Drug-Resistant Infections

Earl of Selborne Excerpts

Thursday 15th September 2016 Lords Chamber

[The Earl of Selborne (Con)]

My Lords, the House will be most grateful to my noble friend Lord Lansley for giving us the opportunity to debate the report and recommendations of the review on antimicrobial resistance, chaired by my noble friend Lord O’Neill, to whom we are all greatly indebted.

In the short time that antibiotics have been available to clinicians, the United Kingdom has played a leading role in their development, and indeed in the development of diagnostics, vaccines and other products vital for the prevention and treatment of infection. I say “short time”, because the first clinician to witness the miraculous potential of penicillin was Charles Fletcher, in February 1941, when he was working as a research student for Professor Howard Florey—later of course Lord Florey, and a Nobel Prize winner along with Sir Alexander Fleming. Professor Florey gave him the task of testing whether it was safe to give penicillin to patients. Told to find the worst case of bacterial infection in the Radcliffe Infirmary, he chose an Oxford policeman who had been infected after a scratch on this face due to contact with a rosebush. After four days of treatment, he was on the way to making a full recovery—it was totally remarkable. But then of course the penicillin supplies ran out, as there was no industrial process for producing this material, and the patient relapsed and never recovered.

As my noble friend reminded us, Sir Alexander Fleming and others warned us of the danger of resistance, which he was aware of soon after his epic discovery of the antibiotic properties of the mould Penicillium notatum way back in the 1920s. It remains a total mystery to me, incidentally, how apparently rational people around the world can witness the remorseless advance of resistance within microbes and yet reject the concept of Darwinian evolution; there it is, in all its clarity.

Now, thanks to this highly influential review, commissioned by our Government, the United Kingdom is continuing its leading role in developing strategies on a global scale to meet the challenges of rising drug resistance. Like the noble Lord, Lord Rees, I pay tribute to the role of Dame Sally Davies in keeping this on the agenda both nationally and internationally.

At the World Economic Forum at Davos in January, the global pharmaceutical industry signed up to what was described as the declaration on combating antimicrobial resistance, which called on Governments around the world to do more than just issue statements of intent and to take concrete action, in collaboration with the companies that had signed up, to support investment in the development of new products to meet the challenges of rising drug resistance. The review has suggested one-off payments to firms that develop drugs that meet predefined criteria of unmet needs, to be paid on top of sales revenue. Not surprisingly, the 85 companies that signed up to the declaration at Davos supported that proposal, and said that if Governments offered them money they would do everything they could to earn it.

Clearly, the business model of expecting new antibiotics, or other products developed at great cost, to be funded by sales is doomed to fail—there is bound to be a market failure. These new products need to be kept as a last line of defence against so-called superbugs and held in reserve for the most difficult cases. Any incentive to maximise sales would be perverse in the extreme. We have heard already about the issues of the irresponsible use of antibiotics in agriculture. One such new treatment is colistin. Last year, genes resistant to this new treatment were discovered in hospital patients in China, and the agricultural use of colistin is thought to be responsible.

If, in the words of the Davos declaration, we are looking to Governments for concrete action, the first priority for our Government in the UK must be to run out a model for the UK that delinks payments for antibiotics from the volume of sales. If such a model could be piloted by, say, 2017, that would be concrete action indeed. It would also be a great stimulus to British innovation, which remains a world leader in the field. That does not apply just to large pharmaceutical companies; quite modest-sized companies are involved as well.

The review calls for the establishment of a global innovation fund for early-stage and non-commercial research, a highly important recommendation and potentially of great significance to all companies that are innovating in this area, particularly to small firms that struggle to comply with the funding arrangements of organisations such as Combating Bacterial Resistance in Europe, the Innovative Medicines Initiative and other funding sources.

The appalling story of colistin-resistant bacteria, attributed to agricultural use, emphasises the importance of the review’s recommendations on antimicrobials in agriculture, on which it published a report in December 2015. The review says that,

“in some parts of the world antimicrobial use is far greater in animals than in humans; in the US, for instance, more than 70 percent of medically important antibiotics are used in animals … Much of the use of antibiotics in animals is not therapeutic … Instead, significant volumes are used either prophylactically amongst healthy animals, to stop the development of an infection within a flock … or simply for growth promotion”.

That is a scandalous state of affairs.

The review proposes three broad interventions to take bold global action to substantially reduce the use of antibiotics in agriculture. This is a global issue; to be fair to the EU, in some ways it has led the field from what was an appalling situation, not just in livestock production but in fish farming, which was absolutely scandalous. We need global action. The proposals in the review were, first, to set global targets to reduce antibiotic use in food products; secondly, the rapid development of minimum standards to reduce antimicrobial manufacturing waste released into the environment—that is a pause for thought; can you really imagine antimicrobial waste being released into the environment? It has happened—and, thirdly, improved surveillance and monitoring to check progress against global targets, which was referred to earlier.

The pharmaceutical companies that signed up to the Davos declaration accepted their responsibility in delivering at least some of these measures, alongside the Governments, who also have to deliver. However, I am not persuaded that the language of the declaration, prepared by the global pharmaceutical industry, is totally appropriate. It calls for,

“more judicious use of antibiotics in livestock”.

That does not sound very robust. The overuse of antibiotics in livestock husbandry is not just injudicious; it is scandalously irresponsible. Immediate action by the companies that sell such products is urgently required, as well as by those Governments who allow it.

The ball is now in the court of the G20 Finance Ministers. As my noble friend said, we have to move from statements of intent to concrete action. We look forward to the United Nations high-level meeting on 21 September. The members of the review team, led by my noble friend Lord O’Neill, have potentially done a wonderful service for patients around the world in setting out its list of 10 specific actions to be followed up by Governments. It is now time for their wise advice to be followed by concrete and timely actions.