Antibiotic threat ‘may rule out caesareans’
The UK is leading the way by working with other nations to tackle this vital problem at the source
The NHS may soon be unable to safely offer caesareans and hip operations because of soaring levels of antibiotic resistance, the chief medical officer for England warns today. Prof Dame Sally Davies’s comments come as the Department of Health pledged £30million to fight deadly superbugs through cutting-edge technology. Contrasting with the Prime Minister’s vision of artificial intelligence creating a more effective NHS, Dame Sally warned of a future in which antibiotic resistance pushed medical science and the health service backwards.
With modern medicine, as with many other aspects of our lives, we tend to believe the journey we are on is linear and progressive – that a combination of advanced technologies, better treatments and smarter techniques will inevitably mean more and better ways of treating disease and living longer.
The Prime Minister’s announcement earlier this week, which talked about how the use of artificial intelligence might revolutionise cancer treatments, saving tens of thousands of lives over the next decade, is a good example of this narrative. History suggests it is well-founded: over the past 70 years, the NHS has given great cause for optimism, and if we’re bold and decisive in embracing the potential benefits of the coming data revolution, the impact on healthcare could indeed be transformative.
Yet there is another possible future, much harder to confront, yet demanding a similar if not greater commitment to act. It is a future in which common infections and minor injuries kill once again, and where the types of intervention we routinely deliver today, such as caesarean sections, chemotherapy and hip replacements, become extremely dangerous. This is due to drugresistant infections, also known as antibiotic resistance.
Over the past five years, I have campaigned extensively for this to be a top-order issue for decision makers around the world across multiple sectors, because failure to act will result in a rapid and devastating decline in medicine’s ability to treat and cure.
Already, we are feeling the first tremors. Each year, it is estimated that about 5,000 people die in England because they develop infections that are resistant to the antibiotics we have. A similar picture is echoed across the world: in Europe and the USA, antibiotic resistance claims about 50,000 lives every year; and this is amplified in low and middle-income countries, where it is estimated that 214,000 newborns die each year from blood infections alone caused by bacteria resistant to antibiotics.
Antibiotics are unique drugs – the more we use them the less effective they become, as bacteria evolve to survive in their presence. So while doctors currently still have other antibiotics to try when the first one fails, their options are running out. We saw this two months ago, when Public Health England detected the first case of multi-drug-resistant gonorrhoea, caught overseas by a British man who then returned to the UK. Thankfully it was treatable in the end, but this is not always the case. The decreasing effectiveness of existing antibiotics is coupled with the fact that no new antibiotic class has been developed since the 1980s.
If we do nothing, by 2050 drugresistant infections are projected to cause 10 million deaths a year – equivalent to one person dying every three seconds and more dying annually than from cancer. The economic costs would also be catastrophic: between $60 to $100 trillion, the equivalent of losing the entire UK economy from global output each year.
So how should we respond? First, we know that prevention is better than cure. There is conclusive evidence that the inappropriate use of antibiotics is the single biggest factor leading to the development of resistance. This is why the UK Government has introduced a target to reduce inappropriate prescribing of antibiotics in humans by 50 per cent by 2020, to reduce unnecessary use in animals, and to tackle issues in the environment that are a source of resistant genes and an accelerator of the issue in humans and animals.
We are starting to see results – there has been a 5 per cent reduction in the human consumption of antibiotics in England since 2012, and a 9 per cent reduction in weight of sales of antibiotics for use in animals between 2014 and 2015.
I also strongly welcome the Health and Social Care Secretary’s drive to tackle healthcare-acquired infections such as E.coli – reducing the number of patients getting infections in the first place is where we need to focus.
Second, we need more research and development to understand the emergence and spread of resistant genes and bacteria in order to develop interventions and products to treat and prevent them. That’s why yesterday the UK Government announced a £20 million investment from the Global Antimicrobial Resistance Innovation Fund into CARB-X – the world’s leading not-forprofit organisation focusing on funding early stage research in academia and industry across the world into new products to treat and prevent drug resistant infections. A collaborative investment alongside the Bill and Melinda Gates Foundation, it brings total UK investment into research and surveillance in this area since 2014 to more than £615 million.
Above all, we need a united “one world, one health” multisector response, and it requires everyone and every country to stand up and play their part in the response.
The signs so far are encouraging, with the United Nations Declaration signed in September 2016 committing the 193 member state signatories to addressing the issue. The UK also co-hosted a landmark “call to action” conference in Berlin last year, to commit key partners to tangible actions; Ghana has agreed to host in 2018, and the G7 and G20 have shown this is a global priority.
From Fleming to Crick, the UK has a proud history of medical innovation. I firmly believe the next 50 years will bring many stories of world-class discovery that project us forward in our pursuit of better medicine.
The exciting world of robotics, artificial intelligence and genomic medicine that the Prime Minister talked about this week will be an important part of this story. But our greatest achievement may yet be the rather more prosaic steps we are taking now to bring countries together to tackle antibiotic resistance at the source. What is at stake here is nothing less than the basic integrity of modern medicine – and without this, quite simply, we, our children and our grandchildren have nothing.