Conrad Fallon discusses how cuts to the foreign aid budget would negatively impact the global effort to prevent the spread of anti-microbial resistance.
If a viral infection can change society as radically as it has in 2020, you would think protecting the country against future health crises would be a priority for any government. However, recent cuts to the foreign aid budget show that this Government does not have its priorities in order regarding one of the greatest health crises of this century: Anti-microbial resistance (AMR).
AMR refers to microbes (viruses, fungi, parasites and bacteria) becoming resistant to anti-microbial medicines designed to combat them, making microbial infections much harder or impossible to treat. The trouble with that is that modern society is dependent on anti-microbials for much that we take for granted: treatment of common diseases, preventing infections around surgery, and in agriculture to prevent infections in livestock. If our medicines cease to be effective, these routine practices become much less safe. This brings back the spectre of people dying from small cuts, increases the risk of foodborne infections, and pertinently, makes it harder to treat secondary infections – which contribute to many COVID-19-linked deaths. And like COVID-19, AMR spreads globally – on individuals, surfaces and in the environment – so the emergence of resistant strains is unlikely to be restricted to one area for long. Worldwide, AMR-linked infections currently cause 700,000 extra yearly deaths, a number predicted to increase to 10 million by 2050; for comparison, COVID-19 has so far caused 1.6 million deaths (albeit after global containment measures).
Unfortunately, dealing with AMR is not as simple as finding new treatments; the rate at which microbes are becoming resistant to existing medicines outstrips the rate at which new ones are being discovered. As such, avoiding a health crisis relies on slowing down the process by which resistant microbes emerge.
In short, resistance develops when anti-microbials are used incorrectly or unnecessarily. Incorrect use refers to the more tangible applications of anti-microbial drugs, such as when patient fails to complete a course or the wrong type of anti-microbial is used to treat a specific microbe e.g., antibiotics for a viral infection. These can generally be ascribed to lack of understanding or resources among health care providers and users. Unnecessary use is more of a structural issue, and refers to when anti-microbials are used as a result of avoidable exposure to microbes, such as when people live in unsanitary environments, or the overdependence on anti-microbials in the agricultural industry*. Preventing incorrect and unnecessary use of anti-microbials requires dealing with medical, social, economic and environmental factors – a holistic approach adopted by the WHO and referred to as the ‘One Health’ strategy.
Foreign aid is essential to this strategy in preventing incorrect and unnecessary use of anti-microbials. It provides the necessary resources and education, so the right medicines are available to treat specific infections and for people to complete their treatment course. It provides the sanitation infrastructure needed to prevent microbial disease outbreaks in the first place; the frequency of cholera outbreaks reminds us of how vulnerable many populations still are. It promotes high agricultural standards to prevent overuse of anti-microbials in animal populations – a population that will grow as meat consumption increases globally. Additionally, it contributes to the reporting infrastructure required to keep track of disease outbreaks, which is essential to know how to target resources. These efforts slow the spread of AMR and are made possible by foreign aid. Every pound cut from the foreign aid budget undermines those efforts and brings the next world health crisis ever closer.
Now, it may come as news to some Tory MPs, but the UK is in fact part of the world**; if resistant strains emerge abroad, they will arrive here eventually. What’s disappointing about this decision is that it disregards the Department of Health and Social Care’s 2019 AMR policy paper. It’s clear from the paper that they’re aware of the need for a holistic approach and global action – the type of action enabled by foreign aid - and yet the government chose to take away the funding required for it. And though they may point to the pandemic’s economic effects as the trigger***, the pandemic should in fact demonstrate why controlling microbial infections abroad is so important.
What the Labour Party and the Left must do now is treat AMR as the looming human tragedy that it is. Like climate change, AMR is a scientific reality and requires serious thought, effort and money to avoid a global crisis in the future. A start would be adopting Antibiotic Research UK’s 5-point plan for dealing with AMR, and beginning to look out for and counteract factors contributing to AMR in the UK and abroad as a matter of urgency. Among these factors are the cuts to the foreign aid budget, which encourage AMR to take root abroad, and will come back to haunt us unless we take action now.
*Which is done as a short-cut to meet health standards, and to promote animal growth.
**To be fair to him, Dominic Raab is from the moon.
***Obviously, you can draw your own conclusions on their full reasoning, but note also that the foreign aid budget contracts with the economy, being a percentage of the total budget, not a fixed number.
Conrad Fallon is an MSc Developmental Biology student at the University of Manchester, and is a member of the University’s Young Fabians society and the UoM AMR society.
UK foreign aid spending 2018: https://fullfact.org/economy/uk-spending-foreign-aid/