O’Neill Review

Martyn Day Excerpts

Tuesday 7th March 2017 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

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.