It is a pleasure, Mrs Main, to serve under your chairmanship. I will make a short speech, and allow as much time as possible for interventions.
Clearly, everyone is concerned about the rise in the number of cases of bacterial infection, whether campylobacter, MRSA or blood poisoning from E. coli, cases of which have increased by nearly 400% in the last 20 years. What makes the problem so much more alarming is the accompanying rise in resistance to those infections. As the Minister will know, antibiotic resistance is a growing worldwide problem. We cannot yet call it a crisis in the UK, but some indications are ominous, particularly as no new antibiotics are in the development pipeline to treat some important infections. It should be noted that, when resistance problems occur, the cost to the NHS of successfully treating a patient may increase between 10 and 100 times.
The Government’s assessment is that most of the resistance problems that affect UK patients can be blamed on the inappropriate use of antibiotics in human medicine. I am sure that is true, but the antibiotics used in veterinary and human medicine are closely related, and a growing body of evidence indicates that, for some serious infections, the inappropriate use of antibiotics on farms leads to the development of resistance among farm animals that can and does pass to humans. Sir Liam Donaldson, former chief medical officer, starkly acknowledged that in his annual report three years ago in 2009, when he said of antibiotics:
“every inappropriate or unnecessary use in animals or agriculture is potentially signing a death warrant for a future patient.”
For far too long, the link between the overuse and misuse of antibiotics in intensive farming and the serious threat from antibiotic resistance have been utterly ignored. For example, although I welcomed last year’s public warning from the current chief medical officer—
Sitting suspended for a Division in the House.
On resuming —
I had just quoted Sir Liam Donaldson, on
“a death warrant for a future patient”,
as a result of the overuse of antibiotics, and I had complained that the British Government have routinely ignored the link between antibiotics in intensive farming and the public health threat. I was about to cite the current chief medical officer, Professor Dame Sally Davies, on the growing problems of resistant strains of bugs, as well as the Health Protection Agency in November. It was striking that the message focused 100% on over-prescribing by doctors, with zero mention of the use of antibiotics in the livestock industry.
Similarly, when I tabled a parliamentary question to the Department of Health on what funding it provided for research into drug-resistant bacteria, the answer from the Under-Secretary of State for Health, the
hon. Member for Central Suffolk and North Ipswich (Dr Poulter), explicitly mentioned hospital-acquired infections, but not the use of antibiotics in farming. I was encouraged, however, by a reply from the then Secretary of State for Health, my right hon. Friend Mr Lansley, when I asked him about the link between E. coli resistance to antibiotics and record antibiotic usage on farms. He said:
“Indeed, I was interested to see analysis some years ago of the extent of antibiotic resistance in hospitals in the Netherlands. Resistance was clearly much more prevalent in parts of Friesland where there was much greater antibiotic usage in farming. I therefore completely understand, and my colleagues in DEFRA understand this too. Just as we are looking for the responsible and appropriate prescribing of antibiotics in the health service, my colleagues feel strongly about the proper use of antibiotics in farming.”—[Hansard, 17 July 2012; Vol. 548, c. 842.]
However, since then, we have had a near complete clean sweep of Ministers at both Departments—the Department of Health and the Department for Environment, Food and Rural Affairs.
I congratulate the hon. Gentleman on raising a very important subject. Is his argument, at least in part, that the collaboration cross-departmentally, which should take place through the chief scientific advisers committee, is not happening, or is what they are considering simply not being taken proper notice of?
I thank the right hon. Gentleman for his intervention. I suspect that that is part of the problem, but as I will come to later, I think it is also the case that the agribusiness sector in this country has had a disproportionate impact on policy. That is a point that I hope to impress during the debate.
As I was saying, there has been a near clean sweep of Ministers at both Departments, so this debate provides an opportunity to clarify Government policy. The Government are right to insist on better infection control in hospitals and changes in the way that antibiotics are prescribed by doctors. However, other than the brief answer that I quoted from the former Secretary of State, there has been virtually nothing from the Government that could in any way encourage vets and farmers to be similarly prudent. Not surprisingly, therefore, there has been little progress; on the contrary, analysis by the Soil Association of the Government’s statistics indicates that the overall use of antibiotics per animal on UK farms increased by 18% between 2000 and 2010, while the farm use of third and fourth-generation cephalosporins—drugs described by the Health Protection Agency as hospital workhorses—increased by over 500%.
Furthermore, recently published data from the Veterinary Medicines Directorate show that sales of fluoroquinolone antibiotics for use in veterinary medicine over the past two years have been 70% higher than they were in 2000. It is worth noting that when fluoroquinolones were first licensed for use in poultry in the UK in 1993, there was no registered antibiotic-resistant campylobacter in people who had not been treated with the antibiotics, but by 2007, almost half—46%—the campylobacter food poisoning cases caused by the most common strain
were resistant. It is worth noting also that in 2008, the European Food Safety Authority said:
“A major source of human exposure to fluoroquinolone resistance via food appears to be poultry”.
Clearly, antimicrobials should be used to treat sick animals, and I do not think anyone would argue against that.
I congratulate the hon. Gentleman on securing the debate. Does he feel that the use by the farming sectors—whether pig, poultry or beef—of antibiotics is unnecessary, because there is a blanket use, rather than reacting to disease? Does he feel that that has a direct impact on us as human beings? Many people come to me and say that the antibiotics are not working, and they are getting three doses from the doctor. Is that feeding off what is happening?
Again, I absolutely agree with the hon. Gentleman’s point, and I thank him for making it. I will come to that in more detail shortly.
There is no argument against treating sick animals with antimicrobials but, surely, not the most modern and medically important ones, especially when other antibiotics, which are not as critically important in human medicine, are available. I recognise that this topic does not lend itself easily to tabloid news, but there is a real, worrying chance that that could change. By overusing antibiotics, we risk ruining for future generations one of the great discoveries of our species. In short, we risk entering the post-antibiotics age.
My hon. Friend the Minister will know that some antibiotics have already been lost to resistance: for example, penicillin for staphylococcal wound infections, ampicillin for infections of the urinary tract and ciprofloxacin for treating gonorrhoea. Many more are under threat, and new antibiotics are increasingly hard to find and license. We are now using our reserve antibiotics, and worryingly, seeing the spread of resistance to them as well. For example, rises in resistance, such as those seen for E. coli, force doctors to use carbapenems, which were previously the reserve antibiotics for use when other treatments had completely failed. However, we are now using carbapenems much more and seeing the spread of resistance to them as well.
University of Cambridge researchers revealed the first cases in UK livestock of a new strain of the multi-resistant superbug MRSA. It is called ST398, and it has become endemic in European and north American pig populations and has spread to poultry and cattle. It is significant because, unlike most strains of staphylococcus aureus found in farm animals, it is readily able to transfer to humans. If not checked, that is likely to lead to rising community-acquired MRSA, just at the time that hospital-acquired MRSA is falling, due to sterling efforts by health professionals.
I congratulate the hon. Gentleman on securing this important debate. In the light of the very real health risks and the strong words from a former chief medical officer, as the hon. Gentleman has said, about the unnecessary use of antibiotics being nothing less than
“a death warrant for a future patient”,
does he agree that we need a legally binding timetable for the phased ending of all routine, prophylactic, non-therapeutic use of antibiotics in animals?
I do, and I will be coming to that point as well, but I absolutely agree with the hon. Lady’s intervention.
Clearly, we need to continue with efforts to reduce the inappropriate use of antibiotics by doctors, but the European Food Safety Authority was spot-on—I do not often say that—last year when it warned that
“it is…of high priority to decrease the total antimicrobial use in animal production in the EU.”
To date, the UK Government’s antibiotic resistance strategy, as I have said, has focused exclusively on over-prescribing by doctors, with zero mention of antibiotics in the livestock industry. Although they have spent money trying to understand why we are seeing a rise in bacterial infections, they are spending nothing, as far as I know, to understand the rise in resistance, which is clearly the issue of importance.
The Department of Health is currently developing its new cross-Government, five-year antimicrobial resistance strategy and action plan for 2013 to 2018, so I ask the Minister these questions today. Will she promise that it will give significant consideration to the use of antibiotics on farms and to the link between farm use and resistance? Will the Government work with the veterinary profession and the agricultural industry, as they have done in recent years with the medical profession? Does she agree that we need better data on antibiotic use, published by antibiotic family and by animal species, as is already done in France? If we do not know the type and quantity of antibiotics used and how they are used, there is very little chance of our being able to understand the emergence of resistance.
Furthermore, will the Minister lobby vigorously her ministerial colleagues at DEFRA to take urgent action to restrict the prophylactic use of antibiotics, to limit the prescription and use of antimicrobials for the herd treatment of animals to cases in which a vet has assessed that there is a clear clinical justification and to limit the use of critically important antibiotics to cases in which no other type of antimicrobials will be effective?
Will the Minister call on DEFRA to ban the use of fluoroquinolone antibiotics in poultry production to reduce the risk of antibiotic resistance in E. coli, campylobacter and other infections in humans? Incidentally, it is worth pointing out that campylobacter is the most common cause of food poisoning in the UK, affecting some 350,000 people a year, and poultry is the source of between 50% and 80% of those cases. A ban of that sort would bring the UK into line with the US, where the Food and Drug Administration stopped the use of those antibiotics in poultry in 2005, because of increasing resistance in campylobacter. Denmark, Finland and Australia also do not use fluoroquinolones in poultry. All those countries have lower levels of resistance in humans.
I mentioned Denmark, and it is worth taking a moment to consider the Danish situation. The latest Danish disease surveillance report showed that, although the presence of antibiotic-resistant bacteria in the country’s pig population had decreased since the tighter restrictions came into effect, including the banning of cephalosporins,
the level of antibiotic-resistant bacteria in meats being imported into the country are higher than in its domestic meat. Nearly half the tested samples of chicken meat imported into Denmark in 2011 contained resistant bacteria. The Danish Government, quite rightly, have taken their concerns to Brussels, complaining that their national approach has been undermined by other EU states’ continued overuse of antibiotics.
Almost certainly, excessive antibiotic use on farms is linked to the intensive manner in which animals are kept. Improving animal health and welfare by limiting overcrowding and the worst excesses of factory farming must therefore become key components of the Government’s antibiotic resistance strategy. Disease prevention should be achieved through good hygiene, husbandry and housing, without recourse to the regular prophylactic use of antimicrobials—a point that has been made by two hon. Members. I recognise that factory farming interests have wielded enormous influence on Government policy for many years and that any move to restrict the use of antibiotics today will be fiercely resisted by them.
Does my hon. Friend have any evidence to suggest that this problem is more prevalent in what he describes as factory farming than in what I would call farming more generally?
I thank my hon. Friend for his intervention. I will come to that point in about 20 seconds if he does not mind, because I want to demonstrate the vigour with which the industry has in the past resisted and will continue to resist any change such as I have described. Indeed, I had a briefing yesterday from the British Poultry Council that included some fascinating statements. In it, the BPC says:
“There is no scientific evidence that intensive farming systems contribute more to the overall risk of antibiotic resistance than extensive farming systems.”
On the contrary, two DEFRA-funded reports find that antibiotic resistance is roughly 10 times lower in organic chickens and pigs than in conventional equivalents. The BPC says in the same report:
“The industry is not aware of any recent evidence that ESBLs”—
“(E.COLI) are increasing in chicken farms across the UK.”
I would like to pursue this point a little further. The reference made then was to organic farming. I was an extensive farmer and I have always had the view that the sloppy use of antibiotics was every bit as bad in extensive farming as in intensive units. I can understand the point in relation to organic farming, but not to extensive farming.
The difficulty is that it is very hard to measure antibiotic use in extensive farming of the sort that my hon. Friend has describes, whereas in organic farming there is quite clear regulation—self-regulation, in effect—which enables that comparison to be made. He is probably right, but I cannot authenticate what he says, because the data simply do not exist.
first half of last year than in the entire previous year, so what it has said to me in its briefing simply is not true.
The BPC also says:
“Antibiotics may only be used on a farm if they have been prescribed by a veterinary surgeon”.
But it knows that producers often go straight to the feed mill, which will write out the prescription, send it to the vet’s at the eleventh hour and put pressure on them to sign it immediately. We know that because a number of vets have complained to the Veterinary Medicines Directorate about just that.
Finally, the BPC says:
“Scientific evidence increasingly recognises that the problem of antibiotic resistance in humans comes largely from the use of antibiotics in human medicine.”
That is true, as I have already acknowledged, but for certain bacteria—salmonella, campylobacter and E. coli—the farm use probably accounts for more than half the problem. It certainly accounts for a very significant chunk of the problem. With MRSA, it is probably accounting at the moment for only a few per cent. of cases, but if it is allowed to get established in UK livestock, that situation could very easily change, and dramatically.
The briefing adds, approvingly, that the use of growth-promoting antibiotics was banned 10 years ago in this country. It is probably worth pointing out that that ban came into force only in 2006 and was vigorously opposed by the BPC at the time. Perhaps for that reason, the British Government of the time, initially at least, was the only EU member state Government to oppose the ban. That is another example, I would suggest, of the industry calling the shots on this issue.
I must acknowledge that, 12 months ago, the BPC agreed to introduce a voluntary ban on the use of cephalosporins in poultry production and to stop giving fluoroquinolones to day-old chicks. That does not go nearly far enough, but it is an important step forward and demonstrates an acknowledgement by the BPC, albeit a reluctant one, of the problem.
There is no excuse to delay. The warning has been there since 1945, when, on accepting his part of the Nobel prize in medicine for the discovery and isolation of penicillin, Alexander Fleming said that
“there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”
If we continue to ignore this risk for fear of upsetting vested interests, we will be complicit in robbing future generations of one of the great discoveries of our species and propelling us—apologies for repeating myself—into a truly frightening, post-antibiotic age. It is surely time for the Government to act.
For clarification to those participating in the debate, it will finish at 5.10 pm.
It is a pleasure to serve under your chairmanship, Mrs Main. I congratulate my hon. Friend Zac Goldsmith on securing the debate, which is on an important subject. I
shall say at the outset that, although I just about heard all the many questions that he asked me, I can say with complete confidence that I fear that I will be unable to answer any—well, a large number of them—in my speech this afternoon, but I undertake to ensure that he receives full written answers to them all. As you will understand, Mrs Main, and as I am sure he will too, it is impossible to answer them all in this short debate, especially because it is such a technical matter, with so many important questions that require technical, detailed responses.
I must begin by saying that of course we all recognise that antimicrobial resistance poses a threat to human and animal health. I can assure my hon. Friend and others that the Government take this resistance very seriously. DEFRA and its agencies have been collaborating for many years with the Department of Health, the Health Protection Agency and the Food Standards Agency on this issue. The Government’s collective objective is to ensure that antibiotic use in animals does not become a significant clinical problem for human health. I am told that there is little evidence on antimicrobial resistance transmission routes from animals to humans. The concern is that if bacteria in food-producing and companion animals develop resistance to drugs used in human medicine, those could be transferred to humans via food or through direct contact.
Controls in the veterinary sector need to be carefully balanced to minimise undesirable animal welfare issues and not hamper the efficiency of UK food production in a way that could disadvantage the industry in relation to other countries where controls may be implemented less well or less effectively enforced. Good farm management, biosecurity measures and animal husbandry systems underpin the health and welfare of food-producing animals. When applied appropriately, they enable the use of antibiotics to be minimised. We all want and welcome that.
We agree that the routine use of antibiotics in animals is unacceptable. I am assured that relevant guidance and regulation is given to the sector to make that absolutely clear. I will ask my hon. Friend the Minister of State, Department for Environment, Food and Rural Affairs, to consider whether current guidance on the responsible use of antibiotics can be strengthened to make it clear that the routine administration of antibiotics is not acceptable. I am also told that intensive farming systems do not necessarily use large amounts of antibiotics. Some have high health status livestock and so use very limited quantities of antibiotics.
The Government fully appreciate that effective controls are needed in the environmental, agricultural, food production, animal and human health sectors. Failure to act promptly and comprehensively could mean that we face impending problems with implications for animal health and welfare and knock-on effects for food supply and safety, as well as, ultimately, human health and patient safety.
Although the link between antimicrobial use in animals and the spread of resistance in humans is not well understood, there is scientific consensus that the use of antimicrobials in human medicine is the main driving force for antimicrobial-resistant human infections. The majority of resistant strains affecting humans are different from those affecting animals. Bearing that in mind, we have developed an integrated strategy to tackle the
challenge of antibiotic resistance, and resistance to other antimicrobials, such as antifungals.
We have been working with DEFRA and other stakeholders to develop a new UK five-year antimicrobial resistance strategy and action plan, which we aim to publish shortly. The strategy will address all sectors, including veterinary use. To have maximum impact, the new integrated strategy will focus on a wide range of intervention measures to safeguard human and animal health, including: promoting responsible prescribing; improving infection prevention and control; raising awareness of the problem; improving the scientific evidence base; facilitating the development of new treatments; strengthening surveillance, and strengthening collaboration, data and technology.
There is general agreement that responsible prescribing is central to slowing down the development of antimicrobial resistance in humans and animals. Antibiotics, used responsibly, remain a vital part of the veterinary surgeons’ toolbox, without which animals suffering from a bacterial infection could not be treated effectively. The use of antibiotics in veterinary medicine is controlled by veterinary prescription and is equivalent to arrangements for humans. In that way, we are encouraging the responsible use of antibiotics and minimising their routine use.
In addition, the use of antibiotics as growth promoters has been banned in the EU since 2006, as my hon. Friend the Member for Richmond Park informed us. In the dairy industry, if a cow has been treated with antibiotics, the milk should be isolated, and there is regular routine testing of tanks to ensure that there are no traces of antibiotics. Those are some of the many checks in place to ensure that antibiotics do not get into the human food chain.
Antibiotic use on farms is increasing not decreasing, so despite the initiatives and efforts we have heard about, the trends are heading in the wrong direction. Will my hon. Friend commit on the record to reviewing and reading the references, with which I will provide her at the end of the debate, for all the points I made in my speech and checking the science behind them, so that she is certain that the brief she received from her Department is accurate?
I am more than happy to do all those things. As my hon. Friend will appreciate, I am no expert in this field and would not pretend to be for one moment. I shall make a very important point: my briefing does not come from the Department of Health only; we work in collaboration with the Department for Environment, Food and Rural Affairs.
One important thing about this debate is that my hon. Friend rightly asked for a Minister from the Department of Health to respond, so I am not, as others might have thought, someone from DEFRA. Many people are concerned about whether how an animal is treated has an impact on them if they consume some or part of it. Although we might not always make too many friends in the farming industry, we are all responsible for ensuring that we know what we are putting into our bodies and feeding our families. We bear that responsibility, so we need good, informed advice. Many people, but often those with the financial means to do so, will not buy fresh meat unless they know its antecedents—that it has come from a good butcher and a good beast.
I am grateful to the Minister for her openness to looking at more of the evidence that the hon. Member for Richmond Park presented. Having examined the greater body of evidence, will she also consider the need for legally binding measures as well as more information and awareness raising? The trends are going in the wrong direction, and we therefore need legally binding measures.
I am sort of grateful for that intervention; I fear that I could be in terrible danger of agreeing to do almost anything, and so would be able to do nothing else, because I would spend most of my time on this. I will do all that I can. It is very important. As individuals and parents, we all should be concerned, as many of us are, about what we eat and what we feed our children and loved ones. This is as much a public health issue as an animal welfare issue.
The Government have published a code of practice on the responsible use of medicines on the farm and a leaflet on antibiotics, which, like the above code, is on the Veterinary Medicines Directorate’s website. We just have to hope and pray that such things are read, but in my experience, responsible producers pay heed to all such advice. There are also regulations.
We continue to work actively with the farming industry to promote the responsible use of antibiotics in farmed animals, and industry organisations have also developed guidance. Furthermore, I am pleased to say that the Veterinary Medicines Regulations 2011 will be changed this year to prohibit the advertising of antibiotic products to professional keepers of animals. In addition, as my hon. Friend the Member for Richmond Park mentioned, from January 2012, the British Poultry Council introduced a voluntary ban on the use of certain critically important antibiotics in chick production, which should be welcomed.
Veterinary use of antibiotics is also being addressed at a European level. It forms a significant component of both the 2011 EU action plan against the rising threats from antimicrobial resistance and the 2012 EU Council conclusions. The EU legislation on veterinary medicines is currently under revision, and the UK, with other member states and the Commission, is examining the available evidence to establish whether there is a need for additional controls on antibiotics used in animals. The Government will continue to press for measures to strengthen controls on antibiotics that are critically important for human health, to make it clear that they should be used for animals only when no effective alternatives exist.
The Veterinary Medicines Directorate at DEFRA closely monitors the use of veterinary medicines in the UK. It analyses samples from food producing animals and their products for residues of veterinary medicines and environmental contaminants. There is no conclusive scientific evidence that food-producing animals form a reservoir of infection in the UK. Food is not considered a major source of infections resistant to antibiotics. Any bacteria associated with food or the environment can be reduced by thorough washing and cooking.
As I mentioned, the scientific consensus is that veterinary use of antibiotics is not a significant driver for human multiresistant infections. However, we are keen to see greater improvements in prescribing in all sectors and
are actively working to encourage that. A wide programme of work to tackle antimicrobial resistance has been under way across the UK in the human and animal health sectors for several years. Although much has been achieved, I fully acknowledge that there are a number of areas that require attention and more radical thinking, if we are to have an even greater impact. I am confident that the new UK strategy will move us forward in that respect.
I undertake to write to any hon. Member who raised a question in the debate. Again, I congratulate my hon. Friend and assure him that I will answer all his questions. It now seems that I will read a great many documents and other evidence, but it is important work. If I feel that there is any need to make any changes, I will make them.
Sitting adjourned without Question put (