[Mr Gary Streeter in the Chair]
Before I call Mr Hollinrake to move the motion, I shall let you know that eight colleagues are trying to catch my eye, in addition to the Front Benchers and the mover of the motion, so I will impose a voluntary time limit of four minutes on Back-Bench speeches. Please—I beg you—keep interventions to a minimum. We will see how it goes. I may have to impose a compulsory limit as we go along, but I hope not.
I beg to move,
That this House has considered the O’Neill review into antibiotic resistance.
It is a pleasure to serve under your chairmanship, Mr Streeter. In advance of this debate, I penned an article for PoliticsHome titled, “Antibiotic resistance—the new Black Death?” As I was writing that headline, I could sense outraged people saying, “A typical politician grabbing a sensational headline to terrify the public once again,” but it reflects the devastating conclusions of the review on antimicrobial resistance, which involved some of the world’s leading scientists, academics and economists, including its chair, Lord O’Neill, the world-leading economist and former Treasury Minister.
The O’Neill review’s report states that bacteria are gradually becoming more resistant to antibiotics, and its most grim prediction is that 10 million lives will be lost globally every year by 2050. That is more than are lost to cancer and similar to the number of deaths caused in the 14th century by the black death, which killed some 75 million people between 1346 and 1353.
My hon. Friend cites 10 million deaths, but the effect will not be the same everywhere. Was he as shocked as I was to discover that the figure for Africa is more than 4 million? Does he think that more research should be done to ensure that the right resources are in the right places?
My hon. Friend makes an excellent point. The key element of the fight against antimicrobial resistance is its global nature. We absolutely must not isolate ourselves from the rest of the world—we must collaborate—but we must take national action, too, and I will come on to that shortly.
That figure is of course a prediction—it could be lower, but it could also be higher. Predictions have been made about other contagions, such Ebola, Zika, HIV and Creutzfeldt-Jakob disease, and our scientists, academics and clinicians thankfully have managed to mitigate the worst effects and worst predictions for those diseases. But there are three reasons for us to be more alarmed this time: first, antimicrobial resistance is already happening; secondly, the problem is spreading rapidly and by all available means; and thirdly, research is not being carried out on anything like the scale required.
A quarter of all the deaths that are predicted to happen as a result of drug resistance will be caused by tuberculosis, a disease that already kills 1.8 million people a year. Does my hon. Friend agree that research and development is essential if we are to develop a vaccine to prevent tuberculosis? No epidemic has ever been fully beaten without a vaccine.
I absolutely agree. The difficulty is that due to the reward mechanisms in the system, such research and development is not happening. I will turn to that shortly.
This is not an apocalyptic prophecy. Antimicrobial resistance causes some 700,000 deaths globally and an estimated 12,000 deaths in the UK every year—similar to the number of people who lose their lives from breast cancer. Quite simply, if the bacteria that cause infections become resistant to antibiotics, people die. This issue is listed in the national risk register of civil emergencies, a five-year Government register, which states that an
“increasingly serious issue is the development and spread of”
antimicrobial resistance and points out that much of modern medicine will become unsafe. Minor surgery such as organ transplants, bowel surgery, cancer treatments and caesarean sections will become high risk—there will be more illness and more deaths.
Dame Sally Davies, our chief medical officer, pointed out that antibiotics have extended life by an average of 20 years—20 years of our lives may therefore be lost—and 40% of our population could die prematurely if this situation is not resolved. Operations would become unsafe due to the risk of infection during surgery or chemotherapy. Influenza pandemics would become much more serious. The national risk register states:
“The numbers of infections complicated by AMR are expected to increase markedly over the next 20 years. If a widespread outbreak were to occur, we could expect around 200,000 people to be affected by a bacterial blood infection that could not be treated effectively with existing drugs”.
Does my hon. Friend agree that it is vital that we heed the O’Neill review’s recommendation that antimicrobial use in farming must reduce if we are to address the frightening consequences that he is outlining? In particular, we need to move away from intensive farming, which is reliant on the prophylactic use of antimicrobials.
My right hon. Friend is right that bacteria can move from animals into humans, and the O’Neill review was clear that we need to take action in agriculture as well as our health services.
The national risk register states that we will be unable to treat some 200,000 people with existing drugs and
“around 80,000 of these people might die.”
That is a Government report.
My hon. Friend is making a powerful argument. Is it not true that it takes about 15 years for a new antibiotic to get to the marketplace? Given the position that he has just laid out—deaths and resistance are happening already—that is quite frightening.
I congratulate the hon. Gentleman on securing this important debate. Is it not self-evident that the prevention of the occurrence and spread of infection must be in the first line of the battle against this problem, and screening people on admission to hospital to determine who might be resistant and carrying infections would be very useful?
The right hon. Gentleman is right. Some 50% of prescriptions are needless, and diagnostics would mean that a lot of drugs were no longer prescribed.
We talk glibly about tens of thousands of deaths—Stalin once said, “One death is a tragedy; a million is a statistic” —but the reality is that these are our partners, our brothers, our sisters and our children, so we must act.
My hon. Friend is making a powerful point, but is not the key to find new antibiotics? Is he aware that several antibiotics originated from organisms in soil? That is how penicillin was found, and the first lead on a new antibiotic was recently found in soil. Does he agree that protecting our soil is key to our future? Given how much soil is being eroded and degraded, the Government should treat that as an important issue.
My hon. Friend is a fantastic champion of the natural environment, and she makes a very good point.
The World Health Organisation has stated that antimicrobial resistance is
“one of the greatest challenges for public health”
and that the problem is increasing and we are
“fast running out of…options.”
Antibiotic resistance is just one form of antimicrobial resistance—others concern viral and fungal infections—but my focus is antibiotics, which the public more readily understand and should have real concerns about. Bacteria undergo an eternal battle for survival, and natural resistance occurs as a result of bacteria fighting that battle, but when we use antibiotics—particularly when we overuse them—that natural resistance accelerates significantly and becomes super-charged, and we end up with many more antibiotic-resistant bacteria.
I congratulate my hon. Friend on bringing the debate. He is right to highlight the scale of the challenge not just here but globally: it is difficult for countries to bring forward large-scale programmes to deal with the problem of antimicrobial resistance. Does he agree that, apart from inappropriate prescribing, one of the key issues in this country is people not always completing courses of antibiotics, which increases the challenges and problems of bacteria developing resistance?
I defer to my hon. Friend’s in-depth knowledge in this area. I recognise my father’s habits in taking antibiotics when he felt a bit unwell—he had a little cupboard in the corner of his lounge. That is a problem, and that is why we need to improve the education on treatment of illnesses for which people are prescribed antibiotics.
The point about antibiotic resistance spreading is that it can be spread in so many ways: on aeroplanes; in our water; from contact with unwashed hands of people who carry bacteria resistance; coughing and sneezing; and from animals to humans. Some Members may have come across the excellent BBC Radio 4 drama “Resistance” —the first episode was aired on Friday and the second episode is this Friday—which talks about the transference from animals to humans. That means we must tackle this problem both in agriculture and in our health services.
Bacteria do not recognise national borders, so, as many hon. Members have already pointed out, this is a global problem. We would think that with those apocalyptic visions of the future we would be spending an awful lot of money on tackling this issue, but that is not the case. About $100 billion is spent every year on cancer research, but only about $5 billion is spent every year on tackling antimicrobial resistance. The reason for that is the commercial return that large pharmaceutical companies will get from bringing forward a new antibiotic to tackle this issue. Almost by definition, any new drug is held as a last line of defence, so there is not a significant commercial return for the pharmaceutical companies who we rely on for such new drugs. About $50 billion a year is spent on antibiotics but only about $5 billion a year is spent on patented antibiotics, which is equivalent to one cancer drug. It is a better commercial activity to be involved in cancer research and cancer drug development than in antimicrobial resistance. There has been a huge reduction in the number of pharmaceutical companies involved in research and development—in 1990 there were 18 and in 2010 there were only four—and no new classes of antibiotic drugs have been developed in the past 25 years.
Of course, the O’Neill review has studied that and come up with clear and compelling recommendations such as rapid diagnostic testing, which the right hon. Member for Oxford East (Mr Smith) referred to. Yesterday we had a Twitter debate, which was interesting, listening for an hour to people’s experiences. Many clinicians got involved in that particular Twittersphere, and we trended nationally at one point, which was certainly a new experience for me. One thing that came across was the pressure that clinicians were under to prescribe antibiotics to people who felt ill. Obviously, if we had diagnostics that could show people that they did not carry something that could be treated by an antibiotic, they would be much less likely to put that pressure on doctors.
My hon. Friend makes a good point about educating patients so that they appreciate that they do not have to come out of the GP surgery with a prescription in their hand if a diagnostic test can be carried out to prove that antibiotics will not work in their case.
That is right. I had a test myself at a drop-in session in Portcullis House that showed me that I was not ill—I did not think I was ill, but they told me that I was not, which was reassuring. Again, we need to ensure that prescriptions are given when they will be effective. One other area that we do not seem to have control over at the moment is the online sale of antibiotics: whether through UK-based pharmacies or those based overseas, it is too easy to access drugs without a proper prescription.
The second key point that the O’Neill review highlights is the need for a global public awareness campaign so that people are aware of the issues. Again on Twitter yesterday, a student who had undertaken some analysis said that 80% of the people she had spoken to had no awareness of antibiotic resistance. We need a significant national and international effort to draw public attention to the problem. As people have already said, we need a reduction of usage in agriculture. That is clearly set out in the O’Neill review as one of the four main recommendations.
The hon. Gentleman is making an important point about the dangers of antibiotic resistance. Does he agree that as well as not prescribing antibiotics for illnesses, it is important to recognise when there are alternatives that will reduce the use of antibiotics overall? For example, there is research being done at Newcastle University into using antiseptics for urinary diseases.
Yes, what we need is a mixture of solutions. The UK by its own admission is mid-range across Europe in its use of antibiotics in agriculture. That is one thing, but we have been world leaders on this issue and for me mid-range is not where we need to be; we need to be at the forefront and world leaders in terms of best practice, whatever aspect of this issue we are dealing with.
There are four key recommendations in the O’Neill review’s 10 main recommendations. The last one is on market entry rewards to solve the problem of pharmas not investing in research and development, as well as a possible levy on drug companies that do not invest in research.
The World Health Organisation has made it clear, chillingly, that resistance to last resort antibiotics is present globally, so we have to act. Does my hon. Friend agree that we will not create vital new drugs until we align better the public health needs with the commercial incentives, and that Governments need to correct what is the most dangerous market failure in history?
That is correct, and the review sets that out clearly. At the moment, if there is not a commercial return, it is difficult for pharmaceutical companies to invest in this field, although some are. For example, AstraZeneca recently sold its late-stage small molecule antibiotic business to Pfizer and so stepped out of research and development, but others, such as MSD, are still investing. It cannot be right that some companies are willing to invest—perhaps for altruistic purposes—when others are not. The O’Neill review discusses whether there should be a reimbursement or an insurance model, so that pharmaceutical companies can be sure that they will get a certain amount every year for drugs if they do develop them. It cannot be right that some contribute and some do not, so a levy for those that do not seems sensible to me. I do not think it should be left simply to big pharma to solve the problem.
The O’Neill review talks about a global AMR innovation fund—GAMRIF—to make funding available for smaller third sector organisations. Having Antibiotic Research UK, the world’s first charity in this field, in my constituency is how the issue was brought to my attention. It is doing fantastic research. From donations made by individuals, it has got hundreds of thousands of pounds that it is investing in “resistance breakers”, which is blending drugs together to repurpose existing antibiotics. That again is one of the recommendations in the report. Yes, big pharma, but we have also got to make some funding available to the smaller organisations, too.
I congratulate my hon. Friend on highlighting this issue, and the wide range of Members here shows the degree of support across the House. He is now on the nub of the problem: there will not be an international levy unless Britain leads the argument internationally; no other country will do it. David Cameron established the review and Jim O’Neill has provided the answers. The British Government now need to double up their efforts and make sure that this is one of the major things we campaign for at the UN, the G20 and the like. We have made a good start and we have an extremely capable Minister, but now we need to finish the job.
I am grateful for that intervention and for my right hon. Friend’s work on the issue in the past. He gives me an ideal opportunity to close my comments; I know you are keen to get other Members in to speak, Mr Streeter.
The UK is a world leader on this in both words and actions, but we need to do much more. The former Prime Minister—and the current Prime Minister, I am sure—and the former Chancellor of the Exchequer are leaders on this on the world stage and have drawn it to the world’s attention, as has Lord O’Neill. It is hugely important that we maintain that leadership. I look forward to hearing the thoughts of colleagues and the clear plans of Ministers for how we will act now to meet today’s challenge, because the fear is that tomorrow will be much worse than today.
I congratulate the hon. Member for Thirsk and Malton (Kevin Hollinrake) on securing the debate. For time reasons, I will focus only on the use of antibiotics in farming. We know that, just as there is a clear correlation between rising levels of human use of antibiotics and growing antibiotic resistance among humans, higher use in farm animals undermines antibiotics’ effectiveness in human medicine.
Too many of the superbugs listed by the World Health Organisation as posing the greatest threat to human health are also found in retail meat and food animals. At the end of last year, yet more studies found antibiotic-resistant E. coli in British supermarket pig and chicken meat and MRSA in UK supermarket pork. It is encouraging that DEFRA has now—after being rather complacent about the routine use of antibiotics in farming, it has to be said—committed to a 20% reduction by 2018, in line with the O’Neill review’s recommendations, but more action is needed.
The Government have said that the Veterinary Medicines Directorate is working closely with the sector to embed responsible use of antibiotics, but we know that is simply not happening. Routine mass medication of groups of animals, either on a purely preventive basis or when a few animals within the group are sick, is still far too frequent, particularly in the pig industry. Last March, the European Parliament voted through proposed new regulations that included a ban on preventive group treatments, but the trialogue between the Parliament, the Council and the European Commission has been delayed yet again until September. At the time of that vote, the then shadow Health Secretary, my hon. Friend the Member for Lewisham East (Heidi Alexander), and I, in my then capacity as shadow Environment Secretary, wrote to our counterparts to ask them to respond positively to the proposals, but we received a pretty opaque response. Will the Minister say whether the Government fully back the European Parliament’s position? It may take several more years before an EU ban, so I urge the Government to take action now and follow the Netherlands and the five Nordic countries, which do not permit such treatments.
There have been welcome moves by the British Poultry Council, but the British pig industry has not moved as fast. Colistin, which is a last resort treatment for life-threatening infections in humans, is now one of few options doctors have left for treating carbapenem-resistant Enterobacteriaceae—CRE—which has been described as the nightmare bacteria. It is important to me because my niece and several of my constituents have cystic fibrosis, and colistin is used for treating lung infections arising from CF. The Cystic Fibrosis Trust described growing colistin resistance as a
“matter of life and death”
for such patients. Only last year, new products were licensed by the Veterinary Medicines Directorate in a move that Professor Timothy Walsh, one of the scientists who originally discovered colistin resistance, described as “sheer, utter madness”. He says that that last resort antibiotic will become useless as a drug within 10 years if its usage in veterinary medicine is not stopped.
The Government also urgently need to set specific targets for “critically important antibiotics” because of their importance to human health. The Alliance to Save Our Antibiotics has called for an 80% reduction in the use of CIAs in farming in five years, and a 95% reduction in 10 years—a call I endorsed this time last year—but sales fell by only 5% in 2015. We need far greater reductions. We also need more ambitious sector-specific targets. As I said, the poultry industry is doing more but antibiotic use is extremely high in the pig industry—more than five times higher per pig than in Denmark and the Netherlands, which are our competitors. As has already been said, intensive farming goes hand in hand with the overuse of antibiotics, which is something the Government need to encourage farmers to move away from.
I congratulate my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) on securing this important debate. I will focus on Lord O’Neill’s call for antibiotic prescriptions to be informed by a rapid diagnostic test “wherever one exists” by 2020. Such tests do exist and have for probably at least 25 years. I know that because I tried to launch such a test previously. At that stage it was about better prescribing, but it is now more about tackling the huge problem of antimicrobial resistance, which Dame Sally Davies has said is as big a risk as terrorism and climate change.
Why are we still only talking about these point-of-care and diagnostic tests, which could make a huge difference? I think it is partly due to the way that in vitro diagnostic tests are block funded through centralised hospital labs. In Scandinavia, point-of-care tests are a lot more widespread, including for C-reactive protein—CRP—and funding is decentralised. There is not yet a mechanism for such tests to be funded in the UK. It is so important to look at how such tests will be funded, whether they are to be used in a GP surgery or local pharmacy. It has been calculated that £56 million could be saved in prescribing and dispensing costs alone if point-of-care tests were introduced, as they can be vital in deciding whether to prescribe antibiotics.
Let me explain. High levels of C-reactive protein are found in somebody with a bacterial infection. The level is normally only slightly raised when the patient has a viral and not a microbial infection. When my hon. Friend was tested, the results showed that he was either healthy or had a viral infection. Point-of-care CRP tests are available and can be carried out by GPs, practice nurses and community pharmacists, and they take just four minutes to determine whether a patient needs antibiotics or not. It sounds very simple, and it can be. As I said earlier, patients feel they have only had their money’s worth from a GP appointment if they come out with a prescription, but studies have shown that giving them a point-of-care test can also leave them feeling satisfied and as though they have had their money’s worth. In one study, 90% of respondents felt reassured by a point-of-care CRP test if they were not prescribed an antibiotic.
The tests are very simple. Patients have their finger or thumb stabbed and a small drop of blood is taken. It is then tested within four minutes, while the patient waits in the doctor’s surgery. Lots of studies have shown a reduction in antibiotic prescribing, including by 30% in one and 23% in another project, which was cost-neutral; the cost of carrying out the tests versus prescribing is very effective. I am mystified as to why we have this problem yet are not tackling it with tests that are already on the market, which is in line with current National Institute for Health and Care Excellence guidelines. I ask the Minister: why can we not change the funding streams for these tests to make sure that they are carried out exactly where they are needed?
Sitting suspended for Divisions in the House.
I congratulate the hon. Member for Thirsk and Malton (Kevin Hollinrake) on securing this very important debate. We will all be aware that the World Health Organisation says that antibiotic resistance is one of the most significant threats to safety in Europe. Resistance is driven by overusing and inappropriately prescribing antibiotics, and it leads to higher medical costs, prolonged hospital stays and increased mortality. The aim of appropriate use is to ensure that patients receive the treatment that is most likely to treat their condition without increasing antimicrobial resistance. That includes ensuring that courses of antibiotics are completed and are not prescribed unnecessarily, and reducing the spread of infection through vaccines and other early interventions.
One area that is often overlooked is dentistry, which accounts for up to 10% of all antibiotics prescribed in the UK. It is essential that dentists play their part in reducing antibiotic prescribing, and I believe that they are willing to do that. The British Dental Association tells me that many patients are not aware that antibiotics cannot cure decay or dental abscesses and that surgical intervention and painkillers are more often the appropriate treatment for tooth-related pain. The briefing sheet that the BDA sent me gives this good example:
“Hundreds of thousands of patients show up at GP surgeries and A&E departments every year with dental pain, but these places are not equipped to help them, and they are sent home with antibiotics to tide them over until they can arrange to see a dentist.”
There should be awareness of that throughout the medical profession.
I agree with Lord O’Neill’s statement that diagnostic technology needs to be improved to ensure that antimicrobials are used appropriately. I am no expert in this area, but the chair of the review board called on the Governments of rich countries to ensure that, by 2020, all prescriptions for antibiotics will be on the basis of surveillance information and a rapid diagnostic test where one is available. The review recommended a diagnostic market stimulus to support the diagnostic technology market. The Minister is not in the Chamber at present, but I hope that the Government will look at diagnostics.
The Government must also look at the factors that have hampered investment in antibiotic development, particularly the low commercial returns on investment. With high costs and long lead times for developing new medicines, there is a need to create an attractive environment for companies to invest in antibiotic development, in order to increase research and development. The current system of antibiotic reimbursement does not provide companies with a fair return on investment. That is driving companies out of the anti-infection market.
Pharmaceutical companies and Government are developing a delinked domestic reimbursement model. That will remove the incentive for companies to promote antibiotic sales, which can accelerate the development of resistance. The proposed model will deliver a return on investment for antibiotics that is delinked from the volume of sales. It will also encourage the appropriate use of new antibiotics by ensuring that they are prescribed based on clinical need and in line with stewardship goals.
I see the time, Mr Streeter, and I am about to conclude. A delinkage model is proposed in the O’Neill report, and we must put our minds to it, but it is very much for the future. What we have to examine now is how we manage patients’ expectations on when antibiotics are and are not appropriate. We should be doing that daily in all parts of the health service.
The O’Neill report focuses on many things, but I would like to focus on three key points. One is unnecessary prescribing. The second is the so-called disappeared antibiotics—those that should be available, but are not. The third is alternatives—something that Jim O’Neill talks about, but does not elaborate on.
Jim O’Neill says:
“Huge quantities of…antibiotics, are wasted globally on patients who do not need them”.
That is a key challenge for us, but he also says that a study in 2012 of 38 high-income countries found that
“two thirds of the antibiotics surveyed were not available in more than half of the countries. The main reason for this is that drugs manufacturers and distributors discontinue the stock where it is not profitable enough to maintain it.”
The point is that those antibiotics are available, but are not being used because of economic factors.
We looked at this issue in the Select Committee on Science and Technology, of which I was a member in the previous Parliament, and we found:
“Of the 18 to 20 pharmaceutical companies who were the main suppliers of new antibiotics 20 years ago, just a handful of companies persist in this field.”
It is all down to money, and we will clearly have to address that with funding.
If we go through the back of the O’Neill report, we find that there are hardly any contributions from anyone who knows anything about anything other than mainstream medicine. Between one third and one half of the world’s population live in China and India, where there is integrated healthcare using herbal medicine and mainstream medicine. There are 60,000 hospitals in China, and there will be a larger number of herbal clinics. In India, the Ministry of AYUSH regulates Ayurveda of different types, yoga and homeopathy, of which there are 200 colleges —we probably will not get on to that this afternoon.
In the previous Parliament, the then Minister, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), asked a group led by the deputy chief medical officer, and me as his deputy, to look at regulation of herbal medicine. My hon. Friend the Minister has just published her response. I congratulate her on it and am very much in favour of the idea of getting better regulation through the Professional Standards Authority. However, I have to tell her that she has been badly advised in one respect. She says, on herbal pharmacies:
“Allowing people with no qualifications to put together medicines and carry this out on unregulated premises conflicts with everything else the MHRA does”.—[Official Report, 28 February 2017; Vol. 622, c. 8WS.]
I have to tell her that that is not the case. Professor David Walker, who wrote to her predecessor, my hon. Friend the Member for Mid Norfolk (George Freeman), made this clear:
“The idea of herbal dispensaries was to allow the preparation of herbal remedies on behalf of individual practitioners, for individual patients, but at a distant location by a third party. This would be safer than unskilled practitioners making products in unsuitable environments.”
So that is completely the opposite. He said:
“We consulted the MHRA about the feasibility of this change in our deliberations and the advice that we received was that it was feasible but…would take considerable work”.
That is the problem—the MHRA do not want to do the work. He went on:
“We felt that this effort would be worthwhile and that dispensaries would improve access to herbal medicines, generate business and improve patient safety.”
If we marry that with the new regime that the Professional Standards Authority has put in place, and if we give the herbal pharmacists from China and India and the phytotherapists in this country oversight of regulation through the PSA, my hon. Friend the Minister will have a powerful tool. However, that will not be the case if she does not have another look at the herbal pharmacies proposal, which we worked on for nearly 18 months. The former Minister, who commissioned the report, is not in his place at the moment, but he would agree.
It is still a pleasure to be serving under your chairmanship, Mr Streeter.
Antimicrobial resistance was described earlier by another Member as a market failure. I have also seen it described as a “tragedy of the commons”, which is a phrase that some of us might associate with the hassle we have to go through because of the antiquated voting systems in this House. It is actually an economic term describing where individual users acting independently according to their own self-interest behave contrary to the common good by depleting a resource that should be there to serve everyone. That is precisely what has happened through the misuse of antibiotic medicines over the years. It shows that the resistance we are discussing today is an avoidable and man-made problem, and it is therefore in our gift to overcome the challenge.
One of my concerns is that we view this as though there should be a proper market functioning. Does the hon. Gentleman agree that we do not actually want a functioning market, in that we want a new generation of drugs to become available and then, as far as possible, not to be used? We do not want the market to operate; we want the use of such drugs to be in reserve.
Absolutely. I wholeheartedly agree. That leads me nicely on to my first point about the particular challenge faced in developing countries.
All Governments in the world have an obligation under the sustainable development goals—it is in SDG 3—to ensure health and wellbeing for all, which includes access to safe, effective, quality and affordable medicines and vaccines. That is about access to medicines; it is not about the right to buy or sell them on the market, it is about treating them as a common good. That is precisely what we want to do, otherwise there is a real risk of backsliding on progress that has been made in tackling neglected and tropical diseases. We heard earlier about TB being responsible for more than 5,000 deaths per day, and about malaria, which is often treated by very strong antibiotics and affects more than 200 million people worldwide a year. That is why there needs to be a broad, co-ordinated response. Drugs that treat TB are often used to treat other infections as well, so in boosting research into neglected diseases there is an opportunity to supercharge the pipeline of development and make more drugs available for treatment as we need them.
I am glad the Minister is back in the Chamber. It would be interesting to hear what further commitments the Government can make. We welcomed the commitment to the global fund, but how is the Department for Health working with the Department for International Development on these issues? In particular, how much of her Department’s spending will be counted as official development assistance when it comes to tackling antimicrobial resistance? The Ross fund was set up by the former Chancellor, the right hon. Member for Tatton (Mr Osborne), who is no longer in his place, and I congratulate him on it. What progress is being made on that fund, and what support will there be for researchers on the ground in developing countries? I am not opposed to using the ODA budget to fund Departments other than DFID, but wherever possible it should be used to support research on the ground in developing countries.
I want to speak briefly about domestic responses. I recently met a constituent, Linda Brooks, who has become the chair of the Scottish steering committee for synthetic biology—an initiative supported by Scottish Enterprise. She is also a manager at the company Thermo Fisher, which supports research in the life sciences sector including pioneering work on antimicrobial resistance and, in particular, the technology of genome editing, which has huge potential. It would be interesting to hear whether the Government provide any support in those areas.
We all have responsibility for the effective use of antibiotics. During the hiatus in this debate I was able to sign up online to become an antibiotic guardian, which Public Health England supports with the encouragement of all the devolved Administrations. It includes a range of pledges to treat symptoms, to talk to pharmacists, to dispose of unused antibiotics carefully, to take the flu vaccine and to always complete the course—I hope everyone will sign up to that pledge.
It is a pleasure to serve under your chairmanship, Mr Streeter. First, I thank my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) for bringing this crucial issue forward for discussion. Keeping it in the spotlight is vital, to ensure that there is sufficient political will to carry forth the recommendations in the O’Neill report on antimicrobial resistance.
Having worked in the NHS as a consultant paediatrician, and having treated many patients with antibiotics, I have seen at first hand the work the NHS is doing to ensure that they are prescribed responsibly. I have also used the CRP test, which my hon. Friend the Member for Erewash (Maggie Throup) mentioned, many times. However, I would caution that the result of that test is only a small part of a much larger clinical picture, and we should be mindful that a normal result does not exclude serious infection.
Over the years of my clinical practice, many measures have come into force to ensure that the right antibiotic, appropriate for the infection and the patient, is used. One of those is limiting access to the newest antibiotics, and using them only in specific circumstances after discussions with the hospital’s consultant microbiologist. The measures have resulted in a more responsible use of antibiotics within the health service. However, as the O’Neill review identified, such stringent measures do not exist within veterinary medicine, and the use of antibiotics in farming accounts for about 40% of the UK’s consumption of antibiotics.
As a Member for a rural constituency and the wife of a farmer, I believe that minimising the growth of antimicrobial resistance through our agricultural practices is of great importance and must be tackled with the same vigour with which we have addressed the use of antibiotics in human medicine. The O’Neill review made a number of recommendations, including the responsible use of antibiotics in animals, restricting the use of antibiotics that are critical to human medicine, and disease prevention. An effective antibiotic monitoring system can have a huge impact on reducing the use of antibiotics, as shown by the implementation of such a system in the British meat poultry sector, which resulted in a 44% reduction from 2012 to 2015. Restricting the use in agriculture of antibiotics that are of the most critical importance to human medicine is vital to ensure their continued effectiveness. The Department of Health requires continued support to bolster the regulatory oversight of veterinary antibiotics, to ensure that they are used responsibly and to keep back the priority antibiotics.
Finally, we must support our farmers in methods to prevent disease by emphasising improvement in overall biosecurity and herd health, including through vaccination. It is important that we do our part to deal with antibiotic resistance, but we also need to recognise, as my right hon. Friend the Member for Tatton (Mr Osborne) said, that this issue can only really be solved with international co-operation and a push for awareness of the problem, not only at home but within the international community, to help develop the regulatory framework. Much talk is made of a cliff edge where drug-resistant bacteria will be able to defeat the entire arsenal of antibiotics, but we have already reached that cliff edge.
It is a great pleasure to see you in the Chair, Mr Streeter, and I congratulate the hon. Member for Thirsk and Malton (Kevin Hollinrake) on securing this important debate.
The O’Neill review is a fundamentally important look at the future of medical treatment not just in this country, but globally. TB is one of the most dangerous diseases worldwide and the most lethal infectious disease in history. As has been mentioned, 5,000 people die from it every day around the world and, as the review indicates, more than 10 million people will die from it annually by 2050 if we are not careful and do not contribute to the development of future research and vaccinations.
I am proud of the work of the all-party group on global tuberculosis and that of my co-chair of the group, the right hon. Member for Arundel and South Downs (Nick Herbert)—I think he has left the Chamber. We have had fantastic support from the Global TB Caucus and RESULTS UK. Both groups worked tirelessly to ensure the proper replenishment of the global fund last year. Eighty per cent. of the funding for the global fight against TB comes from the fund and Britain is the second largest donor. Still, at current rates, eradication will only be possible by 2167, which is not good enough—the speed we are going means that it will take 150 years to eradicate the disease. We have committed to eradication by 2030 but we are not doing enough to achieve it. Hopefully, the O’Neill review will be enough to drive forward the agenda that we need.
We have to work towards not just treatment, but vaccination. The standard treatment currently takes six months and 4,000 pills; it is no wonder that fewer than half of those who start the treatment complete the course. The difficulty of treatment drives AMR and the widespread nature of the epidemic. Hopefully, Lord O’Neill’s review will go some way towards raising awareness of how acute the issue of AMR is for some of the world’s poorest, even in this country. This and previous Governments have led the world on action on resistance. Let them again take up the mantle and drive forward the fight against AMR and help to secure a real vaccination against TB.
I am delighted to serve under your guidance, Mr Streeter, and I congratulate my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) on securing the debate. A disadvantage of being the only practising dentist in the House is having to remember that the Commission is watching, so I have to declare it, Mr Streeter.
As the right hon. Member for Rother Valley (Sir Kevin Barron) will know, as a dentist I am instantly lobbied by the likes of the British Dental Association, and I will stick to that area. As he said, around 10% of the antibiotics that are dispensed are for dental pains and dental problems. Hundreds of thousands of people swarm into GP surgeries and A&Es and they are given pills like lollipops to take away, but the solution is only temporary and does not solve the problem. To ask the Minister one small thing, will she think about working on a system to increase the number of emergency dentists that are available, because dental action, not pills, is needed?
Dental action can take many forms. Part of stopping the broad provision of antibiotics is straight prevention. In the case of dentistry, that is relatively simple. The cause of the majority of dental pain requiring antibiotics is decay and that is totally preventable. I am delighted that Sara Hurley, the new chief dental officer, is really moving on that issue. She is making changes so that kids are taught, from the moment that their teeth arrive right the way through to their school years, about brushing their teeth and using fluoride toothpaste to prevent decay. Many of the hundreds of thousands of patients who go into A&E are children suffering from swollen faces, pain, sleepless nights and so on. They are given antibiotics to tide them over until they have teeth taken out. In England, some 900 kids a week are given general anaesthetics to have their teeth out. That is appalling and preventable. I encourage the Minister to work with the chief dental officer, the health and wellbeing bodies and charities to prevent the need for any antibiotics—or at least, to reduce the antibiotics used—in dentistry by simply preventing dental decay.
It is a pleasure to serve under your chairmanship, Mr Streeter, and I thank the hon. Member for Thirsk and Malton (Kevin Hollinrake) for setting the scene.
I could not help but be shocked by the figures in the information that hon. Members received from the Library. The briefing stated:
“If we are unable to slow the acceleration of AMR, future consequences will be worse still.”
It also stated that
“10 million people a year could be dying as a result of AMR by 2050”.
Professor Dame Sally Davies has said that we could well
“return to a time where 40 per cent of the population die prematurely from infections we cannot treat.”
Those are the facts, so what do we do to solve the problem? I will try to hit on some solutions, and I look to the Minister for encouragement.
I want to highlight the work that has been done on the boundary of my constituency at the world-renowned Queen’s University Belfast. Researchers there are leading a €50 million Europe-wide project to develop new drug treatment to improve the lives of patients with cystic fibrosis and bronchiectasis. The inhaled antibiotics in bronchiectasis and cystic fibrosis consortium—the iABC—which is made up of world-leading lung specialists from across Europe, will develop new inhaled antibiotics to manage chronic lung infection, which is the main cause of disease and death in patients with cystic fibrosis and bronchiectasis. If we look across the United Kingdom of Great Britain and Northern Ireland for solutions and how to address the problem, we can see that we are doing a grand job on moving forward on this issue. The new antibiotics, which are being trialled over a five-year period and are being developed in response to the urgent need for new forms of inhaled antibiotics, are expected to improve patients’ quality of life by reducing lung infections and flare-ups, improving lung function and overcoming antibacterial resistance, which frequently occurs in patients with those conditions.
The consortium is also funded by the European Commission and involves some 20 organisations from eight countries across Europe. As Professor Stuart Elborn, dean of the school of dentistry, medicine and biomedical sciences at Queen’s University, said:
“There are limited antibiotics available to treat lung infection in cystic fibrosis and bronchiectasis, and the bacteria causing them are becoming increasingly resistant to current antibiotics.”
The work being done by Queen’s University has the potential to deliver inhaled antibiotics that will improve the quality of life and survival rates of cystic fibrosis and bronchiectasis patients. It is the latest example of the commitment of the researchers and staff at Queen’s University to advancing knowledge and changing lives by working with international experts.
We are looking at how we can best address these issues, so I ask the Minister to tell us what has been done on the partnerships that clearly operate between big business, universities and Government to ensure that the giant steps being taken by the likes of Queen’s University in Belfast can be replicated across the whole United Kingdom. If that can be done, we can solve the problem.
I declare an interest as a member of the board of the Liverpool School of Tropical Medicine. Indeed, I talked to Dr Adam Roberts who is a senior lecturer in antimicrobial chemotherapy and resistance there; he gave me some pointers to the things that he believes are extremely important in this work. I will touch on four of them.
The first thing, as others have mentioned, is to revitalise drug discovery. We are not talking about one or two drugs but 10, 20 or 30 new drugs. That is the scale of what is needed, particularly in the area of anti-Gram- negatives, because there is the least resistance to those drugs at the moment.
The second point, which has been made, is that the pharmaceutical industry as a whole should be involved. My hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) rightly said that many treatments, such as more intense chemotherapies, rely on the availability of good antibiotics so that patients do not suffer when their resistance levels are lower. Why should those companies not contribute to the development of antibiotics, if they are not doing so already? As we said, that is challenging commercially. Perhaps we could even look at a tax on those drugs to pay for antibiotics or some other way of raising revenue from those that do not participate.
Thirdly, a public education campaign, which has been mentioned, would help people recognise that antibiotics are not to be taken at every opportunity and that we should consider who is using them, particularly in meat production. I believe that one or two major companies in the United States have already started using meat reared without antibiotics, which I welcome. The fourth area, which has also been mentioned, is regulation of the sale of antibiotics online. It is a major loophole that must be closed, and the United Kingdom can play a role.
Finally, I draw a parallel with malaria, which the hon. Member for Glasgow North (Patrick Grady) mentioned. As a result of the development of rapid diagnostic tests for malaria, the use of the very effective anti-malarials has declined, because people no longer see anti-malarials as the only treatment that can be provided when their child gets a fever. Consequently, although resistance exists, it has become less of a problem in some places. Also, initiatives such as the Medicines for Malaria Venture have created a much stronger pipeline of anti-malarial drugs through co-operation among the pharmaceutical industry, charities such as the Gates Foundation, the United Kingdom and other Governments and the Global Fund to fight malaria, HIV/AIDS and tuberculosis. Such co-operation is critical.
I remind colleagues that this debate must conclude at 4.33 pm. Our winding-up speeches will begin now, but I hope that we will be able to give two or three minutes at the conclusion of the debate for the mover of the motion to have a final say.
It is a pleasure to serve under your chairmanship, Mr Streeter, and to take part in this important debate, which has been well informed and highly consensual. I am grateful to the hon. Member for Thirsk and Malton (Kevin Hollinrake) for securing it. This issue is one of the greatest global health challenges facing our generation. I agree thoroughly that it is potentially devastating and that it is already happening.
[Mr Philip Hollobone in the Chair]
Worldwide, antimicrobial resistance currently kills an estimated 700,000 people annually, and approximately 70% of known bacteria have developed resistance to one or more antimicrobials. The O’Neill review sends a clear and stark warning to us all that we must act for the sake of our economy and, more importantly, our health. Lord O’Neill estimates that by 2050, 10 million people globally could die each year because antibiotics are losing their power to tackle common infections, and that a quarter of those deaths will be caused by tuberculosis, whose attributes make TB bacteria more likely to develop resistance. It is worth noting that the O’Neill review final recommendations highlighted that
“tackling TB and drug-resistant TB must be at the heart of any global action against AMR.”
It is also projected that antimicrobial resistance could cut global GDP by 3.5% in the same time period, which amounts to $100 trillion. I am not even sure how many zeroes that is, but it is a frightening sum. Action is needed at a local, national and global level to improve knowledge and understanding of antimicrobial resistance, to conserve and steward the effectiveness of existing treatments and to stimulate the development of new antibiotics, diagnostics and therapies.
To those ends, the Scottish National party-led Scottish Government are taking their role seriously. Last March, the Scottish Government announced a £4.2 million research grant to investigate the prevention and control of healthcare-associated infections, as well as to research new ways of using existing antibiotics more effectively and efficiently. Scottish Government funding was provided to a consortium of researchers led by the University of Glasgow, working with other Scottish universities, to establish a new Scottish Healthcare Associated Infection Prevention Institute.
Antibiotics are not only critical for treating bacterial infections, they are a cornerstone of routine healthcare, as they prevent infections following surgery and cancer chemotherapy. In Scotland, more than 80% of antibiotic use is within primary care. Overuse and inappropriate use of antibiotics can unnecessarily increase the development of AMR. As limited new antibiotics are under development, it is vital that health professionals and the public work together to optimise how antibiotics are used to preserve their effectiveness for future generations.
Some progress is being made. The latest Scottish figures for 2015 show a 2.4% fall in one year in the number of antibiotics prescribed in primary care, a reduction of 84,490 items compared with 2014. As per the recommendations of the UK five-year antimicrobial resistance strategy, a Scottish “One Health” report will be published in 2017. The report will contain antimicrobial use and resistance data for humans, animals and the environment, in line with the aims of the global “One Health” approach, which spans people, animals, agriculture and the wider environment. There is little doubt that a present and serious challenge faces us; what is less clear is how best to tackle it.
It seems to me that we have two principal problems, both of which have been covered by hon. Members who have spoken in the debate. First, pharmaceutical companies do not have a financial incentive to develop new antibiotics. Even if a company invests in developing a new antibiotic, it needs to be held back until we are resistant to other antibiotics. However, while the antibiotic is being held back, the time on its patent is still ticking down, meaning that the company has less time to recoup the money that it has invested developing it. Therefore, the SNP would like the UK to accelerate its leading role in developing solutions to incentivise the development and management of new antibiotics, promote re-investment in antibiotics and appropriate use and reduce the risks for both payer and investor. I look forward to any comments that the Minister might have on that aspect.
Our second major problem is the use of antibiotics in livestock, which we then consume via the food chain. The evidence suggests that the amount of antimicrobials used in food production internationally is at least the same as in humans, and in some places is higher. For example, in the US, more than 70% of antibiotics that are medically important for humans are used in animals. This form of antimicrobial usage is likely to rise as a result of economic growth, increasing wealth and food consumption in the emerging world.
When properly used, antibiotics are essential for treating infections in animals, but excessive and inappropriate use of the drugs may be a problem. It is therefore important that we play our part in working towards the O’Neill recommendation of
“a global target to reduce antibiotic use in food production to an agreed level per kilogram of livestock and fish, along with restrictions on the use of antibiotics important for human health.”
The SNP encourages everyone to play their part in reducing the unnecessary use of antibiotics, raising awareness and pledging to be an antibiotic guardian. I have not yet followed the example of my hon. Friend the Member for Glasgow North (Patrick Grady) and registered, but now that I know it is easy to do, I will do it today.
In November 2015, Scotland’s Health Secretary, Shona Robison, said that the rise of drug-resistant infections is an issue that must be tackled in Scotland and around the world. Marking European antibiotic awareness day, Robison also pledged to be an antibiotic guardian, in a scheme run by a joint UK initiative to encourage everyone to become an antibiotic guardian by making a personal pledge. As part of European antibiotic awareness day, the Scottish Antimicrobial Prescribing Group, alongside UK partners, launched a target of 100,000 people signing up to become antibiotic guardians, including one in 10 prescribers and one in 100 other healthcare professionals.
Inevitably, any solution will have to be multi-factorial and involve a large range of stakeholders including Governments, non-governmental organisations, industry, the pharma, food and agriculture sectors, academia, research, health professionals and the public at large. If we become completely resistant to antibiotics, operations and procedures currently considered routine will become a lot more dangerous. The medical profession in Britain has become a lot better at not prescribing antibiotics unnecessarily. We must maintain that stance, develop it further and encourage others to follow.
My final plea to the Minister is not to allow UK contributions to international efforts to tackle AMR to become diminished. I seriously hope that the issue does not become a casualty of any post-Brexit isolationism.
It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate the hon. Member for Thirsk and Malton (Kevin Hollinrake) on bringing this important debate to the House. He gave an eloquent and knowledgeable speech clearly setting out the issue and the matters to be discussed following the O’Neill review. I thank him for that.
An estimated 50,000 deaths occur every year due to untreatable infections, rising to 700,000 globally. That is why it is only right that we do all we can to address antibiotic resistance. It is believed that the number of deaths will rise to 10 million a year by 2050 if no significant action is taken. As we have heard from a number of Members, deaths from drug-resistant infections could exceed deaths from cancer.
This is an incredibly timely debate. Only a couple of weeks ago, the World Health Organisation published a list of 12 bacteria for which new antibiotics are now needed. Some strains of bacteria have built-in abilities to find new ways to fight off treatments that can then be passed on to other bacteria via genetic material to make them drug-resistant too. I find it a bit scary to consider what we are up against. This is a battle that we have to win.
I also thank other hon. Members who have spoken in this debate. My hon. Friend the Member for Bristol East (Kerry McCarthy) gave a very knowledgeable speech about the use of antibiotics in farming; other hon. Members touched on the subject as well. I really think we need to get a firm grip on it internationally, with the UK leading the way. Ten other Members spoke in this very active debate: my right hon. Friend the Member for Rother Valley (Sir Kevin Barron), my hon. Friend the Member for Ealing, Southall (Mr Sharma), the hon. Members for Erewash (Maggie Throup), for Bosworth (David Tredinnick), for Glasgow North (Patrick Grady), for Sleaford and North Hykeham (Dr Johnson), for Mole Valley (Sir Paul Beresford), for Strangford (Jim Shannon) and for Stafford (Jeremy Lefroy), and the hon. Member for Linlithgow and East Falkirk (Martyn Day), who speaks for the Scottish National party. Their speeches were all thoughtful and knowledgeable, albeit brief because of time constraints.
I will touch on two key points: raising public awareness, and supporting research and innovation to combat antibiotic resistance. It is generally accepted that antibiotic resistance is a natural process—bacteria naturally evolve to become resistant to certain drugs used to fight them off—but it has been exacerbated by humans. As Dr Hsu of the Singapore Infectious Diseases Initiative has said, the causes come down to
“a single axiom—abuse and overuse of antimicrobial drugs.”
Concerns have also been raised that the development of new antibiotic drugs has dried up, contributing to the situation. According to the World Health Organisation, we are left in a precarious position. The WHO’s director general, Dr Margaret Chan, describes antimicrobial resistance as
“a crisis that must be managed with the utmost urgency.”
That urgency applies here in the UK, too. In 2014, the chief medical officer, Dame Sally Davies, said that
“we could be taken back to a 19th century environment where everyday infections kill us as a result of routine operations.”
We could be taken even further back: as the hon. Member for Thirsk and Malton said, this could be the new black death. That is not as melodramatic a statement as people may first think. Antimicrobial resistance is a really serious problem that we need to address here and now, so that those predictions do not come true.
I do not always do this, as I am sure you have noticed, Mr Hollobone, but I must give credit to David Cameron’s coalition Government, who were global leaders when they announced Lord O’Neill’s review into antimicrobial resistance. The review’s 10 recommendations show just how complex and multifaceted the issue is and how wide-scale the actions needed to address it are. The review’s final report was published in May 2016 and the Government responded at the end of last year, so now is a good time to ask the Government for an update.
One of the review’s key recommendations was to introduce a large-scale global awareness campaign to reduce the demand from patients to be prescribed antibiotics when they are diagnosed with an illness. I am a firm believer in public awareness campaigns relating to health issues, especially cancer. My hon. Friends and I fully support such a campaign for antimicrobial resistance and we want to see the Government working hard to achieve it. The review’s recommendation was for an international awareness campaign, but what does the Minister plan to do here in the UK to complement that international work? That is a pertinent question because a 2015 Wellcome Trust study found that people in the UK did not fully understand antibiotic resistance and how it affects their health. They did not understand that antibiotic resistance is to do with the bacteria in people’s bodies, rather than a lack of antibiotics or the cost of them; it is not just a case of doctors being awkward. I would therefore be grateful if the Minister told us what relatable public awareness campaigns she is planning to ensure that people understand more about the problem and about what they can do personally.
I have already mentioned the problems with combating antibiotic resistance caused by the drying up of innovative developments in drug technologies. The O’Neill review identifies that the low commercial return on research and development for antibiotics makes them less attractive to pharmaceutical companies and reduces the chance of new drugs being developed. To reverse that situation, it recommends considering market entry rewards to encourage companies to develop new or improved drugs, especially in areas of urgent need. I hope the Minister will explore that issue further in her reply.
Public and private funding is being made available to help to combat these issues. On 20 December, the Minister referred to
“international programmes to tackle AMR, including the Fleming fund and the Global AMR innovation fund, which represent more than £300 million of investment over the next five years.”—[Official Report, 20 December 2016; Vol. 618, c. 1294.]
There is also the incredible work of the Longitude Prize, which is in the middle of its competition to develop
“a cheap, accurate, rapid and easy-to-use point of care test kit for bacterial infections”
to help to address antibiotic resistance. That is important work and we support it.
In summary, we cannot afford to get antimicrobial resistance wrong. Millions of lives depend on our tackling it. It is not far away; it is happening right here, right now, and it affects us all, so it is important that we do all we can to address this growing problem, both in the UK and internationally.
I congratulate my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) on securing this very well attended debate and on his ongoing commitment to highlighting this issue. I pay tribute to the all-party group on antibiotics, my hon. Friend the Member for York Outer (Julian Sturdy) and the right hon. Member for Rother Valley (Sir Kevin Barron) for their leadership. I also commend my right hon. Friend the Member for Tatton (Mr Osborne), who is no longer in his place. He really set the issue squarely on the international agenda during his time as Chancellor.
As many hon. Members have described well today, antimicrobial resistance has the potential to lead to 10 million deaths by 2050—more than are caused by cancer—and a loss to global productivity of £100 trillion. As my hon. Friend the Member for Thirsk and Malton said, the figures are on a scale that is hard to comprehend, but the good news is that the ramifications of AMR are now widely acknowledged, and we can be proud that the UK has played no small part in that. Our chief medical officer, Dame Sally Davies, has led a global campaign to get AMR and the lack of new drugs in the development pipeline high on the global political agenda.
We have used the UK’s antimicrobial resistance strategy and our response to the O’Neill review, which we published last September, to drive change at home and abroad. This has led to the landmark UN declaration on AMR in September, which was adopted by 193 countries. The declaration recognises that AMR is an issue that relates not just to human health, but—as my right hon. Friend the Member for Chipping Barnet (Mrs Villiers) and the hon. Member for Bristol East (Kerry McCarthy) rightly said—to animal health, agriculture and the environment, with a significant social and economic impact. It puts AMR squarely not just on the global development agenda, but on the global security agenda.
As numerous hon. Members have mentioned, a key Government commitment in response to the review was to work with international partners to develop a global system that rewards companies for bringing new, successful products to market and makes them available to all who need them. There are a number of options for addressing the market failure, but the O’Neill review suggests using a system of market entry rewards to incentivise companies to bring new products to market. A number of international organisations, including the Boston Consulting Group, commissioned by the German Government, have looked at the issue more recently and come to similar conclusions, which is helpful in building an international consensus.
The UK supports that approach, particularly options that involve private sector contributions, but although a global solution is needed, different countries have different perspectives. In some countries, lack of access to effective antimicrobials is as great a risk as resistant bugs. The WHO estimates that 30% of people in developing countries do not have access to essential medicines, rising to 50% in sub-Saharan Africa. The UK is working to reach an agreement at the G20 to acknowledge market failure. The G20 has commissioned the OECD to consider potential solutions, and it will consider a range of options. The UK will support alternative systems that can effectively tackle market failure in a cost-effective and sustainable manner that ensures a long-term, sustainable supply of new antibiotics but also provides access to all.
While Lord O’Neill made it clear that interventions to stimulate the antimicrobials market should be administered at global level, he was also clear that at national level we must have better purchasing arrangements that conserve antimicrobials and do not incentivise unnecessary use. That is why the Department of Health is working with industry, through a joint working group with the Association of the British Pharmaceutical Industry and the National Institute for Health and Care Excellence, to consider reimbursement approaches that support these aims and how reimbursement models that de-link revenue from volume can be operationalised. It is essential that such a scheme is workable, so I will report back to Members when I am able to do so.
Colleagues are right that we will not make progress if we do not improve our stewardship and diagnostics, and cut avoidable infections and inappropriate prescribing. One of our ambitions in that regard is to halve the number of healthcare-associated Gram-negative blood stream infections by 2020. Delivery of that ambition is being led by NHS Improvement. Our initial focus is a 10% reduction in E. coli infections by 2017-2018, because there are established interventions to prevent such infections, and we are making some progress in this area.
A second ambition is to halve inappropriate prescribing by 2020. This work is now being led by the chief pharmaceutical officer at NHS England, with support from Public Health England, but the challenge is to identify the proportion of current prescribing that is inappropriate, so that we can safely reduce our use. Our experts are working to set a baseline, so that we can clarify our ask to prescribers. This will build on work that is already under way to reduce unnecessary prescribing.
I can report that there has been some progress in this area. In November 2016, data showed that total consumption of antibiotics by humans in England fell by 4.3% between 2014 and 2015, which is the greatest change that we have seen since the early 2000s. We are making progress, but our experts believe we can go further so we have put incentives in place through the NHS quality premium and commissioning for quality improvement schemes—which is quite a mouthful—to encourage further reduction, and we will maintain that system for a further two years, so that we can embed those changes.
My hon. Friend the Member for Thirsk and Malton also said that over-the-counter antimicrobials were a key area. It is illegal for websites based in the UK to sell antibiotics online without a prescription. Some websites offer online consultations with doctors, but they must abide by the General Medical Council guidance on remote prescribing, and it is extremely important that people exercise caution in how they use online care providers, especially when it comes to seeking medicines or treatments that may not be appropriate for them.
Regulatory agencies, such as the Medicines and Healthcare Products Regulatory Agency and the Care Quality Commission, are monitoring the safety and efficacy of prescription medicines and those selling them. Following an internal review of all 43 online services that are registered, the CQC has brought forward a programme of inspections, prioritising those services that it considers might pose a risk to patients. It will obviously report soon on that work.
My right hon. Friend the Member for Chipping Barnet and the hon. Member for Bristol East were absolutely right that the Department of Health needs to work closely with the Veterinary Medicines Directorate to reduce the use of antimicrobials in livestock and in fish farmed for food. Between 2014 and 2015, we saw a drop of 10% in sales of antibiotic for food-producing animals, but we know that we need to go further. So we are now in the process of setting sector-specific targets, as my right hon. Friend the Member for Chipping Barnet said, to ensure that we achieve our ambition of 50 milligrams per kilogram weight of animal by 2018.
My hon. Friend the Member for Erewash (Maggie Throup) was also right to highlight the need for better diagnostics if we are to achieve our stewardship ambitions. O’Neill was clear that that was necessary for better clinical decision making in both animal and human health. There is great potential to make better use of the diagnostic tests that are already available in a range of settings, including for self-care and monitoring in pharmacies and other high-street services. So NHS England has a programme in place not only to improve the use of the diagnostic tests that we already have but to identify the priority needs for new tests, so that we can work with researchers and industry to support the development and uptake of those tests. NHS England is also working with NICE to identify how its programmes could support more rapid uptake of effective diagnostic tests. If my hon. Friend would like us to, we will write to her with the details of that work.
In the end, this challenge is a global one that requires global leadership, as my right hon. Friend the Member for Tatton has said. The UN declaration was the start of a longer process to make sure that all countries develop and implement a national action plan, and it is essential that the follow-up process, which was agreed in the declaration, is put in place as soon as possible, to ensure that no time is lost in getting to where we want to be before we go back to the UN General Assembly in 2018. Within that timeframe, we will continue to support other countries to tackle antimicrobial resistance, including providing help to build capability and capacity to develop good surveillance systems in low and middle-income countries, through our £265 million Fleming fund and our £1 billion Ross fund, exactly as the hon. Member for Glasgow North (Patrick Grady) has said.
Lord O’Neill also recommended the establishment of a global innovation fund of $2 billion by 2020. The UK co-hosted a side event at the UN in September 2016 that brought together a package of pledges from Governments around the world to tackle AMR, totalling more than £675 million, which is a really considerable start in achieving that recommendation.
All of this work means that we now have unprecedented levels of global collaboration in research in the UK, co-ordinated by the AMR Funders Forum and supported by the Medical Research Council. We are now working hard to promote research and innovation in AMR globally, which includes making a further £50 million commitment towards setting up a global AMR innovation fund, to increase global investment in AMR and support the development of new drugs and diagnostics.
In closing, I thank all Members—
I will close now but follow up later.
I thank all Members who have attended today. The high turnout and the quality of debate speaks to the fact that AMR is more than a domestic health challenge and more than a global development challenge. It is truly a global security challenge, of a scale that requires long-term political leadership to drive through the international change, the up-front investment to break the cycle of market failure in drugs development and the urgent action needed to improve diagnostics and cut inappropriate prescribing, and to ensure that patients complete their courses of medicines in an appropriate way.
We can be proud of the genuinely leading role that the UK has already taken, both domestically and on the international stage, but my commitment to all Members here today is that we shall not miss a step in driving forward on research and development, on stewardship and on international co-operation. As a science superpower with an integrated healthcare system, we are uniquely well placed to meet this challenge and we are determined to do so.
Before I ask Kevin Hollinrake to sum up, I detect that there may be some Members in the Chamber who are here for the debate on social care in Liverpool. We have a half-hour debate on student loans before we get to that debate; everything has been held up by the Divisions in the main Chamber. I am just trying to be helpful to Members who might here for another debate.
It is a pleasure to serve under your chairmanship, Mr Hollobone.
I thank the many colleagues who have contributed this afternoon to a very constructive debate; there has been a lot of consensus in this Chamber about what needs to be done. I also thank the Minister for her clear and comprehensive response to the many points that have been made; for the commitment she expressed at the end of her response, which is very reassuring; and, of course, for her great knowledge of this area.
It is quite clear from all the contributions that we have heard today that there is no one solution to this issue. There will have to be a holistic solution—a mix of solutions— across both the health and agriculture sectors; that point has been very clearly made this afternoon. That will also involve the different research laboratories that can contribute to this process. Obviously, the big pharmaceutical companies are a key element in making sure that we have the right remuneration mechanism for them and of course, our world-leading universities will also be involved, as well as other clinical institutions.
However, as I said earlier, the third sector is also important. Having the world’s first and only charity that specialises in combating antibiotic resistance in my constituency, I obviously feel honour-bound to support its fantastic activities. It is a collection of some of the UK’s top scientists. It has put an awful lot of work and money into this area, and its initial research has gone very well, using resistance breakers to repurpose antibiotics. Again, that is a key recommendation in the O’Neill review. As I say, the charity is making this progress and it is absolutely desperate to get the right kind of support. Any help we can give, in terms of pointing Antibiotic Research UK in the right direction to get the sources of funding it needs, would be useful. Its approach is innovative. It perhaps does not meet all the criteria that would normally be applied for this kind of research, but I absolutely believe that ANTRUK is certainly part of the short-term solution to this problem, if not the longer-term solution.
As others have already done, it is right that I thank Lord O’Neill for his tremendous work, as well as all the other people who contributed to his report. It is fair to say from what we have heard this afternoon that all the questions and answers are in the report; we just need to ensure that we execute well and follow through on the recommendations in the report.
As my right hon. Friend the Member for Tatton (Mr Osborne) said, leadership is a key part of this issue. We were very lucky with the former Prime Minister and the former Chancellor, who put it front and centre. They took global action and showed global leadership on it, which is critical. With leadership, all things are possible; there is no question about that. It is incredibly important that we continue to show that leadership in Parliament and Westminster.
It was tremendous to have so many contributions to this debate, not only from the Minister and former Ministers, who have so much knowledge of this area, but from those who have shown leadership at the highest possible level. It is great to see the UK front and centre, speaking out on this important issue on the world stage.
I thank you again, Mr Hollobone, for your time. It has been a pleasure to serve under your chairmanship and to contribute to this very important debate.
Question put and agreed to.
That this House has considered the O’Neill review into antibiotic resistance.