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Moving faster on resistance

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LORD O'Neill's report on tackling antimicrobial resistance (AMR), which was published in May, was originally commissioned by Britain's Prime Minister at the time, David Cameron. When he first asked Lord O'Neill to review the subject in 2014, Mr Cameron warned that, unless action was taken on AMR, the world could be ‘cast back into the dark ages of medicine, where treatable infections and injuries will kill once again’ (VR, July 12, 2014, vol 175, p 30).

Against this background, it is perhaps not surprising that, responding to the report last week,1 the Government said that it accepted its recommendations and that it was ‘determined to lead’ in their implementation. By way of illustrating its commitment, it also published a report on progress with the UK's Five-Year Antimicrobial Resistance Strategy.2 The Government reports that good progress has been made under that strategy, but, it says, ‘we need to go further’.

The O'Neill report was very much concerned with tackling AMR globally (VR, May 21, 2016, vol 178, pp 514, 515-516). Advocating a One Health approach, it took a firm line on the use of antimicrobials in animals, listing ‘reducing extensive and unnecessary use of antibiotics in agriculture’ as one of four interventions that would be particularly important in helping to ensure that effective antibiotics continue to be available to treat people. It recommended that countries should set targets aimed at reducing unnecessary use of antibiotics in meat and fish production, suggesting that a target of 50 mg/kg would be appropriate for high-income countries such as the UK. It also recommended restrictions on the use in animals of certain types of antimicrobials considered critical in human medicine.

Embracing these recommendations, the Government says in its response that Defra has made a commitment to reducing antibiotic use in livestock and fish farmed for food to a multispecies average of 50 mg/kg by 2018 and that, taking this further, it will be working with different sectors to achieve appropriate species-specific targets for the future. Regarding the use of critically important antibiotics, it says that it will be consulting with species experts and working with veterinary professional bodies to set agreed rules so that such antibiotics are reserved as a last resort, and that it envisages ‘a significant increase in regulatory oversight of veterinary antibiotics compared with current legislative requirements, enabling restrictions, or even bans, in animals on use of antibiotics of highest priority and critical importance to people, based on scientific recommendations and an evidence-based approach’ (see pp 291-292 of this issue).

The UK's five-year strategy on AMR was published jointly by the Department of Health and Defra in 2013 (VR, September 21, 2013, vol 173, p 254). In some ways pre-empting the O'Neill report, it, too, adopted a One Health approach to the problem, advocating a concerted, multidisciplinary effort. The progress report published last week is the second one produced by the Government, the first one having been published at the beginning of last year (VR, January 17, 2015, vol 176, p 56). In a foreword to the report, the Chief Medical Officer, Dame Sally Davies, and the UK's Chief Veterinary Officer, Nigel Gibbens, highlight the progress being made in raising the profile of AMR internationally. Discussing the situation in the UK, they report that ‘an enormous amount of activity is going on’ in both the human and animal health sectors, referring, in particular, to a reduction in antibiotic use in the meat poultry sector. However, they say that, overall, in humans and animals, the data available have yet to show clearly that the actions being taken are making a difference. For this reason, they explain, action over the coming year will focus on improving delivery at local levels.

In a foreword to the Government's response to the O'Neill report, Jeremy Hunt, the Secretary of State for Health, and Andrea Leadsom, the new Secretary of State for Environment, Food and Rural Affairs, make clear that the Government will continue to drive the UK's AMR strategy forward, ‘setting new ambitions to reduce infections and prescribing, both for animals and humans, recognising that they are fundamentally linked’. The response explains that the UK will do all it can to support international efforts to tackle AMR and that a priority will be to work with international partners to reinvigorate the pipeline for the development of new products. On the domestic front, the aim will be to build on the success of the UK AMR strategy, ‘going further and faster with a focus on preventing infection, and reducing inappropriate use of antibiotics in both human and animal health’.

It is clear from its response that the Government has decided to move up a gear in attempting to tackle AMR. The challenge now will be for everyone else to keep up.

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