Microbial pathogens, such as bacteria and fungi, are increasingly resistant to the medicines designed to treat them, posing a significant health risk. Here, Holly Tipper, Isobel Stanton and Andrew Singer, microbiologists at the UK Centre for Ecology & Hydrology, discuss antimicrobial resistance (AMR) as well as their own role in a new major review evaluating UK action to tackle the problem…

The widespread use of antimicrobials, such as antibiotics and antifungals, over the past century has facilitated one of the greatest improvements to modern medicine, resulting in an immeasurable reduction in disease and death on a global scale for nearly 100 years. Yet, the efficacy of these medicines is being compromised by rising levels of antimicrobial resistance (AMR) which means that infections are becoming harder to treat. This is compounded by the fact that no new class of antibiotics has been developed since the 1980s.

Research has estimated that in 2019, bacterial resistance to antibiotics alone was directly attributable to 1.27 million deaths globally. AMR is a growing global threat that will not only have an impact on human and animal health, but also on the economy and food security. 

Drug-resistant microorganisms like bacteria and fungi, along with antimicrobials such as antibiotics and antifungals are released from polluting sources, including human wastewater and agricultural runoff, into the environment. 

People can be exposed to this ‘AMR pollution’ when they undertake activities like swimming or watersports. Given the diversity of sources and the many routes to exposure, AMR pollution represents a challenging and complex problem to solve. It requires a holistic, integrated approach that considers the interactions between humans, animals and the environment, ie a ‘One Health’ approach. 

In 2019, the UK Government released a five-year National Action Plan for tackling AMR. Some of the ambitions and challenges within this plan addressed the issue of AMR in the environment. This included developing an improved evidence base on AMR, and how it spreads in the environment, and also to humans and animals. It targeted a reduction in the amount of antimicrobial chemicals entering the environment and minimising the spread of AMR through it. 

Researchers at the UK Centre for Ecology & Hydrology (UKCEH), in collaboration with the Policy Innovation and Evaluation Research Unit (PIRU) at the London School of Hygiene and Tropical Medicine, and the Royal Veterinary College, were commissioned by the Department of Health and Social Care to evaluate how the UK has responded to the National Action Plan, Tackling Antimicrobial Resistance 2019-2024

UKCEH focused specifically on how governments, environmental regulators and the water industry of the UK  have responded to the environmental challenges put forward in the Plan. Firstly, we reviewed all publicly available information on their activities that focused on environmental AMR. From this, we identified a number of outputs, including pilot monitoring of AMR in the environment by the Environment Agency (PATH-SAFE) and a project on AMR in wastewater (CIP3) that was delivered by UKCEH and partners for UK Water Industry Research. 

Our review highlighted a lack of coordination and collaboration between the nations and sectors, particularly in the monitoring and hazard characterisation of AMR. 

The report was followed by interviews with relevant government, industry and academic stakeholders to gather their opinions on how the sectors in the UK have responded to the National Action Plan and what they think should be included in the next five-year AMR plan, spanning 2024-2029. 

The interview responses highlighted that better communication and collaboration were needed between UK nations and different sectors to tackle this problem, and that factors such as Covid-19 and Brexit had slowed down policy action and mitigation efforts. 

The interviews also showed that certain sectors need better evidence of the risk that the environment plays in relation to AMR and human health before they implement changes to mitigate against AMR.  

On 8 May 2024, the UK Government published the new National Action Plan, Confronting antimicrobial resistance 2024 to 2029. The evidence given in our reports was used to reflect on what was achieved and what lessons needed to be learned, serving as a benchmark upon which future progress can be built. The new Plan clearly reiterated our points about the need for more joined-up activities between and across government, industry and academic sectors and across ‘silos’ to enable the best outcome over the next five years. 

We are very optimistic that the current National Action Plan offers a sound roadmap for making progress towards tackling the challenge of AMR pollution in the UK environment.