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17 October 2022

Sally Davies: “Anti-microbial resistance could kill us before the climate crisis does”

The former chief medical officer for England warns about the threat AMR poses to humanity – and why we need to act now.

By Alona Ferber

Editor’s note: This interview was originally published on 5 October. It has been republished today in light of the news that Health Secretary Therese Coffey gave leftover antibiotics to a friend. Doctors have accused Coffey of ‘monumental stupidity’ and it has once again highlighted the dangers around antibiotics.

In 2014, the then prime minister David Cameron commissioned a review into a worrying global phenomenon: an increase in drug-resistant infections. “If we fail to act,” he warned, “we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine.”

The economist Jim O’Neill, who chaired the review, predicted that by 2050 “ten million lives a year” and a “cumulative cost of $100trn of economic output” would be at risk from bacteria, viruses, fungi and parasites increasingly resisting treatment. “The magnitude of the problem is now accepted,” he wrote in his final report published in 2016. Six years on, however, anti-microbial resistance (AMR) continues to endanger humanity. The term might be less recognisable to the average Briton than Covid-19, but those who understand it will assure you that it is a similarly frightening issue. 

One such figure is Sally Davies, who was appointed in 2019 as the government’s special envoy on AMR, alongside her position as master of Trinity College, Cambridge. From 2010 to 2019 Davies was the chief medical officer (CMO) for England – the first woman appointed to the role – and it was Davies who convinced Cameron to commission the O’Neill review. 

“As CMO, one of the pleasures is that you get to write an annual report… and I could choose what I wanted,” she recalled when we met in the café of the Wellcome Collection in London’s King’s Cross. “The first one I wrote was in 2013, and I chose infection because clearly it has been terribly important throughout the ages.” 

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As she discussed the chapters with the authors, Davies, who was a consultant haematologist before joining the civil service in 2004, realised that AMR had “become much worse” since she stopped seeing patients. “When I asked the experts what they were doing it was clear they hadn’t managed to find a voice that politicians would hear,” she said.

It’s still not clear if enough people are listening. In his 2016 report, O’Neill said that 700,000 people per year were dying due to AMR. A study published in the Lancet in January estimates that in 2019 “there were 4.95 million deaths associated with bacterial AMR…including 1.27 million deaths directly attributable” to it.

“This makes it the 12th most important cause of death across the globe and the third most important underlying cause of death after heart disease and stroke,” said Davies. AMR disproportionately affects lower income countries; the region with the highest rate of death from AMR is western sub-Saharan Africa. Globally, one in five deaths attributed to AMR occurred in children under five.

Davies, aged 72, is a convincing and colourful character. When we meet, the multicoloured stripes on her black skirt are set off by a pair of red and white trainers, a navy flower-shaped ring and dark blue glasses. To illustrate the sheer scale of AMR she reeled off terrifying scenarios. “Without antibiotics we can’t have modern medicine, which underpins standard care,” she said with an air of unconvincing nonchalance. “One in four patients with cancer gets a nasty infection that can kill without effective antibiotics.” 

AMR puts routine medical procedures we take for granted, such as hip replacements and caesarean sections, at risk. “You only have to look in the developing world to see when they haven’t got access how many people die of infections that aren’t treatable,” said Davies. “Well, if they aren’t treatable because of resistance then we’ve lost modern medicine.”

The problem is hard to explain, let alone solve. “It’s as complex as climate change,” she said. A lack of new treatments and the unnecessary use of drugs contributes to resistance. It is the result of failures of policy, innovation, investment and action, Davies explained, a consequence of the lack of pharmaceuticals regulation and overuse of antibiotics in industrial farming and fisheries.

[See also: Tsitsi Dangarembga: “People started pointing fingers at me, saying ‘She’s a Western puppet!’”]

The Global Monitoring of Pharmaceuticals Project looked at 258 rivers around the world and found that pharmaceutical pollution is “contaminating water on every continent”. In a quarter of the sites there were “potentially harmful concentrations”. There is overlap with the UN Sustainable Development Goals, but when people talk about sustainability AMR usually isn’t mentioned. “We haven’t managed yet to sell it well enough,” Davies admitted. Superbugs, such as the antibiotic-resistant MRSA, make headlines, but AMR lacks a “visible face… It’s ‘AMR? Huh, so who’s dying?’” 

There is also a lack of knowledge among medics. “TB [tuberculosis as a specialism] gets it,” she said, but Davies has met malaria specialists, for instance, who have tried to school her in why bed nets should take priority. “I say, yes, bed nets with the right insecticide are terribly important, but once you’ve got malaria you want to treat them with effective antimalarials.”

Davies left medical practice because she thought “she could have a bigger impact” in policy. Her time as CMO included pandemic preparedness and responses to Ebola, bird flu and the Novichok attacks in 2018. In 2016, after the government’s national pandemic flu exercise, she presciently warned of a lack of ventilators in the event of a real disease outbreak. She left the job in 2019, just before the start of the Covid-19 outbreak.

“I’m glad I dodged the bullet,” she said. Davies is full of compliments about the current CMO Chris Whitty and his team, “he was the right person at the right time. We in this country were lucky in having them.” 

There are lessons from the pandemic response that should prompt action in confronting AMR, including the initial lack of speed in reacting to the virus. “We all know it’s much cheaper to do prevention. Look at Covid, if we had acted early and effectively it would have cost the whole world far less. We are lucky the vaccines came quite fast,” she said.

It will be “interesting”, she added, “to see how the independent review of our performance in the UK behaves”. Davies refused to comment on how critical her testimony will be, though she confirmed she would go in front of the review panel and talk about the UK’s preparedness for a pandemic when she was CMO. 

The basics of prevention is another key lesson from the pandemic. Davies pointed to the “simple, old-fashioned methods” used during the pandemic, such as mask wearing and hand washing, which led to reduced rates of other respiratory illnesses such as flu. “We can make a difference as a society and reduce infection if we choose to,” she added.

So far Davies has worked with government counterparts who take AMR seriously. It is too soon, she tells me via email after our conversation, to comment on Liz Truss and her cabinet appointees. Davies may seem a tad incredulous that she still needs to state her case after so many years, but she does seem hopeful. “It’s not insurmountable, it’s doable,” she insisted. There are solutions. Businesses can prioritise action on AMR as part of their sustainability strategy; society can come together, as it has on the climate crisis. In 2020 the NHS launched a scheme to encourage innovation in antibiotics to combat AMR. In the US, the Pasteur Act proposes a similar intervention.

“Wouldn’t it be wonderful,” Davies posited, if people began to understand that treatments for infectious diseases may not work? In five years’ time, she would like to see governments pushed to take action – whether on the surveillance of resistance, access to drugs or in ensuring new, and better, diagnostics and treatment.

Yet given that after all these years Sally Davies is still stating the basic case, has she failed to get the message across? “I don’t think I’m a failure, but I do wonder how long I have to go on pushing this. Have I failed? Well I haven’t succeeded, have I, or we wouldn’t be sat here.”

[See also: Sabrina Cohen-Hatton: The firefighter using psychology to prevent disaster]

This article is part of an ongoing series on major health crises. See here for more.

This article appears in the 05 Oct 2022 issue of the New Statesman, Crashed!