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Working together on resistance

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ANTIMICROBIAL resistance (AMR) hit the headlines again this week, this time courtesy of England's Chief Medical Officer (CMO), Sally Davies, who, in her annual report,1 warned that ‘global action is needed to tackle the catastrophic effect of antimicrobial resistance, which in 20 years could see any one of us dying following minor surgery.’

Among points made in the report are that, while the past 50 years have seen the development of a wide array of vaccines and drugs that have been effective in ‘winning battles’ against infections, antimicrobials are losing their effectiveness at an alarming rate and the next 50 years could be very different. ‘The supply of new replacement antimicrobial agents has slowed dramatically,’ the CMO says, ‘and we face the prospect of a future where we have far fewer options in the treatment of diseases that, previously easy to control, will become much more significant threats to [human] health.’

The report calls for better ‘stewardship’ of existing antimicrobials and the introduction of measures to promote the development of new ones. It draws attention, too, to the need to improve surveillance for AMR and infections, and for improved diagnostic testing to ensure more tailored interventions. Perhaps reflecting the level of concern about the issue in the medical profession, it also calls on the Government to include AMR in the UK National Security Risk Assessment, which forms part of planning for civil emergencies.

Highlighting the international nature of the problem, it points out that ‘inappropriate use of antimicrobial agents in other countries, and the production of counterfeit medicines, poses risks to our [the UK's] population’ and that international action is needed to mount an effective response.

Although primarily concerned with ensuring that effective antimicrobials continue to be available for use in people, the report also refers to use in animals. Encouragingly, given the level of attention devoted to this issue of late (see, for example, VR, November 24, 2012, vol 171, p 514), its comments are relatively moderate. Specifically, the CMO states, ‘Antibiotic use is not limited to humans and a large quantity of antimicrobials are used every year in veterinary practice and the fishing and farming industries. While the current evidence suggests that this is not a major cause of resistance in bacteria that affect human health (at least in the UK), it does provide a further vehicle for the development of antimicrobial resistance.’ She notes that the Department of Health and Defra will shortly be publishing a joint five-year antimicrobial strategy and action plan, adding ‘Our approach to tackling the problem of antimicrobial resistance must bring together experts in human and animal health to develop joint and complementary initiatives in this field.’

Several of the key messages from the report chime with those in another document on resistance that was published this month. In October last year, the RCVS, the Royal College of Pathologists and the Royal College of Physicians, in association with the Health Protection Agency, held a joint symposium called ‘Antimicrobial resistance in human and veterinary medicine – one medicine, one problem?’ (VR, October 20, 2012, vol 171, pp 391-392). The organisers have now issued a communiqué from the meeting, summarising the main conclusions.2 Not least among these, again reflecting the global nature of the problem, is that ‘The probability that selection for resistance will occur where antimicrobial use is highest and least controlled, coupled with unprecedented mobility of humans, means that, whether AMR originates from animal use or human use, the threats in Britain and in Europe will often emanate from outside … As well as pursuing all reasonable measures to reduce emergence and proliferation of AMR in the UK, our national strategies need to consider measures to reduce, identify (through surveillance) and deal with imported problems, be they in humans, food or animals.’

The symposium was conducted in the spirit of one health, and it is good to see both the communiqué and the CMO's report emphasising the importance of a joint approach. Too often, debate on this subject has degenerated to a finger-pointing exercise, with veterinary and human medical concerns being considered separately, when a coordinated approach is necessary. Effective antimicrobials are needed to treat both people and animals; it is important that the two professions appreciate their respective challenges, and that there is mutual appreciation of the issues involved.

  1. Annual report of the Chief Medical Officer, volume 2, 2011. Infections and the rise of antimicrobial resistance. Accessed March 12, 2013

  2. Available at Accessed March 12, 2013

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