This is a presentation by David Walker at the RUSI Resilience Conference 2014.

1. Resilience Challenges of
Communicable and
Non-Communicable DDiisseeaasseess
David Walker
Deputy Chief Medical Officer

6. Decline in mortality due to Coronary
Heart Disease

9. The UK population is projected to increase by
4.3 million from an estimated 63.7 million in
mid-2012 to 68.0 million by mid-2022 and to
73.3 million over the 25 year period to mid-
2037.
The UK population is projected ttoo rreeaacchh 7700
million in 2027.
The population of the UK is projected to
continue ageing with the number of people
aged 80 and over in the UK to more than double
to 6 million by mid-2037.

10. Population growth by age group

11. Long-term conditions are more prevalent in older people (58
per cent of people over 60 compared to 14 per cent under 40)
and in more deprived groups (people in the poorest social
class have a 60 per cent higher prevalence than those in the
richest social class and 30 per cent more severity of disease).
People with long-term conditions now account ffoorr aabboouutt 5500
per cent of all GP appointments, 64 per cent of all outpatient
appointments and over 70 per cent of all inpatient bed days.
Treatment and care for people with long-term conditions is
estimated to take up around £7 in every £10 of total health
and social care expenditure.
(Department of Health (2012). Report. Long-term conditions compendium of
Information: 3rd edition)

12. Resilience Challenge
• Prevention of long term conditions (NCDs)
• Increase disease free survival
• Improving health of deprived populations
• Health and care services nneeeedd ttoo ccooppee wwiitthh
increasing demand.
• Model of care
• Economic considerations

13. MMR

14. MMR

15. MMR

16. It is not difficult to make
microbes resistant to
penicillin in the laboratory,
and the same has
occasionally happened in the
Antimicrobial resistance
body.
Alexander Fleming, 1945
Nobel Prize Acceptance Speech

17. Susceptibility to antimicrobials used to treat gonococcal
infection in England and Wales
Antimicrobial resistance
Graph taken from 2011 CMO Annual Report, Vol 2”

18. History of antibiotic discovery
Polymyxins,
Phenicols 1947
Macrolides 1952 Glycopeptides,
Discovery
void
Nitrofurans 1946
No new class of
antibiotics has
been discovered
Nitroimidazoles,
Cycloserene, Streptogramins 1953
Novobiocin 1955
Trimethoprim 1961 Quinolones,
Lincosamides,
Fusidic acid 1962
Carbopenems 1976
Oxazolidinones
1978
Sulphonamides 1932
Aminoglycosides,
Bacitracin 1943
since 1987
Antimicrobial resistance
Penicillins 1928
Tetracyclines 1945
Cephalosporins 1948
Pleuromutilins 1950
Rifamycins 1957
Fosfomycin 1969
Mupirocin 1971
Monobactams 1979
Lipopeptides 1987
1920s 1930s 1940s 1950s 1960s 1970s 1980s 1990s 2000s 2010s
Based on diagram from World Economic Forum, “Global Risks 2013”

19. Antimicrobial Resistance
• Resistance to antibiotics is natural and inevitable.
• It is increased by the use of antibiotics.
• Multi-drug resistant bacteria are spreading, here and
•• wwoorrlldd wwiiddee..
• Increasing resistance and a lack of new drugs means a risk
of infections that cannot be treated and more deaths.
• AMR is a threat to many areas of medicine (Cancer
treatment, transplantation, joint replacement etc.)
Antimicrobial Resistance and Good
Stewardship – 26 September 2013

22. UK preparations for Ebola
• Plans in place and regularly exercised.
• Command and control arrangements.
• Flexible resource for deployment in UK or
aabbrrooaadd tthhrroouugghh PPHHEE
• Level 4 laboratory service
• Secure ID beds with capacity for expansion.
• Facility for port health screening.

24. Year Country Ebolavirus species Cases Deaths Case fatality
2012 Democratic Republic of Congo Bundibugyo 57 29 51%
2012 Uganda Sudan 7 4 57%
2012 Uganda Sudan 24 17 71%
2011 Uganda Sudan 1 1 100%
2008 Democratic Republic of Congo Zaire 32 14 44%
2007 Uganda Bundibugyo 149 37 25%
2007 Democratic Republic of Congo Zaire 264 187 71%
2005 Congo Zaire 12 10 83%
2004 Sudan Sudan 17 7 41%
2003 (Nov-Dec) Congo Zaire 35 29 83%
2003 (Jan-Apr) Congo Zaire 143 128 90%
2001-2002 Congo Zaire 59 44 75%
2001-2002 Gabon Zaire 65 53 82%
2000 Uganda Sudan 425 224 53%
1996 South Africa (ex-Gabon) Zaire 1 1 100%
1996 (Jul-Dec) Gabon Zaire 60 45 75%
1996 (Jan-Apr) Gabon Zaire 31 21 68%
1995 Democratic Republic of Congo Zaire 315 254 81%
1994 Cote d'Ivoire Taï Forest 1 0 0%
1994 Gabon Zaire 52 31 60%
1979 Sudan Sudan 34 22 65%
1977 Democratic Republic of Congo Zaire 1 1 100%
1976 Sudan Sudan 284 151 53%
1976 Democratic Republic of Congo Zaire 318 280 88%

27. 16000
14000
12000
10000
8000
Cumulative
Ebola 2014 Epidemic Curve
cases
6000
4000
2000
0
date
deaths

28. Conclusions
• The threats from infectious diseases are
constantly changing.
• Healthcare systems will have to withstand
changes in patterns of disease, ddeemmooggrraapphhyy,,
human behaviour and advances in medical
science.
• Resilience of countries is interdependent and
influenced by economic factors.

30. Athens 430 BC
Liberia 2014 AD