Towards the end of June, I was in Sheffield for Civil Service Live , discussing how we can improve outcomes and build trust in public services.
Having recently joined the Department of Health (DH), I was reflecting on some of the examples I have seen there of ‘A Brilliant Civil Service’ at work. One of the best examples is the department’s world-leading work on antimicrobial resistance (AMR) – not just because of the size of the issue, but also because it illustrates how we must think creatively and openly about new policy challenges.
AMR is insidious and it’s deadly. It’s insidious because we all take the value of antimicrobials, like antibiotics, for granted. It’s deadly because bacteria have become increasingly resistant to our antibiotics. If the number of hard-to-treat infections continues to grow, routine medical care will become much riskier and modern medical interventions will become quite impossible.
This is by no means an exaggeration. It is estimated that about 25,000 people per year in Europe die of infections caused by resistant bacteria. Globally, Lord O’Neill estimates that by 2050 drug-resistant infections could cause 10 million deaths a year.
So how do we tackle this issue? It’s clear that no one overarching solution is workable and that we need to rethink how we are doing policy; a combination of different solutions, which interact with each other, may therefore hold the key.
Three-pronged approach
I am delighted that DH has been at the forefront of action, both domestically and globally, to confront the threat. Crucially, we have a comprehensive cross-government UK strategy to slow the growth and spread of antimicrobial resistance covering human and animal health, and the environment.
Our strategy takes a three-pronged approach, to:
- prevent infections, through better infection prevention and control
- protect the drugs we already have through better stewardship
- and promote the development of new drugs and diagnostics
We are making progress in changing how people think about the use of antibiotics. In the health service we are seeing an important shift in the way antibiotics are prescribed. Last year, GPs in England reduced prescribing of antibiotics by over 7% – that is two million fewer prescriptions compared to 2014. Behavioural science has been key to achieving these reductions, and we have ambitious aims to reduce inappropriate prescribing by 50% by 2020.
Of course, we would need fewer antibiotics if we reduced the number of infections in the first place. So we are working hard to reduce the number of healthcare-associated bloodstream infections.
Global response
Finally, a global threat requires coordinated global action. We lead the world in galvanising action to address antibiotic resistance by encouraging other countries to adopt evidence-based approaches to preventing infections, preserving antibiotics and pursuing new drugs, diagnostics and alternative therapies. We have already secured a World Health Organisation resolution requiring member states to develop national plans to address antibiotic resistance. We are now working towards a UN declaration on antimicrobial resistance to be adopted at the High Level Meeting at the UN General Assembly in September this year.
As a department, we need to have the confidence to reach out beyond government, to experts who want to contribute to this initiative. And we need the humility to listen and accept answers we didn’t invent. Only by overcoming institutional and international boundaries, as in the case of antimicrobial resistance, can we build trust in public services and ultimately improve policy outcomes for the benefit of individuals worldwide. AMR is not only a brilliant example of a challenging issue, but it highlights the benefits of an innovative and open approach to policy-making.
11 comments
Comment by Nicola W posted on
Just in support of colleagues’ comments from other departments a quick note from DFID – our interest being rooted in the huge detrimental effect AMR could have on progress against development goals if left untackled. One of the hallmarks of the AMR work in terms of a “brilliant civil service” is the degree to which it has been a genuinely cross-Whitehall effort, with impressive mobilisation of HMG’s international networks through the FCO in particular, and activation of multiple international political fora, with resolutions last year at WHO, FAO and OIE as mentioned in the previous comment, attention this year at G7 and G20, and the upcoming high level meeting at UNGA in September. This last will be a real milestone, being only the third time the General Assembly has held a high level meeting on a health topic.
Comment by Department of Health posted on
A spokesperson for the Department of Health responds:
We agree it is essential that we focus on the stewardship of antibiotics in animals, as well as in humans. The UK Five Year Antimicrobial Resistance Strategy published in September 2013, takes a strong 'One-Health' approach to antimicrobial resistance, spanning people, animals, agriculture and the wider environment. In driving the strategy forward we have the full participation of key government departments, specifically Defra and its agency the Veterinary Medicines Directorate. They are committed to reducing the use of antibiotics in livestock in this country, together with a renewed focus on encouraging best practice and responsible use of antibiotics in animal health and welfare.
It is also recognised that the inappropriate and widespread use of antibiotics in the animal health sector is a global problem. For this reason the UK has been in the lead in securing significant resolutions in 2015 at the Food and Agriculture Organisation of the UN and the World Organisation for Animal Health on means of addressing antimicrobial resistance. These resolutions engage the leadership in ensuring the prudent and responsible use of antimicrobials in agriculture, and holds the members of these organisations to commitments to take urgent action at regional, national and local levels to mitigate risks posed by inappropriate antimicrobial usage and antimicrobial resistance in food, agriculture and the environment.
Comment by Clare Dawson posted on
Paul Crouch's comments are spot on. The issue is not confined to one animal species; diseases are well known to pass between species. Taking the most publicised ones as an example; avian and swine flu. Although epidemic/pandemic proportions haven't been realised in the former, the latter most certainly "did the rounds". By introducing widespread microbial inoculation in the food chain for man we risk introducing super bugs into our supermarkets. These issues need to be address collectively, not as Chris Wormald has proposed, in an isolated DoH silo.
Comment by Helen posted on
Adam P and Paul Crouch
Although it's not covered in this article, there's lots of work going on at Defra on reducing use of AB's in agriculture. The Government's response to the recent O'Neil review will outline actions we'll be taking on this. It's due for publication in the not too distant future.
Comment by Adam P posted on
Dear Chris,
Thank you for putting your all into this topic of global importance.
Does the Department of Health have an opinion on the risks or otherwise of antibiotic use in animal husbandry in leading to antimicrobial resistance?
Given the lobbying sway of related industries and the volumes of antibiotics used in this sector I would welcome, as would many others I'm sure, an unbiased assessment of this.
Thanks in advance.
Adam
Comment by Maggie McDonald posted on
I am fully aware of the problems over prescribing of antibiotics and agree that something needs to be done. The problem, however with these initiatives is that there seems to be no safeguards built in for people who genuinely need antibiotics and risk getting caught up in a general approach not to prescribe them. I have personal experience of having a debilitating infection and struggling to get the antibiotics I needed. Earlier this year myself and my toddler son had serious chest infections which required antibiotics and one of the main stresses apart from the illness was wondering whether we would see a sensible doctor who would prescribe us antibiotics (thankfully we did). There have been cases of people dying where antibiotics should have been prescribed and may have saved them; including a recent case of a young boy with sepsis.
I understand that there is an initiative where doctors are being paid not to prescribe antibiotics, which, in common with doctors being paid not to refer people, is in my view, unethical.
Comment by Paul Crouch posted on
It seems odd to me that there is no mention of the most significant area of work that is required to reduce the single biggest risk factor regarding antibiotic resistance. That being the industry where the largest consumption of antibiotics takes place - the animal agriculture industry. Now that may sit under a different department, but with no reference to this in the 3 point government strategy, this doesn't promote a joined up approach, or one which recognises that elephant in the room. Why are the government so unwilling to recognise this?
Comment by Ben Ludlow posted on
Thank you for this blog on a fascinating (and alarming) subject. What's the long-term prognosis for fighting antimicrobial resistance? Do we expect to stay a step ahead or are we just buying time before we face a world without antibiotics?
Comment by Tracy Waterhouse posted on
Perhaps vets should stop treating animals with antibiotics as surely this is adding to the problem.
Comment by Andy Derwent posted on
Presumably only for cross-species infections, though.
Comment by Alison Pallas posted on
Paul, well said, I wanted to make the same point.