The Covid-19 pandemic will “seem minor” compared to what humanity faces from the growing number of superbugs that are resistant to current drugs, Prof Dame Sally Davies, England’s former chief medical officer, has warned.
Davies, who is now the UK’s special envoy on antimicrobial resistance (AMR), lost her goddaughter two years ago to an infection that could not be treated.
She paints a bleak picture of what could happen if the world fails to tackle the problem within the next decade, warning that the issue is “more acute” than climate change. Drug-resistant infections are already killing at least 1.2 million people a year
“It looks like a lot of people with untreatable infections, and we will have to move to isolate people who are untreatable so as not to infect their families and communities. So it is a very disastrous picture. It will trivialize some of Covid,” says Davies, who is also the first female master of Trinity College, Cambridge.
AMR means that some infections caused by bacteria, viruses, fungi and parasites can no longer be treated with available medicines. Exposure to drugs allows the bugs to develop the ability to resist them, and overuse of drugs like antibiotics accelerates that process.
Widespread resistance would make much of modern medicine too risky, affecting treatments including caesareans, cancer interventions and organ transplants.
“If we haven’t made good progress in the next 10 years, then I’m really scared,” Davies said.
Without the development of new treatments, “it will continue for decades and it will not burn out. We know that with viruses, they burn out, you usually develop herd immunity, but that’s not the case.”
Last week, the UK government announced a national action plan on AMR, with commitments to reduce the use of antimicrobials in both humans and animals, strengthen surveillance of drug-resistant infections and encourage industry to develop new drugs and vaccines.
Launching the plan, Health Secretary Maria Caulfield said: “In a world recovering from the profound impact of the Covid-19 pandemic, international cooperation and preparedness for global health challenges has an unprecedented level of importance adopted.”
Davies spent more than a decade warning about the issue, but said it really hit home when her “beautiful” goddaughter, Emily Hoyledied of a drug-resistant infection at the age of 38.
Hoyle had cystic fibrosis and underwent two lung transplants before passing Mycobacteroides abscessuswhich was resistant to treatment.
The team that treated her “tried everything”, Davies said. “But I would think to myself, looking back at the year before she died, I thought it was likely that it would kill her.
“And she knew about six months before she died that it was not going to be treatable and that she would probably die from it.
“She had a very beautiful death – she was very dignified, laughed, joked and made it light for husband, family, all of us. She was very special.
“But she gave me permission to use her story as my goddaughter because, well, it got personal for me, before last Christmas.”
Hoyle’s death strengthened her determination to turn the tide, Davies said, describing it as a matter of intergenerational equity.
“My generation and older used the antibiotics [and] we do not supplement them. We do not make sure that our food is produced with as little consumption as possible. And I owe it to my children and – if I have them – grandchildren and the next generations to do my best.”
There are also issues of fairness in the present day, she said. One in five deaths caused by AMR is in a child under five yearsusually in sub-Saharan Africa, where Davies said the problem was “particularly widespread and disastrous”.
Many of the countries are also hit hard by the climate crisis and Davies said the two problems are linked.
“If we don’t control and mitigate AMR, it will kill more people than climate change does,” she said.
to newsletter promotion
“Climate will play out in many ways, but think about flood water, think about sewage, think about displacement, think about storms and what they spread and the lack of clean water when you have drought; infections are increasing.”
There are global efforts to reduce the inappropriate use of drugs such as antibiotics in medicine, although the Covid-19 pandemic has stalled progress on many of those initiatives. Few new antibiotics have been created in recent years and the issue has been “made more complicated” because it involves sectors such as farming as well as human health.
More than two thirds of antibiotics enters farm animalsDavies said, usually to promote growth or prevent infections in crowded, unsanitary conditions rather than to treat specific infections.
Some Asian fish farms “throw antibiotics in with the fish food,” partly because it’s cheaper, she said, but also because of a lack of research on what infections occur in local fish breeds like tilapia, and what vaccines might be. be required.
“If you don’t have appropriate, careful use,” she said, “you run the risk of it getting really out of control.”
Animals, including humans, excrete up to 80% of the antibiotics they take, she points out, “contaminate the environment”. Factories producing antibiotics may not control their effluent, allowing “dramatic amounts” to enter water systems.
Despite her warnings, Davies insisted she is a “glass half full” person, brimming with enthusiasm as she discusses projects that take a different approach. A major US poultry supplier stopped taking antibiotics, “so you can do this”, she said.
Breakthroughs such as genomics and artificial intelligence are “amplifying” the science of new antibiotics. She is also hopeful that programs to encourage pharmaceutical companies to create new antibiotics will bear fruit.
Ideally, such drugs should be kept in reserve as a last resort if existing drugs don’t work, so bugs don’t develop resistance to them. However, this makes it difficult for companies to guarantee a return on investment in research and development.
Several countries are investigating alternative means of funding, such as a subscription model by NHS England, pay a fixed annual fee for access to antimicrobials, regardless of the volume used.
Davies is part of the UN Global Leaders Group on AMR. In September, the UN will hold a high-level meeting on the issue and the group is push for targets by 2030, including reducing global human deaths from AMR by 10%, reducing the use of antimicrobials in agriculture by at least 30%, and ending the use of “medically important antimicrobials for human medicine ” in farming where it is not necessary to treat diseases.
While she was “honored” to be part of the group, she said more formal structures were needed. “We need inter-country governance of some form, a bit like a COP on climate change,” Davies said.
Particularly important would be the establishment of an independent scientific panel similar to the IPCC, “otherwise it’s academics saying, ‘Oh, we need this target’. And however correct that may be, if you haven’t taken the low- and middle-income countries on the journey, there’s no reason why they will – or should – accept it.”
