Medical practice

Superbug 'could kill 80,000 people' experts warn

"Superflu pandemic is biggest danger to UK apart from a terrorist attack – and could kill 80,000 people," is the warning in The Independent. A briefing produced by experts outlines how antibiotic resistance could pose a significant threat (PDF, 440kb) to public health.

"Up to 80,000 people in Britain could die in a single outbreak of an infection due to a new generation of superbugs," reports The Daily Telegraph – one of many news sources reporting on these estimated figures from the government.

Why are superbugs in the news again today?

The news is based on the threat of antimicrobial resistant microbes (sometimes called "superbugs" in the media) described in the government’s 2015 National Risk Register of Civil Emergencies (NRR). This is reported to be the first time the NRR has covered this threat.

What is the National Risk Register?

The NRR is an assessment of the risks of civil emergencies facing the UK over the next five years, and is produced every two years. The NRR report is a public-facing version of a classified internal government report called the National Risk Assessment (NRA). Civil emergencies are events or situations which threaten serious damage to human welfare or the environment in the UK, or threaten serious damage to national security.

In producing the report, the government assesses how likely an event is, and what the impact of it might be. The report considers events that have at least a 1 in 20,000 chance of happening in the next five years, and that would require government intervention. The report also covers issues that are longer-term or broader than single events, but which also have the potential to adversely impact society. The threat of antimicrobial resistance (AMR) is one such longer-term issue.

What is antimicrobial resistance and why is it a risk?

AMR is a global health threat.

Antimicrobials are drugs used to treat an infectious organism, and include antibiotics (used to treat bacteria), antivirals (for viruses), antifungals (for fungal infections) and antiparasitics (for parasites).

When antimicrobials are no longer effective against infections they were previously effective against, this is called antimicrobial resistance. Regular exposure to antimicrobials prompts the bacteria or other organisms to change and adapt to survive these drugs.

Nowadays, fewer new antibiotics are being developed, meaning we have fewer options and stronger drugs in our antibiotics armoury have to be used to treat common infections once they become resistant. This means we are now facing a possible future situation where we will be without effective antibiotics.

What could the impact be?

The report states that the cases of infection where AMR poses a problem are "expected to increase markedly over the next 20 years". It estimates that if a widespread outbreak were to happen, around 200,000 people could be affected by a bacterial blood infection resistant to existing drugs, and 80,000 of these people could die. It also says that many deaths could be expected from other forms of resistant infections.

What about "superflu"?

The Independent’s headline suggests that it is "superflu" which could kill 80,000, and that it is the "biggest danger to the UK apart from a terrorist attack". The headline appears to conflate two parts of the report. 

The 80,000 figure appears to come from the estimates of the potential impact of a resistant bacterial blood infection reported above, not specifically "superflu". The report does note that flu pandemics would become more serious without effective treatments, but does not give an estimate of how many people antimicrobial resistant pandemic flu could kill.

Flu pandemics (not specifically antimicrobial resistant flu) are also one of the specific risks assessed by the report. They are given a maximum relative impact score of five out of five, which is the same score as catastrophic terrorist attacks.

The report estimates that pandemic flu could infect half of the UK population and lead to between 20,000 and 750,000 additional deaths.

A flu pandemic was estimated as having a relative likelihood of between 1 in 2 and 1 in 20, and was reported to "[continue] to represent the most significant civil emergency risk".

How did the report assess the risk of AMR?

The report did not specify how it got to the specific AMR impact figures, but it does give its overall methods. The risks are identified by consulting experts both within and outside the government, and devolved administrations. For each risk the report selects a "reasonable worst case" scenario, which represents something which would be a challenge and could plausibly occur. The likelihood of an event (such as pandemic flu) was based on information such as historical analyses and modelling where possibly, along with scientific expertise. The impact score for an event was assessed on a scale of 0 to 5 (0 least and 5 greatest) and averaged across 5 areas:

  • deaths
  • illness or injury
  • social disruption
  • economic harm
  • psychological impact

What is being done about this threat?

The report notes that AMR is a global problem that needs international action to be tackled. The report describes some of the actions being taken:

  • The government and devolved administrations are working with international partners to get support for joint action internationally.
  • Government departments, the NHS and other partners are working together to implement the UK five-year Antimicrobial Resistance Strategy published in 2013.
  • The impact of actions to reduce the spread of AMR is being measured and reported on by a cross-government high level steering group.
  • There is an ongoing independent review of AMR, which is being chaired by economist Jim O’Neil. Two reports from this review have already been released. Further reports are expected in 2015, and in 2016 the review will recommend actions to be agreed internationally to deal with AMR.

What can you do to help reduce the spread of AMR?

People can help cut antibiotic (or wider antimicrobial) resistance by recognising that many common infections, such as coughs, colds and stomach upsets, are often viral infections that will go away after a short period without treatment (known as "self-limiting" infections). These infections do not need an antibiotic, as they will have no effect.

If you are prescribed an antibiotic (or other antimicrobial), it is also important to make sure you take the full course as prescribed, even if you feel better before you finish the course.

This will reduce the chances of the organisms being exposed to the drug but then surviving, which encourages the development and spread of resistance to the drug.

Taking the course as prescribed will also increase the chances of you getting better. By not taking a full course, you may find that the infection comes back and requires further antibiotic prescriptions, which further increases the chances of resistant organisms developing.

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