To ask Her Majesty’s Government what steps they are taking to reduce deaths from antimicrobial-resistant infections.

My Lords, antimicrobial resistance, or AMR, is a significant global threat and the Government are committed to tackling it domestically and internationally. Over the past five years, we have worked to deliver our strategy and ambitions as set out in response to my noble friend Lord O’Neill’s review. However, we recognise that no country can tackle AMR in a single five-year strategy. That is why we will shortly be setting out our longer-term vision for tackling AMR and setting challenging ambitions for the next five years.

I thank the Minister for that Answer. As he rightly said, AMR poses a grave threat to health. Quite simply, if action is not taken to address this growing threat, it is estimated that, by 2050, AMR will kill 10 million people a year, more than cancer and diabetes combined. This week we saw the publication of the Commons Health Select Committee report which outlined the gravity of this issue. It is of concern that the Chief Medical Officer said to that committee that she would like,

“more visible and active Government leadership”,

on AMR. I think I need to press the Minister. When we will see more visible activity and what form will it take to deal with a huge threat to our nation’s health?

I agree with the noble Baroness about the grave long-term threat AMR poses, but it also poses a threat in the short term. Estimates vary, but between 2,500 and 5,000 people a year in England die because of AMR. In relation to the seriousness with which the UK takes it, I mentioned the new strategy which will be published shortly. I should point out two things that have been a success. First, the UK has taken a very important global leadership role in making AMR a priority for the G20. Secondly, as a consequence of our action plan, we have seen reductions in the prescribing of antibiotics at GP level. That means that we are starting to drill down on the overprescribing and inappropriate prescribing which is driving AMR.

My Lords, is it correct that last-resort antibiotics are being fed to pigs in order that they can be weaned at an earlier stage?

I do not know specifically about pigs, although in my briefing there was a quote from Pig World, which is not a periodical I read very often. Antibiotic use in the veterinary environment has gone down by 40%. It is one of the big successes of the strategy.

My Lords, today the European Parliament is voting to ban all prophylactic use of antibiotics in farming, which will mean that they can no longer routinely be fed to groups. While British farmers have done magnificently in reducing antibiotics, I gather that the UK’s Veterinary Medicine Directorate is not minded to adopt this ban. Can I have an assurance from the Government that, in any new legislation now and post Brexit, a total ban on prophylactic use will be installed and that food standards will be maintained so that, if we ever start taking American meat imports, we will not accept them because of their unacceptable use of antibiotics?

I join the noble Baroness in congratulating farmers on fantastic action in reducing the use of antibiotics. The specific issue the noble Baroness asked about is in the competence of Defra, so I will have to speak to my colleagues in that department about their opinion on the prophylactic use of antibiotics. On food standards, we have some of the highest food standards and animal welfare standards in the world, as the noble Baroness knows, and we have no intention of lowering them in any trade deal.

My Lords, the Minister referred earlier to overprescribing. Will he tell the House what is being done to protect the future of scientific research in this area, particularly post Brexit? Although changing the behaviour of GPs and patients is important, long-term certainty will come from research which is yet to be completed.

The noble Baroness is quite right. A key part of the strategy to date has been a £350 million investment in R&D specifically on AMR. On what will happen after Brexit, as she will know, our intention, as set out in the white paper, is to be part of the successor programme to Horizon 2020, which you do not need to belong to the EU to be part of.

My Lords, in 2016 just under 250,000 people developed multidrug-resistant TB globally, and in 2015 a report found that one-third of London boroughs exceeded the World Health Organization’s high-incidence threshold for TB. This poses a huge threat to public health. What action is being taken to get on top of this by the Department of Health, Public Health England and other agencies?

The noble Baroness is quite right about the risk in London. We actually have a good TB story in this country—a 41% reduction between 2011 and 2016—but London has the highest rates in the UK. I can tell her that Public Health England and the GLA are working closely together to reduce TB. In fact there are innovative new approaches, such as UCLH’s Find & Treat mobile unit, which I myself visited last year, which is going out and finding people at the highest risk, screening them and then taking them for treatment.

My Lords, accepting that the overprescribing or inappropriate prescribing of any drug is a bad idea, the issue of bacterial infections will remain with us. I hope the new strategy that the Minister mentioned will address the issue of how we might tackle bacterial infections in future. This could be by developing new antibiotics; developing drugs that deal with infections but do not produce resistance; developing therapies such as boosting the immune response to be able to cope with these infections; and even, if I may say so, developing drugs that might deal with so-called zombie cells that cause infections, which would be more appropriate for older people. I therefore hope his new strategy will address the necessary research.

I can reassure the noble Lord on that front. We have made good progress in dealing with hospital-acquired infections such as MRSA and C. difficile, although unfortunately we have had less success with E. coli. Obviously, a big part of this is driving down infections completely. The other part is about drug discovery, and that is a big global action. It is part of the G20 work that we are taking forward with Argentina to ensure that we have new classes of antibiotics to deal with these problems.