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.

Photo: Getty
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Michael Carrick is the “Geordie Pirlo” that England misunderstood

The Manchester United legend’s retirement announcement should leave Three Lions fans wondering what if?

That it came in the months leading up to a World Cup arguably added an exclamation point to the announcement of Michael Carrick’s impending retirement. The Manchester United midfielder, who is expected to take up a coaching role with the club afterwards, will hang up his boots at the end of the season. And United boss Jose Mourinho’s keenness to keep Carrick at Old Trafford in some capacity only serves to emphasise how highly he rates the 36-year-old.

But Carrick’s curtain call in May will be caveated by one striking anomaly on an otherwise imperious CV: his international career. Although at club level Carrick has excelled – winning every top tier honour a player based in England possibly can – he looks set to retire with just 34 caps for his country, and just one of those was earned at a major tournament.

This, in part, is down to the quality of competition he has faced. Indeed, much of the conversation around England’s midfield in the early to mid-noughties centred on finding a system that could accommodate both box-to-box dynamos Steven Gerrard and Frank Lampard.

As time went on, however, focus shifted towards trequartistas, advanced playmakers and those with more mobile, harrying playing styles. And the likes of Jack Wilshere, Ross Barkley, Jordan Henderson and Dele Alli were brought into the frame more frequently than Carrick, whose deep-lying capabilities were not utilised to their full potential. That nearly 65 per cent of Carrick’s England caps have come in friendlies shows how undervalued he was. 

In fairness, Carrick does not embody similar characteristics to many of his England midfield contemporaries, including a laudable lack of ego. He is not blessed with lung-busting pace, nor is he enough of a ball-winner to shield a back four solo. Yet his passing and distribution satisfy world-class criteria, with a range only matched, as far as England internationals go, by his former United team-mate Paul Scholes, who was also misused when playing for his country.

Rather, the player Carrick resembles most isn’t English at all; it’s Andrea Pirlo, minus the free-kicks. When comparisons between the mild-mannered Geordie and Italian football’s coolest customer first emerged, they were dismissed in some quarters as hyperbole. Yet watching Carrick confirm his retirement plans this week, perfectly bearded and reflecting on a trophy-laden 12-year spell at one of world football’s grandest institutions, the parallels have become harder to deny.

Michael Carrick at a press event ahead of Manchester United's Champions League game this week. Photo: Getty.

Where other players would have been shown the door much sooner, both Pirlo and Carrick’s efficient style of play – built on patience, possession and precision – gifted them twilights as impressive as many others’ peaks. That at 36, Carrick is still playing for a team in the top two of the top division in English football, rather than in lower-league or moneyed foreign obscurity, speaks volumes. At the same age, Pirlo started for Juventus in the Champions League final of 2015.

It is ill health, not a decline in ability, which is finally bringing Carrick’s career to a close. After saying he “felt strange” during the second-half of United’s 4-1 win over Burton Albion earlier this season, he had a cardiac ablation procedure to treat an irregular heart rhythm. He has since been limited to just three more appearances this term, of which United won two. 

And just how key to United’s success Carrick has been since his £18m signing from Tottenham in 2006 cannot be overstated. He was United’s sole signing that summer, yielding only modest excitement, and there were some Red Devils fans displeased with then manager Sir Alex Ferguson’s decision to assign Carrick the number 16 jersey previously worn by departed captain Roy Keane. Less than a year later, though, United won their first league title in four years. The following season, United won the league and Champions League double, with Carrick playing 49 times across all competitions.

Failing to regularly deploy Carrick in his favoured role – one that is nominally defensive in its position at the base of midfield, but also creative in providing through-balls to the players ahead – must be considered one of the most criminal oversights of successive England managers’ tenures. Unfortunately, Carrick’s heart condition means that current boss Gareth Southgate is unlikely to be able to make amends this summer.

By pressing space, rather than players, Carrick compensates for his lack of speed by marking passing channels and intercepting. He is forever watching the game around him and his unwillingness to commit passes prematurely and lose possession is as valuable an asset as when he does spot an opening.

Ultimately, while Carrick can have few regrets about his illustrious career, England fans and management alike can have plenty. Via West Ham, Spurs and United, the Wallsend-born émigré has earned his billing as one of the most gifted midfielders of his generation, but he’d never let on.

Rohan Banerjee is a Special Projects Writer at the New Statesman. He co-hosts the No Country For Brown Men podcast.