When Richard James set up the University of Nottingham’s Centre for Healthcare Associated Infections at the beginning of 2007, it sounded like an unequivocally good idea. Here was an important public health issue and a new centre that could bring together a wide range of experts from both the university and the city’s Queen’s Medical Centre, one of the largest teaching hospitals in Europe.
It drew on the expertise not only of leading researchers on infections and antibiotics, but also of academics from Nottingham’s business school looking at the structures and economics of hospitals, scholars applying mathematical models to epidemiology, and even social scientists studying patient psychology.
Professor James understandably believed that bringing such groups together would enable them to “take a unique holistic view of the problem of infections”.
Yet in the event, he recalled, the symposium to launch the centre was greeted by “a press release from the chief nursing officer (for England) accusing me of being a sensationalist and a scaremonger about the problem of antimicrobial resistance”.
He said that the launch happened at a “particularly sensitive time”, when there was a lot of speculation about an impending general election. “We later discovered that the centre had been discussed at a Cabinet meeting. Governments over the past 10 to 15 years have been quite sensitive to any health stories, particularly around elections.”
To some extent, one can understand such concerns. In 2006, Professor James gave an apocalyptic interview to The Guardian in which he was quoted as saying: “Unless new antibiotics are discovered, we may have to close all our hospitals within the next five years or so…If I were betting on a race between the superbugs and us developing the drugs…well, right now I’d be betting on the bugs.”
In setting up the centre, he said, his goals were to “increase the research output; to inform the public about the nature of infections and the problems they cause the healthcare system; and to try to influence government policy”.
Policy shifts’ significant impact
As Professor James stepped down from his post at the end of 2012, with a new director of the centre yet to be announced, he spoke to Times Higher Education about what had been achieved and the challenges that still lie ahead.
On methicillin-resistant Staphylococcus aureus (MRSA), Professor James said he regretted that the UK had abandoned its highly effective “search and destroy” policy of early detection and intervention.
He felt that moving away from such action caused unnecessary suffering and death.
Yet “although levels are still higher than in many European countries”, he acknowledged success in cutting infection rates for MRSA and Clostridium difficile, not least by adopting policies set out by himself and others. One policy was as simple as “making chief executives sign off the number of cases to the hospital trust every month - which leads to pressure from the board to the ward”.
But at a time when major pharmaceutical companies are cutting back on antibiotics research and leaving it to small biotech companies and universities, Professor James said he was keen for researchers “to develop completely new mechanisms of action that the bacteria have not seen before”.
He paid tribute to the work of his Nottingham colleague Paul Williams, professor of molecular microbiology, who had found ways of “disabling the ability of bacteria to communicate with each other, rather like jamming a battlefield radio system. The advantage of that is you are not trying to kill the bacteria, so you are reducing the selection pressure which causes resistance.”
Yet despite some notable advances, Professor James said he remained worried by threats from new “superbugs” such as NDM-1 (New Delhi metallo-beta-lactamase-1), which he described as “the kinds of infections which led to the chief medical officer of England, [Dame] Sally Davies, to say that antimicrobial resistance is now as serious a threat to mankind as global warming”.
Equally alarming are “E. coli blood infections” and the spread of extremely drug-resistant tuberculosis, not to mention non-hospital-acquired strains of MRSA that “cause infections in young people with no underlying health problems”.
“It took us 14 years to get to grips with hospital MRSA and now…it’s going to be much more difficult to control because the patients don’t present at hospitals to let you start treating them.”
The prospect of dealing with such threats could also be blunted if Professor James’ fellow researchers fail to take up the mantle of making public their worries.
“Any academic who has an honorary appointment in the NHS signs what amounts to a confidentiality agreement, so they are dissuaded from making public statements about serious public health issues like this.
“A non-clinical academic like me is able to talk to the media.”