Joe Pinkstone
Tue 29 October 2024\
THE TELEGRAPH
The use of bacteria-killing viruses known as phages to treat patients dates back to the First World War
William Stocking, 81, has spent much of the last four years in and out of hospital as an infection slowly destroys his leg.
He caught a superbug, an antimicrobial-resistant strain of Staphylococcus aureus, after going to the Royal Devon and Exeter Hospital in early 2020 with a chest infection.
Superbugs are notorious for being hard to treat because of their immunity to antibiotics. Around 52,000 people a year catch superbugs in the UK, causing around 2,000 deaths and costing the NHS around £180 million annually.
However, a little-known treatment dating back to the First World War is available, if NHS doctors are prepared to spend hundreds of hours fighting a mountain of government red tape.
Bacteriophages, known as phages, are bacteria-killing viruses that inject their own DNA into a bacteria to seize control of the cell and produce more phages until the bacteria bursts.
It is an effective killing mechanism and phages are the most abundant entity in the world.
They are highly precise with only specific strains of bacteria targeted by a certain phage, and phages can be effective against superbug infections impervious to all known medication.
Doctors are increasingly looking at phage therapy to help patients who are otherwise out of options, and Mr Stocking is a pioneering patient in the UK.
The superbug bacteria was attracted to the metal in his knee replacement which he had in the late 1980s following a career-ending injury suffered in the line of duty while a sergeant in the Hampshire Constabulary.
William Stocking and his wife Lorraine hope the treatment will allow him to walk properly again - Eddie Mulholland
“It works a bit like [the video game] Pac-Man and goes around eating the infection. It’s been a partial success so far, and time will tell,” Mr Stocking told The Telegraph from his hospital bed at the Royal National Orthopaedic Hospital (RNOH) in north-west London after receiving his third and final dose of phage therapy last week.
“I’ve had numerous pills, potions, antibiotics, transfusions and none of them worked. We have exhausted the available options and are down to phage which was raised as a last resort,” Mr Stocking said.
The cost of this bespoke and unique treatment, which was paid for and administered by the NHS, is thought to be similar to a course of the most premium and highly-preserved antibiotics, at a few thousand pounds. The procedure is a last hope for him and his wife, Lorraine, 72, also a retired police officer.
After retiring, the couple moved to a smallholding in Devon and ran a rural B&B for a decade. On Wednesday, they celebrated their 48th wedding anniversary by sharing a Mars bar in hospital.
Mr Stocking now has three sinuses on his left leg from his infection which weep constantly and need regular tending.
“It’s got more and more painful, and it’s got worse and worse to the point where I can’t walk very far and I am very unstable,” Mr Stocking said.
“It has prevented us doing lots of things we would have wanted to have done. Everything has just been put on hold,” adds Lorraine.
The couple were not put off by the therapy’s experimental nature, and hope it could allow Mr Stocking’s leg to heal enough to allow him to walk with greater ease.
“I thought it was brilliant when it was first suggested to me,” Mr Stocking said.
“It was put to me that I would be the first one to have phage for something like this and that it was an experiment that could work for a lot of people and, if it works, also help a lot of people.
“I am 81 and I can’t pioneer much more with my life so whatever I can do to be of use to anybody then let’s give it a go.
“I’m never going to win a Butlins Knobbly Knees competition, but I’d like to see my leg sufficiently well to use it and walk. Walking is the main thing, to get about for the final few years of my life.”
But the path to this point, the couple say, has been exhausting. Endless red tape has delayed treatment and made access to phage a multi-year struggle.
Phage therapy is not a licensed medicine in the UK and a phage from the UK can not be provided to an NHS patient unless it reaches Good Manufacturing Practice (GMP) standard. There is no GMP facility for phages in the UK.
However, a “GMP-like” phage from abroad can be used for compassionate use if it is approved by the Medicines and Health Products Regulatory Agency (MHRA) and imported.
Proving this, and sourcing an importer to bring an unlicensed, non-GMP medicine from a laboratory in Brussels required more than 200 hours of work from Mr Stocking’s clinical team and caused most of the delays.
‘Get on with it’
The Stocking family and the doctors both urged politicians and regulators to alter the current legislation to make it easier for other patients to access phage therapy through the NHS.
“While all the faceless bureaucracy goes on we are left 200 miles away with no answers,” said Mr Stocking.
“It’s not been a very pleasant time. Phage could be useful to a lot of people but red tape is holding it all up. It has been months and months of hanging around.
“Give it a chance, expedite it,” he urged politicians. “Money is money but lives are lives and limbs are limbs. Get on with it.”
A medic treats Mr Stocking - RNOH Images
Lorraine said phage therapy could save the NHS millions of pounds a year and help treat thousands of different people around the country who have run out of options.
“Behind the delays and red tape are mental, emotional and physical impacts,” she said.
“His condition three-and-a-half years ago was not so bad and maybe phage would be more effective had we not been this far down the line before getting it.”
Tariq Azamgarhi, the principal antimicrobial pharmacist at RNOH, and Dr Antonia Scobie, research lead for the Bone Infection Unit at RNOH, were central in securing phage therapy for Mr Stocking.
Mr Azamgarhi said phages “fall between the cracks” of much of the existing UK regulation, and urged politicians to make changes to help doctors better access phages for compassionate use in patients with no other option.
‘Huge potential’
Dr Scobie, who is also lead for the UK Clinical Working Group for bacteriophage therapy, told The Telegraph: “We are in the camp of strongly supporting phage therapy and I think it has a huge amount of potential.
“We’re under no illusion that on its own, phage therapy is never going to be able to replace antibiotics but what it does offer is a safe treatment that can be an adjunct to our existing therapies.
“We would never dream of injecting the phage and just crossing fingers and hoping that would be enough. It needs to be used in the right way, but it’s an extra tool. I think it has huge potential and it just needs to be used in the right way.”
The RNOH team is now beginning the long-winded process again for three other superbug patients with joint infections and is helping other hospitals around the country tackle the paperwork.
“We hope that by opening various doors in the process that it may be easier for them and help the next patient,” Dr Scobie said.
A report by MPs on the science and technology committee said earlier this year that the MHRA should change its rules to allow for compassionate use in last-resort medical cases, like those of Mr Stocking.
They also urged the agency to set out new guidance for how doctors can use non-GMP phages.
The MHRA has missed some deadlines set out by the committee at the start of the year and is currently reviewing proposed guidance. It says this will be published “in due course”.
The MHRA declined to comment.
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