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What is the problem?
Interview with Professor Sally Davies on how big the problem
Home / Healthcare & Medicine / Antimicrobial & Antibiotic Resistance / Bacterial Genomes: Antimicrobial Resistance in Bacterial Pathogens / What is the problem?
What is the problem?
Interview with Professor Sally Davies on how big the problem antimicrobial resistance is and what can be done to tackle it
Hello. Today we’re joined by Professor Davies, who’s come to talk to us about the global problem of antimicrobial resistance. Hello, Sally. Hello. Professor Davies, could you introduce yourself to us and tell us about what you’ve done in the past in relation to antimicrobial resistance and what your role is now, please? I am a haematologist, but I became chief medical officer in England and senior medical advisor to the UK government in 2010. And early on in my time, I realised that antimicrobial resistance manifested by drug-resistant infections was out of hand. And not only was it soaring nationally, in the UK, and abroad, but we’d got an empty pipeline, so not enough– hardly any new drugs coming through.
And there really wasn’t much of a focus on it. And I thought that we needed to campaign to try and get people to understand the severity of the problem and then take some action. Thanks. Could you tell us why are antibiotics so important? Why are they so crucial to modern medicine? Well, actually, you’ve said it. Antibiotics underpin modern medicine. In the old days before Fleming discovered penicillin, we would see scratches, even from shaving, could kill someone because they would get a blood infection that was out of control. But now if you get an infection, whether it’s in your blood or your tissues, we can treat it if it’s bacterial, and the bugs are not resistant, effectively.
But we use antibiotics to prevent infections with miscarriages or Caesarean sections. We use antibiotics to underpin gut surgery or new hip joints. We have antibiotics as essential for people with renal failure, with cancer treatments, and with transplantation. So modern medicine is underpinned by effective antibiotics, and we risk losing it. Thanks for the great explanation of how important antibiotics are, but what’s the nature of the problem that we’re facing in terms of antibiotic resistance? Well, drug-resistant infections are now killing a lot of people, at least 7,000 people worldwide. And that’s going to go up to 10 million a year by 2050 if we don’t take action.
Moreover, as it goes up, more than 28 million people will be driven into abject poverty. So this is a serious issue. And if you look at the UK, we know that every day, on average, we have 165 blood infections that are resistant to first-line antibiotics. In the rich countries, we know we’re already, when patients get drug-resistant infections, doubling the time they spend in hospital, so doubling the cost, and doubling the mortality. But this is a problem all over the world. Indeed, it’s worse in low and middle-income countries than in the rich countries. But I do want to put on record, of course, that far more people are still dying now from lack of access to antibiotics than resistance.
It’s just the tipping point is going to come when they’re getting access, but this resistance level has risen so much that the risk of dying is there. So in some degrees, we might say that antibiotic resistance has a twofold problem. We have a problem with the use of drugs, but we also have a problem with access to drugs. And in many ways, it might be regarded as a development problem. Absolutely. They’re in tension, aren’t they?. We don’t want people to use antibiotics when they don’t need them. We want appropriate use. Some people call it stewardship. But at the same time as not over-using them, many poor people can’t get the drugs they need.
And some of the more modern drugs are not being licensed in the poor countries either, so that’s very unfair and not right. So just moving on to that last point you were talking about, the licensing of drugs, I read recently that a number of new antibiotic companies have gone bankrupt, which is adding to the problem of the development of new drugs. What do you think that we can be doing to help new drugs get into the pipeline and then to eventually reach clinic? It’s really scary at the moment.
Even if scientists find a new drug, do all the testing of toxicity, do the trials, and go through to regulation, and then the company goes broke, it shows that we’re not paying enough for antibiotics. The classic example at the moment is Achaogen who produced a really good antibiotic, but the licence they were given by the FDA was just for complicated urinary tract infections. They wanted it for pneumonias as well. They then couldn’t sell it as broadly as they wanted. Meanwhile, they had to transfer all their R&D staff to selling. They went broke. That is not the right way to