Bottles of antibiotics line a shelf at a Publix Supermarket pharmacy August 7, 2007 in Miami, Florida. Photo: Getty Images
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What next, when the drugs won’t work?

The government has made progress on the urgent crisis of antimicrobial resistance, but sustained public pressure is still needed, says Zac Goldsmith.

On accepting his part of the Nobel Prize for the discovery and isolation of penicillin, Alexander Fleming warned: “There is the danger that the ignorant man may easily underdose himself and by exposing his microbes to nonlethal quantities of the drug make them resistant.” From the moment these miracle drugs became available, there has never been any doubt about the link between misuse of antibiotics and resistance to them. But despite that, we have spectacularly failed to heed Fleming’s warning, and as a consequence we now face the prospect of losing modern medicine as we know it.

Dame Sally Davies, chief medical officer for England, has described an “apocalyptic scenario”. She has warned of a return within 20 years to a “19th-century environment”, in which routine operations carry a deadly risk. The World Health Organisation has said that we are hurtling towards a “post-antibiotic era”. 

In 2006 there were just five cases where patients failed to respond to even so-called last-resort antibiotics, but last year that number was 600. Clearly we must hope new antibiotics are developed, but there is no escaping that the principal cause of this crisis is our industrial-scale misuse of the antibiotics we already have. Even in this age of irresponsibility, it is hard to imagine anything more reckless. 

Now that the medical establishment has sounded the alarm, you’d expect this, perhaps the greatest single threat to our health, to top the political agenda and dominate the tabloid news. If only. 

In fairness, the Department of Health has issued stronger guidance to GPs and hospitals. But very little is being done to limit misuse of antibiotics in agriculture. In many nations globally, the use of antibiotics for animals exceeds the amount used for human medicine. A 2012 report produced by the Soil Association suggests that the overall use of antibiotics per animal on UK farms increased by 18 per cent between 2000 and 2010. The problem is even worse in the US, where non-government studies have estimated that upwards of 70 per cent of antibiotics are used on farms.

At the same time, we are fast losing our traditional antibiotics to resistance: penicillin for staphylococcal wound infections, ampicillin for infections of the urinary tract and ciprofloxacin for treating gonorrhoea. We are increasingly having to use reserve antibiotics and, worryingly, seeing the spread of resistance to them as well. 

The link between misuse and resistance is not disputed, and so we have to ask why emergency action isn’t being taken. There is no philosophical or ideological reason why any of the mainstream parties should be reluctant to engage. After all, the solutions involve responsible use of what drugs we have, and the promotion of science. 

So why aren’t the newspapers hounding ministers for action? Why aren’t MPs being bombarded by angry letters? In short, what makes this crisis different, and less important to policymakers than the Aids crisis of the 1980s, which successfully galvanised drug companies and the authorities? 

One answer perhaps is that there is less focus – there is no single infection to fight, no single drug to be found. But more significant, I believe, is the influence of vested interests. If intensive farms have grown dependent on antibiotics, then their removal would require significant changes. Not surprisingly, the resistance put up by agribusiness lobby groups is immense, and I believe that explains a lack of urgency in the Department for Environment, Food and Rural Affairs (Defra).

It would be wrong to suggest there has been no progress. Last year I initiated a debate in parliament on the matter and, in response, a UK health minister told me: “Routine prophylactic use of antibiotics in both humans and animals is not acceptable practice. I am writing to Defra to ensure that existing veterinary guidance makes that very clear.”

Then last year, the Cabinet Office confirmed it would look at resistance as a national security issue. The government subsequently announced a “Five-Year Antimicrobial Resistance Strategy”, which was published by the Department of Health and Defra. The Prime Minister has also openly described the issue as “an extremely serious problem”.

However, we still lag far behind many other countries in terms of concrete steps. The Netherlands, for instance, has endorsed a 50 per cent reduction in livestock antibiotic sales from 2009 levels by 2014. The bottom line is that governments here and elsewhere must prioritise human health over short-term vested interests, and that, I believe, will be achieved only with sustained and intense public pressure. That will happen, but we must hope it does so before a crisis sets in.

Zac Goldsmith is the MP for Richmond Park (Conservative)

Zac Goldsmith is the Conservative MP for Richmond Park and North Kingston.

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Rarely has it mattered so little if Manchester United won; rarely has it been so special they did

Team's Europa League victory offers chance for sorely needed celebration of a city's spirit.

Carlo Ancelotti, the Bayern Munich manager, memorably once said that football is “the most important of the least important things”, but he was only partly right. While it is absolutely the case that a bunch of people chasing around a field is insignificant, a bunch of people chasing around a field is not really what football is about.

At a football match can you set aside the strictures that govern real life and freely scream, shout and cuddle strangers. Football tracks life with such unfailing omnipresence, garnishing the mundane with regular doses of drama and suspense; football is amazing, and even when it isn’t there’s always the possibility that it’s about to be.

Football bestows primal paroxysms of intense, transcendent ecstasy, shared both with people who mean everything and people who mean nothing. Football carves out time for people it's important to see and delivers people it becomes important to see. Football is a structure with folklore, mythology, language and symbols; being part of football is being part of something big, special, and eternal. Football is the best thing in the world when things go well, and still the best thing in the world when they don’t. There is nothing remotely like it. Nothing.

Football is about community and identity, friends and family; football is about expression and abandon, laughter and song; football is about love and pride. Football is about all the beauty in the world.

And the world is a beautiful place, even though it doesn’t always seem that way – now especially. But in the horror of terror we’ve seen amazing kindness, uplifting unity and awesome dignity which is the absolute point of everything.

In Stockholm last night, 50,000 or so people gathered for a football match, trying to find a way of celebrating all of these things. Around town before the game the atmosphere was not as boisterous as usual, but in the ground the old conviction gradually returned. The PA played Bob Marley’s Three Little Birds, an Ajax staple with lyrics not entirely appropriate: there is plenty about which to worry, and for some every little thing is never going to be alright.

But somehow the sentiment felt right and the Mancunian contingent joined in with gusto, following it up with “We’ll never die,” – a song of defiance born from the ashes of the Munich air disaster and generally aired at the end of games, often when defeat is imminent. Last night it was needed from the outset, though this time its final line – “we’ll keep the red flag flying high, coz Man United will never die" – was not about a football team but a city, a spirit, and a way of life. 

Over the course of the night, every burst of song and even the minute's silence chorused with that theme: “Manchester, Manchester, Manchester”; “Manchester la la la”; “Oh Manchester is wonderful”. Sparse and simple words, layered and complex meanings.

The match itself was a curious affair. Rarely has it mattered so little whether or not United won; rarely has it been so special that they did. Manchester United do not represent or appeal to everyone in Manchester but they epitomise a similar brilliance to Manchester, brilliance which they take to the world. Brilliance like youthfulness, toughness, swagger and zest; brilliance which has been to the fore these last three days, despite it all.

Last night they drew upon their most prosaic aspects, outfighting and outrunning a willing but callow opponent to win the only trophy to have eluded them. They did not make things better, but they did bring happiness and positivity at a time when happiness and positivity needed to be brought; football is not “the most important of the least important things,” it is the least important of the most important things.

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