Over the past few months, the political landscape in the UK has been, shall we say, tumultuous. The revolving door of prime ministers and cabinet members is not compatible with a solid long-term strategy in any area controlled by the government. But a particular policy announced last month raised serious concerns about its potentially far-reaching consequences.
The idea sounds reasonable on paper: to bring in pharmacists to help reduce the burden on an already overstretched public health service by allowing them to prescribe drugs for “minor ailments”. The idea of the Secretary of State for Health and Social Affairs for the Environment Therese Coffey in Liz Truss’ short-lived cabinet, the plan immediately caused an uproar in the scientific community. Why should the world care about UK policy changes?
A word: resistance.
The WHO has been warning for decades that bacterial resistance is “one of the biggest threats to global health“, chronically neglected and already causing million dead worldwide. Bacteria very quickly develop resistance to any new antibiotic through the rules of natural selection, and this new characteristic spreads until the resistant strain becomes dominant. This has happened many times before and is the reason why penicillin, the first mass-produced antibiotic, is no longer effective in its original form. Since its introduction around 75 years ago, bacteria have had plenty of time to develop resistance to this once magical drug, as they have for many others that came later.
If it’s going to happen anyway, what’s the point of worrying? It all depends on the replacement rate. If a widely used antibiotic is eventually rendered useless by resistant strains, we need to be able to switch to a new, better one. Therefore, it is imperative that we continue to develop new antibiotics at a rate fast enough to replace those that have already generated resistance.
Naturally, this requires a constant influx of funds into antibiotic research, which has been one of the weakest links in the chain: traditionally left to pharmaceutical companies, markets offer little incentive to invest millions of dollars in a product that will only be useful for a limited time. Even greater pressure is put on the drug if it proves to be truly effective; then, the medical recommendation will be to prescribe it as little as possible, reserving it for the most difficult cases (the “superbugs” who have multiple drug resistance). The better the antibiotic, the less we want to use it. It’s understandable that Big Pharma is more enthusiastic about finding the next Viagra than providing a much-needed social service by adding more strings to our antibiotic bow.
There are solutions to this. One is more public investment in this area, which is already the trend in recent years. Another is to encourage companies to invest in those areas that interest them less (for example by extending the patent protection of one of their flagship drugs in exchange). But alongside these policy measures, we as individuals can also contribute. Doctors should avoid prescribing antibiotics if there is no obvious need, and patients should understand the problem and follow the rules (complete treatment, do not pressure their doctors to get antibiotics, no self-prescription, etc.). Failure to do so only accelerates the exposure of bacteria to the drug and thus hastens the onset of resistance.
An example of political failure is a recent study which reveals that in ten African countries, antibiotic prescribing was rampant during the height of the COVID-19 pandemic, even knowing that only a few patients had bacterial co-infections and the rest would not really benefit. But it’s not just a problem in developing countries: over-the-counter antibiotic use is also common in the United States, as a recent exam found, with 25% of the population having already done so, and up to 50% sorting out antibiotics for future personal or family use.
Britain’s plan to outsource some of the care for minor ailments, which unfortunately means pharmacists can prescribe antibiotics, is one way to add fuel to the fire. If properly trained, pharmacists could be as good as any doctor at minimizing unnecessary antibiotic use. But will this be the case? Deciding whether a disease requires antibiotics is not an easy task, as all GPs know. So the immediate take-home message from this policy is that getting antibiotics will probably be easier now. And expanding access to these drugs is never a good idea.
It now remains to be seen whether the UK government, under new Prime Minister Rishi Sunak, will stick to the Coffey plan. Perhaps Coffey’s lateral shift from health and social services to environment, food and rural affairs is a sign that the controversial idea will be quietly shelved. We will see.
In any case, antibiotic resistance remains a global health challenge that we must take seriously. Every little effort helps, even ensuring that antibiotic prescriptions are as controlled as possible in every country because, as we have seen with the COVID-19 pandemic, problems with germs rarely stay where they are. of origin now that we live in a global society. We really don’t need the next global health crises to be caused by hard-to-treat bacteria.
About Dr. Salvador Macip
Salvador Macip, MD, PhD is a physician, researcher, and writer. He received his MD from the University of Barcelona (Spain) in 1998, then moved to do oncology research at Mount Sinai Hospital (New York). Since 2008, he has headed the Mechanisms of Aging and Cancer laboratory at the University of Leicester (UK). Macip has published over 30 books, including
Where science and ethics meet (2016) and
Modern epidemics (2021). Connect with him on Twitter: