By DDW Editor Reece Armstrong
The threat of antimicrobial resistance (AMR) has long been a talking point for those invested in healthcare and life sciences. Indeed, for many, it is a looming threat for which inaction could result in very serious consequences for healthcare systems worldwide.
AMR is currently listed as one of the top 10 global public health threats to humanity by the World Health Organisation (WHO). In fact, attributable deaths to AMR were higher than previous estimates according to a study published in The Lancet earlier this year1. That study put global deaths from bacterial AMR at 1.27 million in 2019. And by 2050, deaths from AMR have been estimated to reach as high as 10 million per year.
With AMR already posing a threat to healthcare systems and patients, the latest suggestions by current Health and Social Care Secretary Thérèse Coffey to allow patients to obtain antibiotics from a pharmacist, without first seeing a doctor, come across as reckless and wildly irresponsible.
The idea, I suppose, is to ease the burden on GPs in England by freeing up appointments, so that patients with bacterial infections can access treatments without first needing to see their doctor. However, whilst pharmacists are incredibly beneficial to England’s healthcare system, the potential for misdiagnosis and the handing out of antibiotics that serve no purpose to a patient’s ailment, will arguably be much higher through Coffey’s proposed scheme.
The consequences of this action could be severe. The overuse, or misuse, of antimicrobials can lead to bacteria, viruses, fungi or parasites, becoming more resistant to treatments over time, making them less effective at treating infections. AMR poses risks for patients with common infections but also makes surgeries, cancer chemotherapy and even childbirth more dangerous than they ought to be, due to hard-to-treat infections.
AMR is not just a future problem; its impact is being felt right now by healthcare systems. As the WHO states, there are parts of the world where treatments for urinary tract infections are now ineffective in more than half of patients, due to resistance to fluoroquinolone antibiotics in E. coli.
Coffey’s proposals, which were announced by The Times2, were instantly met with criticism from doctors and healthcare experts.
In response to the announcement, Anthony McDonnell, Senior Policy Analyst in the Center for Global Development’s Global Health Policy team and former Head of Economic Research in the UK’s Review into Antimicrobial Resistance, called it a “huge step backwards for the UK which has long been a world leader in the fight against antimicrobial resistance.”
“While moving prescriptions to pharmacies might relieve the burden on GPs in short term, pharmacists don’t have the same training as doctors and will inevitably feel pressure to give out more antibiotics than needed. This will lead to greater selective pressure on bacteria causing them to evolve more resistance, meaning there will be more patients with bacterial infections that cannot be treated by antibiotics and will require even greater care. This will only add to the pressure to our cash-strapped National Health Service,” McDonnell added.
In 2020, Dr Peter Jackson wrote in DDW that when “antibiotics can be bought for human or animal use without a prescription, the emergence and spread of resistance is made worse.”
“Similarly, in countries without standard treatment guidelines, antibiotics are often over-prescribed by health workers and veterinarians and over-used by the public,” Dr Jackson continued.
With between 8.8 – 23.1% of antibiotic prescriptions thought to be inappropriate3, England is not in a position where it can recklessly increase access to antimicrobials. Indeed, the mere suggestion by Coffey demeans the UK’s long-standing position as a leader in the field of AMR. What’s needed now is a concerted and co-ordinated effort by global healthcare systems to reduce the use of antimicrobials and ensure that patients who need them, are receiving the right treatments.
If Coffey doesn’t heed advice by medical experts, the results could be devastating.
As Anthony McDonnell says: “The ultimate result will be that the drugs no longer work for those who truly need them, and this has grave consequences, not only for the UK, but for the rest of the world.”
References
1: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02724-0/fulltext
3: https://academic.oup.com/jac/article/73/suppl_2/ii36/4841818
