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)