Incentives to encourage the pharmaceutical industry to develop new antibiotics must be put in place, and fast, or in just 20 years minor operations could be fatal, chief medical officer Dame Sally Davies has warned.

The call forms part of no less than 17 recommendations made by the CMO to help tackle the growing threat of antibiotic resistance, which, she told the BBC, poses as big a risk to the UK as terrorism.

Mortality rates for infectious diseases have been falling in the developed world, but they still cause around 7% of deaths in the UK, costing the economy a massive £30 billion a year, and antibiotic resistance is on the rise.

A key part of the problem is that, while a new infectious disease has been discovered nearly every year over the last three decade, very few new antibiotics have been developed, "leaving our armoury nearly empty as diseases evolve and become resistant to existing drugs", Dame Sally said.

The dwindling supply of new classes of antimicrobial agents is, in part, due to scientific challenges of the field, but the market conditions for new pharmaceuticals also plays a major role.

Antibiotics are only used for short periods and, over time, their efficacy diminished as resistance develops. In addition, sometimes their use is put on hold so that they are only administered when resistance has developed to others. This means that there is a limited profitability during the patent life. 

Added to this, trial requirements are "onerous and costly", and so, all-in-all, this equates to a market failure, as there are "fewer economic incentives to produce new antimicrobial agents than there are for other classes of drug", the report notes.

"If we are to secure a ‘pipeline’ of new antimicrobial drugs for the future then we must align the private and societal risks, and the costs and benefits of research and development of these agents," according to Dame Sally. 

"There are many ways to incentivise innovation, engaging the private sector, public institutions and academia. The challenge is to alter the balance of these incentives so that we have a thriving, vibrant, sustainable and safe programme of research and development into new antimicrobials," she stressed.

Equally important is to take care of those antibiotics we already do have, which means "using better hygiene measures to prevent infections, prescribing fewer antibiotics and making sure they are only prescribed when needed", the report notes.

"Antimicrobial resistance poses a catastrophic threat…that’s why governments and organisations across the world, including the World Health Organisation and G8, need to take this seriously," the CMO said.

On the risk register

According to her report, antimicrobial resistance should be put on the national risk register, and the national approach to tackling the problem should not just focus on humans but animals as well. Public Health England also needs to work closely with the NHS Commissioning Board to ensure the availability of advanced testing facilities for infections from abroad, it said.

The Department of Health will soon publish its UK Antimicrobial Resistance Strategy, which will outline plans to: encourage the development of new diagnostics, therapeutics and antibiotics; strengthen National Health Service surveillance on antibiotics prescribed and trends in resistance; and "champion" better use of antibiotics.  

Commenting on the report, Stephen Whitehead, chief executive of the Association of the British Pharmaceutical Industry, said Dame Sally is right to raise concerns over antimicrobial resistance, but he noted that there are pharmaceutical companies actively involved in the research and development of new antibiotics.

The Innovative Medicines Initiative (IMI), for example, has brought together several pharmaceutical companies and the public sector to invest nearly 224 million euros in developing a programme to tackle antimicrobial resistance, he said.

"But more still needs to be done and we believe that for there to be a continual supply of effective antibiotics, a comprehensive review of the R&D environment and good stewardship are required urgently," Whitehead agreed.