The environmental dimension of antimicrobial resistance: informing policy, regulation and practice.

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

Abstract

Antimicrobial resistance (AMR) is the phenomenon that leads to treatment failure of infections caused by pathogenic organisms such as bacteria. The Chief Medical Officer Professor Dame Sally Davies has compared the threat posed by AMR to that of climate change and global terrorism. If current trends continue it is estimated that AMR infections will be the leading cause of death by 2050 with a cumulative cost to society of $100 trillion. This Knowledge Exchange Fellowship focuses on AMR in bacteria and specifically the role of the environment in increasing resistance seen in clinical pathogens. AMR is ancient, having evolved in environmental bacteria over millions or billions of years. Resistance mechanisms that evolved over evolutionary time have been mobilised from environmental bacteria to human pathogens through a process known as horizontal gene transfer. Levels of AMR are high in environments impacted by human and animal waste and it is known that significant exposure risk to AMR bacteria occurs in environments such as coastal bathing waters. However, the relative importance of environmental exposure and transmission is currently uncertain as is the nature of evidence required to inform policy and regulation.

This KE Fellowship aims to facilitate knowledge exchange relating to AMR in the environment from, and between, academia, government and industry with the objective of informing policy making, regulation, mitigation and risk reduction strategies. There is demand from Defra, the Environment Agency (EA) and industry for knowledge exchange in this subject area due to its rapid prioritisation by organisations such as the UN and WHO and the probability that increased regulation may occur in the future. Defra and the EA are the policy making and regulatory agencies that are tasked with considering the evidence relating to AMR in the environment and are key partners as are the pharmaceutical and water industries. Knowledge exchange will also take place with a wider range of stakeholders, for example the insurance industry is concerned with potential liabilities associated with environmental transmission of AMR.

A series of reciprocal knowledge exchange placements will take place with Defra, the EA, the pharmaceutical and water industries focusing on evolution of AMR driven by environmental pollution, land scape scale dissemination of AMR and environmental transmission to humans. These three areas are covered by multiple research projects within Dr Gaze's lab who is uniquely placed to fulfill Knowledge Exchange activities due to the scope of his research portfolio which includes three cross-council initiative AMR grants. His research group is one of the largest working on this subject internationally. He has advised UK government and the United nations and has strong links to the pharmaceutical and water industries. Three workshops will take place at the beginning, middle and end of the Fellowship to prioritise KE, assess progress and produce policy recommendations respectively. An environmental AMR network will be set up alongside a website with resources for the network and data on each of the scientific issues. A key activity will be to work with the EA to develop protocols and targets for environmental surveillance as current efforts are largely research based and are not comparable as each lab uses different methodologies. This is a key goal of Defra and the EA and they have offered significant time to co-develop a surveillance strategy with the academic community through this Fellowship.

Outputs will include policy recommendations co-designed by all partners, and a report and scientific publication highlighting knowledge gaps and current barriers to policy implementation.

Publications

10 25 50
 
Description We have brought together key government, academic and industry stakeholders to discuss the environmental dimension of AMR. This is contributing to meeting the challenges described in the 20 year vision and 5 year action plan outlined in the UK AMR strategy.
Exploitation Route Contributing to developing a UK Environmental AMR Surveillance Programme. Further integrating the environmental dimension of AMR in APHA, Defra and EA thinking.
Sectors Agriculture

Food and Drink

Chemicals

Environment

Healthcare

Pharmaceuticals and Medical Biotechnology

 
Description It is clear that there is a great deal of interest in the environmental dimension of AMR. My work in knowledge exchange has included substantive engagement with the environment agency through invitation of EA staff to a week long AMR meeting in Canda, supervision of a member of EA staff for an MRes to embed environmental AMR surveillance in current practice and KE meetings including a two day meeting in Exeter in Feb 2020. I have scoped the water industry AMR R&D programme, continued to work closely with the pharmaceutical industry (AstraZeneca and GSK) and have advised Defra on this subject including reciprocal meetings at Defra and Exeter. I have also led the JPIAMR (MRC) environmental AMR surveillance network as part of this KE activity (at the request of the EA and Defra) which includes APHA, VMD, PHE, EA and Defra participants. This is contributing directly to achieving objectives relating to understanding of AMR in the environment in the UK 5 Year Strategy. Future interactions with government departments and agencies will help translate policy into practice directly contributing to mitigating the negative impacts of AMR on human health and the economy.
Sector Agriculture, Food and Drink,Chemicals,Environment,Healthcare,Pharmaceuticals and Medical Biotechnology
Impact Types Societal

Economic

Policy & public services

 
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 Three papers cited in the Download the JPIAMR Strategic Research and Innovation Agenda on Antimicrobial Resistance 2019
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in other policy documents
URL https://www.jpiamr.eu/wp-content/uploads/2019/05/JPIAMR_SRIA_final.pdf
 
Description Wilton Park The road to UNGA
Geographic Reach Multiple continents/international 
Policy Influence Type Participation in a guidance/advisory committee
URL https://www.wiltonpark.org.uk/event/the-road-to-unga-2024-catalysing-political-commitment-on-amr/
 
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
 
Title Additional file 1 of Existing evidence on antibiotic resistance exposure and transmission to humans from the environment: a systematic map 
Description Additional file 1. ROSES for Systematic Map Reports. 
Type Of Material Database/Collection of data 
Year Produced 2022 
Provided To Others? Yes  
URL https://springernature.figshare.com/articles/dataset/Additional_file_1_of_Existing_evidence_on_antib...
 
Title Additional file 1 of Existing evidence on antibiotic resistance exposure and transmission to humans from the environment: a systematic map 
Description Additional file 1. ROSES for Systematic Map Reports. 
Type Of Material Database/Collection of data 
Year Produced 2022 
Provided To Others? Yes  
URL https://springernature.figshare.com/articles/dataset/Additional_file_1_of_Existing_evidence_on_antib...
 
Title Additional file 2 of Existing evidence on antibiotic resistance exposure and transmission to humans from the environment: a systematic map 
Description Additional file 2. Map 1 supplementary articles. 
Type Of Material Database/Collection of data 
Year Produced 2022 
Provided To Others? Yes  
URL https://springernature.figshare.com/articles/dataset/Additional_file_2_of_Existing_evidence_on_antib...
 
Title Additional file 2 of Existing evidence on antibiotic resistance exposure and transmission to humans from the environment: a systematic map 
Description Additional file 2. Map 1 supplementary articles. 
Type Of Material Database/Collection of data 
Year Produced 2022 
Provided To Others? Yes  
URL https://springernature.figshare.com/articles/dataset/Additional_file_2_of_Existing_evidence_on_antib...
 
Title Additional file 7 of Existing evidence on antibiotic resistance exposure and transmission to humans from the environment: a systematic map 
Description Additional file 7. Extraction sheets. 
Type Of Material Database/Collection of data 
Year Produced 2022 
Provided To Others? Yes  
URL https://springernature.figshare.com/articles/dataset/Additional_file_7_of_Existing_evidence_on_antib...
 
Title Additional file 7 of Existing evidence on antibiotic resistance exposure and transmission to humans from the environment: a systematic map 
Description Additional file 7. Extraction sheets. 
Type Of Material Database/Collection of data 
Year Produced 2022 
Provided To Others? Yes  
URL https://springernature.figshare.com/articles/dataset/Additional_file_7_of_Existing_evidence_on_antib...
 
Title Additional file 8 of Existing evidence on antibiotic resistance exposure and transmission to humans from the environment: a systematic map 
Description Additional file 8. Map 1 interactive geographical map of studies. 
Type Of Material Database/Collection of data 
Year Produced 2022 
Provided To Others? Yes  
URL https://springernature.figshare.com/articles/dataset/Additional_file_8_of_Existing_evidence_on_antib...
 
Title Additional file 8 of Existing evidence on antibiotic resistance exposure and transmission to humans from the environment: a systematic map 
Description Additional file 8. Map 1 interactive geographical map of studies. 
Type Of Material Database/Collection of data 
Year Produced 2022 
Provided To Others? Yes  
URL https://springernature.figshare.com/articles/dataset/Additional_file_8_of_Existing_evidence_on_antib...
 
Title Additional file 9 of Existing evidence on antibiotic resistance exposure and transmission to humans from the environment: a systematic map 
Description Additional file 9. Map 2 interactive geographical map of studies. 
Type Of Material Database/Collection of data 
Year Produced 2022 
Provided To Others? Yes  
URL https://springernature.figshare.com/articles/dataset/Additional_file_9_of_Existing_evidence_on_antib...
 
Title Additional file 9 of Existing evidence on antibiotic resistance exposure and transmission to humans from the environment: a systematic map 
Description Additional file 9. Map 2 interactive geographical map of studies. 
Type Of Material Database/Collection of data 
Year Produced 2022 
Provided To Others? Yes  
URL https://springernature.figshare.com/articles/dataset/Additional_file_9_of_Existing_evidence_on_antib...
 
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 Presentation at the Environmental Dimension of AMR meeting in Hong Kong 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Presentation from EDAR5 (basis for UK:Argentina grant detailing conceptual framework for Environmental AMR) requested by Tim Jinks (Head of Infection at Wellcome) and David Sutherland (WHO Technical Officer One Health Tripartite Coordination Group for Asia and the Pacific). "I'd be very grateful if you could send your presentation. It will be treated in confidence but will help with my briefing to WHO and FAO (duly acknowledged) and modifications to my risk framework".
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 Speaking at House of Commons UKRI AMR research strategy refresh 
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 Speaking at House of Commons UKRI AMR research strategy refresh focusing on existing UKRI funded work in the area of AMR and the environment
Year(s) Of Engagement Activity 2019
 
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-...