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Raising the profile of AMR

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IT IS more than 15 years since a report from the House of Lords Select Committee on Science and Technology, under the chairmanship of veterinary peer Lord Soulsby, highlighted the threat to public health from antimicrobial resistance (AMR), with the committee describing what it had learned during its inquiry into AMR as ‘an alarming experience’. The oft-cited Swan report had expressed similar concerns some 30 years before. Interest in the subject may have waxed and waned over the decades but the problem has not gone away and, in the past few years, reports on AMR seem to have been proliferating almost as fast as the organisms themselves. When the Prime Minister wades into the debate, as he did last week, things seem to be moving up a notch and it starts to look as if politicians are taking the issue seriously. David Cameron's remarks last week about the prospect of the world ‘being cast back into the dark ages of medicine where treatable infections and injuries will kill once again’ broadly echo those made by the Chief Medical Officer, Dame Sally Davies, when the Government published its UK Five-year Antimicrobial Resistance Strategy last year (VR, September 21, 2013, vol 173, pp 254, 255). Meanwhile, the Prime Minister is not the only Westminster MP taking an interest in the subject; AMR is also considered in a report this week from MPs on the House of Commons Science and Technology Committee.1

The Prime Minister drew particular attention to the need to develop new antibiotics to help meet the constantly evolving threat of resistance, and to address concerns that, with no new classes of antibiotic having come on to the market for more than 25 years, the supply of new products may be drying up. As highlighted by the Royal Pharmaceutical Society recently (VR, May 17, 2014, vol 174, p 488), one reason for the dearth of new products is that the cost of developing them greatly exceeds the likely return, and Mr Cameron announced that he had commissioned an economist, Jim O'Neill, to lead a review to explore ways of making investment in new antibiotics more attractive to pharmaceutical companies and other funding bodies. The aim would be to achieve ‘a stronger, more coherent global response, with nations, business and the world of science working together’ to ‘accelerate the discovery and development of a new generation of antibiotics’.

The review looks likely to focus on ways of developing new antimicrobials for use in human medicine. However, as the BVA pointed out last week, there is also a need to develop new products for veterinary use, and this must not be neglected.

Professor O'Neill and his team of experts are expected to make some initial recommendations in spring next year and deliver their final recommendations in 2016. However, this is not soon enough for the House of Commons Science and Technology Committee which, on publishing its own report this week, argued that, while the Prime Minister's announcement was welcome, simply publishing strategies and reviews is not the same as dealing with the problem and that ‘what we really need right now is decisive and urgent action to prevent antibiotics from being given to people and animals who do not need them’.

The committee makes a number of recommendations aimed at curbing inappropriate use of antibiotics, calling, among other things, for better education of medical and veterinary students on using products responsibly and for campaigns to raise public awareness of when antibiotics should and should not be used. It also draws attention to the need to develop cheap, rapid and accurate diagnostic tests for resistance, describing diagnostics as ‘a key tool in targeting use of antibiotics’. Regarding veterinary use, it acknowledges a statement in the Government's five-year strategy that ‘increasing scientific evidence suggests that the clinical issues with antimicrobial resistance that we face in human medicine are primarily the result of antibiotic use in people rather than the use of antibiotics in animals’ but, at the same time, says that the Government should be ‘taking precautionary action to ensure that antibiotics are only being used in sick animals’. It also calls for better recording of antibiotic use in animals and for more research on the transfer of resistance between animals and people.

In many respects, the committee's comments on antibiotic use in animals reflect those made in the European Parliament over the past couple of years and again serve to emphasise that, while the veterinary profession may have detailed guidelines in place for prudent use of antimicrobials, this in itself is not enough; it must also clearly demonstrate that it is using products responsibly.

The select committee's report focuses on the UK situation. However, as numerous World Health Organization reports have pointed out, and the initiative announced by the Prime Minister last week acknowledges, AMR is a global problem. The UK and other EU member states must clearly do everything they can to ensure that antibiotics are used appropriately in their own countries, but action also needs to be taken globally.

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