A major review of antimicrobial resistance, commissioned by the UK government, has reached some terrifying conclusions. Led by Lord Jim O’Neill, the review team published its final report on Thursday, which warns that antibiotic-resistant bacteria will kill one person every three seconds by 2050 unless immediate action is taken to prevent the spread of resistance.

The report warns that, by the middle of the century, bacteria able to withstand antibiotic treatments will kill 10 million people per year, with developing countries in Asia and Africa bearing the brunt of the crisis. Experts have previously warned that widespread antibiotic resistance would take medicine into a ‘new dark age’ making some routine procedures and treatments life threatening or even impossible.

It suggests that not enough new antibiotics are being developed and the drugs on which we currently rely are being wasted through unsustainable use.

These warnings are far from fantastical or exaggerated; in December, a gene that can convey resistance to last-resort colistin antibiotics and can readily pass between different bacteria was discovered by scientists in China. Later in the month, work in Europe revealed the resistance had spread further than previously thought, with cases detected in the UK and a number of other countries.

The scientists who discovered colistin resistance in China said there is a clear link between use of colistins in animal agriculture and effects on human health. They called on governments to prevent use of last-resort medicines in agriculture, but said this will take “substantial political will” to achieve.   

Upon its release on Thursday, Lord Jim O’Neill, Chair of the Review on AMR, said, “My Review… sets out a workable blueprint for bold, global action to tackle this challenge. The actions that I’m setting out today are ambitious in their scope – but this is a problem which it is well within our grasp to solve if we take action now.”

Findings from the government’s review, which began in July 2014, had been published in interim papers before the final report came out this week, but the publication on Thursday, and the review’s recommendations, brought responses from stakeholders in government, industry and civil society groups.

The review calls for incentives to develop antibiotics, improved diagnostics and vaccines, and country-specific targets for the reduction of antimicrobial use in livestock (including a ban on last resort treatments in animal agriculture). Recommendations also called for spending on access to clean water and better sanitation to stop preventable diseases spreading in the first place, and generally raising awareness, as most people don’t appreciate the scale of threat posed by antibiotic resistance.
 
Responses to final report
 
Commenting on the report’s release, Professor Dame Sally Davies, Chief Medical Officer for England, who has been vocal about combatting antibiotic resistance in the past, said, “In every international forum, including the G7, G20 and the UN, we must work with our international partners to ensure global action. At present around 7% of deaths are due to infections. If we do not act, this could rise to 40% - as it was before we had antibiotics.”

Defra’s chief veterinary officer, Professor Nigel Gibbens, added, “The impact of antimicrobial resistance is already serious and is a growing threat to human health and the global economy. We must take action in all areas… that includes restricting the use of antibiotics to where it is both unavoidable and effective. There can be no question that we now have more than enough evidence to take decisive action on antibiotic use in animal husbandry as well as in human health.

“I welcome the framing of the report’s targets in terms of a progressive, monitored process. This will allow the world’s livestock systems to adapt - reducing disease challenges and, as a result, the over-use of antibiotics. However we must minimise the threats to human health as soon as possible. This includes assessing how far the use of certain antibiotics in animals consequently poses a risk to human health - and restricting or even prohibiting such use in animals when necessary.”

British Veterinary Association President Sean Wensley said BVA had provided information on work to reduce antibiotics use in the UK to the review. He said the Association welcomes the reviews findings, adding, “We are pleased that the report recognises the need for targets [on reduced antibiotics use] to be evidence-based and country-specific, acknowledging that the UK and Europe have already taken action such as banning the use of antibiotics as growth promoters.”

Wesley said Britain’s poultry meat sector has done “excellent work” to reduce the use of some drugs deemed to be of critical importance to human medicine, and the pig sector is working to produce benchmarks which will inform any target setting. These two sectors account for most antibiotics use in agriculture.

However, The Alliance to Save our Antibiotics, a coalition of sustainable farming and animal welfare charities, called on the government to reduce farm antibiotic use by 50% by 2020 and by 80% by 2025, including a target to cut the use of antibiotics classified as critically important in human medicine by 80% by 2020 and 95% by 2025. The Alliance said ideally targets for reducing antibiotic use should be set by species, given the disparity in use between different livestock species; an Alliance spokesperson said, proportionally the UK has relatively few pigs and many sheep in comparison to most EU countries, which makes the average use per kg of meat produced in the UK appear fairly low. However, use per animal in pigs and poultry in the UK is at least 3.5 times higher than in Nordic countries and the Netherlands.

Spokesperson Emma Rose  added, “We fully agree that urgent global reductions are needed. The Government must also put a stop to the routine preventative dosing of groups of healthy animals. Allowing such practices to continue in UK farming will undermine any chance of achieving the ambitious reductions targets we need to see. At present, the Government says it opposes routine preventative use, but it also says it won’t take any action until forced to do so by the European Union. That kind of prevaricating isn’t acceptable when faced with the threat of a post-antibiotic era.”

Peter Melchett, Policy Director at the Soil Association said, “If we are to have a chance of tackling the antibiotic resistance crisis, we need to change the way we farm. Global livestock antibiotic use is forecast to increase by 67% by 2030, due to the expected increasing intensification of global livestock systems. If Defra is serious about reducing farm antibiotic use, it must help farmers shift towards higher-welfare and more extensive systems.”