Tackling AMR in Wastewater Systems with Sneaky Bacteria

Lead Research Organisation: Newcastle University
Department Name: Sch of Engineering

Abstract

Domestic wastewater treatment is among the main reasons why community health has improved dramatically since Victorian Times. Waste treatment plants (WTPs) effectively remove pathogens, carbon, and nitrogen, creating a healthier environment and reducing the waterborne infectious disease. However, WTPs were never designed to remove contemporary contaminants, such as antimicrobial resistant bacteria (ARB) or genes (ARG). Current WTPs reduce many ARBs/ARGs from wastes, but the "worst" sub-fraction of ARGs increase in WTPs, especially multi-ARGs (MRGs) that create the potential for indestructible pathogens. Researchers have been studying why multidrug resistance (MDR) is selected in WTPs. However, the cause is unknown, which impacts the long-term resilience of our water infrastructure.

In the 1950s, German researchers observed a strange bacterial form in activated sludge (AS) in WTPs, called L-form bacteria. L-forms are "normal" bacteria that temporarily lose their cell wall. Although interesting, this observation was not pursued further. However, medical researchers recently discovered that L-form bacteria are common in MDR urinary tract (u-tract) infections, and my speculation is that L-form bacteria, which are intrinsically MDR, might be the "unknown" cause of MDR in WTP effluents. To test this bright idea, ~40 samples were collected from two UK WTPs and very high levels of L-form strains were found, especially in AS floc. Further, all L-form strains were putative "gut" bacteria, implying MDR in WTP effluents may be due to the selective survival of gut-originated L-form bacteria that "hide" in floc (in pseudo-dormant state) and then "sneak" back into WTP effluents because they survive waste treatment in their L-form state.

The project do the following:

- Develop better methods for detecting L-forms in wastewater;

- Quantify environmental conditions in WTPs where L-form bacteria are selected and hide, and determine what triggers their reactivation;

- Identify gene expression targets that promote/repress the L-form state and identify specific locations in WTPs where L-forms can be selectively destroyed; and

- Perform bench- and pilot-scale reactor work to develop new treatment strategies to reduce MDR, especially aimed at reducing L-form survival in WTPs effluents.

We already have >700 microbial MDR isolates from WTPs in the UK, Spain and India, although few have been tested for L-form development. However, early data suggest L-forms are common in AS, consistent with German observations. Within this context, work initially will focus on characterising our current MDR isolates in detail, especially categorising strains prone to L-formation and also identifying the presence and absence of key "L-form trigger genes" (in our isolates). Target genes will be refined and tested for diagnostics of L-forms, and also how their prevalence and local environments relate to MDR indictors (using qPCR, NGS and resistomics). With these data, structured sampling will be performed with three industrial partners on eight full-scale WTPs with different biological treatment technologies to identify "hot spots" of L-form selection and survival. Locale data will be used to guide lab- and pilot-scale testing of new and retrofit technologies to reduce MDR levels in WTP effluents, which will inform strategies for increasing resilience in our urban water infrastructure, especially reducing AMR spread and protecting community health.

This proposal will deliver key outcomes for A Healthy and Resilient Nation, specifically H2, H3, R2 and R3, because it will generate basic and practical data that impacts all WTP designs in future; designs to reduce MRGs released to the environment. Beyond this outcome, transcendent discoveries will be made on the genetics, ecology and selection of L-form strains, which will inform the medical community on MDR infections and also improve diagnostics in both clinical and environmental settings.

Planned Impact

This project will transform approaches for reducing antimicrobial resistance (AMR), especially multidrug resistance (MDR) released from wastewater treatment plants (WTPs). The work will deliver outcomes contributing to a "Healthy" and "Resilient" Nation, specifically addressing H2 (improve prevention), H3 (optimise diagnosis), R2 (ensure a reliable infrastructure), and R3 (develop better solutions to health threats). It will use a wholly new idea from cell biology (i.e., selection and survival of L-from bacteria) to develop new and less costly engineering options for reducing MDR in WTPs, which could change the way we view AMR and wastewater treatment in future applications.

Although this project will immediately benefit the water industry, it also benefits other sectors, including city, national and international governments; the public health sector; regulatory agencies; the pharmaceutical industry; and society as a whole. Specifically, growing concern exists over increasing AMR in human and veterinary medicine, and mounting evidence suggests inadequately treated wastewater significantly impacts AMR in the environment, even in the UK. We deservedly trust our WTPs, but they still release disproportionately high levels of MDR, which this project aims to address from a wholly new perspective.

Each sector will benefit in different ways. The public health sector will be provided new knowledge on root causes of MDR in WTPs, and also will be provided new biochemical and genetic data needed to develop better diagnostic tools for MDR detection in clinical and environmental samples. The pharmaceutical industry will benefit by our solutions reducing the spread of AMR through more resilient WTPs, making drug discovery more justifiable and extending the commercial-life of existing antimicrobials. Regulatory agencies (e.g., local governments, environment agencies) will gain by being provided better informed, scientifically robust metadata essential to develop environmental risk management guidance related to AMR and WTPs. As a result, society as a whole will benefit by improved resilience in current and future WTP designs, specifically reducing AMR released in effluents to our water environment.

A wide range of vehicles will be employed to maximise impact of the project. The project includes water industry stakeholders, which will act as an ad hoc Project Advisory Group, providing advice, guidance, access to WTPs, and a pathway for industrial outreach on the project. Impact also will be promoted by publication in leading environmental publications, and presentation at environmental AMR and microbiology meetings, including EDAR5 in Hong Kong and ISME17 in Leipzig. Further, our existing network of contacts will be used disseminate findings to national and international organisations, including the WHO and PACCARB in the US with whom the PI already works. Finally, social and traditional media (TV and radio) will be employed to instantly provide information of community value to the wider public; platforms on which our group has been very successful in the recent past.

Overall, this project with reconsider what fundamentally drives MDR in bacteria, particularly altering their form to an L-form state, which renders bacteria in WTP effluents intrinsically MDR. Through such discoveries and wide stakeholder connections, impact and dissemination of work will be assured, including translation to other disciplines, such as MDR diagnosis and prevention in medicine. However, the ultimate aim is to use engineering to create a healthier, resilient environment in the UK, but then to extend those benefits, which have significant altruistic and economic value, to the wider world.

Publications

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Lamba M (2018) Carbapenem resistance exposures via wastewaters across New Delhi. in Environment international

 
Description Although not yet published, we have found that L-form bacteria are very common in wastewater systems, including in antimicrobial resistant (AMR) strains, including pathogens. We have isolated over 200 strains, which have been phenotyped and genotyped, A subset for strains, including putative pathogens that form and do not form L-form states, all of the which we have had genomes sequenced. There is not clear identified genetic differences in L-form and non L-form states, which suggest differences are in regulation rather than sequence. Therefore, we still do not have a good way of identifying L-form bacteria within actual treatment processes.

However, we are continuing examination of the isolates, especially related to sequencing vancomycyn-resistant phenotypes and their plasmids. Additionally, we are examining the role of protozoan predatory activity on AMR bacterial fate in WWTPs. During our earlier experiments, we noted that AMR strains were much lower where elevated protozoa were apparent, therefore we have developed a parallel study stream examining this as an alternate hypothesis of different levels of AMR survival.
Exploitation Route To it too soon to tell. We know AMR L-form bacteria exist in wastewater systems, but to determine whether this is important or not relative to reducing AMR cannot be determined until; we can identify L-form strains in actual processes.

As noted, we took what we learned here and are now applying to pandemic questions, providing huge added value and impact. However, we plan on returning and finishing this work once the pandemic needs decline.
Sectors Environment,Healthcare,Manufacturing, including Industrial Biotechology,Pharmaceuticals and Medical Biotechnology

 
Description They have guided a patent submission we made in 02/19 and also have been used to underpin guidance we are providing the WHO, US CDC and Wellcome on reducing AMR. This work is became manifest with major impact in June 2020 when the WHO guidance became public. Our has been highlighted in the WHO Policy Brief on AMR and WASH, which has since been translated into six languages to guide countries in developing their own local National AMR Action Plans.
First Year Of Impact 2019
Sector Communities and Social Services/Policy,Environment,Healthcare,Government, Democracy and Justice,Pharmaceuticals and Medical Biotechnology
Impact Types Policy & public services

 
Description Citation to research in the US CDC and Wellcome Report on AMR
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in other policy documents
URL https://wellcome.ac.uk/sites/default/files/antimicrobial-resistance-environment-report.pdf
 
Description Evidence of Wider Environmental Transmission of SARS-CoV-2: Assessing risk of transmission through outdoor air, water, outdoor surfaces, and food - Transmission of Covid-19 in the Wider Environment Group (TWEG), reporting to UK Scientific Advisory Group for Emergencies (SAGE) [DW Graham co-author]
Geographic Reach National 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
Impact A number of significant evidence gaps hamper assessment of transmission risk of SARS-CoV2 through environmental pathways. While various studies have detected viral RNA signatures from environmental samples (from air, water, treated effluents and sewage and surfaces) using RT-PCR, infectivity has not been assessed in most cases. Very few studies have investigated the presence of infective virus using culture techniques. In addition, the infective dose of SARSCoV-2 is still uncertain. Assessments of risk and uncertainty therefore draw heavily on expert judgement and knowledge of other pathogens throughout this document. The level of risk of catching SARS-CoV-2 from the environment is highly dependent on the levels of infective SARSCoV-2 circulating in the population and its geographical spread.
URL https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/8996...
 
Description Initiatives for Addressing Antimicrobial Resistance in the Environment: Current Situation and Challenges. Prepared for U.S. Centers for Disease Control and Prevention, the UK Science & Innovation Network, and the Wellcome Trust [co-authored by D Graham]aham
Geographic Reach Multiple continents/international 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
Impact Key points taken from report Executive Summary: • Antimicrobial resistance (AMR)-when microbes (i.e., bacteria and fungi) develop the ability to defeat the drugs designed to combat them-is a public health threat and global priority. Resistant pathogens can cause infections in humans that are difficult or impossible to treat. • Scientific evidence shows that antimicrobials and antimicrobial-resistant microbes are present and can persist and travel (spread) through the environment (waterways and soils). Human activity can contaminate the environment with antimicrobials and antimicrobial-resistant microbes, which can accelerate the development and spread of resistance. • Contamination can occur from human and animal waste, pharmaceutical manufacturing waste, and use of antimicrobial pesticides for crops; however, the scale and risk associated with this contamination is not fully understood. There are outstanding scientific questions related to the presence and impact of antimicrobial-resistant microbes in the environment and the direct risk posed to human health. • The environment is a key element of the One Health framework. It is necessary to better understand risks, prioritize action to address antimicrobial-resistant microbes in the environment where potential risks to human health are greatest, and cultivate a collaborative global approach. • Scientific review suggests that there are actions that could improve understanding and guide action: - A better understanding of hospital waste treatment in different global settings is a priority, requiring establishment of evidence-based waste standards and implementation of effective waste management practices and capabilities where interventions are most needed. - Good hygiene and sanitation, including effective waste disposal and treatment, are important ways to mitigate the risk of antimicrobial-resistant microbes in the environment associated with human waste and wastewater contamination. - When feasible, contamination by animal waste could be reduced by improving antimicrobial use, developing alternative disease control methods (e.g., vaccines), and improving the quality of the rearing environment to help reduce the need for antimicrobials. - Agreement on a discharge limit for effluents leaving manufacturing sites and standardized monitoring and reporting of effluent levels could significantly reduce contamination and potential human health risks associated with exposure to resistant microbes in the environment. - Potential risks from using antimicrobials on crops could be reduced through greater global transparency of antimicrobial use, implementation of best management practices when applying antimicrobials as pesticides, and greater use of alternative disease prevention and treatment strategies. • To maximize potential impact, align activities to address antimicrobial-resistant microbes in the environment (e.g., addressing knowledge gaps) with existing global public health and development efforts, such as Sustainable Development Goals; the Water, Sanitation and Hygiene Initiative; and the Global Health Security Agenda.
URL https://wellcome.org/sites/default/files/antimicrobial-resistance-environment-report.pdf
 
Description Monitoring the presence and infection risk of SARS-CoV-2 in the environment: approaches, limitations and interpretation - Transmission of Covid-19 in the Wider Environment Group (TWEG), reporting to UK Scientific Advisory Group for Emergencies (SAGE) [DW Graham co-author]
Geographic Reach National 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
Impact This paper provides an overview of the key principles and approaches to monitor SARSCoV-2 in the environment. It covers sampling from water (freshwater, wastewater and marine), air and surfaces (including surfaces of food), and discusses the strengths and limitations of key detection methods. It is intended as a primer for Government officials, managers of organisations and those without technical expertise in the subject who may be considering the need for assessing Covid-19 risk in a setting for which they are responsible. While it is not an in-depth review or a methods manual, it provides some guidance on how to interpret research results and environmental monitoring data. References to more detailed specialist literature are provided.
URL https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/9458...
 
Description Monitoring wastewater for COVID-19. Prepared for The Parliamentary Office of Science and Technology [Author: Amelie Ott, with contributions by D Graham and M Quintela-Baluja]
Geographic Reach National 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
Impact This impartial brief was prepared for Members of the House of Commons and the House of Lords to get them up to spread on wastewater monitoring for Covid-19. This review is written in plain English making it accessible to a broad audience. Additionally, it identifies the government-led projects for England, Wales and Scotland and how information gathered by these projects are passed on to NHS Test and Trace and the local council, who were able to alert local health professionals to the increased risk and contact people in the area to warn of the increase in cases.
URL https://post.parliament.uk/monitoring-wastewater-for-covid-19/
 
Description Technical brief on water, sanitation, hygiene and wastewater management to prevent infections and reduce the spread of antimicrobial resistance. Published by World Health Organization, Food and Agriculture Organization of the United Nations, and World Organisation for Animal Health [D Graham co-author]
Geographic Reach Multiple continents/international 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
Impact This document defines the six Action Areas that need to be addressed to reduce global AMR, especially in LMICs via full WaSH implementation. The Technical Brief has been translated into six languages so far and is underpinning One Health solutions to AMR around the world.
URL https://www.who.int/publications/i/item/9789240006416
 
Description WHO/FAO/OIE Policy linking WASH Implementation and AMR Mitigation
Geographic Reach Multiple continents/international 
Policy Influence Type Membership of a guideline committee
Impact The policy provides evidence that implementing WASH and decentralised sanitation can reduce AMR spread in LMICs. The formal WHO/FAO/OIE Policy Brief has not yet become public (expected April 2020), but its content already has been shared with some governments and evident changes are occurring on the ground. One of the goals of the Brief is to provide a template for developing AMR National Action Plans, which was among key elements contributed by our work.
 
Description Embedding Antimicrobial Resistance (AMR) and Childhood Malnutrition Studies in South Asia into World Health Organisation (WHO) Policy
Amount £27,033 (GBP)
Organisation Newcastle University 
Sector Academic/University
Country United Kingdom
Start 03/2020 
End 12/2020
 
Description GCRF Water Security and Sustainable Development Award
Amount £17,100,000 (GBP)
Funding ID ES/S008179/1 
Organisation Economic and Social Research Council 
Sector Public
Country United Kingdom
Start 02/2019 
End 02/2024
 
Description Chinese National Academy of Science - Xiamen 
Organisation Chinese Academy of Agricultural Sciences
Country China 
Sector Academic/University 
PI Contribution We are working with CAS (w/ Prof Yong-Guan Zhu) on samples from this project using our extraction methods and their multiplex qPCR methods. This is an extension of on-going joint work.
Collaborator Contribution We are sharing resistome samples for comparisons between samples within this new project, our previous collabarotion on ARC AMR, and their samples from Antartica and Tibet. The goal of this additional work is to determine how background AMR gene levels compare in "remote" locations around the world.
Impact None as of yet, but are about to submit a manuscript on AMR levels in the High Arctic.
Start Year 2012
 
Title New treatment core for Dentrifying Downflow Hanging Sponge (DDHS) reactors 
Description The patent application has just been submitted and the paperwork is complete. DDHS are among the options available for local-scale waste treatment in locations like rural Malaysia. The optimised core allows the reactor remove Total Nitrogen, AMR genes and infectious disease from wastewater in a highly effective manner at local scales. No other technology has been proven to do this. Further data to confirm the value of the technology is being gained in the Newton Institutional and other awards. 
IP Reference Not available yet 
Protection Patent application published
Year Protection Granted 2019
Licensed Commercial In Confidence
Impact None yet. However, we are currently negotiating the scale up of the technology being tested in the Newton award to full-scale, both in Malaysia and also in India.
 
Description Decentralized WASH Systems to combat Antimicrobial Resistance (AMR) workshop (Colombo, Sri Lanka) - David Graham 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This workshop was presented on behalf of the World Health Organisation. It was held at the IWA Sustainable Development Congress & Exhibition in Colombo (Sri Lanka) to inform and guide practitioners in the water industry about their critical role in reducing AMR via improved water quality. Graham, and two colleagues from IWMI (Sri Lanka) and RIVM (the Netherlands), respectively, presented the workshop, which informed the audience of future guidance from the WHO.
Year(s) Of Engagement Activity 2019
 
Description Adviser and co-author of new WASH guidance from the World Health Organisation relative to AMR - David Graham 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact As a result of working with the US CDC, Graham was invited to advise and co-write WASH guidance. The guidance document is currently in revision (as of 02/19) with a planned publication date of 05/19. Our role was to write sections on the value of incremental sanitation improvements to reduce AMR and infectious disease. Our work was informed by all our prejects that relate environmental AMR and contaminated soils and water.
Year(s) Of Engagement Activity 2018,2019
 
Description Annual Graham Group Newsletter 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Annual Graham Research Group newsletter available online and set as a pdf to interested parties. It highlight the group's research efforts and compliments the group's research blog. It provides a condensed version for our funders, research partners, university colleagues, alumni, and students as well as friends and family.
Year(s) Of Engagement Activity 2020,2021
URL https://blogs.ncl.ac.uk/grahamr/?page_id=31
 
Description Antimicrobial resistance in the environment of emerging countries [Amelie Ott] 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Stop-motion film entry for the Institute for Social Science Post Graduate Researcher Impact Award 2019. Awarded third place. It was posted on YouTube for 18 months but has since been made private by the creator Amelie Ott.
Year(s) Of Engagement Activity 2019
 
Description Calls for action now to prevent next global pandemic 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Newcastle University Press Office. 12 June 2020. Accouchement the accompany the Conversation piece that call for greater international co-operation to bring about improved water, sanitation and health provision as a way to prevent the next global pandemic
Year(s) Of Engagement Activity 2020
URL https://www.ncl.ac.uk/press/articles/latest/2020/06/amractionnowtopreventnextpandemic/
 
Description Co-author of the whitepaper on global led by the US Center for Disease Control - David Graham 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact The draft whitepaper was prepared for April 2, 2018. Graham was the oral spokesman on proposed whitepaper mitigation strategies related domestic and hospital waste management at the international forum in Vancouver on April 4 and 5. This event had 150 policymakers from around the world, representing over 40 countries. The final whitepaper was published in December 2018, which consolidated the Vancouver meeting and was released to the WHO and all governments that have contributed to the forum.

The report was entitled "Initiatives for Addressing Antimicrobial Resistance in the Environment: Current Situation and Challenges" and was published on the Wellcome Trust webpage. A component of the whitepaper related to rural sanitation was informed by the Newton Institutional award, using new data collected from Malaysia.
Year(s) Of Engagement Activity 2017,2018,2019
URL https://wellcome.ac.uk/sites/default/files/antimicrobial-resistance-environment-report.pdf
 
Description Coronavirus: Testing sewage an 'easy win' 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Article written by Gill V. (2 July 2020)for BBC | News | Science & Environment. It contains quotes from Professors David Graham and others related to the UK National Surveillance Programme.
Year(s) Of Engagement Activity 2020
URL https://www.bbc.co.uk/news/science-environment-53257101
 
Description Expert panel and co-writer of whitepaper sponsored by the Sackler Instuitute for Nutrition and New York Academy of Science - David Graham 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Graham is working as co-author and expert advisor in developing an integrated One Health strategy for reducing antimicrobial resistance in the animal food production industry. Initial meetings are occurring now (March 2018 to March 2019) with the goal of an international launch for proposed strategies in New York in April 2019.

Launch announcement can be found at https://www.nyas.org/events/2019/antibiotics-in-animal-agriculture-what-you-need-to-know/.
Year(s) Of Engagement Activity 2018,2019
URL https://www.nyas.org/events/2019/antibiotics-in-animal-agriculture-what-you-need-to-know/
 
Description Fighting the Next Pandemic: Water quality, antimicrobial resistance, and global health 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact 2020 Newcastle University Alumni Day lecture. 10 October 2020
Year(s) Of Engagement Activity 2020
URL https://youtu.be/DB5aKt7YdD8
 
Description Ganges: sewers could be making water quality of India's great river worse [authors Milledge D and Bunce JT] 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact The article touches on the fact that sewers may be making the Ganges water quality worse.
Year(s) Of Engagement Activity 2019
URL https://theconversation.com/ganges-sewers-could-be-making-water-quality-of-indias-great-river-worse-...
 
Description GrahAMR Research Group Blog 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact The GrahAM Research Group blog highlights the work of the Graham research team, focusing primarily on work surrounding antimicrobial resistance (AMR), taking a collaborative and multidisciplinary approach to global health and well-being. The team of researchers, led by Newcastle University Prof David W Graham, utilises a holistic 'One Health Approach', and contributes to several of the UN's Sustainable Development Goals (SDGs).

Our research provides guidance to various international organisations, including the World Health Organisation, and bridges sustainable development, engineering, health, and sociotechnical mitigation options for reducing global AMR.

The main topics we explore are

the transmission, fate and impact of antibiotic resistance genes in the environment resulting from human activity;
energy minimization in water, wastewater and solid waste management systems;
the microbiology and ecology of greenhouse gas suppression and production in geochemical settings, especially in Polar regions; and
water and environmental quality in the developing and emerging world.
Year(s) Of Engagement Activity 2020,2021
URL https://blogs.ncl.ac.uk/grahamr/
 
Description How testing sewage could help the UK predict COVID-19 outbreaks 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact This article written by Thomas White for CGTN (China) touches on how sewage testing could be used to predict Covid-19 outbreaks. It includes quotes from Prof David Graham.
Year(s) Of Engagement Activity 2020
URL https://newseu.cgtn.com/news/2020-07-13/How-testing-sewage-could-help-the-UK-predict-COVID-19-outbre...
 
Description India-UK team tackles antimicrobial resistance spread in waterways 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Newcastle University Press Office. 6 August 2020. Announced the launch of the AMRFlow project. Story picked up be various media outlets including: Hindustan Times, The Times of India, Deccan Herald, India Education Diary, The Times of Bengal, and The Week, India Inc.
Year(s) Of Engagement Activity 2020
URL https://www.ncl.ac.uk/press/articles/latest/2020/08/uk-indiaamrflows/
 
Description Keynote talk at the 27TH Meeting of the Spanish Society for Microbiology 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact Keynote presentation at the special symposium at the Spanish Microbiology Society meeting on antimicrobial resistance )AMR). It brought experts from across Europe. Graham's presentation was on environmental AMR spread, including results from the Darwin, Sneaky Bacteria and other projects.
Year(s) Of Engagement Activity 2019
 
Description Lecture series in Paraguay - Marcos Baluja 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Dr Marcos Baluja was invited to provide a series of lectures and tutorials on environmental AMR in Paraguay related to work from the project. The series spanned August and September 2019, and included six lectures in medical, environmental and governmental agencies, but also meetings with senior politicians, including the the Minister of the Environment. An MOU between Newcastle University UNA in Asuncion, which will lead to mutual projects, and student and staff exchanges between the two universities.
Year(s) Of Engagement Activity 2019
 
Description Lecture tour of environmental and medical institutions in Israel - David Graham 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Provided a series of lectures at different organisations in Israel, including the Rambon Healthcare Center, the Technion University, The Hebrew University (in Rehovot), and at the Ben Gurian Desert Institute, all on AMR mitigation, especially blocking environmental pathways of spread. Audiences ranged from students to healthcare professionals to academics across disciplines. These have led to collaborative work on AMR spread, initially in Ethiopia. More impact would have been seen if the UK had not ceased their funding to the JPIAMR scheme.
Year(s) Of Engagement Activity 2019
 
Description Policy adviser to the World Health Organisation on AMR in revised global WASH guidance 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Graham was asked and it now jointly co-writing new guidance for the World Health Organisation on AMR within new WASH policy. This guidance centres around the relative value and impact of local scale waste management technologies that can be used for reducing AMR in low resource countries. This is a central element of the Newton Institutional award; i.e., seeking such data. First reporting of information will at the WHO meeting in Ghana on November 19-20, 2018. This is meeting will be to between 100 and 200 policy representatives from over 40 countries, but the final Policy Brief will ultimately be made public, which will the report both public and global.
Year(s) Of Engagement Activity 2018,2019
 
Description Researchers looking at sewage to learn about COVID-19 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact MSNBC | The 11th Hour with Brian Williams ran this piece to address - why researchers are looking to the sewers to learn more about COVID-19.
Year(s) Of Engagement Activity 2020
URL https://www.msnbc.com/11th-hour/watch/researchers-looking-at-sewage-to-learn-about-covid-19-87790661...
 
Description SARS-CoV-2 wastewater epidemiology 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact BBC Look North, 3 November 2020, with a Twitter post by Lee Johnson.
Year(s) Of Engagement Activity 2020
URL https://twitter.com/i/status/1323721151005233152
 
Description Scientists around the world are already fighting the next pandemic 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Graham DW and Collignon P (9 June 2020 • 06:00 am) The Conversation.
Year(s) Of Engagement Activity 2020
URL https://theconversation.com/scientists-around-the-world-are-already-fighting-the-next-pandemic-11524...
 
Description Training Workshop on Mitigating antimicrobial Resistance (AMR) in the water cycle: Analytical methodologies and improving water quality - David Graham/David Werner 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact We organised and led this workshop in association with four universities in Ethiopia, two universities in Israel, and members of the FAO and WHO. The goal was explain AMR in comparatively simple terms, and then promote new work in Ethiopia that bridges government, NGOs and academic groups in the country. It is also taught research methods.
Year(s) Of Engagement Activity 2019
 
Description Workshop on Pharmaceuticals in the Environment: Risks in low and middle income countries (Nairobi, Kenya) - David Graham 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Industry/Business
Results and Impact This was a think tank organised by AstraZeneca to discuss the impact of pharmaceutical pollutants in the environment in developing countries. It included experts from around the world, but also included representatives from NGOs, government agencies. The product of the workshop is a call for action, which is aimed at industry and governments around the world.
Year(s) Of Engagement Activity 2019
 
Description Workshop on the use of molecular biological methods for environmental research - David Graham 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This workshop was for researchers and professional practitioners in Malaysia and Singapore. It taught how to collect environmental samples for molecular analysis, extract and purify DNA, quantify DNA signatures and then interpret data. The methods are now being using used by colleagues in Malaysia and Singapore. The course was taught by our group, but primarily by senior PhD students and junior PDRAs, both of which gained valuable experience from designing and delivering the course.
Year(s) Of Engagement Activity 2018