Drug resistance and the lack of new antibiotics are creating a potential medical crisis, the government’s Chief Medical Officer Professor Dame Sally Davies warned in this year’s University of Manchester Cockcroft Rutherford Lecture.
We are in danger of losing modern medicine. Growing drug resistance among bacteria, viruses and other microbes poses a catastrophic threat to health – both nationally and globally. Antimicrobial resistance is on the government’s risk register along with terrorism, flu pandemics and climate change. It is an equivalent threat.
Since taking on my role as Chief Medical Officer five years ago I have recognised that I must be involved in leading global action in the fight against the trend of infections becoming resistant to antibiotics. This is a trend which is expected to kill about 10 million people a year around the world by 2050.
If we do not act now, any one of us could go into hospital in 20 years for minor surgery and die because of an ordinary infection that can not be treated by antibiotics. And routine operations like hip replacements or organ transplants could be deadly because of the risk of infection.
Mine has been a golden era, where drugs were a solution to many of our illnesses. But, meanwhile, there has been a natural process of bugs getting more and more resistant. We have lost this sweet spot where we could treat all infections. People are dying across the world from infections that were treatable, should be treatable but which are resistant to the antibiotics we have.
As a society, we have become too relaxed about the use of antibiotics. They are being used too widely, often indiscriminately. For example, antibiotics are used in meat production for growth promotion and to compensate for poor hygiene. It would be more intelligent to avoid the use of antibiotics and instead improve hygiene standards and take other steps to prevent infection. If fish farms vaccinated salmon (as happens in the UK) instead of feeding them with antibiotics the yield of the farms would increase, while reducing the misuse of antibiotics.
Meanwhile, there is overuse of antibiotics among the human population. We must do more to explain to patients and doctors the limitations on the effectiveness of antibiotics. We need to persuade doctors not to prescribe them where they will not work and patients not to expect them where they will not work. There is no clinical benefit in taking an antibiotic for a viral infection.
The problem is also a market issue. There have been no new classes of antibiotics discovered and marketed that have been developed since 1987. We expect antibiotics to be cheap, yet we only take them on average once a year – so there is no profit to be made in developing new ones. Of the 41 antibiotics currently being developed, only three will work in humans and reach the market.
We need to develop new antibiotics. That means we need a totally different market system. And while we have gone through a phase of not making new antibiotics, we have disinvested in the scientific underpinning that could produce new antibiotics. So it is going to take a long time to put the problem right.
It is essential to help the drugs industry to develop new antibiotics. One initiative addressing this problem has involved the Prime Minister commissioning University of Manchester honorary Professor Jim O’Neill to look at the reasons for market failure and propose ways that Governments globally could stimulate R&D.
While this initiative is very important and welcome, it is not enough in itself. That is why as part of my role I have been engaged in creating new strategies in the UK and lobbying government to fund more research into the issue. I have also worked with the World Health Organization to encourage more global co-operation to address this crisis. Any one organisation’s work on antimicrobial resistance is not enough. This is a global problem and we can not do it alone.
The challenge is vital for our future, because when it comes to antibiotics, what we have got is what we have got. So we have to look after the antibiotics we have. That means better hygiene, more careful use of antibiotics and more rapid diagnostics at the point of care. All of us need to change the way we behave, including as consumers – for example, in our expectations of the meat industry. We also need to improve our hygiene practices in our daily lives. How many people can put their hands on their hearts and say their infection prevention is perfect?
There is best practice – and we can learn from it. The NHS recognised the enormous threat posed by MRSA. Since 2003, the number of cases in hospitals has fallen by 80% as a result of improved hygiene measures.
If we do not get this right the next generation may not live the 20 years longer our generation has benefited from – thanks to antibiotics. The economic implications will also be vast. Productivity and national incomes will fall, healthcare costs will rise with longer time spent in recovery in hospital and cleaning costs will multiply as we belatedly address the need for improved hygiene.
We have learned to live with bacteria and, with the help of antibiotics this has made us dangerously complacent. In the average body, a person is carrying one and a half kilograms of bugs. What can today be made harmless could in the future become a widespread killer without the benefits of effective antibiotics and other drugs.
To turn the tide and overcome antimicrobial resistance we need to be brave, demanding and powerful. We must work together against the threat of bacteria. But I am optimistic. I do believe that we will achieve global co-operation on this issue and I am confident that the UK government’s five-year strategy will make a difference. It has to.