Britain’s most senior medical adviser has warned MPs that the rise in drug-resistant diseases could trigger a national emergency comparable to a catastrophic terrorist attack, pandemic flu or major coastal flooding.
Dame Sally Davies, the chief medical officer, said the threat from infections that are resistant to frontline antibiotics was so serious that the issue should be added to the government’s national risk register of civil emergencies.
She described what she called an “apocalyptic scenario” where people going for simple operations in 20 years’ time die of routine infections “because we have run out of antibiotics”.
The register was established in 2008 to advise the public and businesses on national emergencies that Britain could face in the next five years. The highest priority risks on the latest register include a deadly flu outbreak, catastrophic terrorist attacks, and major flooding on the scale of 1953, the last occasion on which a national emergency was declared in the UK.
Speaking to MPs on the Commons science and technology committee, Davies said she would ask the Cabinet Office to add antibiotic resistance to the national risk register in the light of an annual report on infectious disease she will publish in March.
Davies declined to elaborate on the report, but said its publication would coincide with a government strategy to promote more responsible use of antibiotics among doctors and the clinical professions. “We need to get our act together in this country,” she told the committee.
The issue of drug resistance is as old as antibiotics themselves, and arises when drugs knock out susceptible infections, leaving hardier, resilient strains behind. The survivors then multiply, and over time can become unstoppable with frontline medicines. Some of the best known are so-called hospital superbugs such as MRSA that are at the root of outbreaks among patients.
“In the past, most people haven’t worried because we’ve always had new antibiotics to turn to,” said Alan Johnson, consultant clinical scientist at the Health Protection Agency. “What has changed is that the development pipeline is running dry. We don’t have new antibiotics that we can rely on in the immediate future or in the longer term.”
Changes in modern medicine have exacerbated the problem by making patients more susceptible to infections. For example, cancer treatments weaken the immune system, and the use of catheters increases the chances of bugs entering the bloodstream.
“We are becoming increasingly reliant on antibiotics in a whole range of areas of medicine. If we don’t have new antibiotics to deal with the problems of resistance we see, we are going to be in serious trouble,” Johnson added.
The supply of new antibiotics has dried up for several reasons, but a major one is that drugs companies see greater profits in medicines that treat chronic conditions, such as heart disease, which patients must take for years or even decades. “There is a broken market model for making new antibiotics,” Davies told the MPs.
She has met senior officials at the World Health Organisation and her counterparts in other countries to develop a strategy to tackle antibiotic resistance globally.
Drug resistance is emerging in diseases across the board. Davies said 80% of gonorrhea was now resistant to the frontline antibiotic tetracycline, and infections were rising in young and middle-aged people. Multi-drug resistant TB was also a major threat, she said.
Another worrying trend is the rise in infections that are resistant to powerful antibiotics called carbapenems, which doctors rely on to tackle the most serious infections. Resistant bugs carry a gene variant that allows them to destroy the drug. What concerns some scientists is that the gene variant can spread freely between different kinds of bacteria, said Johnson.
Bacteria resistant to carbapenems were first detected in the UK in 2003, when three cases were reported. The numbers remained low until 2007, but have since leapt to 333 in 2010, with 217 cases in the first six months of 2011, according to the latest figures from the HPA.