Antimicrobial Resistance

Maria Caulfield Excerpts

Wednesday 17th April 2024 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Mr Dowd. I thank my hon. Friend the Member for Colchester (Will Quince) for securing today’s debate, for his contribution to the Department of Health and Social Care during his tenure as a Minister and, in particular, for his work on this issue.

This is a pivotal year for confronting antimicrobial resistance, because the emergence of resistant infections is relentless and, as my hon. Friend eloquently described, the pipeline for new antibiotics is running dry. The evidence is stark, not just domestically but globally: more than 1 million people die every year from infections that have become resistant to treatment. To put that number in context, that exceeds the number of people who die from HIV or malaria.

AMR is sometimes described as an ignored pandemic, but if we do not act, the cost of treating resistant infections could compare to having a pandemic such as covid-19 every five years. My hon. Friend is absolutely correct to say that, if we were to walk outside this place, many of the people we talked to would not understand what AMR is or appreciate the consequences of not dealing with it domestically or internationally. That is why we are committed to addressing antimicrobial resistance.

My hon. Friend is also right that in 2019 we published our vision for antimicrobial resistance to be contained and controlled by 2040, and that date looms ever closer. That vision recognises that it is a complex problem. There are three tiers to the way we are tackling it. First, we must lower the burden of infection in humans and—my hon. Friend touched on this slightly—in animals: if you do not get the bug, you will not need the drug.

Secondly, we must use antimicrobials only when they are absolutely needed, and we should use them correctly. That is also true for both people and animals, as I will touch on in a moment. Thirdly, we must develop new antibiotics or new technologies to treat these infections so that we have more tools in our armoury as resistance emerges.

We can all play our part. I make a public health plea to everyone: we all have a responsibility to finish courses of antibiotics prescribed to us—often, we do not finish our course, because we feel better and think there is no need to take the rest of it, but that is a key way of developing resistance—and not to self-medicate after keeping the strip, which is equally harmful. There are bad practices in other countries, but we all have a responsibility to take our antibiotics as prescribed, and not to self-medicate, should we have some antibiotics looming in our cupboards.

[Richard Foord (Tiverton and Honiton) (LD)]

I am grateful to the Minister for giving way and I pay tribute to the hon. Member for Colchester (Will Quince) for securing the debate. On a brilliant Radio 4 documentary called “Swimming in Superbugs”, Dr Anne Leonard of the University of Exeter Medical School talked about her Beach Bums project and said that people who use the sea are three times more likely to have antibiotic bacteria in their gut. Does the Minister agree that we should not import human sewage sludge to spread on farmland, given that we think traces of antibiotic resistance material might have ended up in the sea?

[Maria Caulfield]

That goes back to my first pillar of reducing and preventing infections in the first place. We need to do that domestically, but internationally we are also doing huge amounts of work in that space to improve water sanitation. With animal health, too, we have done a huge amount of work, in particular on antibiotic use in food. Among animals used in food production, the UK has reduced by 59% the amount of antibiotics going into the food chain, which has a knock-on effect.

We are also investing in innovation and capitalising on our world-leading science, including phage therapy, as my right hon. Friend the Member for Tunbridge Wells (Greg Clark) pointed out. I had not heard about the Leamington Spa facility, and I am interested to catch up with him after the debate to see what more can be done. The National Institute for Health and Care Research is investing almost £90 million in that type of research, so if there is potential to develop that further, we are always keen to hear it. Our plan is cross-sectional, a one health approach, recognising the links between the health of humans, animals and the environment, and the spread of resistance between them.

We have a national action plan, which is not limited to activity in the UK. We all know that infections do not respect borders. As my hon. Friend the Member for Colchester said, we are therefore working internationally and taking a lead in many elements of that across the global community, with our UK special envoy on antimicrobial resistance, Dame Sally Davies, spearheading some of the effort. On updating my hon. Friend on the action plan post 2024, we are working it up as we speak and hope to make an announcement soon. There is an ongoing piece of work to drive forward some of the changes across the three sectors.

We are doing our bit here and are leading internationally, but my hon. Friend also touched on what is happening in other countries. Low and middle-income countries have to be part of the change so that we can safeguard ourselves against antimicrobial resistance.

[Jim Shannon]

One of the groups that I speak to reminded me to mention—I quote—

“the need for Group B Strep screening in pregnant women during labour instead of using antibiotics for all routinely.”

The Minister is interested in that subject and has an opinion on it. Does she agree that this is a chance to raise awareness of that particular issue?

--- Later in debate ---

[Maria Caulfield]

The hon. Gentleman is absolutely right. I will touch on how much more we can do with screening to prevent some infections. This cannot just be about developing new antibiotics; it is about preventing infections and screening for them in a range of scenarios.

To touch on some of the high prevalence internationally, 89% of all antimicrobial resistance deaths occur in Africa and Asia, so we have responsibility to ensure that we help out in those countries that struggle most with the issue. We must continue to ensure that people around the world have access to the antibiotics they need, which is why the £40 million in innovative research through the global AMR innovation fund that my hon. Friend the Member for Colchester mentioned is so crucial. It enabled the development of a new antibiotic for drug-resistant gonorrhoea, the first in 30 years.

The hon. Member for Tiverton and Honiton (Richard Foord) touched on the role of water, which requires an international effort. Sanitation is often a leading cause of infection in other countries. That is why we are working hard with other countries and the WHO to improve water sanitation and hygiene to reduce infections occurring in the first place.

In 2022, we made a further £210 million commitment for the second phase of the Fleming Fund to strengthen our surveillance systems. As the hon. Member for Strangford (Jim Shannon) said, it is not just about treatment, but about picking up infections and trends and trying to prevent them in the first place. The Fleming Fund is having an impact. Since 2015, over 240 laboratories have been upgraded with state-of-the-art equipment, training and new systems, and over 75 national action plans on AMR have been developed in Africa and Asia to try to get the death toll from antibiotic resistance down. The Fleming Fund leverages UK expertise, with over 3,000 healthcare workers being trained in antimicrobial surveillance principles through a partnership with the NHS.

Looking ahead, we recognise the risks. We are not being complacent either domestically or internationally. Through the hard work of my hon. Friend the Member for Colchester, we have put some good building blocks in place, but we need to look to the future. Our next five-year antimicrobial resistance national action plan will be published later this year.

[Greg Clark]

I am grateful to the Minister for what she said about phages. She knows that UK science is world-leading, especially in this area. In Imperial College alone, there are 180 researchers working on AMR. One such researcher, Professor Jonathan Cook, has noted the real benefits of point-of-care testing and the fact that other countries, including the Netherlands, have managed to make a big impact. Can the Minister say whether we have plans to accelerate the availability of such testing in this country?

[Maria Caulfield]

My right hon. Friend makes a good point, which I will take away and follow up on. There are some really good examples in primary care where some testing is done. Primary care nurses particularly will do point-of-care testing to see whether someone’s infection will be sensitive to antibiotics or not. I believe there is more we can do in that space, both in primary and secondary care, so I am happy to write to him about how we can roll that out nationally. Importantly, that testing helps to maintain patients’ expectations. I cannot remember who, but someone said that people go along to GPs and expect to be given antibiotics. Point-of-care testing will be able to reassure them that they either do or do not need antibiotics and tell them which type is best suited to their type of infection. That is crucial.

Our plan will set out an ambitious programme of work, learning from covid-19 in testing, surveillance and treatment to prepare for infections of the future. I can reassure my hon. Friend the Member for Colchester that we will continue to collaborate internationally with organisations such as the WHO and use our soft power to help to support in particular African and Asian nations, which are suffering greatly from the mortality of antimicrobial resistance. This is a hidden pandemic that will have consequences for us all if we do not deal with it.

Question put and agreed to.