Health

Thursday briefing: How antibiotic shortages are holding back the fight against Strep A


Good morning.

If you have been struck down by a particularly gnarly cold recently, you are not alone. Two years of social distancing, masking and lockdowns has meant that many of us were able to avoid getting the usual, seasonal respiratory infections. But now that it’s becoming normal to go into the office or socialise with a tickle in your throat or a congested nose, a lot of people are continually catching colds and flus.

Since September, the bacterial infection known as Strep A has been on the rise and the deaths of 15 children in the UK has caused widespread concern, especially as the spread of the disease is happening far earlier than usual, meaning that the number could rise. However, Strep A is not Covid 19: it’s not a new infection, it is well researched and it is treatable … with the right antibiotics.

But with reports of antibiotic shortages pharmacists have been warning that people will not be able to access treatment unless action is taken. I spoke to Dr Leyla Hannbeck, the chief executive of the Association of Independent Multiple Pharmacies, about the supply shortage and its impacts. That’s right after the headlines.

Five big stories

  1. Channel crossings | Warnings that a boat carrying asylum seekers had capsized in the Channel were first raised in a call to a French NGO. The Guardian obtained a recording from an unidentified man on the sinking vessel, calling for help. Four people died and more than 40 were rescued in the accident.

  2. Fire service | London fire brigade has been placed into special measures after a report revealed incidents of misogyny, racism and bullying. The industry watchdog made the move saying that behavioural problems were “deep-seated and have not improved”.

  3. Nurse Strike | Tens of thousands of nurses will strike across England, Wales and Northern Ireland today in the first such action in NHS history. It’s the first of two days of scheduled walkouts over pay claims.

  4. Police | A damning report into how police forces tackle rape cases has exposed persistent failings in the criminal justice system, including a failure to track repeat suspects, “explicit victim-blaming” and botched investigations. The official examination was launched by the government after a catastrophic fall in rape prosecutions.

  5. Wealth | Elon Musk has lost his status as the world’s richest person, after further falls in the value of shares in his electric car company Tesla. Forbes and Bloomberg reported that Musk had lost the top spot to France’s Bernard Arnault, the chief executive of the luxury group LVMH.

Read More   Chinese court sentences 'gene-editing' scientist to three years in prison

In depth: ‘My concern is what it will take for the government to listen’

Schoolchildren during class at a primary school.
Preventive antibiotics could be given to children at schools affected by Strep A infections, the schools minister has confirmed. Photograph: Danny Lawson/PA

If it is caught and treated early, Strep A is nothing to panic about. However, people are struggling to get appointments at overstretched GPs – making it hard to administer medicine soon enough. This problem is only exacerbated by a chronic shortage of antibiotics that has been on the horizon for months. Pharmacies are being pushed to the brink and parents are unable to access the right treatment for their children – with some resorting to crushing adult tablets and mixing them with Ribena to make it palatable for young children. How has this happened?


What is Strep A?

Group A streptococcus (GAS), otherwise known as Strep A, is a bacterium found in the throat and on the skin and is spread through coughs and sneezes. For many people it can live in the body without causing any illnesses and generally when it does cause symptoms, they are fairly mild – a fever, sore throat and headache that can be treated at home. The infection is commonly associated with strep throat (tonsillitis) but in a few cases, the symptoms can be more aggressive, especially if they turn into scarlet fever, which can be identified through skin rashes and “strawberry tongue”. At this point people are encouraged to go to the GP or the hospital to get antibiotics, to stop the infection progressing and becoming worse.

Some experts have suggested the uptick in cases is because people are socialising far more this winter than they have in the previous two because of the pandemic, but others have said that it is too early to suggest that this is the main cause behind the surge – for example, there was a surge in 2018, pre-pandemic, which resulted in 32,000 cases, although the rise in numbers started earlier this year than then.


An antibiotic shortage

Ten days ago Leyla Hannbeck raised concerns about the supply of antibiotics in the country – her comments were reported all over the national media. Since then she says the problem has gone from “bad to worse”. The cause is more fundamental than just a surge in demand – Hannbeck says that the supply chain problems that were caused by the pandemic are still affecting the pharmaceutical industry: “We know that it now takes on average about six months longer for a product to be manufactured. This antibiotic shortage is not the first time that we’ve experienced this problem.” Pointing to the HRT shortage in the spring, Hannbeck says that this has been an ongoing issue that has been ignored. The government has insisted that there is no such shortage: “As long as they want to be in denial, it’s very difficult to move forward”.

Not only has it been difficult to obtain the medicine in the first place, pharmacies have been dispensing antibiotics at a steep loss because wholesale prices for amoxicillin or penicillin liquid solutions have been rocketing. In recent weeks the cost of antibiotics that could treat Strep A have risen more than tenfold in the UK but, regardless of how much they are forking out to get the supplies, the NHS will not reimburse pharmacies above the tariff that has been set.


The impacts

Millions of people need pharmacies to access their medicine, however 670 pharmacies have had to close since 2015. “This is going to accelerate a lot in 2023 and 2024 because people simply cannot pay the money to wholesalers and investors,” Hannbeck says of the impact of the NHS paying under cost for common treatments. It comes at the same time that other costs such as staff, business rates and energy bills have all gone up. Most retailers can add the cost on to their products and pass it on to the consumer, but pharmacists can’t, “because it’s medicine and we don’t want to deprive people from having essential medicines just because they can’t afford it”, Hannbeck says.

There is little that pharmacies can do to help, the guidelines at the moment say that they should send patients to other pharmacies if they can’t supply treatment. Patients can also go back to the GP to ask for a different prescription, for another antibiotic for example – but both options are long-winded and stressful and leave more time for the infection to get worse.

After first denying that there were any supply issues, the government has put an export ban on Strep A antibiotics to stabilise stock in the country – but this is a short-term solution for a longstanding problem that healthcare experts and professionals have been warning about. “It’s become a constant battle to try to manage the situation,” Hannbeck says. “My concern is what will it take for the government to listen and take action since we’ve been bringing this to them since the beginning of this year.” A lack of forward planning has meant that a problem that could have been anticipated and mitigated, could become a crisis.

Hannbeck says that until the government talks to pharmacies, manufacturers and wholesalers to create a cohesive solution, the shortage will continue and likely get worse, adding to the concern felt by already worried parents. If there is some small solace, it is that while more children have been affected, the mortality rate for the disease so far this year is no higher than normal (though that will be of little comfort to grieving families). The real worry is what will happen if the spread continues unabated – could already stretched supplies of vital drugs cope with a spike on the scale of 2018?

What else we’ve been reading

  • After Rishi Sunak’s plan to clear the asylum backlog and the dreadful news of more deaths in the Channel yesterday, this piece by Enver Solomon is a necessary corrective to a discourse around the small boats crisis that tends to forget the human beings at the centre of it. Archie

  • Gordon Brown has called for a moratorium on debt collection by the government. “There is no huge cost to the government in suspending deductions, for it will get its money back later”, Brown writes in the Guardian. “[But] this could be a lifesaver for millions now suffering under a regime that seems vindictive beyond austerity”. Nimo

  • Nearly 20 years of the hot priest calendar, and only now do I learn that some of them are not actually priests! Morwenna Ferrier’s interview with photographer Piero Pazzi contains several other bombshells, including the fact that some of them are repeated year to year. I’m so naive. Archie

  • In the Guardian’s Top 50 shows of 2022 at number six comes a personal favourite of mine: the Channel 4 comedy, Big Boys. Hollie Richardson unpacks the significance of this special series that chronicled a minefield of self-discovery, mental health and male friendship in the early 2000s. Nimo

  • Lots of interesting things in this New Yorker interview with James Acaster, especially his view of heckling: “Sometimes, as a comedian, you can feel like they’re not treating you like a human being, if you get really upset about it. But we don’t always treat the audience like they’re human beings, either.” Archie

World Cup

An early goal from Théo Hernandez and a second half strike from Randal Kolo Muani was enough to see France progress to a World Cup Final against Argentina on Sunday. But the broad brushstrokes of this match do little to take in just how much Morocco made the title holders sweat.

The first African team to reach a World Cup semi-final were a 200-1 shot at the beginning of the tournament, but have proved themselves more than able to upset some of the biggest teams in the competition.

The Guardian’s Jacob Steinberg was watching the match in Qatar. Looking ahead to Sunday’s final his assessment of France is that, “barring another Messi masterclass, they are about to become the first country since Brazil in 1962 to successfully defend the World Cup.”

For all the latest on Qatar, from the scandal to the scores, sign up to Football Daily – our free, sometimes funny, newsletter

The front pages

Guardian front page 15 December
Photograph: Guardian

The Guardian leads with “Scathing report condemns police for ‘victim blaming’ in rape cases”, with newly released analysis finding persistent failings and forces struggling to cope with case loads.

The Times headlines “Four dead after migrant dinghy sinks in Channel”, while the i has “Please help us: desperate plea from sinking migrant boat”. The Sun says “£5000 ticket to death”.

The Mirror looks at today’s nurses strike with a full page headline: “We are with you”. The Telegraph says “Damage of nurses’ strikes ‘will get worse’”.

Finally the Financial Times looks ahead to the interest rate decision today: “Fed’s half-point rate rise sets tone for slower squeeze on eve of BoE decision”.

Today in Focus

A London ambulance service crew respond to a 999 call in south London
Photograph: David Levene/The Guardian

33 hours on the frontline of the NHS

From GP surgeries to pharmacies to hospitals, there is no part of the NHS that is not under enormous strain this winter. Andrew Gregory, the Guardian’s health editor, and his colleagues spent hours on the frontline of the NHS to find out how doctors, nurses, paramedics – and the patients they treat – were coping.

Cartoon of the day | Steve Bell

Steve Bell cartoon
Illustration: Steve Bell/The Guardian

The Upside

Sarah & Grandma.
Sarah & Grandma. Photograph: Supplied image

A bit of good news to remind you that the world’s not all bad

When Sarah Ann Harris’s grandmother died unexpectedly in 2016, her absence made Christmas brutal: “Everywhere I looked, there were holes where Grandma should have been,” she writes. One of the sharpest reminders was the absence of the festive fruit tart that she always used to bake on Christmas Eve. “We couldn’t find the recipe anywhere. We scoured her kitchen, flicking through cookbooks and notes, but there was no sign of it. Her recipe, it seemed, had died with her.”

Five years later, Sarah tried to recreate the dish. After racking her brains for a few ingredients that might be clues, she found the missing recipe in a genuinely unexpected place. The story of how that discovery helped restore a family tradition – and memories of a beloved relative – is the latest part of the ‘moment that changed me’ series.

Sign up here for a weekly roundup of The Upside, sent to you every Sunday

Bored at work?

And finally, the Guardian’s crosswords to keep you entertained throughout the day – with plenty more on the Guardian’s Puzzles app for iOS and Android. Until tomorrow.



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