NEWS Q&A

UK medical chief: ‘We are in an arms race against microbes’

Britain’s outgoing chief medical officer, Sally Davies, says there are still clear gaps in the fight against antimicrobial resistance.

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Dame Sally Davies speaking at the Huxley Summit, which is being held by the British Science Association at the BFI in London

As UK chief medical officer, Sally Davies has raised global awareness of the risk of antimicrobial resistance.Credit: Frantzesco Kangaris/PA Archive/PA Images

Sally Davies is part of a group that this week issued a stark warning to the head of the United Nations: if no action is taken on antimicrobial resistance, 10 million people worldwide could die each year by 2050.

Davies, the United Kingdom’s outgoing chief medical officer, has raised the profile of antimicrobial resistance (AMR) on the world stage. On 29 April, the UN’s Interagency Coordination Group on Antimicrobial Resistance, which she co-convened, published a report that said immediate, coordinated and ambitious action is needed to avert the crisis.

Countries must urgently phase out the use of antimicrobials in farming, invest in new technologies to combat resistance and strengthen regulation, it says.

Davies also helped to establish a £265-million (US$344-million) UK government fund to develop laboratories around the world to track the problem of AMR.

A physician and haematologist, Davies was the United Kingdom’s first female chief medical officer. She will leave in September, after nine years in the post, to become master of Trinity College at the University of Cambridge.

Davies spoke to Nature about the research needed to help stem resistance, and her time as a scientist at the heart of government.

How is the fight against AMR going?

AMR is an escalating and highly complex problem — ultimately, we are in an arms race against microbes, which are expert at evolving resistance rapidly, so we have to respond quickly and in a multifaceted way.

There is considerable work ongoing to tackle this threat, but there are very clear gaps in progress. Certain countries — such as Norway, Sweden and the Netherlands — are doing very well in their human health sectors, whereas others have very high rates of resistance and need to take much more action.

The United Kingdom has made impressive progress over the past few years: antibiotic use in humans has reduced by 7.3% from 2014 to 2017, and use in the animal sector fell by 40% in the same period.

We also desperately need new antibiotics, diagnostics and alternative treatments. There is a ‘market failure’ so companies are disinvesting as the current model of payment does not marry up with the complex nature of resistance. There has been some movement on this through the G7 and G20 countries, but this is an area where much more action is needed.

Do you think that the interagency group’s recommendations will have an impact?

I am optimistic.

Is there a need for more research on AMR?

Absolutely. There is a great need for more research into new antimicrobials, alternative treatments for infection, and improved diagnostics that will help guide appropriate prescribing. And more research into optimal infection prevention and control, and new vaccines, will help drive down resistance by preventing infections in the first place.

Research is needed to understand the role of the environment in the emergence and spread of AMR. We know that runoff from farms, hospitals and factories contributes to the spread of resistance, but our knowledge of this is currently limited.

We also need greater work and research into behavioural aspects of AMR. Increasing public understanding is a crucial component of tackling the problem, because we all have a role to play.

How difficult is it to advocate for scientific evidence in UK government?

I have generally found politicians to be receptive to hearing this, and in favour of implementing evidence-informed policies. The key is how we communicate the evidence to them.

High-quality scientific advice is valued. The challenges are either when poor-quality research is presented as high quality, or the media and academia hypes work. We all have a duty to be objective with evidence and to present without bias.

What have been your biggest frustrations in this post?

A late recognition of the role of prevention, and of the importance of the environment we live in for promoting health.

doi: 10.1038/d41586-019-01409-x

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