Towards Developing an International Environmental AMR Surveilance Strategy

Lead Research Organisation: UNIVERSITY OF EXETER
Department Name: Institute of Biomed & Clinical Science

Abstract

There is an urgent and increasing need to fully understand the development and transmission of AMR both into and within the wider environment. However, at present research into environmental aspects of AMR has been largely confined to individual institutions or academic laboratories. National governments and international bodies (EU, UN, WHO) have recognised that we must establish effective environmental surveillance systems to identify and monitor AMR in our waters, soils air and wildlife in order to increase understanding of the natural environment's role in emergence and spread of AMR and how the introduction of antimicrobials / resistant microorganisms from human / animal sources into the environment contribute to AMR. A One Health approach promotes harmonised surveillance across human, veterinary and food sectors and the use of common outcome indicators to monitor AMR and antimicrobial use: several joint national reports publish AMR trends for key indicator bacteria and key antibiotics (for example UK One Health report, DANMAP and Scottish One Health Antimicrobial Usage and Antimicrobial Resistance Report (SONAAR). However, there is no clear consensus so far regarding which indicators to measure for the environmental sector. This network aims to identify robust, measurable surveillance indicators and methodologies for environmental AMR by: building on and transferring existing knowledge from clinical and animal AMR indicators and methodologies in the context of a multi-sectoral, One Health approach. We will bring together key researchers with policy makers and regulators across the environmental, human health and veterinary sectors and from countries with a wide range of economic settings. We aim to arrive at a standardised set of targets and reproducible, accessible methodologies allowing comparative data to be generated in a coordinated manner. We will then set out our findings in advice and briefings to governments and international bodies.

Technical Summary

With growing awareness of the role of the natural and farmed environments in the evolution, landscape scale dissemination and transmission of AMR, coordinated efforts to undertake environmental surveillance are required. Microbial populations are highly complex with billions of bacteria present in 1 gram of soil, sediment or faeces. A considerable number of these bacteria carry mobile genetic elements (MGEs) which can be passed between even unrelated species, and these mobile elements may carry a wide range of different resistance mechanisms to widely used and even last line of defense drugs used to treat infection. Human and animal waste introduce AMR bacteria to the natural environment, where they mix with environmental bacteria in the presence of antimicrobial residues, leading to the possibility of new AMR bacteria emerging from these environments. Acute transmission risk also occurs through direct contact with the environment or indirectly through the food chain from exposed crops and livestock. Due to the complexity of microbial populations (billions of bacteria of thousands of species per gram) and the number of AMR genes (numbering in the thousands) determining appropriate endpoints for surveillance is challenging. There are also a variety of analytical methodologies with varying utility in terms of cost, complexity and data outputs. Currently many labs use different surveillance targets and methodologies making comparison over time and between sample sites extremely difficult. The aim of the network is to establish standardised targets and protocols for surveillance, bearing in mind varying analytical capability across the globe. We will liaise with other funded JPIAMR networks with overlapping remit, to ensure efficient use of resources, alignment across networks and to reduce duplication of effort.

Planned Impact

The membership of this network has been carefully considered in terms of geographical coverage (EU, North America, Africa, South Asia and SE Asia), research expertise and policy / regulatory / government coverage including those involved in environment, animal and human health. Between network members we cover membership of a wide range of national and international regulatory and policy making bodies and we have a wide network of contacts within the global academic research environment and industry. We will use these networks to communicate network outputs in addition to the impact focused objectives which includes a series of expert recommendations on potential methods for environmental surveillance and monitoring of AMR.

Publications

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EFSA Panel on Biological Hazards (BIOHAZ) (2021) Role played by the environment in the emergence and spread of antimicrobial resistance (AMR) through the food chain. in EFSA journal. European Food Safety Authority

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Larsson DGJ (2023) AMR, One Health and the environment. in Nature microbiology

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Vos M (2020) Zinc can counteract selection for ciprofloxacin resistance. in FEMS microbiology letters

 
Description ? Participated in Epi-Net meeting Dec 3rd 2021.
Geographic Reach Europe 
Policy Influence Type Membership of a guideline committee
Impact Will determine future AMR surveillance policy and practice on Europe
 
Description ? Second consultative meeting in preparation of the report on the environment and health impacts of pesticides and fertilizers (UNEP, WHO, FAO). Geneva, UNEP. 2019.
Geographic Reach Multiple continents/international 
Policy Influence Type Membership of a guideline committee
Impact I sit on the WHO/FAO working group on pesticides and fertilizers where the risks of AMR and environment are being discussed in relation to manure based fertilizers and biosolids amendments to agricultural land.
 
Description Advised European Bank for Reconstruction and Development on AMR
Geographic Reach Europe 
Policy Influence Type Contribution to new or improved professional practice
Impact Advised European Bank for Reconstruction and Development on AMR
 
Description Advised the water industry on scoping their AMR R&D programme with Atkins and University of Newcastle
Geographic Reach National 
Policy Influence Type Membership of a guideline committee
 
Description Advising Deloitte on evaluation of the UK gov AMR surevillance programme PATH-SAFE
Geographic Reach National 
Policy Influence Type Participation in a guidance/advisory committee
Impact Informing national policy
 
Description Consulting for DG Sante on AMR policy
Geographic Reach Europe 
Policy Influence Type Contribution to a national consultation/review
Impact Informing EU policy
 
Description Held KE meeting at the University of Exeter attended by ES, Defra, Welsh and NI devolved governments, water industry, clinicians etc
Geographic Reach National 
Policy Influence Type Membership of a guideline committee
 
Description Informing decision making around the WFD watch list of antibiotics
Geographic Reach Europe 
Policy Influence Type Citation in other policy documents
Impact Research has influenced decision making on inclusion of antibiotics on the WFD hazardous compound watch list
 
Description Invited by British Society of Antimicrobial Chemotherapy to contribute to discussion around new AMR National Action Plan. One of a small number of academics to be invited.
Geographic Reach National 
Policy Influence Type Participation in a guidance/advisory committee
 
Description Invited to participate in Surveillance and Epidemiology of Drug Resistant Infections Consortium (SEDRIC) Genomic Surveillance of Antimicrobial Resistance working group workshop lead by Professor Kate Baker, Dr Elita Jauneikaite, Professor Sharon Peacock and Professor Nicholas Feasey.
Geographic Reach Europe 
Policy Influence Type Participation in a guidance/advisory committee
Impact NA
 
Description MRes student embedded in EA bathing water testing laboratory
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
 
Description Member of UK AMR NAP Stakeholder group
Geographic Reach National 
Policy Influence Type Participation in a guidance/advisory committee
Impact iNFORMING NATIONAL HEALTH POLICY
 
Description Second consultative meeting in preparation of the report on the environment and health impacts of pesticides and fertilizers (UNEP, WHO, FAO).
Geographic Reach Multiple continents/international 
Policy Influence Type Membership of a guideline committee
 
Description We are currently involved in five AMR PATH-SAFE contracts in collaboration with UKCEH on three contracts and WSP on one contract
Amount £200,000 (GBP)
Organisation Environment Agency 
Sector Public
Country United Kingdom
Start 08/2022 
End 03/2023
 
Description Supervising EA staff member for postgraduate degree on environmental AMR surveillacne 
Organisation Environment Agency
Country United Kingdom 
Sector Public 
PI Contribution We have supervised the EA staff member who works on the UKHSA?FSA/EA PATH-SAFE AMR surveillance programme
Collaborator Contribution Research student
Impact Will inform EA AMR surevillance strategy
Start Year 2022
 
Description Work with APHA, co-supervising PhD on AMR in wild birds and livestock 
Organisation Animal and Plant Health Agency
Country United Kingdom 
Sector Public 
PI Contribution Combining our knowledge on AMR and environment with APHAs expertise on AMR in livestock.
Collaborator Contribution Contributed to cross-sectoral discussions on AMR
Impact PhD studentship
Start Year 2019
 
Description Working with UKCEH on PATH-SAFE projects 
Organisation UK Centre for Ecology & Hydrology
Country United Kingdom 
Sector Public 
PI Contribution We have jointly bid and are delivering three contracts on AMR for the Environment Agency through PATH-SAFE
Collaborator Contribution Joint delivery of three contracts
Impact Three reports which may lead to publications
Start Year 2022
 
Description ? Presented to the APPG on Antibiotics with report generated requestruing AMR be included in the new Environment Bill 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Myself, Aimee Murray and Isobel Stanton gave evidence to the APPG on Antibiotics, highlighting the importance of the environmental dimension of AMR. We presented evidence that should inform the environment bill which is currently at amendment stage.
Year(s) Of Engagement Activity 2020
 
Description Advising European Bank for Reconstruction and Development Bank on their Environment and Social Policy regarding AMR 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Talk about AMR to the investment community
Year(s) Of Engagement Activity 2023
 
Description Attended AstraZeneca meeting on pharmaceutical contaminants in LMICs in Nairobi 
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 I led a working group on AMR and environment, considering the issue from a LMIC perspective
Year(s) Of Engagement Activity 2019
 
Description Contributed to Aviva Investors report on AMR, biodiversity loss and climate change 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Presentation of report at Aviva Investors, London
Year(s) Of Engagement Activity 2022
URL https://www.avivainvestors.com/en-gb/views/aiq-investment-thinking/2022/11/antimicrobial-resistance/
 
Description HCWH webinar with myself and Dame Sally Davies, I hr to journalists and other specialists eg. WHO. 
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 Policymakers/politicians
Results and Impact Webinar with myself and Dame Sally Davies answering questions from policy makers and media around AMR
Year(s) Of Engagement Activity 2019
 
Description Invited speaker UK:Russia AMR roundtable, Nov 23rd organised by BSAC. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact ~30 AMR specialists from the UK and Russia discussing potential collaborations, coordinated by the British Society for Antimicrobial Chemotherapy.
Year(s) Of Engagement Activity 2021
 
Description Invited to speak at Bolivian conference on AMR attended by the minister of health. Santa Cruz, June 2019. 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact I had previously been invited to travel to Bolivia and speak to the AMR Action plan committee hosted by the British Embassy in La Paz, this was a follow up presentation to a similar group including the Minister of Health.
Year(s) Of Engagement Activity 2019
 
Description Keynote speaker at the Environmental Dimension of Antibiotic Resistance conference in Hong Kong in June 2019 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This was an international conference attended by academics and representatives from Wellcome, WHO and UNEP. I presented the theoretical framework which underpins this project grant and it was well received with both Wellcome and WHO requesting a copy of my presentation.
Year(s) Of Engagement Activity 2019
 
Description Quadripartitie one health priority research agenda for antimicrobial resistance 
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 Contributed towards the report, sitting on a panel of experts who contributed to teh report
Year(s) Of Engagement Activity 2023
URL https://www.who.int/publications/i/item/9789240075924
 
Description Wrote opinion piece on One Health and AMR for the Microbiology Society 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Wrote opinion piece on One Health and AMR for the Microbiology Society
Year(s) Of Engagement Activity 2020
URL https://microbiologysociety.org/static/c7d8d35c-6936-4d8d-af7576c5d28b2722/Antimicrobial-Resistance-...