Dame Sally Davies, Chief Medical Officer for England, warns that within the next 20 years, people having simple operations may die because there will be no antibiotics left that can deal effectively with routine infections. She says antibiotic resistance is now so serious a threat to public health it should be added to the government’s list of civil emergencies.
Speaking to MPs on the House of Commons Science and Technology Committee, Dame Sally says she will be highlighting the threat in her report on infectious diseases which comes out in March. She will also be listing some possible solutions.
A spokesperson for the Department of Health told the MailOnline Dame Sally’s report will come out at the same as a government strategy to encourage doctors to use antibiotics more responsibly.
While hospital superbugs like MRSA are among the most well-known antibiotic resistant germs, MPs were also warned of other less well publicized infections like gonorrhea and TB that are in the general population.
In a BBC report of the meeting released on Thursday, Dame Sally says that:
“It is clear that we might not ever see global warming, the apocalyptic scenario is that when I need a new hip in 20 years I’ll die from a routine infection because we’ve run out of antibiotics.”
She says the situation is “very serious” because all over the world we are not doing enough to ensure we use antibiotics effectively. In the case of gonorrhoea, there is now only one effective antibiotic.
Dame Sally also touched on the “pipeline” of new drugs which is now “empty”, because of a “broken market model” which has made pharmaceutical companies turn to more profitable new drug developments, such as those to treat chronic diseases.
Hugh Pennington, microbiologist and professor at the University of Aberdeen says we have to realize there are no “wonder drugs” coming along because there “just aren’t any”.
To qualify as a “civil emergency”, the public health risk of antibiotic resistance would have to go through a rigorous, legally defined assessment.
Every year, the UK government revises the National Risk Register of Civil Emergencies in line with requirements of the Civil Contingencies Act 2004, which describes a civil emergency, among other things like war or terrorism, as:
“… an event or situation which threatens serious damage to human welfare in a place in the United Kingdom …”.
The definition of “serious damage” includes “loss of human life, human illness or injury”.
A system called the National Risk Assessment (NRA) assesses how serious the risk of an emergency is depending on the likelihood that it will happen over the next five years and on the consequences or impact on people if it does.
In conducting the risk assessment, the NRA takes into account factors like number of deaths that could occur, extent of illnesses or injury, levels of social disruption, economic harm, and psychological impact.
Each of these dimensions is scored on a scale of 0 to 5, and averaged to give an overall impact score.
In the latest (2012) edition of the Register, the highest priority risks include: Pandemic flu, coastal flooding, catastrophic terrorist attacks, severe volcanic eruptions abroad (such as that in Iceland), and severe space weather (eg solar flares and other events that can disrupt communications and power infrastructures).
The Register also shows the risk (likelihood and plausibility) of the event occuring in the next five years.
For example, the risk assessment of terrorist and other malicious attacks puts the the plausibility of cyber attacks and attacks on transport systems as “high risk”, and the risk assessment of natural hazards and accidents, puts the relative likelihood of pandemic flu, severe space weather, disruptive industrial action, and other events, as between 1 in 20 and 1 in 2.
On 18 November 2012, the European Centre for Disease Prevention and Control (ECDC) put out a statement about the growing problem of antibiotic resistance to coincide with the fifth European Antibiotic Awareness Day (EAAD).
At the same time, on behalf of the Health Protection Agency (HPA) in the UK, David Livermore, an international expert on antibiotic resistance, put together a list of the top ten facts about antibiotics and resistance to antibiotics. The following is a summary:
- Antibiotics revolutionized medicine: without them many surgical procedures like transplants and heart bypasses would carry too high a risk of infection.
- They carry the seeds of their own destruction: they kill sensitive bacteria, allowing resistant ones to survive, storing up problems for future treatments.
- Some antibiotics now no longer effective: eg staphylococcal wound infections no longer respond to penicillin, urinary tract infections are no longer treatable with ampicillin (a type of penicillin), and gonorrhoea is no longer treatable with the synthetic antibiotic ciprofloxacin.
- Pipeline for new drugs is running dry: many pharma companies have now turned to more profitable areas of drug development.
- We need to manage drugs better and prevent resistance: eg not use antibiotics for common colds and other viral infections, and get better at preventing infections in the first place, such as improving hand hygiene and using condoms.
- Successes have happened: MRSA has fallen by 80% in English hospitals, largely due to better infection control, and new vaccines have reduced numbers of some bacteria, including resistant strains.
- Although we have won some battles, we could lose the war: resistance is going up in other pathogens, especially gram-negative bacteria in hospitals. The rising rate of antibiotic-resistant E. coli strains is alarming: they cause one third of all bloodstream infections.
- We are using up our reserves: as first line antibiotics fail, we turn to our reserves like carbapenems for E. coli, the result being that were are seeing increasing resistance to them as well.
- The backups to the reserve are toxic and less effective: while drugs to treat bacteria can always be found, we are on a slippery slope of reducing effectiveness and increasing risk of toxicity.
- We have to act by practising: “antibiotic stewardship” to choose only those drugs that are appropriate and known to work for a particular infection; good infection control; and reducing the number of patients who receive antibiotics when they don’t need them. Other solutions include better diagnostics and better targeted use of antibiotics.
For a more in-depth review of the issues, see our article “The Antibiotics Crisis: How Did We Get Here And Where Do We Go Next?”
Written by Catharine Paddock PhD