Both Prevention and Adaptation Are Vital to Avert a Global Health Crisis in Antimicrobial Resistance

In the Global Health Framework launched recently, the UK announced plans to improve global health, build resilience to future threats and invest in antimicrobial resistance research. The Government’s research-led, international approach to tackling antimicrobial resistance, contrasts with European countries’ drive to prevent the overuse of antibiotics through domestic policies. To most effectively mitigate the threat that antimicrobial resistance poses to global health, both strategies must be urgently deployed.

Antimicrobial resistance is not the “ticking time bomb” that it is often tritely dubbed, but a present-day global health emergency killing millions of people every year. It is particularly deadly in low- and middle-income countries that have typically higher rates of infectious diseases. With only half of multidrug resistant tuberculosis now effectively treated with existing drugs, urgent research is needed to develop new antibiotics, vaccines and treatments, tailored for the countries that need them most. In establishing and investing in the Global Antimicrobial Resistance Innovation Fund, the UK is leading these efforts.

The UK’s response to antimicrobial resistance could be likened to efforts to improve our resilience to climate change. Both are vital and lifesaving interventions, but should not be considered a substitute for the preventative actions of reducing carbon emissions and reducing misuse of antibiotics. Adapting to antimicrobial resistance is not enough to avert a catastrophe in global health. As fewer and fewer antibiotic discoveries are being made, it is unlikely that they could ever offset the increasing numbers to which pathogens are developing resistance. All national and international strategies to tackle antimicrobial resistance must include tangible commitments to reduce the overuse of antibiotics that is the leading cause of the crisis.

Global efforts to prevent antimicrobial resistance are being led in Europe.

While the UK’s Global Health Framework makes vague reference to reducing the risk of farming practices spreading antimicrobial resistance, routine and preventative antibiotic use is already illegal on farms in the EU. After telling the House of Commons as early as 2018 that the Government planned to implement restrictions in line with the EU, a consultation was finally launched in February this year. The long awaited draft legislation falls short of EU law due to the omission of an outright ban of preventative antibiotic treatment on groups of farm animals.

Agricultural use of antibiotics is not the only area in which the UK’s action on antimicrobial resistance prevention lags behind the continent. The recent announcement promised investment in “early development of rapid diagnostics.” Yet many Northern European countries already utilise rapid diagnostics to determine whether an infection is viral or bacterial. With c-reactive protein (CRP) results within minutes of a finger prick, primary care clinicians use the technology routinely to accurately inform every decision on antibiotic prescribing. In the Netherlands, where point of care CRP testing is standard practice in primary care, there are fewer antibiotic prescriptions for respiratory tract infections than any other European country. There is no need for the UK to invest in the development of technology that is already widely used and proven to be effective. Rather, immediate action is needed to make it available as standard in GP practices and pharmacies nationwide.

The recent research funding announcement brings hope of more effective treatment options against the drug-resistant infections that are already claiming the lives of many. The UK should look to build on this world-leading response to antimicrobial resistance by following global best practice in its prevention. If cutting-edge research could be combined with policies to prevent the overuse of antibiotics on farms and in primary care, as has been achieved in Europe, the UK will demonstrate true global leadership in its national action plan for tackling antimicrobial resistance next year.