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20th December 2021
Blog: Tackling antimicrobial resistance in the UK and the UK’s role on the global stage

This blog reports on the ‘Tackling antimicrobial resistance in the UK and the UK’s role on the global stage’ policy conference organised by the Westminster Health Forum on 1st December 2021.

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The conference examined priorities for tackling AMR in the UK and globally, and took place following the UK Government leadership role at United Nations high-level interactive dialogue on antimicrobial resistance (AMR) in April 2021, and the G7 Health Minister meeting in June 2021, where AMR was identified as a key area for strategic action. A commitment was made to work together, and in close coordination with other international initiatives.

Setting the scene, Dr Haileyesus Getahun (World Health Organisation) described the priorities for driving international collaboration and global innovative research in tackling AMR. He highlighted the UK’s role in the global stage supporting initiatives such as those listed below, and his hope that this leadership will continue. · The Fleming Fund, · The Global AMR Innovation Fund (GAMRIF), · The Joint Programming Initiative on Antimicrobial Resistance (JPIAMR), · Global Antibiotic Research and Development Partnership (GARDP), · The Combating Antibiotic Resistance Bacteria Biopharmaceutical Accelerator (CARB-X), · The Foundation for Innovative New Diagnostics (FIND), · The Veterinary Solutions for AMR (InnoVet-AMR).

Throughout his presentation, he showed how WHO is working towards R&D for new antibiotics development with the AWaRe classification, the Priority Pathogens List for R&D and the assessment of pre-clinical and clinical pipelines. Other actions including sustainable access via GARDP SECURE , continuous political action and advocacy for the AMR agenda, and establishment of an Independent Panel of Evidence for Action against AMR.

The conference had contributions from representatives of several organisations, and topics discussed included:

 

One Health approach to tackle AMR

AMR is a complex problem requiring a comprehensive response. Solutions should be considered under a One Health approach since humans share antimicrobials with animals and plants and it is important to understand their relationship with the environment, and especially consider the transmission of drug resistant pathogens from animals to humans.

Absence of data and research limits the development of an economic case. More comprehensive and better data is required, in particular connecting drug dosages and usage, with treatment outcomes.

Priority should be given to critical pathogens and the identification of research questions and research needs for evidence-base actions.

 

The challenges for R&D, market failure, and what incentives are needed for sustainable development of new antibiotics

The sole focus on R&D of new antibiotics is problematic with the current lack of economic incentives. Total investment for AMR R&D for humans, animals, plants, and the environment has decreased over the years. It is important to have ways to calculate investment/return and to consider new ways for the market, including Public-Private Partnerships.

R&D for alternatives to antimicrobials in the food and agricultural systems is not well advanced with efficacy of products varying across species.

Dr Tom Ashfield (Pfizer) presented an industry perspective and showed how his company is working collaboratively to overcome the threat of AMR. He argued that infection and antimicrobials must become a priority, but there is a need for actions beyond therapeutics such as AMR awareness, education policy and diagnostic and a package of incentives is needed to support sustainable development.

 

Who are the key players for transformation?

The meeting highlighted the importance and value of an international and well-integrated collaborative approach, involving the UN, WHO, G7, governments, the scientific community, NGOs, charities and engagement with a wider range of stakeholders. This needs to occur at different levels from national to global, including appropriate support for National Actions Plans and surveillance systems. Since the advent of Covid-19 there has been increasing public awareness of the need for improved monitoring and science-based decision making.

 

How is the UK supporting transformative initiatives and innovation?

Several examples on activities were given, including:

· Dr Phil Packer (UKRI Innovate UK) explained the AMR Innovation Missions connecting companies through the entire value chain and developing partnerships for global health protection.

· Dr Henry Skinner spoke about opportunities for accelerating international research via the new AMR Action Fund that aims to bring 2-4 new antibiotics to patients by 2030. They work with partners to create market conditions that enable sustainable investment in the antibiotic pipeline.

· Dr Stephen Oakeshott (UKRI MRC) stressed AMR is a priority area, and their interdisciplinary funding via cross-UKRI initiatives. He exemplified the significant participation of UK in the Global JPIMR call in 2021. From 19 projects funded, the UK has participation in 10, and is leading 4.

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What are the other priorities for research support?

· Prof. Alison Holmes (Imperial College) reminded the inequality of AMR funding between R&D for new drugs, and optimising use of existing ones. This contrasts with the relative lack of research and funds for stewardship, implementation, policy and understanding of contextual, cultural and behavioural drivers.

· Dr Chrysi Sergaki (MHRA) spoke on alternative approaches to tackle AMR, such as Fecal Microbiota Transplantation, a potentially promising area. Such new approaches to overcome AMR require standardization on methodology to increase confidence in the data and to accelerate research and innovation in the field.

· A relevant discussion addressing issues related to antibiotic prescribing included views from Dr Ron Davies (Sepsis Trust) and clinical practitioners Dr Anita Sharma and Dr Sundeep Kaul. Early intervention is essential to improve patient outcomes, but accurate diagnosis may take longer. There was an overall consensus of the need to reduce data gaps to inform antibiotic prescribing, and the value of patient involvement. In contrast, Professor Roberto La Ragione (University of Surrey) explained how veterinary approaches to antimicrobial stewardship including campaigns to educate vets and farmers, have successfully reduced antibiotic usage.

As well as research on new drugs, efforts should also be made on the development of rapid diagnostics, better use of real-time monitoring to ensure timely treatment, linkage to individual patient data and outcomes, as well as more fundamental understanding of resistance mechanisms.

What  lessons learned from the Covid-19 pandemic could be applied for AMR?

A list of topics discussed included:

· The pandemic increased awareness of the importance of a global coordinated approach and exchange of information.

· The impact of the pandemic is bringing leverage for better guidance and new practices especially in Infection, Prevention and Control (IPC) as discussed by Dr Colin Brown (PHE).

· Make greater use of quick testing results in large scale, to build on increased public awareness and acceptance of testing and expand this to AMR.

· Covid helped to highlight the need for better drug pipeline but this didn’t lead to a surge in investments for antimicrobials as the market remains unappealing. However, it is vital to keep stressing the relevance of the topic at this time.

· A contrast between the timescale for the covid-vaccine development versus new antimicrobials was made by Dr Daniel Berman (NESTA). His views are the accelerate pace of the former was due to the emergency and increased flexibility in regulatory pathways and procurement, along with an unprecedent level of investment. He questioned if more action could be motivated without the immediate health emergency.

· While the emergence of Covid-19 was a positive driver for innovation in medical science, the impact of prescribing the use of antibiotics during this period is not yet fully understood.

· On a global scale, we should not treat without a diagnostic. However, diagnostic is not only about treatment choices, but also understanding what shapes the decision making, and should therefore be a dynamic and integrated process. Concerns were raised on who should pay for this integrated approach when it is not part of a pandemic response.

Professor Dame Sally Davies ended with the message that the momentum is building, and briefly reflected on the impact of all these global initiatives. She advised there is not time to wait, and there is a need for a bolder move and long-term thinking. A further commitment was made by representatives at the All-Party Parliamentary Group on Antibiotics to continue to fight for this cause within UK Government.

 

Dr Adélia de Paula, Programme Manager

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