Antibiotic Resistance: The Challenge We Face
September 6, 2017
Next year will mark ninety years since Sir Alexander Fleming identified the antibacterial qualities of penicillin. The ground-breaking discovery was made upon return to his untidy laboratory following a family summer holiday. As I return to my parliamentary office this week following the summer recess I expect I shall be having a similar experience; my unwashed coffee mug resembling the Scot’s famous Petri dish.
For his contribution to medical science, Fleming was bestowed with a knighthood, awarded the Nobel Prize for Medicine and made a firm fixture on any list of 100 greatest Britons. His merit for any of these accolades is overwhelmingly clear and his discovery in 1928 has saved hundreds of millions of lives.
What is less well documented about Sir Alexander is that he was also acutely aware of the threat posed by antibiotic resistance from the very beginning. This hazard results from the overuse and misuse of antibiotics, and is all the more a threat today due to the lack of new drug development.
The task we face is as much an economic challenge as it is a medical one. Essentially, the demand for new drugs has grown due to increasing resistance but the supply has dried up. Much of this is down to the distinct nature of antibiotics. Whereas pharmaceutical companies are incentivised to develop drugs for the future profits on the units sold, this is not the case with antibiotics given that increased use exacerbates resistance and such drugs should be used as sparingly as possible.
Last year, I sponsored a Westminster Hall debate focused on how steps could be taken to promote and incentivise research and development aimed at tackling antibiotic resistance. Whilst scientific opinion overwhelmingly subscribes to the view that a global crisis can be avoided if we take action; I made very clear that without contrived action we run the risk of slipping into a medical Dark Age where routine surgeries cannot be undertaken and standard infections will once again become deadly.
The threat of antimicrobial resistance, to give it the more comprehensive description, is already proving to be lethal. Each year 50,000 deaths across Europe and North America are attributed to our inability to treat those who have developed resistance and by 2050 it is projected that 10 million people will die each year across the globe according to the O’Neil Review. To put this into perspective, the World Health Organisation’s figures show that cancer was responsible for 8.8 million deaths worldwide in 2015.
In the short-term Antibiotic Research UK, a charity based in my constituency, are advocating the production of antimicrobial resistance blockers. This will not solve the problem but it can provide us with much needed time. Another crucial step is the development of diagnostic tests that will give a clear and swift indication as to whether a patient does in fact require antibiotics; and if so which antibiotic drug should be prescribed.
Britain has a substantial foreign aid budget and I have long advocated the merits of using a small part of this to tackle the growing threat of antibiotic resistance in developing countries. We can take all necessary action to reduce resistance at home but this will prove to be entirely futile if a drug-resistant illness is able to spread from a part of the globe where relevant authorities are unable to take sufficient action.
Over the longer-term we must find an alternative to the reimbursement model, whereby the profitability of bringing new antibiotics to market is linked to the volume of sales. The Government will be investing £50 million over the next five years to set up the Global AMR Innovation Fund with the aim of attracting significant additional investment to stimulate global research. On the other side of the coin, we must promote the responsible use of antibiotics and raise awareness across the globe.
When it comes to prevention and cure, history always tends to look more favourably upon the latter. It is sad to say that those who find a solution to this pressing problem will not go into the history books or curriculum alongside Fleming. However, this should not detract from the task we face: safeguarding the future of medicine as we know it.
This opinion piece appeared in Comment Central on 4 September 2017: http://commentcentral.co.uk/antibiotic-resistance-deadlier-than-cancer/