 Rwy'n meddwl i'r next item of business, which is a debate on motion 4070, in the name of Humza Yousaf, on the Scottish approach to managing the global risk of anti-microbial resistance. I invite members who wish to speak in the debate to press their request to speak buttons now. I call on Humza Yousaf to speak to and move the motion up to 10 minutes, cabinet secretary. Thank you very much, Presiding Officer, and at the beginning of my contribution, let me move the motion in my name. Over the past few years, we have understood what it means to be faced with a health crisis that at first we couldn't treat. We have seen its impact on so many areas of our lives, but what happens if many more infections couldn't be treated? What if antibiotics no longer work to protect patients while they are undergoing surgery or chemotherapy? In reality, what could happen if anti-microbial resistance AMR was allowed to rise uncontrolled? Today's debate on this important global issue is the first in the history of devolution. I don't use that term global threat lightly. AMR is a global threat. I want us all to be under no illusion whatsoever about the severity of that threat. The World Health Organization has described the rise of anti-microbial resistance as one of the top 10 global health threats facing humanity. The Lancet estimates that there was almost 5 million deaths in 2019 associated with bacterial AMR and of those 1.27 million directly caused by anti-microbial resistance. However, there are things that we can do to address that threat. Today, I want to focus on three key ways that we can contain it. First, through our people, by not only recognising the extraordinary efforts of those already working in this field in Scotland but looking into the future and thinking about those whom we will need to help us combat AMR. Secondly, through information flows to address any problem, we must understand the nature of it. I will talk about how we gather and share that data domestically and internationally and the rationale and the need to do that. Finally, by recognising the global nature of the issue of AMR, we know that we do not recognise borders and so I will talk a little about our international facing work in this regard. At AMR, we know that it does not just spread between humans across borders and around the world. It can develop and spread via animals and indeed the environment too. I will speak about the people and information flows across health and social care and our work with global partners. In closing the debate, my colleague, Mary Todd, will give some focus on our work in animal health and the environment. We need action in all of these sectors, working together to control and contain AMR, taking a one-health approach to the problem. In terms of our people, I want to first talk about all those who are involved in helping us to tackle AMR, because they are absolutely critical to our success in containing it. AMR control starts with infection prevention. Every time we use an antimicrobial drug, there is a chance for resistance to develop. Health professionals across Scotland work hard to prevent as many infections as possible and control them quickly when they happen. That not only helps the patient of today but also avoids the use of some drugs altogether, which is a great thing to keep them working for the patients of tomorrow. Sadly, as we know, not every infection can be prevented. When infections do occur, we need to use our lifesaving antimicrobial drugs in the most appropriate and the most effective way. As a Government, we have invested in specialist antimicrobial pharmacists, healthcare scientists and researchers who all work together to get the right drug to the right patient at the right time. The right diagnostic tests, undertaken promptly in our laboratories, can help to identify the right drug for a patient's particular infection and protect important treatments for the future. In Scotland, we are fortunate to have groundbreaking organisations leading the way on AMR. The Scottish antimicrobial prescribing group, a consortium of prescribers from within the NHS, published regular guidance and educational materials for their colleagues on the best possible use of antibiotics and other antimicrobial drugs. They have continued this critically important task alongside the clinical work throughout the Covid-19 pandemic. With their help, spotting opportunities for good stewardship of those drugs can be part of every health and care professionals' job. However, we are not just thinking about how to tackle this issue with our current workforce as important as that is. A long-term problem requires long-term planning. We are also taking stock of our on-going specialist workforce and staffing needs building on the lessons learned during the pandemic by the infection prevention and control, antimicrobial stewardship and health protection workforces. We are working hard to determine and address our evolving service needs. This workforce not only safeguards antimicrobials but also supports health and social care in the prevention and control of existing and new emergent infections, which is critically important to any future pandemic. Every effective workforce needs to have appropriate data to manage their task, and our clinicians have shown strong leadership in collecting surveillance data on the issue. In Scotland, we have the uniquely wide-ranging Scottish One Health antimicrobial use and antimicrobial resistance report that is published every year in November to coincide with World Antibiotic Awareness Week. That covers humans, animals, the environment and the food chain. It is hugely important to our understanding of AMR. Only with the accurate and most up-to-date information can we keep track of how resistance is changing, evolving and continually guiding our health system towards the best possible treatments to use. However, we want to go further learning from the Covid-19 pandemic. Scotland needs and deserves a once-for-Scotland electronic surveillance system for infection. That could support patients, help staff at the front line of infection control and underpin our important AMR work. I have asked my officials to start looking into the best system for Scotland, of course. Although that is very important, is it also not very important that we have communication between healthcare staff that can actually talk to each other and we are all able to see each other's notes? It is a very important issue raised by Dr Sandish Mhaghani. Of course, he has first-hand experience in his clinical role. That is why we have published our data strategy for health and social care. I commend it to Dr Sandish Mhaghani and to anybody in the chamber. It talks importantly not necessarily about uprooting every single IT system across health and social care but about creating that cloud-based infrastructure, which I think is going to be critically important for sharing the information that he talks about. Of course, they are all. Michael Marra, thank you for taking the intervention. Talking about surveillance and issues of stewardship, is the third leg of the tripod not discovery and the fact that we need new interventions? Will the minister cover that in the speech? Yes, of course, we will cover that aspect. I should say, and I was going to come to the end of my contribution, that is why I am keen to accept the amendment by Jackie Baillie and by Scottish Labour, because I think that it is very important that that work is done around research and the various different research streams that exist. I think that it is a very good amendment and that is why we will be accepting it later on today. The last point that I really want to touch upon was the global nature of the issue that we are dealing with. It is a global crisis. AMR leaves no part of the world unaffected, so it requires a global response. Scotland is rising to meet that shared challenge. Like climate change, AMR is an issue that does not respect borders. Resistant microbes can and do spread widely via the environment, via people and animals that shall travel. We work closely on the issue with colleagues from all four UK nations. In fact, I will be attending a ministerial round table on AMR with my colleagues from the other UK nations next month. With them, we will be discussing a new way to incentivise pharmaceutical companies with a view to encouraging them to invest in research and development for new antimicrobials. Scottish experts have also played a leading role in the development of the UK's national action plan in AMR, which runs from 2019 to 2024. The University of Stathplide is undertaking some of the key research and modelling work underpinning the delivery of the plan and the contribution that is made by infection prevention and control. I take the point that Michael Marra raised just a moment ago that it is various pieces of work and important that we get an understanding of that landscape and bring that work together in a collaborative way. That is why, as I said, already we will be supporting the Labour amendment in relation to the role that the Scottish funding council could play in that regard. However, we also look much further afield. Like climate change, AMR is a threat to the achievement of the sustainable development goals and to the hopes and aspirations of millions. That is why we look to work globally on the issue. To give one example, the Scottish antimicrobial prescribing group has worked in partnership with Ghanian colleagues for several years, helping to improve antimicrobial prescribing in practice in Ghanian hospitals. We are now considering what further we can do as part of Scotland's international development work. Let me also just say that, on a note of slight disappointment, the free trade agreements that have been included by the UK Government since the EU exit have been lacking ambition on AMR. Therefore, my ministerial colleagues have written to the UK Government to express Scotland's regret in this issue and to push the UK Government perhaps in future free trade agreements to increase its ambition in that respect. In conclusion, I suspect that most people in the country probably have not heard of the threat that AMR poses. Why would they? Given the severity of the potential impact of AMR, we have a collective duty to raise awareness of the dangers of antimicrobial resistance. We all have a role to play. All of us can listen to our healthcare and veterinary professionals and take their advice on whether we, whether our family members, our cats or dogs, really need that antibiotic. We can take unused drugs back to the pharmacy whether we are properly disposed of and not end up in our environment. AMR is an enormous challenge. To tackle it requires conscientiousness, creativity and health and social care, in veterinary surgeries and on farms and laboratories and when working with international partners. It requires professionals from different sectors and backgrounds to work closely together. We have been doing that in Scotland, and despite the threat of resistance in the many ways that it can spread, what is happening in Scotland is a positive story, but there is much more to do. As I said, in the body of my speech, we intend to accept Labour's amendment today. I look forward to what will be undoubtedly a very thoughtful and considered debate. Before we move on to the next contribution, the chamber will wish to be aware that there is time to give time back for any interventions. I now call on Jackie Baillie to speak to and move amendment 4070.1. Thank you very much, Presiding Officer. Whilst I absolutely understand the importance of discussing the global risk of antimicrobial resistance, this debate was supposed to be a chance to discuss the impact of long Covid in Scotland. I hope that the Presiding Officer will allow me just a little latitude to mention this first before turning to the substance of the debate today. In doing so, I note that the one-health approach to tackling antimicrobial resistance was adopted in Scotland in 2016. The Government has had six years to bring forward a debate but has not done so until now, not once in that entire six-year period. The situation surrounding long Covid could not be more urgent, and for the 132,000 people across Scotland living with the condition, that debate would have provided much needed information and, indeed, impetus for the Scottish Government to act. That would have been the opportunity for the Scottish Government—let me finish and then, by all means—to tell us whether it has finally spent any of the £10 million announced for long Covid treatment seven months ago and to share what research it has done on the condition since we first learned about it two years ago. I suspect that that is the reason that the debate has been cancelled. There have been a few bids for the money because health boards are too busy fighting the latest wave of Covid, which is overwhelming our hospitals. Perhaps just giving them the money to get on with making provision is the best thing to do rather than trying to micromanage help for long Covid sufferers who, in the meantime, have to suffer for even longer. Instead, the debate was changed at the very last minute. Scared of criticism, political spin at the forefront of their consideration, the SNP Government cancelled the debate. They made the wrong decision. In truth, both date debates are required. I will give way to the cabinet secretary and then I will turn to antimicrobial resistance. Thank you for giving way. I regret the characterisation, which I think is inaccurate, that she is putting on why this debate is coming forward. It is not unusual for business to be revised. The debate has not been cancelled. It will take place in a few weeks' time. The reason for that is precisely because the detail that Ms Bailey is rightly asking for, we will be able to put into the public domain at that time in a few weeks, which is what she wants, which is what stakeholders want to suggest that the debate has been cancelled. I think that that is incorrect. It will take place subject to Parliament's agreement, of course, in the next few weeks. I simply say that people will look at the record. They will see that we have waited six years for a debate on antimicrobial resistance and that there has not been anything in that entire time. However, a long Covid debate, which is about people now experiencing the most dreadful symptoms and not getting treatment, is put off to some point in the future. If left unchecked, resistance to antimicrobial drugs could have long-lasting and profound effects on global health. Routine surgeries, such as kit replacements, organ transplants, would become less safe. Childbirth would be more dangerous, and a number of infections such as UTIs, pneumonia and tuberculosis could become harder to treat or require a stay in hospital. A report that was published late last year found that the total use of antibiotics in Scotland had fallen by 17.1 per cent in the last five years. That is positive progress. However, the report also found that antibiotic use in hospitals is rising and is up by 2.3 per cent since 2016. Despite the stats showing that use of antibiotics has generally decreased, it is important to recognise that Covid-19 may have altered this picture. Although antimicrobial usage has decreased in primary care, there have been increases in prescribing by dentists, for example, due to limited options for dental treatment during the pandemic. It is also important to consider greater public awareness of infection prevention over the past two years, including handwashing and mask wearing and an overall decrease in socialising, which has reduced infection transmission. However, that is not an issue reserved to Scotland or one that can simply be fixed by a Scottish approach. Antimicrobial resistance is prevalent across the globe, with countries in sub-Saharan Africa and South Asia experiencing the highest death rate. In Europe, rates of resistance in the south are greater than those in the north. As we have seen over the course of the pandemic, the spread of virus in bacteria is not stopped at a border. If the global spread of disease is coupled with antimicrobial resistance, then there is the threat of future pandemics. The Government must have plans in place to support our NHS and care sector. Scotland's hospitals are already under great strain. Patients are waiting for up to eight hours to be seen in accident and emergency, and we know from the Royal College of Emergency Medicine that there is clear evidence that long waits in emergency departments are directly associated with patient death. We must therefore act to prevent antimicrobial resistance from impacting on the NHS in the future. As antimicrobial resistance makes infections more difficult to treat and leads to longer hospital stays, the NHS will be faced with higher medical costs and increased mortality, so it is right for us to co-operate across the UK and globally to deal with that. When the MRSA crisis posed a similar threat over a decade ago, Scottish Labour took action, which was then followed up by the SNP. We established a system of national mandatory surveillance of MRSA, developed the introduction of an antimicrobial resistance strategy, created new standards for hospital infection control and cleaning services, and invested in better facilities for decontaminating reusable medical devices. Those steps were delivered quickly and effectively and were the difference between life and death for many people. The World Health Organization ranks antimicrobial resistance as one of the 10 greatest global public health threats facing humanity. It has highlighted the concerning development of multi- and pan-resistant bacteria that causes infections that are currently untreatable. As we come out of the pandemic and many people are left with weakened immune systems, then we are in danger of long-term health problems such as long Covid, interacting with untreatable diseases, which of course is a cause for concern. Labour's amendment seeks not just to highlight but to support the Scottish research environment. There is much work being done by Scottish research groups in the key themes of surveillance, stewardship and discovery. We know that the share of research council income peaked in 2012-13 but has declined since. We are now outside of the formal EU research environment and must do everything that we can to rebuild the collaborations internationally and the partnerships across the UK that are so critical to advancing research in antimicrobial resistance. Tasking the Scottish Funding Council with a rapid review of resource options is a simple yet impactful step. 18 higher education institutions in Scotland already conduct research in this area and that is welcome. The Scottish Government should outline what financial support it can give to ensure that Scotland is on the front foot when it comes to dealing with this looming crisis, how much funding is being allocated for this work. The NHS must also be given the research and development capacity and funding that is required to effectively tackle the issue, to monitor microbiological data, to train and educate staff in those issues. World Health Organization scientists are concerned that Covid-19 has caused greater inappropriate use of antibiotics, which makes the risk of antimicrobial resistance greater still. Those in care homes with specific needs are particularly susceptible. I hope that the Scottish Government will make sure that the rise of antimicrobial resistance is addressed within our care homes at pace. We cannot allow residential care to become the ground zero of antimicrobial resistance. It is real, it is a threat to modern medicine and it is important that this Government acts now to fund research and prepare the health service and our care sector for all eventualities. We need to learn from the mistakes made during the pandemic to ensure that Scotland is not caught once again on the back foot. I am grateful to the cabinet secretary for support for the Labour amendment and I therefore move the amendment in my name. Thank you, I know call on Sandesh Gulhane. Thank you Presiding Officer and I refer members to my register of interest. I'm a practicing NHS doctor and probably the only one here that can legally prescribe antibiotics. Today's debate is very important in its own right and I believe there is consensus across Parliament on much of our approach to tackling antimicrobial resistance. That said, the Scottish Government's motion, like so many others, is somewhat self-congratulatory and doesn't call for any specific action and that is why, like the SNP, we will be supporting the Labour amendment. Before drilling into this however, I would like to pay respect to over 130,000 Scots who are struggling with the debilitating condition that we were supposed to be addressing today. Before the SNP-Green Government pulled the debate from the schedule, we only received the revised agenda about two days ago, a move that didn't go unnoticed by so many people up and down the country who are struggling with long Covid and still waiting for this Government to deliver a credible action plan. The cabinet secretary says that this is to allow the Government to make an announcement. Well, I've been talking about long Covid since I got here and it's been eight months since the cabinet secretary announced money and yet we are still apparently not ready for this debate. We look forward to the discussions that will be coming after the elections. For today's revised business, we're focusing on Scotland's approach to managing the global risk of antimicrobial resistance, or AMR. I'd like to start by travelling back some 94 years before Alexander Fleming discovered penicillin in 1928. An infection from a simple cut could mean the end of life. There was a medical history game changer with the invention of penicillin. In fact, there was a famous case where a surgeon was performing an amputation of a limb. This one surgery killed three people. The patient, the surgical assistant who was holding down the patient and was cut, and the surgeon himself, who managed to nick himself on his blade, and all of this because of the inability to treat the infection. But why? It's because when antibiotics kill bacteria, there is a chance through a random mutation, like we see in the Covid virus, that this mutation allows the bacteria to evade the antibiotics and gives it an advantage, and so it profflicks, it reproduces, and then it dominates. As antibiotics lose their ability to kill strains of microbes, and if we cannot deliver new drugs that can beat those bugs, then by the year 2050 we can expect about 10 million deaths per year worldwide from drug resistant infections, 10 million deaths every year in under 30s. That would be more than today's deaths from cancer and diabetes combined. Back in 2013, seven years before Covid, the UK Secretary's Agency Chief Medical Advisor, Dr Susan Hopkins, said that AMR was a catastrophic threat. She said, if we don't act now, any one of us could go into hospital in 20 years for minor surgery and could die because of an ordinary infection that can't be treated by antibiotics, and routine operations like hip replacements or organ transplants could be deadly because of the risk of infection. Could you imagine a return to the days when childbirth are cut in the arm or even an insect bite could give rise to a serious risk of death? This might seem far fetched now, but did we heed the warnings about a possible respiratory pandemic? In fact, we're not working fast enough to deal with long Covid. Warren Buffett once said, what we learn from history is that people don't learn from history. I do hope that AMR and long Covid he's wrong. Presiding Officer, we simply cannot allow ourselves to emerge from the Covid pandemic and enter into another crisis, AMR or indeed long Covid. AMR infections are causing an estimated 700,000 deaths each year globally. In the UK, AMR causes an estimated 12,000 deaths per year. It was reported recently that antibiotic resistance increased by 4.9% between 2016 and 2020. This means one in five people with a bloodstream infection in 2020 has an infection with an antibiotic resistant, a potentially life-threatening situation. There are now strains of tuberculosis that are resistant to almost all lines of treatment. TB deaths have increased for the first time in a decade, and global targets are no longer on track. When I was on my infectious diseases rotation, I remember seeing a patient who was stuck in a small negative pressure room. He was stuck there for months and months and months because he had a multi-drug resistant TB strain. His mental health was awful. He was sick because of the severity of the side effects of the antibiotics he was forced to be given. So what are we doing about AMR? While clinicians are reducing the antibiotic risk and use where possible, and GPs have decreased prescribing by 20% since 2016, but over the same period we've seen a 2.3% increase in hospitals. So why can't we just come up with new drugs to replace the ones that don't work anymore? Unfortunately, it's not that easy. No new class of antibiotic have been developed since 1987, and the market for antimicrobials is frankly broken. Developing new antibiotics is massively inexpensive. In fact, there are just 40 antibiotics and clinical trials globally. The problem is compounded by the fact that new antibiotics should and they should be used sparingly, and this endangers the risk-to-return ratio. To overcome the high failure rate of new antimicrobials, the UK government has stepped in and developed an innovative solution that's now being tested. The model moves away from paying for individual packs of antimicrobials towards an annual payment based on the health benefits to patients and the value it adds to the NHS. The new subscription-style payment is a win-win for the NHS and for industry. Patients can benefit from secure supply of potentially new antimicrobial drugs, while pharmaceutical companies can reliably forecast a return on their investment. The UK government is also committed to investing in health research, increasing public research and development investment to record levels equated to £20 billion by 2025, an increase of around a quarter in real terms. I take it that the cabinet secretary welcomes this commitment. In Scotland, we're fortunate here to have expert intelligence, evidence-based guidance, clinical assurance and clinical leadership. National Services Scotland has a dedicated department to reducing the burden of infection and antimicrobial resistance, and its experts are represented on the UK's advisory committee on antimicrobial prescribing resistance and healthcare-associated infection. That is a four-nation body that provides practical and scientific advice to the UK and to all governments on minimising the risk of healthcare associated and drug-resistant infections. I'm interested to know if the cabinet secretary shares my view that AMR and indeed other pressing health crisis that may emerge are best tackled on a four-nation basis, not just a Scottish data and research solution but a four-nation one. In 2019, the UK and devolved government set out a joint vision to contain and control AMR by 2040. This is supported by our five-year national action plan with clear targets. The commitment is serious to reducing the need for antimicrobials by lowering the burden of infection in our communities in the NHS on farms and in the environment. This one health approach has seen antibiotic use in farmed animals decreased by 52% since 2014, with a decrease of 79% in sales of veterinary antibiotics for the most critical ones used in human health. The UK plays a leading role in tackling AMR on the world stage as a witness when Britain used its G7 presidency secure ambitious commitment on AMR to strengthen the resilience of antibiotic supply chains and develop sustainable, clean and green solutions for antibiotic manufacturing. AMR is a global problem that requires global action, but this is not the time to pat ourselves on the back. We cannot be distracted. Our children would never forgive us if we fail. We must step up our efforts to work seamlessly across the UK to ensure that we deliver on the national five-year plan and control AMR by 2040. In doing so, we can ensure that Scotland's world-class expertise maximises its contribution to global research efforts through the UK and international research partnerships. We now move to the open debate. I would be grateful if members who wish to take part in the debate could press their request-to-speak buttons. I call Emma Roddick to be followed by Michael Marra. Anyone who has worked in the NHS or knows someone who spends a lot of time in hospital or care homes will understand the massive importance of tackling antimicrobial resistance. I admit that back in 2022, when we first started putting antibacterial gel on everything, I did feel a bit anxious about what that and the inevitable group of people who, no matter what doctors tell them in system oxasil and somehow makes their viral infection go away more quickly, might do to bolster the other slower pandemic. I think that it is important now to reiterate what the Scottish Government, what health advisers and what many others have been saying weekly for the past few years that washing your hands is the best thing that you can do to prevent spreading viruses. Washing for 40 seconds will prevent bacteria from developing that resistance and overuse of hand sanitiser might do the opposite. Anti-infectives such as anti-bacterial spray and hand sanitiser have their place in hospitals and in homes where there is an active infection, for example, but they are also something that deserves real consideration in tackling AMR. Indeed, reducing unintentional exposure to those is a policy within the five-year action plan that we have signed up to. Using those more responsibly may have been quite a difficult circle to square in the peaks of the pandemic, but now is probably a good time to start educating people better and encouraging them to read the labels, use the appropriate kind of sanitizer and stick to hand washing when possible. We desperately need to be able to rely on disinfectants and other anti-infectives in hospitals, and it is just not worth risking that to save 40 seconds of your time. We also have to be able to trust that when we are prescribed antibiotics, we need antibiotics, so the reduction in unnecessary antibiotic use drew to an increased awareness of an action against AMR, as well as research that has provided better knowledge of when antibiotics are not needed is a key part of building that trust. Similarly, we have to be able to trust that when we need antibiotics, those antibiotics are going to work, and that is only going to continue as long as everyone honours their responsibility to preserve the effectiveness of those drugs. What the Scottish Government needs to do, and what we have heard from the Cabinet Secretary this afternoon, is to make sure that the public is armed with the knowledge that they need to understand when antibiotics are simply not useful and why AMR is a very real threat to our future healthcare standards. What is heartening for me to see is that Scotland's efforts in tackling AMR are already showing its strong results. We have cut post-surgical deaths and have a patient safety record amongst the best in the world, and it is right that part of Scotland's approach to managing that risk is signing up to the UK's five-year action plan and 20-year vision. Working closely together with other countries in the UK on a global issue, alongside in-house efforts such as our world-leading patient safety programme, is exactly the sort of international co-operation that Scotland should seek to nurture. Post-Brexit is more important than ever to build links and share knowledge, funding and efforts. Resistance anywhere in the world poses a risk to Scotland and the UK, and it is a global effort that is required here to overcome it. I am glad to see that the Scottish Labour's amendment recognises that and I will be happy to support their position on the Scottish funding council reviewing funding streams available to our universities and research groups at decision time. Whatever constitutional situation Scotland is in, co-operation is vital. This Scottish approach to work with other countries to promote best practice and work closely together to tackle AMRs is undoubtedly the right one to take, and I look forward to seeing the trend of better managing antimicrobial resistance continue. I now call on Michael Marra to be followed by Fulton MacGregor. Thank you, Presiding Officer, and my compliments to Emma Roddick. I think I find speech with practical advice about the way that we can all contribute to tackling AMR, and we appreciate her particular support on those comments for Labour's amendment. AMRs and antimicrobial resistance is, as people have already said, near the top of most lists of global risks that we face collectively, but then so was a pandemic, and our preparedness both in Scotland and internationally was chronically limited. Some of the exercises that we undertook were insufficient in preparing for that, and we have to take these big global warnings and offer a lot more seriously. Because we should be clear on this, that nobody and nowhere is doing enough to deal with this issue. In my conversations with clinical and research colleagues in recent days on this subject, that has been made clear to me time and time again. There have been limited progress in different places, but the pandemic has been a huge displacement for our scientific and medical community in terms of their focus on other issues. At rightly so, that is entirely appropriate that that effort was put in, but we know that there has been a lack of progress as a result on AMRs. That is just one of many, many deep and hidden consequences and opportunity costs that come from dealing with the global ramifications of the Covid pandemic. However, the warnings, as others have already pointed out, are nothing new. The great Scottish scientist Alexander Fleming, who discovered penicillin the first antibiotic, spoke of microbial resistance in his acceptance speech for the Nobel Prize in 1945. That was 45 years after resistance was first detected, and he specifically highlighted the issue of underdosing, so using a limited and low-level amount of what might be viewed as prophylactic antibiotics and actually rendering those ineffective over a period of time. The analysis, as we pointed out, is nothing new. For many, the idea that childbirth routine surgery is as little as a cut finger, as colleagues have been pointed out, could result in death is unimaginable, but for many across the world that is still the lived experience on a day-to-day basis. The advances that were unleashed by Fleming and his many collaborators and successors have transformed health systems across the world, and they have held out the promise of more certain, happier lives to billions. However, the retreat of the broad applicability of antibiotics risks global costs estimated at $100 trillion by 2050. Over 1 million people currently die globally as a result of antimicrobial resistance today, and if we do nothing or continue on the current course, they'll look set to reach 10 million lives lost per year, eclipsing the 8 million lost to cancer. The O'Neill report was issued in 2017, and that was a call to arms that was requested by then Prime Minister David Cameron. In my view, the most incompetent Prime Minister of this country has seen more than 200 years. I would say that, in competition with the current incumbent also, one of the very few positive things to be issued. However, our work in surveillance, stewardship and discovery have been utterly critical, and as a country with highly advanced medical and research infrastructure, it is incumbent on us to do more. However, the result of that report in 2017, the response to it, has been nowhere near commensurate to the scale of the threat that was identified. I want to, in my last few seconds and likely, highlight some of the outstanding research being done in our universities. I'm keen to draw attention to the work of Professor James Chalmers at the University of Dundee. He's become a familiar figure on our TV screens due to his vital work on the Covid pandemic. He and his research team is having global impact, and prior to the emergence of Covid-19, his studies included phase 1 and phase 2 studies on non-antibiotic alternative therapies for respiratory infections, diagnostics to reduce antibiotic use and much more. I would have been citing Professor Chalmers' work today had the promise long Covid debate being delivered. His research is proving the high prevalence and debilitating nature of that condition and the various groups for whom it's at a particular risk. However, that's an illustration of the displacement of the pandemic and the result and the impact on our research communities and why it's important and we're grateful for the support of the Scottish Government and other parties for the amendment that we have today. This work is vital if we ensure that AMR is not just put on track as it was previously, but it's reinvigorated and accelerated. We're keen to have that health check on the research environment that's been blown off course. We have to acknowledge as a Parliament the fact that our universities have lost their lead in research funding capture over the last decade, which, as Jackie Baillie pointed out in 2013, was up to a 10 per cent lead across the rest of the UK and that we are now in a situation of parity. That analysis by the Scottish Funding Council should focus on surveillance stewardship, but it must focus on discovery too, the idea that new therapies can be put in place. We can be proud and hopeful that the drug discovery unit at the University of Dundee, again the most influential institution on the pharmaceuticals industry in the entire world, is turning its guns on anti-microbial resistance by developing entirely new drugs. Our Scottish Government should be doing everything in its power to support those efforts and avoid the terrible and, unfortunately, very predictable consequences of failure. As others have said, Scotland has always proudly been at the forefront of revolutionary scientific breakthroughs, and it was, of course, a Scotsman, Alexander Fleming, who pioneered research into anti-microbials almost 100 years ago. Essentially, since Dr Fleming's work, innumerable lives have been saved thanks to the discovery of those antibiotics. It is impossible to put an exact figure on that statement, but, as the cabinet secretary said, the World Health Organization estimated that anti-microbials have added roughly 20 years to global life expectancy. For many, those have seemed to be a miracle cure, and although that sentiment may be true, it is a double-edged sob, as we have heard today. Over-reliance on those treatments can encourage evolutionary pressure, favouring anti-microbial resistant organisms. Indeed, the WHO noted that in 2019, 1.27 million global deaths were attributed to ineffective treatments due to AMR. Even for less severe ailments and conditions, AMR can lead to longer recovery times, resulting in lengthier hostiles days, higher medical costs for our NHS and prolonged suffering for patients, and I think that Dr Gohani made that point very well. Tackling the issue of AMR must remain a key priority for the Scottish Government and our NHS, and I am proud to say that Scotland has already been a world leader in fighting anti-microbial resistance, and that must continue. Both the Scottish Government and NHS Scotland contribute to the UK Government's five-year action plan 2019-2024. The action plan is a stepping stone for the aim that, by 2040, AMR will be effectively contained and controlled through strong mitigation. It is important to emphasise that the plan does not foresee the eradication of AMR as this, by definition, is a never-evolving issue that requires constant vigilance. A key step taken by Scotland that came from this action plan was the establishment of the Scottish One Health national AMR action plan group. This group works in collaboration with UK and European colleagues in conducting research to understand the risk factors for developing new anti-microbials, as well as research into the effectiveness of interventions aiming to drive behavioural change around their use amongst healthcare professionals and the general public. I mentioned that Scotland has been a world leader in fighting AMR, and that is evident through examining Scotland's patient safety programme, which was introduced in 2008. The programme is the national quality improvement scheme that aims to improve the safety and reliability of care and reduce harm. Importantly, for this debate, a key facet of the programme is ensuring that patients are treated responsibly and safely with the right medicines across a wide range of care settings. Since the implementation of the programme, the number of hospital and post-surgical deaths and complications have been cut significantly. Two major illnesses, MRSA and CDF, which have direct links to AMR, have seen their numbers fall year on year since the programme began. There are three methods in which the Scottish Government can continue the mitigation of AMR. The first is to reduce the need for antibiotics. That can be achieved by measures such as continuing to hold food standards to the highest level, ensuring animal safety through protection from infection and mitigating against environmental changes that can cause epidemics to develop. The second is to ensure that their use is optimised and only used when necessary in programmes such as the aforementioned SPSP is vital for educating healthcare professionals on that matter. However, as the cabinet secretary said, we all need to take personal responsibility about when we may need antibiotics, when our children or other dependents may need antibiotics and, of course, our pets. The final way is for the Scottish Government to continue to invest in expert research on the topic of AMR, as well as basic research, specialised research into new therapeutics, diagnostics and best practice will be invaluable for our continued fight against this looming issue and the current problem. In 2018, at the start of the last parliamentary term, Presiding Officer, I had done some work with Christine Bowne from the University of Aberdeen. Amongst her many titles was the trustee of the antibiotic research UK. There are a number of issues that she put forward. She put forward a test to show whether antibiotics will work or not and was questioning why health authorities around the world were not using it. She has done quite a lot of research in probiotics and I think that her work is something to be looked at by the Scottish Government and others going forward if they have not already done so. Presiding Officer, I can see that I am over time. I want to thank you again for the opportunity to speak in this very important debate. Those are some of the things that I think that the Scottish Government and their interests have done very well, but we will need to continue this excellent work to challenge this problem as we move into the future. Thank you Presiding Officer. Antimicrobial resistance has emerged as one of the most serious public health issues of the 21st century. Posing a threat to effective prevention and treatment will have never widened range of infections caused by bacteria, parasites, virus and fungi that are no longer susceptible to common medicines. Antibiotic resistance in bacteria makes the problem of AMR even more important. Bacteria that causes common or serious infections have developed resistance to each new antibiotic that comes to the market over several decades to variable degrees. Faced with that fact, we must all take action to advert a global health crisis not just here in Scotland but worldwide. We have heard warnings from the welcome trust that, without effective antimicrobial drugs, many of the routine surgeries could become life threatening with common infections becoming untreatable. Several fields of modern medicine that every single one of us take for granted depend on the availability of effective antibiotic drugs, including hip replacements, intensive care for pre-term babies, chemotherapy for cancer, treatment, organ transplantations—these, along with many other activities, could not be performed with effective antibiotics. The economic impact of antibiotic resistance is difficult to assess as a number of far-reaching consequences must be taken into account. For example, increased resistance leads to elevated costs associated with more expensive antibiotics, specialised equipment, longer stays in hospital and isolation procedures for patients. In the 2015 review of antimicrobial resistance, it is estimated that the failure to act on AMR, which result in 10 million lives being lost each year to drugs-resistant strains of malaria, HIV, TB and certain bacterial infections by 2050, cost to a world economy of US$100 million. That is a failure compounded by starting figures, estimated by a World Bank group, but estimates that an additional 28 million people could be forced into extreme poverty by 2050 through shortfalls and economic output unless the resistance is contained. A World Health Organization has declared antimicrobial resistance to be one of the top 10 global health threats facing humanity, with numbers such as these that it is clear to see why. The symptomatic misuse and overuse of antimicrobial drugs, such as antibiotics, is widely believed to be one of the main drivers for microbes developing antimicrobial resistance. The inappropriate use of antibiotics is also a factor, particularly self-medication, as it is almost always involves unnecessary, inadequate and ill-time dosing, which then creates an ideal environment for microbes to adapt rather than be eradicated. It also recognises that a substantial percentage of the total use occurs outside the field of human medicine, with the use of antibiotics in food-produced animals and in agriculture, a major contributor to the overall problem of resistance. The one-health approach to tackling AMR, adapted in Scotland in 2016, acknowledges and addresses that health of humans, animals and environment are interconnected and that an efficient approach to tackling issues must be co-ordinated and an nationwide effort is seen to. The UK five-year action plan for antimicrobial resistance in 2019-24, which supports the UK 20-year vision of antimicrobial resistance, is contributed to by the Scottish Government and NHS Scotland, recognises that AMR cannot be eradicated. The plan focuses on free-key aims to tackle AMR, reducing the burden of infection, optimising the use of antimicrobials and developing new diagnostic therapies, vaccines and interventions for the core ambition of the world in which AMR is contained, controlled and mitigated. The establishment of the Scottish one-health national AMR action plan group, led by Health Protection Scotland, to co-ordinate the delivery of a UK five-year national plan, has seen research undertaken to better understand the risk factors for acquisition and the outcome of certain resistant organisms, as well as the research into effectiveness on interventions that aim to drive behavioural change around antimicrobial use. Globally in that home, the progress of AMR is hugely encouraging. Initiatives such as Scotland's world-leading patient safety programme are delivering substantial results for which our NHS Scotland staff must be commended. I welcome the significant work that is already under way to develop new evidence-based interventions, to prevent infections, decrease the need for the use of antimicrobials and, in turn, reduce the potential for the development of resistance. I also applaud the commitment to those working to contain and control AMR within our NHS and across the health sectors of Scotland. The slow-burning pandemic affects every one of us. Globally, nationally and locally, where this must be continued to be raised, we will have a role to play and sustain action to prevent antibiotics and reduce drug-resistant infections to ensure future development of our healthcare. I now call Gillian Mackay, who is joining us remotely to be followed by John Mason. Ms Mackay. This is a global concern and my contribution today will largely focus on the global situation. It threatens our ability to treat common infections and could lead to the rapid spread of so-called superbugs that cause infections that are not treatable with existing antibiotics. According to a report published in January on the global burden of bacterial antimicrobial resistance, in 2019, there were an estimated 4.95 million deaths associated with bacterial antimicrobial resistance, including 1.27 million deaths directly attributable to bacterial AMR. The World Health Organization has warned that not enough new antimicrobials are being developed and that a lack of access to quality antimicrobials remains a major issue. Antibiotic shortages are affecting countries and healthcare systems all over the world. The UK Government's five-year strategy states that antimicrobials are crucial medicines in modern healthcare, yet up to 2 billion people still lack access to them. For most antimicrobials, there are few replacements or alternatives being developed, and according to the UK Government, research and development of the vaccines, diagnostics, tools and tests needed to prevent infections is similarly lacking. The WHO has highlighted that greater innovation and investment is required in research and development of new antimicrobial medicines, vaccines and diagnostic tools. The UK Government must provide greater support for that as a priority. The cost of antimicrobial resistance to both healthcare systems and patient care is significant, as it means more prolonged hospital stays and more extensive and intensive care. If we do not tackle AMR, more people will be pushed into poverty. Although it is true that AMR is a global problem that affects all countries regardless of borders, it does not affect every country equally. Studies have shown that the burden is disproportionately higher in low-income and middle-income countries, and we have a responsibility to act. High rates of resistance against antibiotics, often used to treat common bacterial infections, have been observed globally, and that indicates that we are running out of effective antibiotics. A well-known example of a bacterium that is resistant to a number of antibiotics is MRSA, which has caused infections that are difficult to treat across the world. As we have already heard this afternoon, antibiotic resistance is not just purely a health issue. Evidence and research papers are continuing to be published on the impacts of routine antibiotic use in farming. That can expose people to antibiotic-resistant microorganisms through contaminated food or water. While routine antibiotic use is less prevalent in Scotland, it should be kept in mind when scrutinising trade deals that the UK Government is seeking post Brexit. It is also not just combined with terrestrial farming practices. Globally, aquaculture is also an increase in contributor to antibiotic use. According to an article in Nature by Char et al entitled Global Trends in Antimicrobial Use in Aquaculture, global antimicrobial consumption in aquaculture in 2017 was estimated at 10,259 tonnes. While antimicrobial use in Europe is likely to reduce by 2030, in Africa, for example, it is likely to increase. We need to ensure that sufficient protein sources can be produced in developing nations to meet nutritional needs while tackling the global issue of antimicrobial resistance. That makes that a social justice issue, as well as a health one. Release of antibiotics or the metabolites into the environment could increase the emergence of antibiotic genes. That release could be from hospitals, agricultural run-off, for example, and could enter the food chain or water system. Antibiotic-resistant organisms can also follow the same path. A paper by Char et al in Nature published in 2020 says that such types of environments become likely hotspots for the development of new antibiotic-resistant genes. Humans come into contact with resistant microorganisms through numerous routes, including consumption of contaminated foods, interactions with animals and within contaminated environments. Ensuring that we minimise antibiotic use and explore other therapeutic avenues will hopefully reduce the instances of those interactions. Antiviral drug resistance is also an increase in concern amongst immunocompromised patients, as resistance has developed to most antivirals. Without the tools to prevent and treat drug-resistant infections, more treatments will fail and medical procedures will become more risky. While new antimicrobials are needed now, if the way we currently use antibiotics does not change, they will suffer at the same fate as existing ones. Antibiotics have saved millions of lives since they were first invented. We must act now to ensure that treatment with antibiotics remains effective now and for generations to come. I am happy to confess that this is not my main area of expertise, either from my professional background or since I came into Parliament. However, where I first came across the subject was when I lived in Nepal in the 1980s, both in relation to leprosy and TB. I am focusing on the world aspect mentioned in the motion. I welcome the fact that the cabinet secretary mentioned Ghana in his opening speech. Leprosy was fairly common in Nepal and, for both it and TB, there was and is a problem with people not completing the course of their treatment and therefore not being cured while also building up resistance. That was entirely understandable as people were having to pay for drugs, many from a very poor background. It was not surprising that, when symptoms receded, they did not continue with the treatment that they could ill afford. Money was very tight in the hospital in Tansen, where I worked, and we had to assess people before they got treatment, as sometimes richer people would turn up disguised as poor in order not to have to pay. I understand that, over the last 20 years, global numbers of new leprosy cases have remained stable, irrespective of available effective treatment. In 1981, the WHO recommended multi-drug therapy against leprosy. In 1996, the first case of primary multi-drug resistance was reported. Reports of mycobacterium leprosy resistance rates have ranged from 2 per cent to 16 per cent, while an Indian study of 239 relapses and 11 new cases found 21.6 per cent of cases to be drug-resistant and 6.8 per cent to be multi-drug resistant. On tuberculosis, the TB Alliance reports that about 29 per cent of deaths caused by 29 per cent of deaths caused by anti-microbial infections are due to drug-resistant TB. There are over half a million cases of drug-resistant TB each year, either because of the somewhat complex drug regimen that is improperly administered, or when people with TB stop taking their medicines before the disease has been fully eradicated from their body. Treating a single case of multi-drug-resistant TB or extensively drug-resistant TB can be thousands of times more expensive than drug-sensitive TB. In South Africa, drug-resistant TB consumed 32 per cent of South Africa's $218 million national TB budget, despite accounting for only 2 per cent of all cases. Some of those figures are slightly out of date, but to give a comparison, for a drug-sensitive TB case, the cost is something like $260, for multi-drug-resistant TB $7,000 and for extensively drug-resistant TB $27,000. Clearly, anti-microbial resistance has a worldwide impact. It affects all areas of health, as others have said, and involves many sectors as an impact on the whole of society. It is a drain on the global economy with economic losses due to sickness of both humans and animals, along with higher costs of treatments. Just as we have seen with the availability of Covid vaccines, that is likely to mean that the poorest countries suffer most. There now seems to be a global consensus that anti-microbial resistance poses a threat to humanity and could, following the pandemic, be the defining health issues of our time. I have seen the figure of 700,000 people a year dying due to anti-microbial resistance, although more than £1 million has been mentioned in this debate already. That shows the need for a united approach across the world to tackle such a complex problem. The WHO considers that this issue is one of the top 10 global public health threats, as several others have said in this debate. If allowed to continue procedures such as cesarean sections, hip replacements, cancer, chemotherapy and organ transplantation will all become riskier. The 2015 review on anti-microbial resistance estimated that if we fail to act in AMR, an additional 10 million lives could be lost each year from drug-resistant strains of malaria, HIV, TB and so on by 2050. The Scottish Government's action plan accepts that AMR cannot be eradicated, but the core ambition is that it should be contained, controlled and mitigated. In conclusion, I fully accept the focus of this Government and this Parliament is rightly on Scotland. However, just as with Covid, one country cannot deal with anti-microbial resistance in isolation. As one of the world's richer nations, we have a responsibility to work with our partners worldwide and not least with our closest partners in Malawi, Zambia and Rwanda. I now call Stephanie Callaghan, who will be the last speaker in the open debate. Like my colleagues, I want to discuss the momentous global challenge that anti-microbial resistance AMR presents in an evolving world. I will attempt to limit repetition, but there will be some. In 2022, we face the imminent danger of climate Armageddon. The recent IPCC report outlines that current plans to address climate change are not ambitious enough to avoid catastrophic events. We also continue to fight the Covid pandemic, a global health crisis that is far from over. In these existential threats, exacerbate inequality, poverty and displacement, and they tie directly into the battle against AMR. Why can I not say this in everyone else's can? Anti-microbial resistance is not a new challenge, nor is it something in the horizon. It is with us now, today. As with the climate and Covid, scientists have been raising the flag of concern for years, but we have not yet seen robust mitigations or the necessary global leadership. We have recently got the data from the global research and anti-microbial resistance study showing that deaths associated with AMR are the third leading cause of death globally. A few members have already mentioned that, right now, this year, up to 700,000 people will die from antibiotic resistance infections across the world, and that figure is worth repeating again and again. The latest report from the UK surveillance programme for anti-microbial utilisation and resistance tells us that antibiotic resistance has increased by 4.9 per cent in the last four years. Covid has taught us that preparation is absolutely key and that inaction is abdication. Failure attack now means that countless families will be grieving in the future. So what is needed? First, we need a strong system for monitoring the impact of rising AMR here in Scotland. I know that the Scottish Government has been looking into recording AMR, or antibiotic resistance, as a cause of death, and I would welcome an update from the cabinet secretary on where we are with data recording. Secondly, we need to start slowing the increase of AMR through strengthened infection prevention and control, enhanced hygiene and improved sanitation. As Emma Roddick said earlier today, washing our hands really is absolutely key. Scotland's world-leading patient safety programme is an excellent foundation for managing AMR. For example, in Scotland, the infection from seadiff in the MRSA dramatically reduced in over 65 by 88 per cent and 94 per cent under this SNP Government. Thirdly, we need to have initiatives to address the systematic misuse and overuse of antibiotics, which has resulted in microbes developing anti-microbial resistance. Worldwide, the food sector needs to urgently listen to the who and their calls for work farmers in the food industry to stop using antibiotics routinely to promote growth and prevent disease in healthy animals. Going back to the overuse, my colleague John Mason hits the nail in the head with his comments on TB and leprosy. A further challenge is the severe lack of research and development of new anti-microbials. The way farms of local companies operate, depending on sales, for returns and investment, is not conductive to addressing AMR. The UK's pilot scheme introduced a fixed fee model to finance the development of new antibiotics is innovative and encouraging. If we are to respond to the existential threat through AMR, we need a global scientific response. The rapid development of Covid vaccine shows us what really is possible and we can and we must remove constraints and collaboration between scientists. I am encouraged that Scotland has adopted a one-health approach to tackling AMR since 2016. The acknowledgement that the health of humans, animals and the environment are interconnected is vital. I will close by recognising those who do tireless work on the issue. The scientists and public health experts have already achieved so much in the fight to hold back the next pandemic, but they cannot fight this war alone. They need the backing of legislators, big pharma and individuals to make sure that this time we prepare properly for the next pandemic. That absolutely will happen if we do not put the right steps in place. May I thank everyone who has contributed to the debate so far for their very important and engaging contributions? I must, however, know my disappointment that we are no longer discussing long Covid as planned, a debate that I believe is of utmost importance and one that we need to take place soon. Tens of thousands of people across Scotland are believed to be suffering from this, and we must speak about it in this chamber. I have heard what the cabinet secretary has said, but I do not think that the Government has given us a sufficient reason for why the subject of the debate was changed, and that should be noted by the Parliament. I will now return to the important issue of antimicrobial resistance. In closing the debate, I would like to reiterate some of the important points that were made and sum up my own party's view on the important issue for the future of the country. From my own colleague Jackie Baillie and Emma Roddick, they both mentioned that there is some very good news around, and that is most welcome. Realising that there is reduction in use in many places and, of course, we are managing to prevent many more of the infections that are around. Emma Roddick also gave an excellent speech about how we try to look at prevention first and make sure that we have the right messaging and training in place for that, and I thank you for that speech. I thought that it was very good and that it was an excellent contribution. Sandesh Galhane, of course, gave us some of the history. He was the first to give us some of the history. Many other members mentioned the history of antibiotics, and in actual fact, I think that the comment about it being a game changer is very important. That is why we have to take that issue very seriously. The number of deaths associated with the loss of antibiotics and their function would, as many members have mentioned, be a dreadful step backwards. TB was mentioned in particular that it has increased, and that we are unlikely to meet our global targets unless we really do something about it. As a number of my colleagues have remarked, Scottish Labour really welcomed the efforts to address the risk of antimacrobial resistance both in Scotland and around the world, and it is important that we recognise that any attempts to do this must take place on a UK-wide basis and, indeed, globally. The rapid development of the Covid vaccine was a great example of just how much can be done in record time when nations work together with common purpose, and that is the attitude that we should move forward with. As we all know, any progress in the health field begins with well-funded and effective research, and antimicrobial resistance is no different. Ensuring the long-term support for this research is a vital step that we must take in order to preserve the effectiveness of antibiotics and key medicines for years to come. The Scottish Government should be doing all it can to support the many universities across Scotland doing that work so that we can play our part in the promising international work on antimicrobial resistance. I am afraid that, at the moment, that is not as good a case as it could be. Unfortunately, Scotland trails behind England in funding, with a third less per head of the population devoted to clinical research of that kind. The British Heart Foundation estimates that, without charitable funding, Government and other public bodies would need to increase direct funding by 73 per cent to make up for that shortfall. That does not sound to me like it is a priority for this Government, and that needs to change. If we want to be world-leading, we have to put in the funds to do that. It is with that in mind that my party is calling for the Scottish Funding Council to be tasked with a review of domestic and global funding streams available to Scottish universities and research groups, so that we can effectively contribute to the global research efforts into antimicrobial resistance and the avenues that are available throughout the UK and international research partnerships. As we have heard from other members today, effective prescribing has a role to play in preventing the risk of antimicrobial resistance too, but the health committee report into the supply and demand of medicines across NHS Scotland from last year was very critical of the progress that has been made in improving prescribing practices in Scotland by the Government. In particular, the committee was very critical of the inability of the NHS in Scotland to collect data on the outcomes of medicine use of patients, which, of course, will make it much more difficult to better understand antimicrobial resistance. That prescribing in primary care makes up the bulk of our NHS medicine spend. Despite the ineffective monitoring of medicines, whether medicines reviews are being carried out with patients, again, it does not sound like it is the kind of foundation that we want if we are to push ahead with tackling the antimicrobial resistance. As the cabinet secretary says, those things have to change and my party wants to fully support the efforts to do that. In closing, I would again like to reiterate that, though the debate was useful and some very important—I would say that I have learned a lot—it was very useful, it is disappointing that, after months of evading the question of support for long Covid patients, the Government still has no answer or solution in place that could give thousands of people some peace of mind. The habit that we have developed in kicking the can down the road and hiding behind unpublished reports is not a healthy one, and it really is time that we started to reconsider the way in which we do business and discuss in the chamber the true priorities of the population of the people, not simply that that suits the Government at that particular moment in time. I now call on Sue Webber to wind up on behalf of the Scottish Conservatives. Antibiotics are one of the most powerful tools in healthcare underpinning every aspect of modern medicine. We need them not just when we are poorly at home with an infection but when we are going through significant life-changing procedures such as chemotherapy, hip and knee replacements. Antibiotics work by killing bacteria, but in the same way that the Covid-19 virus mutates and evolves, so can bacteria, developing resistance to antibiotics. Anti-microbial resistance poses a substantial threat to human health. It is estimated that, by 2050, AMR could claim as many as 10 million lives a year worldwide, more than cancer and diabetes combined. Michael Marra made those points earlier, too. Already, AMR infections are causing an estimated 700,000 deaths each year globally, while in the UK it is estimated that AMR causes at least 12,000 deaths per year. It is not a vague threat that is happening elsewhere. It is happening in the UK, and it is getting worse, and we will continue to do so. Professor Jennifer Ron from University College London has said that AMR has very much not gone away and, in the long term, the consequences of AMR will be far more destructive. Although we have seen a welcome decline in total antibiotic use across the UK and Scotland, its use continues to increase in hospitals. The good news is that a great deal of action is under way. The O'Neill report commissioned by David Cameron was groundbreaking. It was a highly influential around the world, and 135 countries have finalised action plans on tackling AMR. Last year, it was very welcome that the UK Government has been using their G7 presidency to try and deliver more tangible progress as it did last time they held the presidency in 2013. However, as Dr Gohanny said, there are only 40 new novel antibiotics that are in clinical trials, and that should concern us all. The UK Government is working with the devolved Administrations to tackle AMR effectively, including through the national five-year action plan. The five-year national action plan, developed in conjunction with the devolved Administrations, identifies three ways to fight AMR—reducing the need for and the unintentional exposure to antimicrobials, optimising the use of antimicrobials and investing in innovation, supply and access. Alongside its five-year strategy, the UK Government also published a long-term ambition for AMR. The document set out a vision of a world that antimicrobial resistance is effectively contained, controlled and mitigated. It laid out nine ambitions for the UK—to continue to be a good global partner, to drive innovation, minimise infection, provide safe and effective care to patients, protect animal health and welfare, minimise environmental spread, support sustainable supply and access, demonstrate appropriate use and engage with public. I would like to mention Ms Roddick's comments, a reminder to us all that antibacterial agents do not impact on viruses. She also reiterated when antibiotics are not useful. In July 2019, the Government announced that its investments in combating AMR included £32 million of capital funding to support AMR research. That includes £19.1 million for AMR research at four national institutes for health research by medical centres and £8.8 million for two NIHR health protection research units on healthcare associated infections and antimicrobial resistance. The UK is also working internationally on AMR. In September 2019, the Department of Health and Social Care announced a £6.2 million package of funding to strengthen existing surveillance systems that track AMR trends across Africa and Asia. In the 2019 manifesto, Conservatives pledged to turn our attention to the great challenges of our time, including solving antibiotic resistance. To do that, we committed to do the fastest-ever increase in domestic public R&D spending to meet our target of 2.4 per cent of GDP being spent on R&D across the economy. Some of that new spending will go on a new agency for high-risk, high-pay-off research at arms length from government. Furthermore, at last year's autumn budget and spending review, the UK Government increased public R&D investment to record levels. That equates to £20 million by 2024-25 million, which is why it is important that we really reinforce the co-operation globally and across the UK and why a Scottish approach is unnecessary, but we will do the same as the rest of the world and why we will support the Labour motion and amendment today because we need to reinforce the gap between Scotland and England in funding, and we need to come up to and match what has been done elsewhere. We have to play our equal part. The progress that we have seen in recent years is welcome, especially the UK Government's new subscription-style payment model for antimicrobials, which will incentivise companies to invest in that area. The new subscription-style payment model is a win-win for both healthcare systems and industry. It demonstrates that NHS patients can benefit from a secure supply of new antimicrobial drugs, while pharmaceutical companies can reliably forecast their return on investment. This is a serious issue, and one that we must continue to work together on. It is heartening to see the UK Government taking positive steps to ensure that action is not only being taken now, but putting plans in place for the future. My colleague has vividly described why we must keep antibiotics working when modern medical procedures are so reliant on the ability to treat bacterial infections. The threat posed by antimicrobial resistance must not be underestimated, and we cannot afford to be complacent in our response to the risk. I look forward very much to debating long Covid in a few weeks' time, but I have to say, as a pharmacist and indeed a legal prescriber, as Sandesh Gullhane would say, that I have spent my professional life promoting the rational use of medicines and good stewardship of antibiotics, and I welcome the opportunity for this Parliament to give its attention to this global threat. I absolutely agree with her about the importance of this, because she may explain to the chamber why, in the past six years, there has not been one Government debate about this. That is actually in the past 23 years, since we had devolution. There has been no debate on this, and I, for one, am absolutely delighted. I was reflecting on my years, delighted that we are finally debating antimicrobial resistance. Indeed, when I was at university as a student, my honours project was on antibiotic prophylaxis in caesarean section. Jackie Baillie will reflect that there were debates on CDIF, MRSA and a whole variety of different diseases that were caused as a result of antimicrobial resistance. Indeed, but not on the specific topic of EMR. In fact, I was going to highlight that CDIF, in my days—because I am decades beyond being qualified—in my days at university, CDIF was called Antibiotic Associated Colitis. That shows you the change in perception over the decades. I am very proud that Scotland has made such massive progress in treating that particular hospital healthcare-acquired infection. We need to recognise that EMR is not something that just affects humans, though. Bacteria, with the potential to become resistant to antibiotics, existent in animals and in the environment, too. For that reason, a one-health approach to this threat is required. That recognises that the health of people is closely connected to the health of animals and our shared environment. In short, we cannot tackle EMR in humans in isolation, and I want to step outside my usual brief to say more about this. The Scottish Government committed to a one-health approach to combat EMR. In 2015, as Ms Baillie has said, we formed the Scottish Animal Health and Antimicrobial Resistance Group. That forum features representation from government, from industry bodies and human health and veterinary sectors that are truly encompassing our one-health vision. It provides leadership and engages with key stakeholders in a co-ordinated, quality-driven approach to anti-EMR measures, including promoting good infection prevention and control practice for animal keepers, improving veterinary prescribing practice for pets and livestock, learning from the data that we have in animal populations. A vital tool in tackling EMR is a coherent, consistent advice for the animal keeping public, including farmers and pet owners. We have established the Scotland's healthy animals website to centralise guidance for animal keepers and veterinary professionals and to promote responsible antimicrobial stewardship. Monitoring levels of antimicrobial usage and rates of resistance is also essential. To that end, as my colleague mentioned earlier, NHS Scotland produces an annual Scottish one-health antimicrobial use and antimicrobial resistance report. That provides information on the use of antibiotics by humans and veterinary practices in Scotland and levels of antibiotic resistance found in a range of important human and animal infections and in their environment. Bacteria of particular interests are those that can potentially transfer between animals and humans, including bacteria that are common causes of food poisoning such as salmonella and E. coli. While it is accepting that there is much more to do in the battle against EMR, achievements in terms of overall usage of antimicrobials in the animal sector should be acknowledged. On-going monitoring demonstrates an overall decline in usage of antibiotics and livestock species. That is really significant and demonstrates the hard work of producers and veterinarians to safeguard the efficacy of our antibiotics. We also aim to harness the power of genomic technology, something that, thanks to the pandemic, we are all much more aware of, to identify and to track foodborne pathogens and antimicrobial resistant organisms through the agri-food system and the environment. I previously mentioned that one health includes the wider environment in which humans and animals live. That is why we have convened EMR in the environment in Scotland's stakeholders group, including representation from the Scottish environmental protection area. I will address some of the points that were made around research. The Scottish Government is fully engaged with the research programme within the national action plan and across research categories of evidence generation, implementation, evaluation, co-ordination and guidance. Active Government-funded research is going on in many areas, including food safety research, sustainable investment, environmental contamination and diagnostics. I will highlight just one of the environmental contamination research projects that go on. Our efforts to combat EMR in the environment have led to the formation of the One Health Breakthrough Partnership, an initiative that is based in the highlands to address the issue of environmental pharmaceutical contamination. This unique partnership is driven by NHS Highland, by Scottish Water and the Scottish Environmental Protection Agency and the Environmental Research Institute. Scottish universities and research institutions generate a significant contribution to EMR research. We have ensured that the breadth of the contribution is captured by commissioning a register of all Scottish One Health research into EMR from the previous five years, which we will be maintaining as an active updated resource. The register will continue to inform our evidence-based policy making in the future. On the point that Mike O'Mara raised about the pandemic facing immediate challenges over the course of the last couple of years in derailing research, I would respond saying that, while necessarily the pandemic has absolutely been at the forefront of everyone's mind for the last couple of years, there has undoubtedly been transferable learning from this episode in history. We have seen absolute strides forward in infection prevention and control in all settings—hospitals and in-care homes. We have seen an astonishing level of global collaboration in everything from developing vaccinations to understanding genomic sequencing of new variants of viruses. I fully acknowledge the points that Mike O'Mara has made in terms of the potential benefits of long-term changes to the research environment that describe the collaboration that can take place. I would not say that the research agenda has been derailed more than that there has been a displacement process and that some members of the research community have been doing other work in that process. If we are going to get back on track and accelerate that work, I do think that the review that we have asked for and that you have graciously agreed to with the SFC is critical to making sure that additional resource can be identified to allow that work to take place. I agree that that is a very fair point. We are committed to taking action on AMR throughout our work, including via international trade. As the coronavirus pandemic has also demonstrated, diseases do not recognise national borders and that is also true of AMR. As the UK embarks on trade negotiations with prospective third-country trading partners, Scotland continually presses for measures to tackle the development and spread of AMR in all UK free trade agreements. My ministerial colleagues have written to their counterparts in the UK Government several times to ensure that AMR is recognised during negotiations. I am really grateful to the experts in many areas who lead Scotland's efforts to contain and to control AMR, but, as my colleague said in his opening speech, we can all help to support this work. For example, we can all listen to those who are treating us or our pets when they advise us that an antibiotic is not the best course of action. I myself at the moment am coughing furiously and I am living proof that antibiotics do not treat viruses. We can all ensure that we stay healthily hydrated, for example. That helps to reduce urinary tract infection and prevents the use of some antibiotics and the development of further complications. We can all make sure that we never flush away unused medicines into the environment. Of course, as a pharmacist, I would say to take them back to your pharmacy for safe disposal. My thanks to all those who are working to control AMR in their daily life, whether in hospital or a GP surgery or a pharmacy or a lab or a farm or a veterinary surgery, a research institute or in many other settings. We recognise your efforts to keep our drugs working and we can all support you. In conclusion, we in Scotland are vigilant to the threat by AMR. We are ready to meet the challenge and we have made great strides forward, supported by experts and the Scottish public. However, we must not become complacent. We must maintain our focus and energy on ensuring that our antibiotics continue to work. To that end, we will continue to adopt a one-health approach, tackling AMR in humans side by side with protecting the environment that we exist in and protecting the animal and plant life that we share with it. That concludes the debate on the Scottish approach to managing the global risk of antimicrobial resistance. It is now time to move on to the next item of business, which is consideration of motion 4074 on legislative consent motion health and care bill UK legislation and I call on Humza Yousaf to move the motion. The question on this motion will be put at decision time and I am minded to accept a motion without notice under rule 11.2.4 of standing orders that decision time be brought forward to now and I invite the minister for parliamentary business to move the motion. The question is that decision time be brought forward to now. Are we all agreed? We are agreed. Therefore, there are three questions to be put as a result of today's business and the first is the amendment 4070.1 in the name of Jackie Baillie, which seeks to amend motion 4070 in the name of Humza Yousaf on the Scottish approach to managing the global risk of antimicrobial resistance. Are we all agreed? The motion is therefore agreed. The amendment rather is therefore agreed. The next question is that motion 4070 in the name of Humza Yousaf, as amended on the Scottish approach to managing the global risk of antimicrobial resistance, be agreed? Are we all agreed? The motion is therefore agreed. The final question is that motion 4074 in the name of Humza Yousaf on health and care bill UK legislation be agreed? Are we all agreed? The motion is therefore agreed. That concludes decision time and I close this meeting.