Parliament: A Longterm Approach to Tackling Antimicrobial Resistance

Yesterday I responded to a debate about Tackling Antimicrobial Resistance 2019-2024: the UK’s five-year national action plan. Like Climate Change, AMR is one of the greatest global health risks facing us today. Unchecked it will cost the world economy $1tn by 2030 and lead to millions of preventable deaths. This is why it is vital the UK delivers on the commitments of the national action plan and maintains its globally recognised leadership role on this agenda. The future health of each and everyone of us is depending on our success.

‘My Lords, I thank my noble friend Lord Lansley for securing a very important debate which has been filled with expertise and wisdom from all sides. I am grateful to him for saying that, if he could, he would have chosen to make this a “take note with approval” debate, which is not always the case when debating a government strategy.

My noble friend is right that antimicrobial resistance is one of the most pressing global challenges that we face in this century. Unchecked AMR threatens the achievement of many of the sustainable development goals, including those affecting health, food security, trade and labour supply. The World Bank estimates that an additional 28 million people could be forced into extreme poverty by 2050 through shortfalls in economic output unless resistance is contained.

In recognition of the threat of AMR, we published the strategy in 2013 and, as my noble friend has rightly said, we can count many significant achievements over the five years since. I pay tribute to him for the role he played in developing it before he moved on. We have seen unprecedented levels of research investment and collaboration, with £350 million having been invested since 2014. We have also reduced antibiotic use in humans by 7.3%, as he noted, and as the noble Lord, Lord Trees, who is an expert in this area, rightly pointed out, sales of antibiotics for use in animals ​have reduced by 40%. However, the noble Baroness, Lady Masham, said that this is of value only alongside the development of comprehensive surveillance systems, which we have also been putting in place.

Finally, resources and campaigns have been delivered for front-line staff. As the noble Baronesses, Lady Redfern and Lady Walmsley, said, they have an essential role to play in changing the culture and communicating with the public. I would like to point to a particular tool which has been developed, known as “Treat Antibiotics Responsibly Guidance, Education and Tools”. It turns into a fantastic acronym—TARGET—which I know the noble Baroness, Lady Thornton, will like. It is a toolkit of evidence-based resources to help clinicians and commissioners in England to reduce inappropriate antibiotic prescribing. Some 99% of CCGs promote this to their GP practices. I hope that responds to the question raised by the noble Baroness.

However, we must be up front about the scale of the challenge that AMR presents here at home, let alone in developing countries. As has been noted in the debate, resistance continues to increase. Between 2013 and 2017, we saw a 35% increase in resistant infections in humans here in the UK. Just as my noble friend says, this is a dynamic problem that requires a dynamic response. However, I would like to reassure the noble Baroness, Lady Masham, on her questions about Candida auris. It can establish itself within the hospital environment and be difficult to control, but currently the NHS has no persistent outbreaks. It is an uncommon fungus in the UK and our surveillance shows a low risk to patients in healthcare settings. No multi-drug resistant strains have been identified and there have been no deaths in NHS hospitals.

In order to respond to the dynamic challenge we face, the Government have recognised that no single five-year plan could deal with it, so we have set out our vision for a world in which AMR is contained and controlled by 2040 and we will continue to play our part in tackling the global problem of AMR by modelling best practice at home. Further, by supporting progress internationally through strong action to prevent infection generally, we will contain the emergence and spread of resistance. Alongside this vision we have published a five-year AMR national action plan which sets challenging five-year ambitions that will begin to fulfil the vision.

I would like to reassure the noble Baroness, Lady Thornton, on the question she raised regarding the workforce. Unlike the NHS Five Year Forward View, the NHS Long Term Plan commits to implementing the AMR national action plan which sets out to assess current and future workforce needs for strong infection prevention and control as well as antimicrobial stewardship. This should ensure that we develop the correct workforce targets. This is reassuring in terms of hoping we can achieve the priorities we have set out in the plan.

Our new plan includes a strengthened focus on infection prevention and control, renewing our commitment to halve levels of healthcare-associated Gram-negative bloodstream infections by 2023-24. It includes a world-first target to reduce the actual numbers of resistant infections, with an aim to reduce them by 10% by 2025. We will go further on our previous ambition to reduce antimicrobial prescribing, reducing ​it by a further 15% by 2024, strengthening stewardship programmes and raising public awareness, while ensuring rapid and timely treatment with antibiotics where it is essential to save lives. Through greater interoperability of data, we will develop real-time, patient-level prescribing and resistance data to inform antibiotic treatment, optimise life-saving treatments for serious infections and help develop new interventions to reduce AMR.

The noble Baronesses, Lady Masham and Lady Walmsley, are absolutely right that better use of diagnostic testing is essential. However, we found many challenges in this area over the last five-year period with the previous plan. We believe that, through data linkage work, by 2024 we will know which diagnostic tools and tests have been used in support of every prescription for antibiotics and will be able to target improvement. There is also further research work going on, which I will come back to.

The noble Baronesses, Lady Greengross and Lady Walmsley, and the noble Lord, Lord Trees, raised the important issue of vaccines for humans and animals, which play a key role in tackling AMR. One of the nine ambitions for change set out in our 2040 vision is to minimise infections in humans and animals. Optimising the use of effective vaccines will be critical in achieving this ambition. The national action plan includes commitments to stimulate more research into and promote broader access to vaccines. One of the ways in which we are doing this and supporting the development of the uptake of vaccines in lower and middle-income countries is through the Global AMR Innovation Fund and the UK vaccine network, as well as through our significant contributions to Gavi, the Vaccine Alliance and, more recently, through CEPI, the Coalition for Epidemic Preparedness Innovations—which, we understand, is having a significant impact on the pipeline.

My noble friend Lord Crathorne raised the question of the use of antibiotics as growth promoters. He was rather put right by the noble Lord, Lord Trees, but I will just repeat for the sake of certainty that since 2006 antibiotics for use as growth promoters have been banned in the UK and Europe, and they will continue to be.

This brings me on to a point raised by the noble Baronesses, Lady Miller and Lady Thornton, and a point of clarification on the response to Kerry McCarthy. The Government have confirmed their intention to implement their restrictions on the preventative use of antibiotics in line with EU legislation, but this will require a consultation with all interested stakeholders following the usual processes when amending domestic legislation. I hope that is a reassuring clarification. If noble Lords would like to follow up in writing, I shall be happy to respond on that.

I will respond to a follow-up point that also came from the noble Baroness, Lady Miller, and the noble Lord, Lord Trees, regarding trade agreements and AMR. I assure the House that any future trade agreements must work for consumers, farmers and businesses in the UK, and we will not water down our standards on food safety, animal welfare or environmental protection as part of any future trade deal. I hope that is a reassuring response.​

I hope the noble Lord will forgive me, but following the debate I shall raise his point regarding AMR funding associated with the Agriculture Bill with the Minister and return to him.

I will now move on to the question regarding research and treatment development. Building on our research co-ordination and collaboration, we must continue to invest in research and to support the development of new, alternative treatments, vaccines and diagnostics. As noted by noble Lords from across the House, this is clearly essential if we are to make progress on the aims we have set out in what is rightly an ambitious plan.

Significantly, as my noble friends Lord Lansley and Lord Crathorne point out, the plan includes a commitment to lead the way in testing solutions that address the failure of companies to invest in the development of new antimicrobials. We are the first country in the world to announce that we will test new models that pay companies for antibiotics based primarily on a health technology assessment of their value to the NHS as opposed to the volumes that are used. This is an exciting and important step and we must fight hard to push it forward.

The noble Baroness, Lady Walmsley, asked about timelines. NICE and NHS England are leading on this complex work and a core team of experts and specialists are already in place. There is no delay in pushing forward this work. We anticipate it will take 18 months to two years to complete. The current NICE appraisal processes take about 49 to 60 weeks but this project requires a bespoke process to deal with the complexity of considering the full dimensions and value for antimicrobials. I look forward to reporting back to the House as the project continues.

We are sharing our learning with other countries and encouraging them to do the same or similar. I hope that we can push for this to be raised in international fora, as it is only when these kinds of pilots happen on a global scale that we can hope to see real progress. We hope that the data generated from this work will help other countries to think about how they value these precious drugs and how we can work with the industry to overcome market failure.

A number of noble Lords raised the question of a global fund. We have made some initial progress with the Global AMR Innovation Fund, GAMRIF, which has been set up. We are pushing at every opportunity to improve collaboration and to get support for it. However, it is a challenging picture and I hope to be able to report more progress in coming months.

On co-ordination, the national action plan was co-developed across government departments, agencies, the health family and the devolved Administrations, with an input from a wide range of stakeholders. We intend to continue in that vein as it is the only way in which we will make effective progress. The UK has played a lead role in strengthening international co-operation to tackle AMR, not least in securing the UN declaration at the General Assembly in 2016.

I pay particular tribute to the noble Lord, Lord O’Neill, for his ground-breaking early work and expertise in this area. I join others around the House who have paid tribute and expressed gratitude to Dame Sally Davies in advance of October. She has been a driving ​force on the global stage on this agenda. I have no doubt that, whatever happens in the autumn, her leadership will continue from Cambridge and beyond. It will be of tremendous value to the United Kingdom and everywhere else that she goes.

Whether it is getting it right with new antimicrobials and getting them through the pipeline or it is supporting the development and testing of rapid point-of-care diagnostics, the Government are clear that we want to improve the whole system. I am pleased to update the House: today I announced a new and expanded accelerated access collaborative to serve as an umbrella organisation for UK health and innovation. The new AAC will work with patients and the system to pull through the best and most cost-effective innovations, to get them to clinicians and patients faster than ever before. This includes the use of digital tools and health tech alongside the best new medicines. From new diagnostic tools to better identify people who need treatment, to improved ways of monitoring usage to ensure that patients complete treatment courses, together these innovations will help to address the growing threat of AMR.

I hope that with this information I have covered the points raised by noble Lords today. We can be proud of the work that we have done in the UK to secure AMR on the global agenda, not only as a health issue but as a “one health” issue with an enormous social and economic impact. We have invested to turn declarations into concrete actions and to support countries to develop their capacity to tackle AMR, improve global surveillance and undertake vital research and development. Through this plan we are setting out our challenge to ourselves and to other countries to continue life-preserving work to preserve antimicrobials for future generations.

In closing, I do not think that I can do better than to follow my noble friend in quoting from the IACG report to the Secretary-General:​

“The challenges of AMR are complex … but they are not insurmountable”.

We should take courage from this, but should remember that our success will depend on the urgency with which we drive forward this response and the continued success in securing international collaboration. I believe that together we can achieve that.’

Read full debate here.