguably the most serious threat to global health security and is threatening to undo major gains in the control of infectious diseases. If it is left unaddressed, 300 million people will die prematurely because of AMR by 2050 and the world’s GDP will be 2% to 3.5% lower. This year, the World Health Organisation and the G20 are considering AMR, providing the UK Government with an opportunity to build on the leadership they have shown to date. The UK Government prioritised tackling drug resistance in their aid strategy published last November. They also created the related Ross fund, which they are to be congratulated on. In addition, they brought the issue to the attention of the international community by commissioning the independent review on AMR in 2014.

The Ross fund is a commitment to spend £1 billion over the next five years on research and development on infectious disease, including £315 million to fight AMR. It is jointly administered by the Department of Health and the Department for International Development. Will the Minister give us some indication of how those Departments are working together to achieve the goals set? Commitments under the Ross fund are yet to be detailed. The all-party group played an instrumental role in securing the Conservative party’s manifesto pledge to create the fund. Given the urgency of tackling the TB epidemic, it is important that TB is prioritised within the Ross fund. Will the Minister tell us— I am sure he will—how that will happen? Although the Government’s steps are welcome, we must ask when the funding provided through the Ross fund will be allocated, because many of us are keen to see that happen. The hon. Member for York Outer also asked that question. Investment in TB diagnostics, drugs and vaccines through the fund is critical, and we need to see where the money is being spent and what the feedback is.

TB is the world’s leading infectious killer, killing some 1.5 million people every year, or 4,000 every day. TB is the biggest killer of people with HIV, as I mentioned earlier with reference to London. As the only drug-resistant infections spread through the air, multi-drug-resistant and extensively drug-resistant TB pose a serious threat to global health security. When we think about what is happening in London with TB and HIV, we should also think about what is happening in other parts of the world, where greater numbers are affected and there could be even more deaths.

Multi-drug-resistant TB—MDR-TB—is resistant to certain drugs. It can take more than 4,000 pills over a period of six months to cure someone with TB, and the drugs are often associated with severe side effects that can make treatment unbearable. As a result, patients often do not finish treatment, which increases the likelihood of drug resistance. I do not know whether any research is happening into how to make the drugs more palatable, if that is possible.

As well as treatment failure, inferior treatment and infection with resistant strains are drivers of MDR-TB. The number of cases of drug-resistant TB is increasing. There were nearly half a million new cases of MDR-TB last year and almost 200,000 deaths. One quarter of MDR-TB cases are in the WHO European region. MDR-TB requires patients to take a course of drugs over an 18 to 24-month period, including eight months of daily intravenous injections. That would be quite hard for anybody. Fewer than half of people who start treatment successfully complete the course due to the unbearable side effects, which can include permanent deafness. We have to be aware of not only what is done to treat people medically but the side effects.

The treatment of MDR-TB can cost 450 times the amount usually required to treat TB. In the UK, treatment of MDR-TB costs about £70,000, which is quite a lot of money, but if it addresses the issue, it has to be done. Due to stigma, lack of access to services and poor understanding, 3 million people—more than a third of those who fall ill with TB each year—fail to be diagnosed. MDR-TB already accounts for one third of the 700,000 annual deaths from AMR, and if it is left unaddressed, an additional 2.59 million people will die each year from the disease by 2050. It is imperative that TB is included in the AMR review’s recommendations to be published this year and considered in any international negotiations that follow. The G20 and the WHO will consider AMR this year.

I will finish with one more point—I am conscious of the suggested time for speeches, Mr Evans, but it is important that Members hear this. Although there may be a natural inclination to focus on the impact of increasing resistance to antibiotics on people, there is great work happening within the livestock industry, and particularly the poultry industry. The British Poultry Council has managed to achieve some encouraging results with its antibiotic stewardship scheme. It is the first UK livestock industry to pioneer a data collection mechanism to record antibiotic usage, which covers 90% of production across the chicken, turkey and duck sectors. It is important to record that since the scheme began monitoring overall use, it has demonstrated an encouraging downward trend. Between 2012 and 2015 production increased by 5%, with UK poultry meat accounting for 44% of total UK meat production. The total quantity of antibiotics used by scheme members in the same period decreased by 44%. In 2012, the scheme introduced a voluntary ban on the use of third and fourth-generation cephalosporins and a commitment to reduce the use of fluoroquinolone antibiotics. In 2016, the scheme made a further commitment not to use colistin.

Those encouraging results within the poultry industry should be recognised and encouraged, but as we have seen, when it comes to antibiotics for people, we need to wake up to the issue sooner rather than later. We need the Government to commit to delivering on the Ross fund and to continuing to look for further ways in which they can help address this issue.

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It is a pleasure to serve under your chairmanship, Mr Evans. I congratulate the hon. Member for York Outer (Julian Sturdy) on securing this debate on an issue he has long championed. I became interested in the issue having listened to presentations by clinicians and scientists in my constituency. They made it absolutely clear that incentivising research into and the development of new antibiotics is essential not only for our generation but for future generations. Antimicrobial resistance and its consequences are happening now. The World Health Organisation has cautioned:

“A post-antibiotic era—in which common infections and minor injuries can kill—far from being an apocalyptic fantasy, is instead a very real possibility for the 21st Century.”

Last year, antimicrobial resistance was added to the Cabinet Office’s national risk register for civil emergencies. The Government rightly warned that without effective antibiotics, even minor surgery and routine operations could become high-risk procedures.

Long lead times for developing new medicines and the relatively low commercial returns on investments have unsurprisingly hampered investment in antibiotic development. In 2014, the Select Committee on Science and Technology highlighted the fact that only 22 new antibiotics have been launched since 2000. The Association of the British Pharmaceutical Industry—I thank it for its help in preparing for this debate—points out that whereas 18 large pharmaceutical companies were actively involved in antimicrobial research and development in the 1990s, that number had fallen to four by 2010.

To ensure that new antibiotics are developed, it seems that we need a new reimbursement system, as other Members have said. Unless the environment for companies to invest in antibiotic development becomes more attractive, the problem will continue to grow. Looking at the wider field of the development of new drugs, I fear that some indicators suggest we may be going in the wrong direction. In 2010, 6% of international clinical trials were based in the UK, but the figure now stands at a mere 2%.

There are a wide range of suggestions for what we might do, including altering the regulatory framework to incentivise innovation and developing new economic models, perhaps through innovative pricing and reimbursement mechanisms to incentivise more investment in researching new antimicrobials. There may be possibilities through the emergence of what is termed venture philanthropy, which is an exciting development for some of the big research charities.

It has to be said, however, that if there is not enough money in the system as a whole, it is hard to see a way forward. Some caution that whatever the accelerated access review brings, chronic funding shortages will continue to hamper innovation. If we add to that the changes in capital allowances that make other countries more attractive and the uncertainty over the replacement of the political fix known as the cancer drug fund, it is easy to become pessimistic.

The industry needs to think hard about the future. As the independent O’Neill review said:

“Big pharma…needs to look beyond short-term assessments of profit and loss, and act with ‘enlightened self-interest’ in tackling AMR, recognising that it has a long term commercial imperative to having effective antibiotics, as well as a moral one.”

The fact remains that the Government must position the UK as the most compelling global location to develop new treatments. Methods for doing that might include committing to, and funding, a reimbursed early access to medicines scheme; and ensuring that there are sufficient funds to continue funding some of the important schemes focused on innovation, such as the biomedical catalyst. Indeed, the World Health Organisation recommends that policy makers can help to tackle antimicrobial resistance by rewarding innovation and the development of new treatment options. A global innovation fund was one of the preliminary recommendations of the O’Neill review, and we await the final recommendations, which are due to be published this summer.

In addition to incentivising research and the development of new antibiotics to tackle antimicrobial resistance, as we have heard, the Government must focus on preventing the inappropriate prescription of antibiotics, which is causing resistance to spread. The Science and Technology Committee has said that the Government

“needs to set clear responsibilities at all levels of the NHS and veterinary medicine to achieve better stewardship of the antimicrobial drugs vital in modern medicine.”

Indeed, the National Institute for Health and Care Excellence has warned that more than 20% of prescriptions issued for antibiotics are likely to be unnecessary. That is about 10 million prescriptions.

Another problem that is contributing to growing antimicrobial resistance is the use of antibiotics in livestock production. Other European countries have already set targets for reducing the use of antibiotics in farming, but the UK Government have not. Considering that farm animals account for almost two thirds of antibiotics used in Europe, and about 40% of those used in the UK, it is hard to overestimate the significance of that in the increasing problem.

Antimicrobial resistance is a grave threat that is only going to grow and intensify. The Government must act now to tackle the barriers to the development of new antibiotics and make the environment for researching and developing new drugs less challenging. The alternative, to go back to a world without antibiotics where almost half of people in this country died of infection, must be avoided at all costs.

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It is a pleasure to serve under your chairmanship, Mr Evans. I congratulate the hon. Member for York Outer (Julian Sturdy) on securing this important debate on an issue that is not well enough known or understood.

Tackling the over-consumption of antibiotics is one of the greatest health challenges of this generation. Alexander Fleming warned in 1945 that micro-organisms could develop resistance to antibiotics. Unfortunately his prediction proved to be correct. A report published by the World Health Organisation in 2014 said antibiotic resistance was now “a global threat”. The hon. Member for Strangford (Jim Shannon) described that threat to global security as being on a par with other, better-known threats. The US Centres for Disease Control have pointed to the emergence of “nightmare bacteria”, and Professor Dame Sally Davies has evoked parallels with the apocalypse. The hon. Member for York Outer mentioned that antimicrobial resistance is estimated to kill more than 700,000 people globally every year—a horrifying figure to us all, I think.

A number of hon. Members, including the hon. Members for Erewash (Maggie Throup) and for Cambridge (Daniel Zeichner), discussed the inappropriate prescription of antibiotics. The picture in Scotland reflects that in the rest of the UK. In 2014, 55,000 people—1% of the population—were taking antibiotics at any one time, and in up to 50% of cases, they were for conditions that would have got better without them.

Resistance is a natural biological phenomenon, but it is increased and accelerated by various factors, such as the misuse of medicines, poor infection control and global trade and travel. That is a particular concern with antibiotics. Many of the medical advances of recent years, such as organ transplantation and chemotherapy, need antibiotics to prevent and treat the bacterial infections that can be caused by the treatment. Without effective antibiotics, even minor surgery and routine operations could become high-risk procedures. The hon. Member for York Outer talked about a grazed knee becoming a serious condition, and I have personal experience of that, because a small cut to my knee did not respond to antibiotics, and I ended up in a serious situation, needing an operation and fairly strong antibiotics to save my leg. The situation we are talking about is a real one, and a major threat.

Inaction could mean the loss of effective antibiotics, which could undermine our ability to fight infectious diseases. The hon. Members for Poplar and Limehouse (Jim Fitzpatrick) and for Strangford both talked about TB, and the hon. Member for Poplar and Limehouse spoke of the high rates in his previous constituency. As he said, it is a devastating disease, causing 1.5 million deaths worldwide every year. Of most concern are the cases of drug-resistant TB that hon. Members have highlighted.

Action is needed at local, national and global level to improve the knowledge and understanding of antimicrobial resistance, to steward the effectiveness of existing treatments, and to stimulate the development of new antibiotics, diagnostics and therapies. The Scottish Government are taking the issue seriously. In March they announced a £4.2 million research grant to investigate the prevention and control of healthcare-associated infections, and to research new ways to use existing antibiotics more effectively and efficiently. The hon. Member for Strangford spoke about the use of antibiotics in farming and mentioned that some advances had been made in reducing their use. That is certainly positive and praiseworthy.

I welcome the UK Government’s focus on AMR, including the establishment of the independent review led by Lord O’Neill to explore the surrounding economic issues, and I look forward to seeing the review, which I hope will be published next month. It is important to acknowledge that we are simultaneously dealing with a health problem and an economic problem. The Association of the British Pharmaceutical Industry has argued that it would like a clear set of actions to be taken on developing new economic models, in particular through innovative pricing, and reimbursement mechanisms incentivising more investment in the search for new antibiotics.

There are many challenges in the current antibiotic funding landscape. The hon. Member for York Outer talked about the timescale for getting new treatments to market. I think that we would all agree that 15 years is far too long, in both economic and healthcare terms. The expected returns and associated risk with antimicrobials mean that they are not competitive with other therapeutic areas. New, innovative antibiotics often have a low price, as society expects generic antibiotics for treating large numbers of patients to be economical. The hon. Member for York Outer also talked about a fixed price for antibiotics, and perhaps that could be investigated further. The hon. Member for Cambridge talked about the drop in the number of trials of new drugs in the UK. We must ask what the reason for that is. Why cannot trials be carried out in the UK? We must look at the funding for that. I would like the UK to accelerate its leading role in developing solutions to incentivise the development and management of new antibiotics; that would promote investment in antibiotics as well as their appropriate use, and reduce the risks for both the payer and the investor.

Total antibiotic prescribing, measured using daily doses, continues to increase. The Scottish Government have been encouraging everyone to play their part by reducing the unnecessary use of antibiotics, raising awareness, and pledging to be an antibiotic guardian. That campaign aims to increase knowledge of antibiotic prescribing and resistance. It has reached more than 12,000 individuals in the first six months. Those were predominantly healthcare professionals, but everyone can pledge to become an antibiotic guardian at www.antibioticguardian.com. I did it earlier today, and I hope that many hon. Members will do so, too.

The hon. Member for Erewash discussed future public engagement work and how we raise awareness of antibiotic resistance. It is essential that we educate people about when and why antibiotics are needed. That should include helping patients to understand the duration of illness and alternative treatments for common viral infections, such as colds and flu, that do not require antibiotics.

In November 2015, Scotland’s Cabinet Secretary for Health, Wellbeing and Sport, Shona Robison, said that the rise of drug-resistant infections must be tackled around the world. She marked European Antibiotic Awareness Day by pledging to be an antibiotic guardian. The Scottish Antimicrobial Prescribing Group and UK partners have launched their target. Is the Minister willing to sign up to be an antibiotic guardian? When does he plan to launch his public awareness campaign?

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It is a pleasure to serve under your chairmanship, Mr Evans. I congratulate the hon. Member for York Outer (Julian Sturdy) on securing this extremely important debate, and on the knowledgeable and measured way in which he introduced it. I also commend his ongoing efforts to bring antibiotic resistance to the House’s attention since his election in 2010. As he said, he secured a Westminster Hall debate in October 2014 in which he called for co-ordinated action to be taken to tackle this issue. Today’s debate offers a valuable opportunity to take stock of progress since then, and to redouble our efforts to ensure that the right conditions are created to incentivise the development of the next generation of antibiotics.

The hon. Gentleman rightly said that something as minor as a grazed knee could claim lives. It is difficult to comprehend how that could happen, but there is a real risk that incidents of that sort will become commonplace in future. He cited the staggering statistic that of the 20 pharmaceutical companies that were originally developing antibiotics, only four are now in operation. He highlighted the tension between the need to encourage innovation and the financial uncertainty in this area of research. He also gave some interesting facts about regional variance in antibiotic prescription, about which I would like to learn more after the debate.

It was a pleasure, as always, to hear from my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick). He discussed tuberculosis from the perspective of both a member of the all-party group on global tuberculosis and the representative of a constituency that historically had severe problems with TB. He highlighted the increasing incidence of drug-resistant TB, and raised important questions that I look forward to hearing the Minister answer.

The hon. Member for Erewash (Maggie Throup) discussed the obstacles to the development of new antibiotics and the issue of inappropriate prescribing. She made a fair analogy with road deaths, as did my hon. Friend the Member for Poplar and Limehouse. The hon. Member for Strangford (Jim Shannon) made a valuable contribution. He was right to acknowledge and encourage the political leadership that is needed on this issue. He also made an important point about the side effects from treatments.

It was good to hear from my hon. Friend the Member for Cambridge (Daniel Zeichner), who brought a great deal of knowledge from his constituency and revealed the alarming statistic that the UK has gone from having 6% of the world’s clinical trials in 2010 to just 2% today. He echoed Jim O’Neill’s comments about pharmaceutical companies needing to look beyond the short term; I think we would all agree that that is an important challenge that we face. He also stated clearly that he believes that more should be done to encourage research and development in this country. We have been a leader for many years, and it would be a real shame if that position was under threat.

The debate is timely, as the Government-commissioned review on antimicrobial resistance is due to report next month. I pay tribute to the huge amount of work that Jim O’Neill and his team have undertaken. I hope that the conclusions of the review will lead to the far-reaching changes that we know are necessary, both in this country and around the world. Antibiotic resistance has been described by the World Health Organisation as the

“single greatest challenge in infectious diseases today, threatening rich and poor countries alike.”

The hon. Member for York Outer referred to the future as a nightmare scenario, and the WHO has also said that if we fail to act on antimicrobial resistance, by 2050 an additional 10 million lives will be lost each year to drug-resistant strains of malaria, HIV, TB and certain bacterial infections, at a cost to the world economy of $100 trillion.

As Dame Sally Davies set out in the foreword to the “UK Five Year Antimicrobial Resistance Strategy 2013-2018”:

“The harsh reality is that infections are increasingly developing that cannot be treated. The rapid spread of multi-drug resistant (MDR) bacteria means that we could be close to reaching a point where we may not be able to prevent or treat everyday infections or diseases.”

Despite that, so far, drug-resistant bacteria have not had anything near sufficient attention in terms of medical research.

It is easy to forget that it was less than 100 years ago that Alexander Fleming discovered penicillin after a piece of mould contaminated a petri dish at St Mary’s hospital, and it was not until the 1940s that the true era of antibiotics began. Despite an exponential increase in the use of antibiotics and an increasing awareness of the threat posed by antimicrobial resistance, since the year 2000 just five new classes of antibiotics have been discovered, most of which are ineffective against a number of resistant strains of bacteria, including Gram-negative bacteria.

We need to take a wide variety of steps to get to grips with the problem, including, of course, looking at how we address the long-term decline of the pipeline for new antibiotics through incentivising research and development, which I will come to shortly. We must also improve our focus on disease prevention, improving surveillance over drug resistance and tackling unnecessary antibiotic consumption. I will briefly address each of those matters in turn.

First, disease prevention, particularly in hospitals and care environments, is vital if we are to tackle antimicrobial resistance. Around 300,000 people a year get an infection while being cared for by the NHS in England—that is one in every 16 people treated by the NHS. As the Royal Society for Public Health said,

“it is alarming that the very place you would expect public health to be a high priority remains a breeding ground for life threatening infections.”

Despite improvements in recent years, the rate of healthcare-acquired infection in England has remained stubbornly high, while checks on compliance with hand hygiene best practice can only be described as inadequate. On 13 January, hand hygiene was the subject of a Westminster Hall debate, to which I responded on behalf of the Opposition. Will the Minister set out what additional steps have been taken since then to improve hygiene in all care settings? There is still a lot we can do to deny superbugs such as MRSA the opportunity to spread.

Secondly, we need to tackle surveillance blind spots in all parts of the world. As Jim O’Neill made clear,

“if we can’t measure the growing problem of drug resistance, we can’t manage it.”

We know that the technology exists to combine rapid diagnostics with data sharing, but we need to build consensus on precisely how that will take place. I would welcome any comments from the Minister on the steps being taken to improve surveillance, both in the NHS and internationally.

Thirdly, as the Science and Technology Committee found in July 2014, there is an urgent need to tackle unnecessary antibiotic consumption in healthcare and in farming, which is one of the key causes of antibiotic resistance. The Chair of the Select Committee at the time, Andrew Miller—my predecessor as MP for Ellesmere Port and Neston—called on the Government to take

“decisive and urgent action to prevent antibiotics from being given to people and animals who do not need them.”

Nearly two years on from that report, there is little evidence that such decisive and urgent action has taken place, or that all the Committee’s recommendations have been implemented. When the Minister responds, will he update us on what steps have been taken to reduce the unnecessary use of antibiotics? Although at the time of the report the Committee welcomed the launch of the O’Neill review by the Prime Minister, it cautioned against using that as an excuse or a reason to delay any progress. I hope the Minister will assure us that that has not happened.

The need to

“stimulate the development of new antibiotics, rapid diagnostics and novel therapies”

was one of the three strategic aims set out in the chief medical officer’s September 2013 report on the five-year antimicrobial resistance strategy. It was also one of the key recommendations of the Science and Technology Committee report. 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. The barriers that existed to the development of new drugs have still not been addressed. I hope that today’s debate, and the final report of Jim O’Neill’s review, will provide the catalyst needed for meaningful action finally to be taken. As the hon. Member for York Outer said, a firm timetable from the Minister would be helpful.

The key issue is that in other medical fields, once a new drug is developed that significantly improves on previously available drugs, it quickly becomes the standard first choice for patients once it comes to market. However, as we have heard, a new antibiotic might not become the first choice until there was resistance to previous generations of drugs. Indeed, health officials logically seek to limit prescribing a new antibiotic drug, with the goal of delaying resistance for as long as possible. By the time that a new antibiotic becomes the standard line of care, many years or even decades are likely to have elapsed, bringing it near to or beyond the end of its patent life. If a company has spent tens of millions of pounds on its development, that would leave it unable to generate sufficient revenue and to come close to recouping its original investment. As the hon. Gentleman said, from that perspective, the system is certainly broken.

In the review, “Securing New Drugs for Future Generations: The Pipeline of Antibiotics”, Jim O’Neill suggests a number of interventions to tackle the systematic issues that prevent the development of new antibiotics. He says that those interventions, which require political leadership at a global level, have the potential radically to overhaul the antibiotics pipeline. Will the Minister assure us that the Government will do everything they can to secure an international consensus? We have been told by report after report over the past decade how important tackling antimicrobial resistance is. I am sure Members from all parties will agree that it is time we started to put those findings into action. If the Government do the right thing and take action, they will have our full support.

Members have talked about the challenges, which are on a par with climate change, global terrorism and various other apocalyptic scenarios. It is a sad fact that generally our constituents talk about these issues only when they become everyday concerns. If that happens with antimicrobial resistance, we will have failed. We are all committed to ensuring that that does not happen; we certainly have a duty to do so.

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It is a great pleasure to serve under your chairmanship, Mr Evans. I believe we are expecting a vote, so my speech may be interrupted. I shall crack on, awaiting the bell.

I congratulate my hon. Friend the Member for York Outer (Julian Sturdy) on securing the debate and on the tenacity with which he has raised this issue in the House in recent years. It is a great opportunity to have this debate today, when so much is going on this week in London on international health leadership. My hon. Friend’s speech and the informed and constructive comments that he and others have made highlight how seriously this issue is taken throughout the House. Last Monday we had more than 60 Members of Parliament in this Chamber. The fact that we have a dozen today does not suggest that there is any less interest; many Members are tied up in other debates. I know that Members from all parties are concerned about this issue.

The debate is timely, because it coincides with a two-day international summit on antimicrobial resistance convened by the Wellcome Trust in London, which brings together a global gathering of scientists and policy makers to explore key areas for action. I thank the Wellcome Trust and pay tribute to it for its leadership. In so many areas of public policy, it has put its money and expertise to work for us. I also pay tribute to Jim O’Neill and his team, as others have done, for their work on the issue.

I will set out the context of the debate, as a number of other hon. Members have done. Antibiotics play a crucial role not just in human health but in animal health and welfare—my hon. Friend is a doughty campaigner for agricultural causes—and so are of great strategic interest in the wider field of biosecurity. We have seen the impact of diseases in domestic and agricultural poultry and in some of our tree species, and we are trying to view this issue in the wider global context of biosecurity from infectious diseases.

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There have been some marvellous steps forward in addressing the use of antibiotics on poultry, as I indicated in my speech. Many people are trying to move that forward. If we take steps forward with poultry and other animals, we can transfer that work to humans too.

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The hon. Gentleman makes an excellent point. As ever, Belfast University and the Northern Ireland life sciences cluster are doing good work in agriculture and in the medical space.

For the reasons that I outlined, the growth of resistance presents a genuine strategic global threat, which, as hon. Members from throughout the House have gratifyingly acknowledged, the Government have taken a strategic grip of. Globally, some 700,000 people will die this year because of antimicrobial resistance. In Europe, the healthcare and societal costs of resistance are estimated to be of the order of €1.5 billion per annum. That translates into a verifiable and measurable cost to the NHS of £180 million, but it may well be an awful lot more. Meanwhile, we face an antibiotic discovery void. The golden age of discovery ended in the 1980s. We have had very few new antibiotics since then and no new class since 1987.

I had a 15-year career in the sector and spent one chunk of it starting, financing and managing a small anti-infectives company that was spun out of Hammersmith and Imperial College and used some phenomenally powerful technology to look at the genetics of how microbes reproduce. We spent a lot of money on some elegant science, but we did not produce a new anti-infective. The truth is that these bugs are very difficult targets in biomedicine. It is difficult to go after the cell wall of Gram-positive and Gram-negative bacteria. Their ability to reproduce and develop resistance to drugs—they are moving targets, as it were—makes it particularly difficult to design effective drugs for them.

The good news—if I may put it that way—is that we can do things that will make and are making a real difference. The chief medical officer outlined the scale of the issue and its implications for public health in her 2013 annual report. She called for urgent action at a national and international level. The UK responded by publishing our five-year antimicrobial resistance strategy, the core aims of which were to improve understanding of resistance, to ensure that existing medicines remain effective and to stimulate the development of new antibiotics, diagnostics and therapies. Three years on, we have made considerable progress. We have put the building blocks for success in place, including better data, guidance and a strengthened framework—

Sitting suspended for Divisions in the House.

On resuming

[Mr Philip Hollobone in the Chair]

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I leave Mr Evans for five minutes and he transforms into you, Mr Hollobone. I am grateful for the opportunity to serve under your chairmanship.

We are three years into our strategy and we have put building blocks in place, including better data and guidance and a strengthened framework for antimicrobial stewardship. I want to highlight one or two areas of progress. The first is surveillance. The UK has one of the most comprehensive surveillance systems in the world. We collect baseline data from which antibiotic prescribing and trends in antibiotic resistance can be monitored, and we are continuing to improve those data so that we can identify problems early and take action.

Alongside that, we have published outcome measures against which the UK will assess progress, and we have produced a range of tools and guidance to support best practice on antibiotic stewardship. We have introduced incentives for the NHS to improve the prescribing of antibiotics and the quality of data, which will be supported and enhanced by a set of AMR indicators that will provide NHS teams with local data on infections, resistance rates and prescribing, so they can set their own ambitions to take action and drive improvement locally.

Of course, it is simply not possible to look at the challenge presented by AMR without examining it from a global perspective. AMR is a global problem and no one country can tackle it alone. The UK has played and continues to play a major part, if not the major part, in raising awareness and pushing forward international commitment and action, as several colleagues throughout the House have acknowledged. We sponsored the World Health Organisation’s 2015 global action plan on AMR, we created the £265 million Fleming fund specifically to help poorer countries tackle drug resistance, and we are promoting work on AMR through the G7, the G20 and the United Nations.

The other, perhaps obvious point to make is that there is no single solution to antimicrobial resistance. We must prevent infection, conserve the antibiotics we have, develop new diagnostics and promote the development of new drugs. The UK’s strategic approach rests on those pillars, and they resonate across the world.

I turn briefly to the Jim O’Neill review. It is widely recognised that the systems on which drug discovery and development currently depend cannot and will not deliver the new antibiotics the world needs. Hon. Members have made that point clearly. That is why my right hon. Friend the Prime Minister established the independent review. It has run for two years and has made a comprehensive and highly informed assessment of the AMR challenge. Hon. Members will have seen some of the authoritative and readable papers the review team has published, setting out its thinking on a number of key areas, stimulating debate here and globally, and paving the way for the final report, which we all await and which is due to be published next month.

Not surprisingly, research and development has received much attention from Lord O’Neill’s team. It featured particularly in their paper on AMR and the antibiotic pipeline, which appeared in May 2015. That paper argued for the establishment of a global payer fund and an innovation fund to boost funding for blue-sky research into antibiotic drugs and diagnostics. Elsewhere in their publications, the review team identify some of the neglected areas of research that they believe such a fund could help address.

The Government’s response to the review team’s work will rightly follow the publication of its final report, which we eagerly anticipate. In line with our manifesto commitment to take forward the review team’s recommendations, that response will be positive, ambitious and timely, building on what we have already achieved. We do not intend to delay in a sector that needs urgent action.

One reason why the review team published their series of thematic papers was to stimulate international debate. The value of that approach was made very clear when the President of China came to the UK in the autumn, which led to agreement on a joint UK-China innovation fund modelled on the very proposal that Lord O’Neill set out. We have committed £50 million to that fund and are now in discussion with the Chinese on how it can be taken forward. We hope at the end of it not only to have increased financial collaboration in antimicrobial research and development, but to have brought together the best research teams from industry and academia in the search for practical solutions.

The review explored how the disincentive to antibiotic research and development presented by the absence of a viable commercial market could be tackled. Hon. Members will know that, as I have painfully experienced in the industry, there is an irony in the anti-infectives field. If a new class of anti-infectives is developed, they will tend to be used as a last line of defence, so the level of usage is quite low and patent protection is often not as significant as is required or justified by other drug discoveries. The fundamentals are not the same with anti-infective drug discovery, which is one reason why the standard model does not work as well as in other areas.

The Government are convinced of the need to look again at how we fund antibiotic development, based on Lord O’Neill’s groundbreaking work. It seems clear from that work and other studies that a global solution will be needed, although I cannot, of course, pre-empt what Lord O’Neill will recommend.

Inevitably, global solutions take some time to come to fruition, and for that reason my officials have had meetings with a number of pharmaceutical companies, including AstraZeneca, to discuss alternative approaches to reimbursement. They include the insurance model and a number of others that have been widely discussed. Progress is being made and the discussions are continuing. We do not intend to allow the potential delay in global discussions to get in the way of this country taking all the steps it can to facilitate our leadership in this space.

Meanwhile, Government investment in antimicrobial-related research here in the UK continues to grow. The Medical Research Council funds an AMR research funders forum, which we established to co-ordinate research across different funding bodies. The forum has set up a number of AMR-themed research programmes, and its members have together allocated some £36 million to them. Themes include resistant bacteria and how they interact with their hosts, and projects to speed up the development of therapies and diagnostics. At the applied end of the spectrum, the National Institute for Health Research is funding health protection research units at Oxford and at Imperial College. An NIHR research call has led to the allocation of around £15 million in support of some 16 projects.

I want to reinforce the point made by my hon. Friend the Member for York Outer and others about the important role of charities—not just the Wellcome Trust, which leads, but in the sector in general. In my reform of the life science space, I have made a clear offer to charities to come to the top table as we set out the policy and reform landscape. Medical research charities in the UK now invest £1.4 billion in research every year, which puts them at the top table alongside the biggest pharma companies. I am determined to ensure that they have a voice in policy setting to reflect their increasing voice in the research landscape. We are especially fortunate in this country to have the Wellcome Trust, whose work this week is timely.

My hon. Friend referred to the Antibiotic Research UK charity, which has been set up in his constituency. It is very encouraging to hear about that initiative and its work and ambition. He has had meetings about it with the Minister with responsibility for public health, my hon. Friend the Member for Battersea (Jane Ellison), and with the Prime Minister, and is being typically diligent in ensuring that its existence and profile are raised. He knows that I cannot pre-empt the outcome of the O’Neill report, but it is incredibly encouraging to see a charity coming forward in this space. We look forward to continuing to work with that charity and others in our response to the O’Neill report.

Antibiotic Research UK is, understandably, enthusiastic about what it has to offer. My hon. Friend the Member for York Outer and other hon. Members will understand that the NIHR does not award research money by particular therapeutic area. There are good reasons for that, which I will not go into in the few moments I have left. We fund the infrastructure and are open to research bids, and I encourage that charity and others to put bids together in conjunction with industry. We stand ready to support them. I have no doubt that when we respond to the O’Neill report we will look at how we can do more to encourage and support those bids.

In the time remaining, I want to deal with some of the questions that have been asked. My hon. Friend asked whether I would meet Antibiotic Research UK. I would be delighted to do that. It would probably be sensible to do so with my hon. Friend the public health Minister after publication of the O’Neill report, but I am happy to meet them before that.

My hon. Friend made a point about the foreign aid budget. He and other observers will have noticed that in the autumn statement we announced yet more funding from the prosperity fund to go into global public health. Whether in relation to vaccines or anti-infectives, we are determined to ensure that our international development spend addresses global public health issues, and we are harnessing UK science to that end.

My hon. Friend made a point about Sweden. We are trying to strike a balance between global leadership and supporting global collaboration. My position on that, as on wider EU affairs, is that I am ambitious for the UK life sciences sector, ambitious for life sciences in Europe and ambitious for the European single market in a global race for investment. We need every collaboration network we can get.

My hon. Friend the Member for Erewash (Maggie Throup) mentioned diagnostics, and she was absolutely right. She brings to the debate her experience and professional background. Diagnostics are key, and there is some very exciting work in that field. It is fair to say that the diagnostics sector is probably ahead of the therapeutic sector on this one.

The hon. Member for Poplar and Limehouse (Jim Fitzpatrick) asked about the Ross fund, as did a number of other hon. Members. It is good to hear the level of support for the fund, which is aimed at developing, testing and delivering a range of new products, including vaccines, drugs and diagnostics, to help combat the most serious infections in low-income countries. My right hon. Friend the Chancellor of the Exchequer announced the Ross fund with added detail in January, with a portfolio of projects and programmes led by DFID and the Department of Health. The hon. Gentleman asked which Department is responsible for that, and I can confirm that it is the Department of Health through the health research budget and portfolio, for which I am responsible.

Time is against me, but I want to deal with the point made by the hon. Member for Cambridge (Daniel Zeichner) about clinical trials. As a result of an awful lot of hard work across the Department, led by the chief medical officer and the NIHR, we are turning the corner on trials—we got recruitment to trials in the NIHR clinical trials network up from 200,000 to 600,000 last year. We are starting to see an increase in the number of first-in-human trials globally, which is an indicator of cutting-edge clinical science, and we have reduced the rate of time to first patient recruitment. We are never complacent—there is more to do—but we are turning the corner on global trial recruitment.

I believe that 2016 is set to be a critical year for the AMR challenge. The O’Neill report is shortly to land, as is my accelerated access review. We have secured a historic science budget for capital and revenue and a series of initiatives in global public health. We are well placed to convene and pull together that international leadership and ensure that British science is leading in what is ultimately, and needs to be, a global endeavour. I look forward to Lord O’Neill’s report and to working with colleagues across Government to implement it as speedily as we can to ensure that the momentum is maintained. I want this country to lead in what must ultimately be a global effort to find models to ensure that we bring all our science to bear to generate new diagnostics and new treatments. We must prevent the appalling situation, which a number of us have discussed today, of antimicrobial resistance becoming one of the great scourges of the 21st century.

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I thank the Minister for his comments. He is absolutely right to say that 2016 is a crucial year. There have been many detailed and thoughtful contributions this afternoon, especially about the devastating impact of TB and drug resistance. I want to finish by going back to the firefighter analysis, just to please the hon. Member for Poplar and Limehouse (Jim Fitzpatrick). If we have a chip pan fire, we put it out to prevent a house fire. Antibiotics put out the chip pan fire by preventing the spread of infection, but they also go on to prevent a house fire, because without them we would have widespread outbreaks of infection. Without antibiotics, we could have widespread outbreaks running right across the country, uncontrolled, like wildfires. As many hon. Members have said, a world without antibiotics is a very—

Motion lapsed (Standing Order No. 10(6)).