The UK’s AMR strategy and coordinating a global response

Posted on April 14, 2020   by Tina Joshi

The Westminster Health Forum on Antimicrobial Resistance took place on Thursday 20 February 2020 at Glaziers Hall, London – a month before the country went on lockdown due to the infectious disease SARS-CoV-2, the cause of COVID-19. The event was run by the Westminster Health Forum. Dr Tina Joshi was invited to attend as a member of the Microbiology Society Policy Committee, member of the Science Committee of Antibiotic Research UK, and on behalf of the University of Plymouth, where she lectures their future NHS biomedical scientists and healthcare staff on clinical microbiology (particularly on the impact of antimicrobial resistance).

I was excited to attend this event as my expectation (and assumptions) were that Members of Parliament (MPs) would be present at the forum, to hear about the progress in tackling antimicrobial resistance (AMR) and for tangible outputs and actions. However, I was disappointed. Not a single MP attended and considering that at this point, COVID-19 was definitely on its way to spreading within the UK, it was surprising that there was no representation from government (that I was aware of) at an infectious disease focused policy event.

The day started with opening remarks from the Chair, Professor Hilary Thomas, who highlighted the importance of tackling AMR. Professor Brian Ferguson, Chief Economist of Public Health England (PHE) commenced the first session with his talk ‘Improving the prevention and control of infections and assessing the public health benefits of tackling AMR’. Professor Ferguson presented clear information about the economic impacts of AMR. Next, Professor Julie Robotham informed delegates about how PHE diagnoses and tracks multidrug resistant Gram-negative pathogens. While this was useful for those in the room that had limited knowledge of AMR; this did appear to tread on old ground for those familiar with the area and who had been to similar events.

The second session ‘Priorities for research’ was also repetitive, and there was limited new information presented that had not been covered elsewhere. This was disappointing considering the aim of the event was to cover progress in the UK AMR strategy. The discussion about the role of diagnostics by  Becton Dickinson’s Director of AMR Strategy, Adam Zerda was useful; however, there was an element of bias as Becton Dickinson’s diagnostics were discussed in detail- rather than the area as a whole- and Becton Dickinson sponsored the event. Jon Harrison of the British in vitro Diagnostics Association (BIVDA) lent a more neutral voice to the diagnostics discussion in the later sessions and explained the diagnostics adoption process and economics involved. It was shame that Nesta’s Longitude Prize were not involved in panel discussions on the day. Arlene Brailey of Antibiotic Research UK also importantly talked about the perspectives of patients with AMR infections and the real impact this has on patient’s lives.

The later session was highly engaging and delivered new information. Dr Roger Harrison light-heartedly talked about the role of public engagement and education in tackling AMR, and Dr Michael Weinbren discussed the role of blood culture in detecting AMR infections in great style. Rose Gallagher from the Royal College of Nursing finally discussed the importance of infection control – an important research theme in AMR that was, unfortunately, not fully explored in this event. Dr Kitty Healey then showed data about the progress in reduction of antibiotic use in the veterinary sciences, which was well received. The final presentation – given by Dame Sally Davies, UK Special Envoy for AMR and formerly the Chief Medical Officer for England – was an excellent summary of where we need to be and how we need to progress the UK’s AMR strategy. She mentioned clear progress in reduction of antibiotic use in animals and came across as a breath of fresh air.

Crucially, throughout the morning there was limited mention of the importance of infection control or vaccines as an alternative research and implementation strategy to effectively tackle AMR. The focus of the event stayed on antibiotic resistance and antibiotic discovery as the main way of combatting AMR infections. This is an incredibly important area but, worryingly, what was also highlighted was that the antibiotic discovery pipeline was broken at the core economic level. Antibiotics that have gone to manufacture are not being purchased or adopted, and the millions invested have not yet resulted in a single newly discovered antibiotic that has reached the end user; the patient.

So… if the pipeline is broken why is there not an action plan or drive to have a back-up plan and invest in other research areas that have direct and immediate impact? Are we hitting ourselves against a brick wall hoping that the economic pipeline will magically work at some point? None of these questions were answered or could be answered on the day. There was frustration from some delegates who posed questions to panels, and it was clear that there is no consensus about how to truly deal with this global challenge. We need answers from our key healthcare and policy leaders, to ensure provision of medicines and reduce drug resistant infection mortality rates in future.

The forum was supposed to cover antimicrobial resistance (as named); however, the main and only topic discussed by all present was antibiotic resistance (bacterial). This seemed like an elephant in the room and was rather strange to me as a lecturer who teaches clinical infectious diseases. Surely, AMR covers antimicrobial resistant parasites (for example, malaria), viruses, fungi (such as Candida auris) and bacteria –  so why were these important topics also not addressed? It is perhaps hardly surprising that AMR has failed to ignite the public imagination and the public are confused at what these terms really mean, when there is no consensus on how to discuss AMR appropriately and in context. Perhaps the event should have been called the “Forum on Antibiotic Resistance” or, as the Wellcome Trust have suggested, discuss AMR as “drug-resistant infections”.

Months ago, prior to the COVID-19 associated lockdown, the main global challenge firmly on the agendas of governments was, and still is, climate change. Infectious diseases and AMR have not had the public reach that climate change and Greta Thunberg have had for varying reasons. Now, with the stark and dramatic societal, economic and cultural impacts of COVID-19, the consequences of not dealing with infectious diseases effectively, are clear to see. Perhaps there will be more impetus from world governments to take infections seriously and invest in appropriate measures to tackle them.

I now find myself wondering who is advising the government on these issues and why fresh ideas have not come into play, when it is glaringly obvious that the current strategies are not working. Yes, the antibiotic pipeline is broken. But the links between the government and the scientific community are also broken, when only a small proportion of the same scientists are advising the government and being invited to air their views in a merry-go-round of similar AMR-focused events. Transparency and inclusivity are important from all sides, and the government need to realise there are a plethora of helpful scientists and experts in the area, whose impartial voices and ideas are going unheard.

As part of the Microbiology Society’s 75th Anniversary, we are asking experts to contribute to our ambitious policy project ‘A Sustainable Future’. The aim of this project is to raise the profile of microbiology in helping to achieve the United Nations Sustainable Development Goals (UN SDGs). For this, we are focusing on three project streams where the contribution of microbiology is particularly significant and relevant. These include antimicrobial resistance, the circular economy and soil health. Within each project stream we will be undertaking further engagement activities and events, including workshops with a wide range of stakeholders. We want to hear from scientists from a wide range of disciplines and backgrounds, and welcome the input from all microbiologists whose work relates to the SDGs. If you would like to contribute or find out more about future activities, contact our policy team: policy@microbiologysociety.org.