Are you AMR aware? Part two

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During the Westminster Health Forum Professor Dame Sally Davis outlined the terrifying global antimicrobial resistance situation

Professor Dame Sally Davis is the Chief Medical Officer for England and the chief medical advisor to the UK government. She is a member of several prominent international advisory committees and sat on the WHO Executive board. Her 2013 Annual Report highlighted the increasing threat of antimicrobial resistance (AMR) and called for global action to address the problem. She currently chairs the WHO AMR Strategic & Technical Advisory Group, and has raised public awareness of AMR through a Penguin book and TED talk.

We were midway through the Westminster Health Forum Keynote Seminar – covering the nest steps for antimicrobials and combating AMR – when Dame Davis began her talk. She instantly stamped her authority on the crowded Glaziers Hall by London Bridge. She reiterated some of the numbers that had been cited earlier. According to current (low) annual estimates 700,000 people die worldwide as a result of AMR. That figure is likely to be much higher, with AMR deaths being misreported as due to cardiac or respiratory complaints. Dame Davis compared that number to the biggest killer on the planet, stating that annually 8.2 million people die from cancer. Unless something can be done – starting now – that balance will change.

By 2050 it is estimated that the annual AMR worldwide death rate could rise to 10 million, and will cost the global economy $60-100 trillion. To put that figure into perspective the combined Gross Domestic Product of the U.S, China, Russia and the UK in 2015 was just under $33 trillion, a third of the highest estimate. And AMR targets a broad demographic that Dame Davis described as YOPI: young, old, pregnant, and immunocompromised; which includes a vast percentage of the Earth’s population. That 10 million might eventually prove an optimistic forecast. According to Dame Davis, combating the problem requires a “whole system” approach involving planetary health, agriculture, aquaculture, and overall environmental awareness. And AMR is not just about excessive medical use of antibiotics causing disease resistance. Antimicrobials are getting into the food chain. In a Chinese primary school a class of students were tested for antimicrobial products. None had been prescribed the drugs. Nearly 20% of those tested had up to three different antibiotics show up in their urine.

A specific drug for specific indications

Dame Davis stipulated that this is not the time to allocate blame, but to work to ensure the AMR situation gets better, not worse. We need to raise awareness and get the public behind us with an urgent call to action. However, positive things are happening. On the 17 March 2017 the Secretary-General of the United Nations announced the official establishment of the UN IACG (Interagency Coordination Group) on antimicrobial resistance, with the purpose of preventing a “post antibiotic era”. Dame Davis is part of that Group, along with a number of other leading authorities. During his announcement Secretary-General António Guterres said: “The objective of the Group will be to provide practical guidance for approaches needed to ensure sustained effective global action to address antimicrobial resistance, including options to improve coordination, taking into account the Global Action Plan on Antimicrobial Resistance.”

To help raise awareness Dame Davis announced a massive programme of AMR action events in mid-October, more of which in a future posting. However, she also sees an urgent need for funding to be better coordinated nationally and globally. “The UK is leading the world in this,” she explained, “but we could do more.” Funding initiatives, she explained, are moving at the pace of snails, they must speed up.

Globally, more people are dying from a lack of access to antibiotics than the excessive use of them, but in the developed world people have come to think of antimicrobials as a validation of illness. In the UK, patients believe their GP says no to prescribing antibiotics because the NHS needs to save money. Doctors need to learn how to say no. They need to put up posters about antibiotics saying, “Be careful how you use us or we won’t be there for you in the future.” There needs to be a cultural awareness paradigm change.

In conclusion Dame Davis explained that antibiotics are not the panacea for everything that ails you, they are a specific drug for specific indications, and there lies the principal problem. Antibiotics are cheap, while diagnostics are expensive and can be time consuming.
The floor agreed. A doctor said that something must be done to address the situation in some hospitals and GP surgeries where doctors are confronted by a queue of sick people with no cross-contamination control and no time to diagnose their illnesses properly. That is when broad spectrum antibiotics will be given out to save time, even though the drug might be the wrong treatment for the illness. That culture of fast patient throughput must end, even in the dental surgery.