Select Committee on Science and Technology Written Evidence

Memorandum by The Royal Pharmaceutical Society of Great Britain

  1.  The Royal Pharmaceutical Society of Great Britain is the professional and self-regulatory body for pharmacists in Great Britain. The Society's functions include: maintaining the register of pharmacists and of pharmacies; regular inspection of pharmacies to monitor standards of practice and compliance with legal and professional requirements; accrediting undergraduate pharmacy degree courses; ensuring fitness to practice at the point of registration; promoting continuing education; and producing clinical audit tools for pharmacy practice, and tools to support uni- and multi-professional clinical governance. The Society also produces a Code of Ethics containing standards governing the conduct and practice of pharmacists.

  2.  Amongst the objects of the Society are:

    —  To advance chemistry and pharmacy.

    —  To promote pharmaceutical education and the application of pharmaceutical knowledge.

  Thus, we have a major interest in fighting infection, particularly in the development and best use of medicines to combat infection.

  3.  Since the House of Lords Resistance to Antibiotics report four years ago, there has been considerable interest in antibiotic resistance. To take stock of the position and look forward to what is needed in the future a meeting was held at the Royal Pharmaceutical Society on "Anti-infectives: the way forward" in the Summer of 2002. This was organised principally by the Institute of Biology and the Royal Pharmaceutical Society of Great Britain, but with assistance of a number of learned societies within the Affiliated Societies together with the Department of Health and Medical Research Council.

  4.  As a result of the meeting certain observations, predictions for the future and suggested actions were developed. These are given below and are offered in evidence to the Committee.

  5.  At the moment:

    —  There are 5,000 deaths per annum in the UK from infectious diseases contracted in hospitals.

    —  There has been no completely new class of antibacterials developed in the last 30 years.

    —  Virtually all major pharmaceutical antibiotic research has moved out of the UK.

    —  New antibiotics take in excess of 12 years to bring to market at an approximate cost of £250 million.

    —  Any new antibiotics would be promoted for use by companies seeking to recover development costs, which is counter to the desire to limit their use to treat resistant organisms.

    —  In many countries, antibiotic availability and use is so indiscriminate that resistance is a serious burden worldwide.

  6.  Importantly in 2002 we are aware of these facts:

    —  Parliamentarians understand how important these issues are, and in 1998 the House of Lords published a report on antibiotic resistance.

    —  Antibiotic use as prophylactics in agriculture is declining, with application as growth promoters negligible in the UK.

    —  We have the necessary scientific and medical expertise to prevent the future scenario envisaged.

  7.  The bad news is that:

    —  In 1969 the Swann Committee recommended that Government address resistance, but the Expert Advisory Committee on Antimicrobial Resistance recommended by Swann was only set up in 2001.

    —  Little progress has been made implementing recommendations of the House of Lords Report issued in 1998.

    —  Continuation of the national surveillance system currently provided by the PHLS is in doubt.

  8.  If the situation remains unaltered, then within the next couple of decades:

    —  There will be more strains of bacteria resistant to all antibiotics in our communities and within many hospitals in the UK.

    —  There will be strains of bacteria resistant to some antibiotics in all hospitals in the UK.

    —  Reliable surveillance data on the various antibiotic-resistant strains of bacteria in either our hospitals or local communities will not be available.

    —  Numbers of intensive care patients will rise (costing £1,000-£1,800 per patient per day), resulting in a commensurate increase in NHS costs.

    —  A marked increase in the number of deaths per annum from infectious diseases will occur in the UK.

    —  It is unlikely that effective new antibiotics will be available to tackle the problem.

    —  There will be few medical microbiology specialists being trained at degree level, and new doctors will have only a rudimentary grasp of infectious disease.

    —  The UK will have returned to the pre-antibiotic era and average life span will significantly decrease.

  9.  To prevent this future scenario, decisive action is urgently required.

  The UK must:

    —  Ensure that the recently published UK Antimicrobial Resistance Strategy and Action Plan is actively adopted by all stakeholder departments and agencies. The Interdepartmental Steering Group, and the recently established Expert Advisory Committee on Antimicrobial Resistance, must continue to press for widespread acceptance of the strategy.

    —  Develop a cross-departmental co-ordinated funding programme, involving charities and industry as appropriate, to stimulate efforts in antibiotic research, to facilitate effective long-term surveillance of antibiotic resistance, and to tackle the growth of hospital-acquired infections.

    —  Increase funding for academic research focussed on development of new therapeutics.

    —  Provide a more favourable climate for pharmaceutical companies to develop new antibiotics by extending market exclusivity for these beyond the current 20 years from patent registration, through changes to patent legislation, to provide patent rights running 20 years from marketing.

    —  Ensure that foreign policy champions best practice for antibiotic use overseas, particularly in Europe, with new products being given EU-wide licences.

    —  Require literature and advice at school level to encourage pupils to pursue careers in pharmaceutical science and medical microbiology and related professions. Government Departments should liaise with learned societies to this end.

    —  Revise medical and veterinary curricula to reflect the significance of infectious disease and the appropriate use of antibiotics.

  10.  The science behind the above evidence was presented at the meeting and is contained in the enclosed book of Abstracts of the presentations which also gives key, relevant references from the scientific literature in support of the evidence given.

October 2002

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