On Friday, the government published its official response to the O’Neill Review on Antimicrobial Resistance (AMR), which ministers commissioned to investigate the threat of antibiotic resistance to human medicine.

The review, which was published late last year, landed just as researchers in China discovered that bacteria on pig farms had developed resistance to polymyxins - a class of antibiotics used in human medicine when other treatments have failed. The resistance was readily transferable to other bacteria and was subsequently found in medical samples in Europe as well as Asia.

Lord O’Neill, an economist who headed up the review team, warned upon its publication that the death toll from antibiotic resistant infections (which currently stands in the hundreds of thousands of people a year) could rise to ten million people annually by 2050 unless immediate action is taken. What’s more, certain surgical procedures currently considered routine could become life threatening or impossible if the world enters this post-antibiotic age.   

The review recommended moves to improve awareness of AMR and boost hygiene and sanitation around the world, demanded funding for new antibiotic treatments and the creation of a ‘banned list’ of antibiotics deemed to important to human medicine to risk using in agriculture.

Government response

On Friday, the government accepted the review’s recommendations. Noting that AMR is a global threat and that global action is required to tackle it, the government pledged to share the findings and and push for international action on specific recommendations.

Responding to calls for financial incentives to stimulate development of new antibiotics, ministers said the UK has committed £50m over the next 5 years to set-up a Global AMR Innovation Fund to target and coordinate investment globally. The government also said it plans to reduce antibiotic use in livestock and farmed fish from current levels (62mg/kilo in 2014) to 50mg/kg by 2018 and in the response promised, “We will continue to support development of veterinary legislation which enables restrictions or even bans on use in animals of antibiotics which are of highest priority and critical importance to people.”

Commenting on the response’s publication, Chief Medical Officer, Professor Dame Sally Davies said, “Action on antimicrobial infections must be taken internationally. Jim O’Neill’s review has made challenging recommendations for the world and I’m delighted that the UK is helping to lead the fight on this. No country can afford to be complacent about the catastrophic risk we are facing. If drugs like antibiotics no longer fight infections, 10 million lives could be lost globally every year by 2050.”

Government chief vet Andrew Gibbens said, “We are already making good progress in monitoring and reducing the use of antibiotics across the farming industry - today’s commitments mean we will remain at the forefront of the global effort to tackle this international challenge.”

On Monday, BVA President Sean Wensley commented, "It’s encouraging that the [government] response emphasised the need for all health sectors to play their part in ensuring positive steps are taken to preserve these essential drugs for future generations, with the reduction of antibiotic use in animal agriculture just one piece of the jigsaw.”

Uncertainty over government reduction targets
 
The BVA president added, “BVA has opposed the introduction of arbitrary, non-evidence based target setting; such targets risk restricting vets’ ability to treat animal diseases, which could have serious public health and animal welfare implications. However, we accepted that evidence-based targets to reduce usage in animal agriculture were likely to form part of the solution to address AMR on a global scale – as the Government has confirmed. The veterinary profession will be working with Government to develop sector specific targets through the RUMA Targets Task Force.”

Emma Rose from the Alliance to Save Our Antibiotics, which has campaigned for urgent action on antibiotic resistance, said, “The Alliance… supports the adoption of targets for the reduction of antibiotic use in livestock. In particular we were pleased by Defra’s commitment to set species-specific targets. In the UK, intensively reared pigs and poultry account for about 90% of total farm antibiotic use – and antibiotic use in UK conventional pigs is likely to be around 280mg/kg. The setting of appropriate targets for these priority areas is crucial.
 
“However, we are concerned that Defra will fail to reduce veterinary antibiotic use to the AMR Review’s suggested level of 50 mg per kg of livestock unless it commits to a ban on routine preventative mass-medication of livestock. With the UK set to leave the EU, it is even more important that the Government takes strong unilateral action to ban routine prophylaxis.”