Ensuring access to working antimicrobials - Science and Technology Committee Contents

Conclusions and recommendations

Communicating the danger

1.  We are convinced that greater public awareness surrounding the necessity for stewardship of antibiotics is crucial in reducing pressure on practitioners to prescribe antibiotics. We welcome the awareness of the Government of the need for sustained campaigns to educate new generations. However, the previous Strategy would appear to have had insufficient impact in achieving a high enough public awareness and the current Strategy has no definitive targets or measures of success. We recommend that the Action Plan set challenging targets for improvement of public awareness against which success may be measured and reported. These targets should be re-evaluated, and communicated to this Committee, once a rigorous evaluation of the 2014 European Antibiotic Awareness Day has been conducted. (Paragraph 16)

2.  It is essential that responsible antimicrobial stewardship is practised in the animal sector. The Government should, in the Action Plan, outline its plans to ensure that veterinarians, farmers and other animal carers have a stronger focus on antimicrobial resistance. (Paragraph 60)

Antimicrobial resistance within the NHS

3.  Given the focus on antibiotic resistance since 2000, we found it difficult to understand how the Government has failed to act decisively to address the issue of inappropriate prescription of antibiotics. We recommend that, as a matter of public interest, the Government drives the development of clinically proven alternative, safe and effective strategies to ease the demand placed on General Practitioners by people with acute infections so that they can develop an appropriate response to these requests without creating further antimicrobial resistance. We support calls for better education of medical students and greater focus on antimicrobial resistance during clinical career development. It is essential that the Government, as a matter of urgency, puts measures in place to drastically reduce the unnecessary prescription of antibiotics. (Paragraph 20)

4.  It is inevitable that strategic goals such as stewardship of antimicrobials will get lost in the daily tactical decisions made by healthcare staff. We consider it necessary that there are clear responsibilities within all levels of the NHS for better antimicrobial stewardship and we recommend that the Government outline, in its Action Plan for the Strategy, how they will embed those responsibilities across all roles within the NHS and how compliance with the Strategic goals will be monitored and reported. We have concerns that the implementation of new structures and chains of command may exacerbate those difficulties in the short term. (Paragraph 23)

5.  Diagnostics are a key tool in limiting and targeting use of antibiotics. The Government should indicate in its response to this report how it intends to ensure better use of current diagnostic facilities, how it intends to speed up diagnostic provision and how it will ensure that the Catapult for Precision Medicine delivers diagnostics for infectious diseases. (Paragraph 30)

6.  We are concerned that Infection Prevention and Control (IPC) does not appear to be delivered in a coherent fashion within the National Health Service. Our key concern is that the integration of antimicrobial resistance measures will be more difficult in the absence of a coherent IPC policy across the NHS. (Paragraph 33)

7.  We acknowledge the success that introducing Healthcare Associated Infection Targets has achieved in reducing the incidence rates of infectious diseases like MRSA and C. difficile. However, it is now time to design a more sophisticated approach to infection prevention and control that avoids undue reliance on particular antibiotics, thus exacerbating the problem of antibiotic resistance. (Paragraph 36)

Dealing with the information gap

8.  It is essential that the Department of Health develop a system for monitoring post-prescription behaviour of patients who have been prescribed a course of antibiotics. That system should be outlined in the Government's Action Plan for Antimicrobial Resistance and should include data from community-based patients. (Paragraph 40)

9.  The Government recognises that there is a lack of information concerning environmental drivers of antimicrobial resistance. We recommend that the Government publish, in its Action Plan, a research programme that will recruit expertise across the UK to fill the knowledge gaps on how antimicrobial resistance exists and may be transmitted via environmental routes. Hoping that research grant applications to research councils will serendipitously gather this necessary information leaves too much to chance. Research council funding should be, in this important field of study, complementary to Government directed, and funded, research programmes. (Paragraph 45)

10.  There is circumstantial evidence that antimicrobial resistance can be transmitted from animal pathogens to human pathogens although the evidence base is incomplete. The Government needs to ensure that this is addressed. We recommend that this is an additional focus of research in the action plan and that in the meantime, the Government takes action to ensure the use of antibiotics in farm animals is strictly required for therapeutic use. (Paragraph 51)

11.  With regard to the transmission of resistance from animal to human pathogens it is clear that the Government does not hold and is not collating the necessary information. The Action Plan should detail how the Government intends to collect, collate and share this data and have target dates for when this will be achieved. (Paragraph 56)

12.  As the development of new antibiotics and new technologies is dependent on private enterprise working closely with academia, we were disappointed to find that the membership of the Government's High Level Steering Group for the Strategy did not incorporate voices from industry or learned societies. We recommend that the membership of the High Level Steering Group be expanded to include those voices. (Paragraph 66)

Economics of new antibiotics

13.  Antimicrobial resistance has the potential to send medicine back to the early 20th century, severely limiting the use of what are now considered basic and routine surgical procedures. The best current defence against this scenario is a strong global pipeline of new drugs, possibly using a range of solutions as described above. But that is dependent on the infrastructure that provides financial incentive to the industries that deliver these technologies including means of compensating for the uncertainties inherent in research and development. (Paragraph 82)

14.  We agree with the Prime Minister that, if there is no change to the economic landscape for developing new antimicrobials, the pipeline of new antimicrobials will run dry. We also agree that the Government needs to work with researchers, investors, small and medium sized enterprises, large pharmaceutical companies and other Governments to urgently identify appropriate economic models that might encourage the development of new antimicrobials. We hope that the review, which will take almost two years to report back with recommendations, will not delay work on any pricing alternatives that could be agreed with the pharmaceutical industry over a shorter timescale. (Paragraph 83)

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Prepared 7 July 2014