Wednesday, October 24, 2018

The UK and Antibiotic Resistance - What Happened?

 In 2016 I wrote a series of blogs on the many ways the United Kingdom was leading the fight against antibiotic resistance.  Tamar Ghosh blogged about the Longitude Prize for a new rapid diagnostic for resistant infections. I wrote two (1,2) blogs speculating on the effect of Brexit on the UK’s fight against resistance and comparing efforts in the UK to those in the US in this regard. A key personality in the UK’s approach to resistance was David Cameron.  He was supported by George Osborne, his Chancellor of the Exchequer, and Dame Sally Davies, his Chief Medical Officer. Cameron made antibiotics and resistance a top priority of his government. Antimicrobial Stewardship became a high priority within the National Health Service and used financial incentives and disincentives to achieve goals. 

So, what has happened under Teresa May? First, antibiotic resistance is no longer among the “top five” priorities in her government’s strategy – where it was in that list under Cameron. With Brexit looming, the European Medicines Agency (Europe’s pharmaceutical regulatory agency) decamped from London and opened up shop in Amsterdam. In the UK you hear very little these days about action and funding to deal with resistance. Brexit dominates the news cycle. (Of course, in the US, one might say that things are even worse than in the UK).

While there was progress in the area of stewardship, many of the other recommendations from the O’Neill Commission (as I call it), have not seen any progress.  Specifically, those recommendations dealing with the broken antibiotic marketplace have fallen by the wayside. A recent report from the UK parliament highlighted these shortcomings of the May government. According to CIDRAP, the report makes a number of key observations and recommendations.

·     In spite of lowering antibiotic usage by a relatively small percentage, there has been an increase in resistance among bloodstream infections in the UK.
·     40% of all antibiotic use in the UK remains in animals. The report recommends that this be further curtailed.
·     The report targets environmental discharge of antibiotics and other waste that might provoke or disseminate resistance.
·     Finally, and of greatest importance, the report notes that there has been a complete failure to follow the O’Neill Commission recommendations on fixing the broken antibiotics marketplace.  They parliament suggests a six month time period for government and industry to get together and provide specific recommendations for dealing with this problem. In other words, find a pull incentive that will work and then implement it! (Seeing is believing).

I don’t live in the UK and don’t spend enough time there to judge for myself whether there is any chance that this parliamentary report will result in concrete action.  (If this occurred in the US, I know exactly what would happen . . . ). But I do remember the days of the O’Neill Commission, the days when Dame Sally Davies was frequently covered by the world press as she spoke about the dangers of resistance and when antimicrobial stewardship policies in the UK grew teeth. Are those days gone?

One bright light in this story in the UK has been and continues to be the Wellcome Trust. The Trust clearly understands the importance of the resistance threat and it reacts by providing funding for a large variety of efforts to combat this threat. They do this alone and through collaborations here in the US, in China and throughout the world. But without key government action (think pull incentives), the Wellcome, even with all its collaborations, will not be able to finally deal with the threat of antibiotic resistance that is knocking at our door. 

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