Antimicrobial Resistance — House of Lords, 2019-05-02
Topic: Mixed Topics
Charles Dugdale (Conservative, Centre-right): I congratulate my noble friend on getting this debate. Prior to this has been a debate on climate change, but this is just as important. We know from my noble friend’s fine speech the importance of finding a solution to AMR. I will certainly not repeat any of the things he has said so eloquently, but it is good news that the Government in their five-year plan are taking this extremely seriously First, I declare an interest as having a small number of shares in a company called Helperby Therapeutics, which is involved with trying to find a solution to the AMR problem. There is no question that the world is facing a crisis. Although there are still some climate change sceptics, I do not think that there is anyone who does not believe that we are facing a catastrophe on this Margaret Chan, the former director-general of the World Health Organization, said that, "antimicrobial resistance is a global crisis—a slow motion tsunami. The situation is bad, and getting worse" The problem has really arisen because pharmaceutical companies have thus far failed to find a solution. What is particularly worrying is that many of the big pharmaceuticals have left the field, basically because of the massive costs of bringing a drug to the market and the prospect of not being able to make it economically viable A documentary film called "Resistance Fighters" has just been made. I mention it so that noble Lords can keep an eye out for it, as the hope is that it will air on television in England. The film shows how much the problem has been ignored for a long time, against better judgment, and makes it clear how new resistance mechanisms could emerge that were hardly conceivable until recently. It also looks at how the mass use of antibiotics in animal fattening can lead to the uncontrolled release of resistant germs into the environment. Negligence and powerful economic interests, which put profit well above the well-being of people, have been putting lives at risk I know that the noble Lord, Lord Trees, will talk about the use of antibiotics in animals, but I will quote one set of statistics which I found particularly interesting. In 2016, 80% of all antibiotics administered in the USA were used in animal feed. That is a total of 15 million kilograms, which is equivalent to 300 milligrams of antibiotics per kilogram of produced meat. All hearings on the topic of antibiotic growth promoters were completely blocked in the US Congress for 40 years, despite scientifically proven correlations. Most recently, the US pharmaceutical industry made an annual turnover of $13 billion with antibiotics in animal feed. I think that is quite something. There was an interesting article in the Times on 14 February, entitled "Rise of superbugs puts everyday surgical operations in jeopardy". It said that: "Tens of thousands of patients in Britain are struck down by superbugs because antibiotics to protect them during surgery have failed, a global study says One in five infections picked up during common operations worldwide is resistant to standard antibiotics, suggests research that reveals how far resistance to drugs has advanced towards a so-called doomsday scenario" I had a successful operation for colon cancer 18 months ago and was given a large course of antibiotics to ensure that no infection developed—and none did. It was quite a thought that if antibiotics did not work, in the worst-case scenario, that antibiotic treatment would no longer be possible. Dame Sally Davies, the Chief Medical Officer, has warned of a "post-antibiotic apocalypse" The Times article describes a study which looked specifically at gastro-intestinal surgery, "which is carried out a million times a year in British hospitals", and where infection is really quite common. The study showed that antibiotics were becoming measurably less effective. According to the article, Dr Harrison of the University of Edinburgh said that, "the results could apply to many more of the five million surgical procedures carried out in Britain each year" That is an astonishing number—5 million procedures. The article continues: "Nicholas Brown, a consultant medical microbiologist at Addenbrooke’s hospital in Cambridge and director of the campaign group Antibiotic Action, said the findings were a sign that standard preventative antibiotics were failing. He said: ‘The doomsday scenario, the end of the antibiotic era, is in some countries only a theoretical possibility but in other countries it is beginning to have a very significant impact’" Professor Anthony Coates, who started Helperby Therapeutics, told me that, as the big pharmaceuticals leave the field, it leaves just a handful of small companies, including Helperby, to "fight on alone". If that were not bad enough, one of the most promising pharmaceutical companies filed for bankruptcy a few weeks ago—my noble friend Lord Lansley referred to this. This was because it had developed a new antibiotic entity, which cost $500 million to develop. To recuperate these high costs, the company marketed its product for nine months at a price of $10,000 per course. Basically, that price is too high for the antibiotic market, although cancer drugs sell successfully for a lot more than that. The company sold only 50 courses in nine months, and this was not viable Professor Coates told me that he was very concerned that all the rest of the handful of small companies developing antibiotics were in the same boat. In other words, they are developing expensive new chemical entities, so when they get to market, they will struggle to survive. Interestingly, Helperby is going down a slightly different route by experimenting with the combination of existing drugs. If it can make that work, that will be marketable at a much more reasonable price Professor Coates also said that he thinks the thing that is missing from this key market is market-entry rewards. This is a reward to companies which reach the market with a new antibiotic or combination. The Government introduced NHS incentives for new antibiotics, which is a good start, but unfortunately it did not make any difference to the company which has just gone bankrupt. Professor Coates also said that he thinks that this will make no difference to other small companies, including Helperby, because they nearly all launched in the USA. Apparently the NHS does not have a very good reputation for welcoming new drugs. Perhaps that is one of the things that the Government could look at.