Thursday, January 24, 2019

UK Launches 5-year Action Plan Against Antimicrobial Resistance


In addition to death and taxes, two more inevitabilities of life you can take to the bank are 1) the world will face another pandemic and  2) evolutionary pressures due to overuse and misuse of antibiotics will continue to erode our limited armamentarium of these lifesaving drugs.
Pandemics are far more dramatic, and tend to produce a sharper impact, but over time antimicrobial resistance (AMR) could prove far deadlier.
Each year we draw a little closer to a dreaded, but highly plausible `post-antibiotic era', where even common infections become resistant to most antibiotics, and something as simple as a scraped knee, or elective surgery, could be deadly.
And while antibiotics still work today for most infections, for tens of thousands of people every year, that `post-antibiotic era' is already here. 
Last November, in The Lancet: Attributable Deaths & Disability Due To Infections With Antibiotic-Resistant Bacteria - EU 2015, we looked at an ECDC study that estimated the burden of five types of infections caused by antibiotic-resistant bacteria in the European Union and in the European Economic Area (EU/EEA). 

Their conclusion?  

33000 people die every year due to infections with antibiotic-resistant bacteria
The study estimates that about 33000 people die each year as a direct consequence of an infection due to bacteria resistant to antibiotics and that the burden of these infections is comparable to that of influenza, tuberculosis and HIV/AIDS combined. It also explains that 75% of the burden of disease is due to healthcare-associated infections (HAIs) and that reducing this through adequate infection prevention and control measures, as well as antibiotic stewardship, could be an achievable goal in healthcare settings.
As tragic as that number is, globally it is far higher. 

Despite efforts by many nations and health care stakeholders to improve antimicrobial stewardship (see CIDRAP's Antimicrobial Stewardship Project), inappropriate prescribing or use of antibiotics, rampant (and unnecessary) use in farm animals, and the plethora of fake or adulterated antibiotics sold around the world continue to take their toll.

A few past blogs include:
CDC Traveler's Advisory: Drug-Resistant Pseudomonas aeruginosa Infections In Mexico
WHO Report: Wide Differences In Antibiotic Use Between Countries
The Lancet: WHO Estimates That 50% Of Drugs For Sale Online Are Fake

mBio: The Gathering Storm: Is Untreatable Typhoid Fever on the Way?
WHO: First Global Antimicrobial Surveillance System (GLASS) Report
WHO: The World Is Running Out Of Antibiotics
Today the UK has published an ambitious 97-page 5 year action plan - and a `20 year vision' -  for tackling this slow rolling, yet inexorable, health care crisis.  
Whether it proves to be adequate, achievable, or comes in time, all remain to be seen. It is, however, movement in the right direction.
Growing antimicrobial resistance is a global problem, and while efforts by individual countries are both laudable and necessary, it will require a concerted global response if we hope to seriously impede this juggernaut.  

The UK's press release, and links to both policy papers, follow:

Antimicrobial resistance: UK launches 5-year action plan and 20-year vision

The plans outline the UK's contribution to containing and controlling antimicrobial resistance (AMR) in health, animals, the environment and the food chain.
Published 24 January 2019
From: Department of Health and Social Care

The government has published a 20-year vision and 5-year national action plan for how the UK will contribute to containing and controlling AMR by 2040.

The plans include targets, such as:

  • cutting the number of drug-resistant infections by 10% (5,000 infections) by 2025
  • reducing the use of antibiotics in humans by 15%
  • preventing at least 15,000 patients from contracting infections as a result of their healthcare each year by 2024
A major focus of the plan is to make sure current antibiotics stay effective by reducing the number of resistant infections and supporting clinicians to prescribe appropriately.

New technology will also be used to gather real-time patient data, helping clinicians understand when to use and preserve antibiotics in their treatment. This could be followed and adapted all over the world, building the database on antibiotic use and resistance.

The plans cover animals and the environment as well as human health. The government has committed to working with vets and farmers to further reduce antibiotic use in animals by 25% between 2016 and 2020, with objectives to be refreshed by 2021.

The pharmaceutical industry will also be expected to take more responsibility for antibiotic resistance. NICE and NHS England will explore a new payment model that pays pharmaceutical companies based on how valuable their medicines are to the NHS, rather than on the quantity of antibiotics sold.

Antibiotic resistance is predicted to kill 10 million people every year by 2050 without action, as outlined in the independent review on antimicrobial resistance. Without effective antibiotics, straightforward, everyday operations like caesarean sections or hip replacements could become too dangerous to perform.

Since 2014, the UK has cut the amount of antibiotics it uses by more than 7% and sales of antibiotics for use in food-producing animals have dropped by 40%. But the number of drug-resistant bloodstream infections have increased by 35% from 2013 to 2017.

The national action plan and 20-year vision were developed in close collaboration with the devolved UK administrations.

Health and Social Care Secretary Matt Hancock said:

Imagine a world without antibiotics. Where treatable infections become untreatable, where routine surgery like a hip operation becomes too risky to carry out, and where every wound is potentially life-threatening. What would go through your mind if your child cut their finger and you knew there was no antibiotic left that could treat an infection? This was the human condition until almost a century ago. I don’t want it to be the future for my children – yet it may be unless we act.

As Health Secretary, responsible for one of the most advanced healthcare systems in the world, I could not look my children in the eyes unless I knew I was doing all in my power to solve this great threat. We have time to act. But the urgency is now.

Each and every one of us benefits from antibiotics, but we all too easily take them for granted, and I shudder at the thought of a world in which their power is diminished. Antimicrobial resistance is as big a danger to humanity as climate change or warfare. That’s why we need an urgent global response.

Prime Minister Theresa May said:

The increase in antibiotic resistance is a threat we cannot afford to ignore. It is vital that we tackle the spread of drug-resistant infections before routine operations and minor illnesses become life-threatening.

I am very proud of the UK’s global leadership on this important agenda. We will continue to work with our partners to drive international action that will protect the health of future generations.
UK 20-year vision for antimicrobial resistance

24 January 2019 Policy paper
UK 5-year action plan for antimicrobial resistance 2019 to 2024
24 January 2019 Policy paper