Antimicrobial resistance (AMR) is a problem that affects the whole of mankind and requires a global response. Evolution means that microbes will naturally respond to antimicrobials so we have to stay one step ahead in this ongoing battle. Finding the solution to this problem is of the greatest importance to Governments the world over.
As stated by Jim O’Neill, it needs to be seen as the economic and security threat that it is, and be at the forefront of the minds of finance, agriculture and health ministers and especially heads of state and government. It is estimated that 700,000 people die every year from drug-resistance. The increase in multi-drug resistant and extremely drug-resistant related deaths is even more concerning because of the challenges that resistance poses, for example 200,000 people die every year from drug resistant TB alone.
The overuse of antibiotics increases the rate at which bacteria evolve resistance. As the Department of Health’s five-year AMR strategy noted, it is important to ensure the efficacy of existing antibiotics is maintained, but there is also a very real need to ensure a robust pipeline of new medicines to target infections as they develop resistance. There has not been a truly new class of antibiotics discovered since lipopeptides in 1987.
Without a robust pipeline of new antibiotics there will be an increase in mortality during essential or routine treatments, such as chemotherapy, hip replacements and caesarean sections. Fears of increased mortality will also lead to operations being cancelled and therefore people won’t have the life enhancing treatments or lifesaving procedures because of the greater risk of infection. We can all see the implications that this will have on our health and social care systems.
Market Failure
A problem we face is that to develop the next generation of drugs there is not a functioning market which will lead to drug development and to preserve efficacy, we do not want the next generation to fit into a conventional market. The reasons for this problem are economical and also commercial. In the case of antibiotics, prevailing prices are low and the unpredictable patterns of resistance make future medical needs (and thus commercial opportunities) harder to predict.
Conservation measures necessary to limit the prescribing of antibiotics would relegate new products to last-line treatments used only when nothing else works. This all leads to antibiotics being seen as commercially unattractive.
But, this is not just about normal markets, it is about Governments around the world acting where markets do not or cannot work. We do need another class of antibiotics but we cannot allow the uncontrolled application of these drugs - because this is how antimicrobial resistance can develop in the first place. Economic interventions are therefore needed to procure investment whilst protecting drugs from unnecessary use.
Conclusion
Anti-microbial resistance is already a huge problem but it is also a looming catastrophe; drug-resistant superbugs already kill hundreds of thousands of people every year and, according to the O’Neill review, if left unchecked they will kill up to 10 million every year by 2050.
It is a problem that spans multiple areas and cannot be solved by any one solution, neither is it a problem that any one country can address successfully by acting alone.
I hope the Minister will use his response today to renew this Government’s commitment to tackling AMR, working globally, investing in R&D and increasing public awareness.