The environmental dimension of antimicrobial resistance: the transition from policy formation to implementation
Lead Research Organisation:
University of Exeter
Department Name: Institute of Biomed & Clinical Science
Abstract
Prof Dame Sally Davies, the previous Chief medical officer and current UK Special Envoy on Antimicrobial Resistance (AMR) said that if antimicrobial drugs lose their effectiveness it would spell "the end of modern medicine". It has been estimated that by 2050, 10 million deaths a year will be attributable to AMR, more than seven times the current mortality caused by the COVID-19 pandemic. The global economic cost of AMR infections is estimated at a trillion US dollars by 2050.
There is a growing consensus that AMR must be tackled using a One Health approach, ie. that human and animal health must be considered in relation to the environment. We know that resistance mechanisms bacterial pathogens acquire can originate in environmental bacteria that have evolved resistance over evolutionary time. Bacteria are unusual in that they can pass on genetic material (genes) horizontally, including to different species, rather than the vertical transfer of genes from parents to offspring that occurs in most animals and plants. It should also be remembered that many antimicrobials used as drugs are produced naturally by bacteria and fungi, so predate human antimicrobial usage. It is therefore not surprising that there is a vast reservoir of AMR genes present in environmental bacteria. In addition to this "natural" reservoir of AMR bacteria and genes, human and animal waste also introduces AMR bacteria and antimicrobials to the environment, where further evolution of resistance can take place with associated risks of environmental transmission to humans.
This Knowledge Exchange (KE) Fellowship will build on previous work by Professor Will Gaze and colleagues that has informed international, EU and UK policy on AMR. It will focus on informing planning and implementation of environmental AMR surveillance with the Department for Environment, Food and Rural Affairs (Defra) and the Environment Agency (EA). In addition, KE will take place with the water industry who are focusing on this subject, due to efforts to reduce risk associated with AMR bacteria and antimicrobial residues in human waste which can reach aquatic environments with associated transmission risk to humans. The European Union Water Framework Directive is focusing on risks posed by aquatic residues of certain antimicrobials, and this may translate into regulation of discharge to rivers and coastal areas. KE will also take place with the pharmaceutical industry who are keen to ensure that their drugs do not pose an environmental risk in terms of driving further increases in AMR. This is also important in safeguarding the activity of our remaining useful antimicrobial drugs. The combination of KE with Defra, EA water and pharmaceutical industries provides opportunities for cross-sectoral development of ideas, and in this phase of KE, moving towards implementation of new strategy and policy.
There is a growing consensus that AMR must be tackled using a One Health approach, ie. that human and animal health must be considered in relation to the environment. We know that resistance mechanisms bacterial pathogens acquire can originate in environmental bacteria that have evolved resistance over evolutionary time. Bacteria are unusual in that they can pass on genetic material (genes) horizontally, including to different species, rather than the vertical transfer of genes from parents to offspring that occurs in most animals and plants. It should also be remembered that many antimicrobials used as drugs are produced naturally by bacteria and fungi, so predate human antimicrobial usage. It is therefore not surprising that there is a vast reservoir of AMR genes present in environmental bacteria. In addition to this "natural" reservoir of AMR bacteria and genes, human and animal waste also introduces AMR bacteria and antimicrobials to the environment, where further evolution of resistance can take place with associated risks of environmental transmission to humans.
This Knowledge Exchange (KE) Fellowship will build on previous work by Professor Will Gaze and colleagues that has informed international, EU and UK policy on AMR. It will focus on informing planning and implementation of environmental AMR surveillance with the Department for Environment, Food and Rural Affairs (Defra) and the Environment Agency (EA). In addition, KE will take place with the water industry who are focusing on this subject, due to efforts to reduce risk associated with AMR bacteria and antimicrobial residues in human waste which can reach aquatic environments with associated transmission risk to humans. The European Union Water Framework Directive is focusing on risks posed by aquatic residues of certain antimicrobials, and this may translate into regulation of discharge to rivers and coastal areas. KE will also take place with the pharmaceutical industry who are keen to ensure that their drugs do not pose an environmental risk in terms of driving further increases in AMR. This is also important in safeguarding the activity of our remaining useful antimicrobial drugs. The combination of KE with Defra, EA water and pharmaceutical industries provides opportunities for cross-sectoral development of ideas, and in this phase of KE, moving towards implementation of new strategy and policy.
People |
ORCID iD |
William Gaze (Principal Investigator) |
Publications
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
Hayes A
(2022)
Predicting selection for antimicrobial resistance in UK wastewater and aquatic environments: Ciprofloxacin poses a significant risk.
in Environment international
Murray AK
(2021)
Dawning of a new ERA: Environmental Risk Assessment of antibiotics and their potential to select for antimicrobial resistance.
in Water research
Stanton IC
(2022)
Existing evidence on antibiotic resistance exposure and transmission to humans from the environment: a systematic map.
in Environmental evidence
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 | 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 | 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 | 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 | 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 | 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 | 09/2022 |
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 | 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 | 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 | 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 |