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UK's 5-year action plan to fight super-bug threat

Drug-resistant superbugs are as big a threat to the world as climate change or wars, Britain's Health Secretary Matt Hancock warned during a speech at Davos in which he unveiled a five-year action plan for the UK, and a 20-year vision, to tackle the threat of antimicrobial resistance by 2040. "I could not look my children in the eyes unless I knew I was doing all in my power to solve this great threat," CNN reports Hancock said during a speech at the World Economic Forum in Switzerland. "I shudder at the thought of a world in which their (antibiotics') power is diminished. Antimicrobial resistance is a big danger to humanity and is as big a danger as climate change or warfare."

Antibiotics are used to prevent bacterial infections related to a range of medical problems and procedures, such as surgery, but, the report says, overusing them can lead to the bacteria becoming resistant. This has led to the development of superbugs – bacteria that have become resistant to the main antibiotics used against them – which present a major threat to global healthcare. Scientists believe that around 70% of bacteria that cause infections are already resistant to at least one antibiotic that would otherwise be used to combat it.

The report says as part of a new 5-year plan in the UK, Hancock announced that the government will offer pharmaceutical companies incentives to develop "urgently needed" new drugs. Current models mean companies are incentivised to sell as many antibiotics as possible at a time when the world is trying to reduce antibiotic use.

Low returns on investment in developing drugs also mean the pharmaceutical "industry does not innovate enough and as a result, very few of the new drugs that are currently in the pipeline are targeted towards priority infections," the report quotes the UK's Department of Health and Social Care as saying.

The UK's National Health Service will also explore new payment models that focus on drugs of most value to the health system, such as drugs to treat infections already showing resistance. "Under the current market system, companies are paid for the number of drugs they produce rather than how valuable the drugs are to the NHS," the department says.

Work to introduce a new payment model will be underway within six months, Hancock in the report, adding that this will encourage companies to invest in the "estimated £1bn needed to develop a new drug."

"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," the report says UK Prime Minister Theresa May the report said in response to the plan.

At present, there are just 28 new projects in late-stage development worldwide, with very few new drugs making it onto the market each year.

Medical charity the Wellcome Trust welcomed news of the government plan but urged it to move quickly. "If we are to bring the global threat of AMR under control, we must ensure that new antibiotics currently in development make it to the people who need them most," Ed Whiting, Wellcome's director of policy, is quoted in the report as saying. "This plan makes a strong argument for continuing UK leadership on this important debate, but we must move further and faster to ensure there is a sustainable pipeline for the antibiotics we so urgently need," he added.

The report says the UK government also plans to control and contain drug resistance within 20 years and reduce the use of antibiotics in humans by 15% over the next five years. Since 2014, the UK has cut antibiotic use by more than 7%, but the number of drug-resistant bloodstream infections nonetheless increased by 35% between 2013 and 2017, Hancock said.

In 2018, Public Health England reported the case of a UK man infected with a multidrug-resistant form of gonorrhoea. "With the emergence of drug-resistant infections like super-gonorrhoea posing serious threats to health, we need to protect the antibiotics we have by making sure they are used only when needed," the Department of Health and Social Care said. The report says Public Health England also warned last year that common procedures including caesarean sections and hip replacements could carry greater risks if antibiotic resistance and shortages of the drugs continue to grow.

Hancock also announced a plan to work with vets and farmers to reduce antibiotic use in animals by 25%. "(AMR) not only affects human health, but threatens animal health and welfare and food security. Resistance occurs everywhere that bacteria are found: in people, in animals and in the environment," Environment Secretary Michael Gove said in the report. Only three countries in WHO's African region and seven countries in its Americas region have limited the use of antimicrobials in animals, moves which WHO calls "an important step to reduce the emergence of antimicrobial resistance."

The report says, according to the 2016 Review on Antimicrobial Resistance commissioned by the UK government, there has been increasing urgency to tackle antibiotic resistance as drug-resistant bacteria are expected to kill 10m people a year by 2050 if nothing is done to solve the problem.

Countries around the world are taking a range of steps to tackle the issue, but the World Health Organisation warns that "serious gaps remain" and urgent action is needed.
"Promising findings include 105 countries with a surveillance system in place for reporting drug-resistant infections in human health and 68 countries with a system for tracking consumption of antimicrobials," the agency is quoted in the report as saying.

But antibiotics are easily available over the counter in many low- and middle-income countries, which means "unregulated medicines are still available in places such as street markets, with no limits on how they are used," it said.


Pharmacists will be asked to intervene to avoid over-prescription of antibiotics under the new plans, says an report. Health contracts expert Louise Fullwood of Pinsent Masons, said there is value in utilising the resources at high street pharmacies in the delivery of primary care to ease the burdens on doctors, and welcomed the plans to involve pharmacists in the battle against AMR.

The report says AMR is recognised by scientists as a growing problem – many bacterial diseases are evolving in a way which makes them resistant to existing medicines. If unchecked, this development will pose a health risk to the global population.
Strengthening "antibiotic stewardship" is one of the UK government's stated ambitions in its 20-year vision to fight AMR.

As part of its efforts to achieve this, the government is quoted in the report as saying it plans to "enhance the role of pharmacists in primary care to review the dose and duration of antimicrobial prescriptions (especially long-term or repeat ones) and work with prescribers to review those that are inappropriate through evidence-based, system-wide interventions".
A "patient-level prescribing and resistance data source" to facilitate "timely access at point of care to support clinical decision making" is also to be developed, and the government said it will also raise public awareness to "encourage self-care and reduce expectations of antibiotics".

Fullwood said: "This is a great example of using the skills and expertise of pharmacists to help tackle the real problem of AMR. A survey, reported in the British Medical Journal in 2014, identified that more than half of GPs felt pressurised by patients to prescribe antibiotics, and 44% admitted having done so to get the patient to leave the clinic. Pharmacists are under less time pressure and are well positioned to be able to give time to patients to fully explain why antibiotics may not be suitable, or even dangerous."

"The development of involving pharmacies should be welcomed as part of the progress to a more integrated and connected healthcare system, which we are observing and working with a range of clients on developing various aspects of," she said.

The report says plans to change the way pharmaceutical companies are reimbursed when supplying medicines to the NHS will also be explored, in a move that may be seen as an attempt to incentivise the development of new antibiotics. "To support global initiatives increasing access and stewardship, the UK will … develop and test new models for national purchasing arrangements that de-link the price paid for antimicrobials from the volumes sold, using a NICE (the National Institute of Health and Care Excellence)-led healthcare technology assessment to support robust stewardship," the action plan said.

"The rise and spread of antimicrobial resistance is creating a new generation of ‘superbugs’ that cannot be treated with existing medicines," the government said. "Already, the organisms that cause many common diseases such as tuberculosis, HIV/Aids, malaria, sexually transmitted diseases, urinary tract infections, chest infections, bloodstream infections and food poisoning, can resist a wide range of antimicrobials. Some cases of tuberculosis and gonorrhoea are already resistant to antibiotics of last resort."

"For most antimicrobials, there are few replacement or alternative products in the development pipeline. Research and development of the vaccines, diagnostics, tools and tests needed to prevent infections is similarly lacking. The impacts of unchecked antimicrobial resistance are wide-ranging and extremely costly, not only in financial terms, but also in terms of global health, food security, environmental wellbeing, and socio-economic development," it said.

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