Imagine a world where antibiotics no longer work; it’s a nightmare scenario that threatens the very foundation of modern medicine. Antibiotics currently gift us, on average, an additional 20 years of life. As the King’s Fund aptly noted, without them, “we would lose modern medicine as we know it.” Amidst mounting concern from doctors, public health experts, and governments, the issue of antimicrobial resistance, or AMR, is intensifying.
A February report by the National Audit Office highlighted grim progress since 2019. Of five key domestic goals aimed at combating AMR, only the reduction of antibiotic use in food-producing animals has been achieved. Targets such as a 10% reduction in drug-resistant human infections have faltered, with a 13% uptick in such infections since 2018.
AMR often sparks misconceptions. Many people fear developing resistance by taking antibiotics themselves. In reality, AMR is about pathogens, like bacteria, viruses, fungi, and parasites, which evolve to resist existing drugs, rendering treatments ineffective. Consider the potential danger of routine infections or surgeries, like C-sections, becoming perilous without effective antibiotics.
Despite my concern, I feel it’s important to recognize the UK’s earnest efforts in addressing AMR. Our research team, spearheaded by Jay Patel, assessed global responses to AMR across 114 nations, with results published in the Lancet Infectious Diseases journal. The UK ranked among the top three, only outpaced by the US and Norway, followed by countries like Sweden and Germany. This progress is largely thanks to Dame Sally Davies, the chief medical officer for England from 2011 to 2019, who made fighting AMR a key priority and continues her advocacy as the UK’s special envoy on AMR.
While there’s worry about overprescription by NHS doctors, I see the greater menace as the emergence of resistant pathogens in countries relying heavily on antibiotics for livestock. In places like China, Brazil, and India, antibiotics are used extensively for meat production—50% to 80% in some nations. These resistant pathogens form, spread from animals to humans, and eventually cross borders through travel.
This isn’t just theory: a 2018 study in Nature traced colistin-resistant bacteria, found even in London hospitals, back to a 2006 event in China where bacteria jumped from pigs to humans. Colistin is a last-line defense antibiotic, yet was used in animal feed, prompting significant policy change in China, India, and Japan. These actions likely have more impact than many UK-based measures.
To combat drug-resistant infections, the UK needs to collaborate globally on regulating antibiotic use, particularly in agriculture. Dame Sally Davies continues to push for international alignment of health, agricultural, and veterinary standards. However, there’s an impasse when others prioritize meat production for burgeoning populations.
Why not just create new antibiotics? Unfortunately, it’s not that simple. Developing antibiotics is notoriously difficult, with little progress. Since 2017, only two of 13 newly authorized antibiotics represent genuinely new classes. Innovations are crucial, for without them, resistant pathogens prevail.
Our best hope lies in preserving our current drugs’ efficacy by fostering international cooperation on prudent use. This is no small task in a world trending towards isolationism. The UK, however, stands out as a global leader on the AMR front.
Prof. Devi Sridhar holds the chair of global public health at the University of Edinburgh and penned ‘How Not to Die (Too Soon)’.
