We should think of expenditure on antimicrobial policies as insurance against a catastrophe
The evidence behind the warning is summed up in the second volume of the CMO's annual report and comes as the UK prepares to launch a new Antimicrobial Resistance Strategy and Action Plan, reflecting the need for a clear change in our understanding of and response to antimicrobial resistance by the public, NHS and government.
The knighted professor urged Britain to raise the issue at a G8 foreign ministers' meeting in London this month.
"We need to work with everyone to ensure the apocalyptic scenario of widespread antimicrobial resistance does not become a reality. This threat is arguably as important as climate change for the world" Davies said.
She added: "Antimicrobial resistance poses a catastrophic threat. If we don't act now, any one of us could go into hospital in 20 years for minor surgery and die because of an ordinary infection that can't be treated by antibiotics".
This week UK science minister David Willets announced that at the upcoming G8 summit he would indeed be proposing far-reaching measures to clamp down on overuse of antibiotics by GPs and hospital doctors. He noted also the need to restrict usage on farms and fisheries, where the drugs are blended with feed to boost yields.
But is there really any political will to tackle the problem at source?
Davies and Willets aren't the only ones to voice concern.
Evidence from the Environmental Working Group in the US also shows how superbugs are invading our supermarkets via conventionally reared livestock.
In Canada the Ontario Medical Association (OMA) has warned that the common practice of using antibiotics to promote growth in farm animals must be banned immediately as part of a campaign to combat drug-resistant infections in humans.
This week the subject that simply won't die has raised its head again with the Daily Mail reporting on the story of a young woman who has nearly died twice in the past two years from blood poisoning caused by an antibiotic-resistant bug she picked up in hospital.
The Mail reported what the CMO did not - that livestock are a chief cause of antibiotic resistance in the human population. It quoted MP Zac Goldsmith bemoaning the fact that ‘Governments have routinely ignored the link between antibiotic resistance and the excessive use of drugs on factory farms".
UK Health Secretary Jeremy Hunt announced that the Government is preparing a five-year plan to tackle the problem. But is that leisurely time scale really enough to tackle a problem that is a threat as great as that posed by terrorism?
An economic burden
According to a report in the British Medical Journal (BMJ), also published earlier this year, current estimates suggest that in comparison to other problems antibiotic resistance is not a costly problem for the NHS. But such estimates do not take account of the fact that antimicrobial medicines are integral to modern healthcare. For example, antibiotics are given as standard to patients undergoing surgery, to women delivering by caesarean section, and to those having cancer treatment.
Although it is difficult to forecast the likely economic burden of resistance, they believe that even the highest current cost estimates "provide false reassurance" and this may mean that inadequate attention and resources are devoted to resolving the problem.
The authors conclude that a change in culture and action is needed to plan for a future with more antibiotic resistance: "Waiting for the burden to become substantial before taking action may mean waiting until it is too late. Rather than see expenditure on antimicrobial policies as a cost, we should think of it as an insurance policy against a catastrophe; albeit one which we hope will never happen."
A global problem
The UK's five year plan has yet to be published, but in an accompanying editorial, Professors Anthony Kessel and Mike Sharland say it "represents an important step in both recognising and responding to this significant threat."
The problems are global and the terminology complex, but the importance is clear, they write. "A fundamental standard of the NHS should include basic high quality routine infection control and clinical care, as noted by the Francis inquiry. These standards of care are crucial to the prevention and control of all healthcare associated infections, including multi-drug resistant Gram negative bacteria."
Ignoring stealth antibiotics in livestock
If it all sounds scary that's because it is. And yet the CMO's report and the screeds of media coverage and accompanying related reports in medical journals all fail to mention one of the biggest influences on the problem: the widespread use of antibiotics in livestock production as stealth growth promoters.
Will the ‘five year plan' pay any attention to this important issue?
Currently more than half of all global antibiotic use is in farm animals, most commonly in the pig, poultry and dairy sectors, where they are used as to promote growth and to fight the infections endemic in the unacceptably crowded, stressful and unhygienic factory farm conditions in which commercial livestock is reared.
In the US the figure is even more shocking: 80% of the antibiotics sold there go to chicken, pigs, cows and other animals destined for the food chain. Yet producers are not required to report on which drugs they use, what types of animals are receiving them and in what quantities.
Much like the EU, the US government has dragged its feet for 30 years on this issue. And yet last year figures released by the federal government showed that the problem of resistant bacteria in meat is growing, in some cases by as much as tenfold.
These antibiotics enter our food chain, our soil and our water supply and find their way into our bodies.
We must look at the bigger picture
In 2011 three environment and animal welfare groups, The Soil Association, Sustain, and Compassion in World Farming, announced they had formed the Alliance to Save Our Antibiotics - a campaign that calls for:
- a legally binding timetable for the phased ending of all routine preventative, non-therapeutic use of antibiotics
- a ban on the use of modern cephalosporins in poultry, pigs and for dry-cow therapy in cattle. Off-label use of these antibiotics should also be banned
- a ban on the use of fluoroquinolones in poultry
- new legislation aimed at ensuring that farm animals are kept in healthier, less intensive conditions, wherever possible with access to the outdoors
- support for farmers to shift to higher-welfare systems that depend less on antibiotic use, by using money budgeted under the Common Agricultural Policy to back investment, spread best practice and fund the most relevant research
- improved surveillance of antibiotic use and antibiotic-resistant bacteria in farm animals.
At its launch the Alliance also produced a report Case Study of a Health Crisis that threw a spotlight on the link between excessive antibiotic use on farms and the rise in antibiotic resistance and incidence of superbugs - such as E. coli and MRSA - in humans.
As the CMO released her statement in March of this year, the Alliance also released a new report Antibiotic resistance - the impact of intensive farming on human health that shows the Government is still not facing up to the issue of excessive use of antibiotics on farms.
The EU recognises the antibiotic/livestock threat
The 2011 launch of the Alliance came as the European Commission launched a 12-point plan to tackle antibiotic resistance and called for farmers play a key role. So it's not as if this issue is floating around somewhere beneath the radar of our politicians and policy-makers.
It's interesting to ponder the question, then - why did the Chief Medical Officer, concerned as she is about our health, not acknowledge this important facet of the problem?
Instead of pointing the finger of blame at a simplistic nexus of anxious patients and overworked doctors, as the CMO was happy to do in most of her interviews, we would urge the G8 ministers when they meet in London to put political point scoring and media grandstanding aside and genuinely broaden their view and make a priority of placing rational and long-overdue restrictions on the frivolous use of antibiotics in farming.
Pat Thomas is a former editor of the Ecologist. She is a journalist, author and campaigner and currently a trustee of the UK's Soil Association. This piece was originally published at NYR Natural News.
Image courtesy of www.shutterstock.com
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