Culture shift: tackling antimicrobial resistance from agriculture to operating table
Antibiotics have saved millions of lives since their discovery. However, globally increasing levels of antimicrobial resistance (AMR) are reducing the effectiveness of these crucial drugs. Research from experts at The University of Manchester is helping to address this global crisis and provide better protection for us all
Antibiotics have been a key weapon in the fight against a range of infections and diseases since their discovery almost a century ago. We have all grown used to having easy access to these medicines to help us get better when we are ill. But what causes those medicines to stop working – and what happens if they do?
Globally, increasing levels of antimicrobial resistance (AMR) mean that these crucial drugs are no longer effective for treating many bacterial, viral, fungal, and protozoal infections such as malaria. Keeping antimicrobial drugs working has been highlighted as a global priority by the United Nations (UN) and World Health Organisation (WHO).
That challenge is something that Policy@Manchester, The University of Manchester’s policy engagement unit, has been seeking to address. The University’s AMR Network is working both to understand the root causes of AMR and to develop new solutions that could potentially save millions of lives.
A recent contribution to Policy@Manchester’s On Resilience publication details the various approaches researchers from across the University are taking to address AMR. In particular, the report considers the origins of AMR, the complexity of the relationships between clinical and agricultural uses, and identifies potential solutions that may help tackle this global crisis.
The scale and urgency of the challenge is set out at the start of the paper with a sobering fact about the potential impact of increasing antibiotic resistance on human health.
“In 2019, drug-resistant microbial infections claimed more than 1.3 million lives,” the researchers tell us. “During the next 25 years, it is expected that more people will die from drug-resistant infections than from cancer.”
One critical issue highlighted by Manchester’s researchers is the use of antibiotics and antifungals in agriculture. Whilst AMR is usually regarded as an issue that impacts human health, the On Resistance report particularly zeroes in on the way that widespread use in other sectors ultimately creates the perfect environment for resistance to develop.
The report provides a stark example of the impact of the currently fragmented approach to regulation and licensing. The University of Manchester Fungal Infection Group recently developed a completely new drug to treat fungal diseases – offering hope of life-saving treatment to millions. However, recent approval given to a new agricultural compound that kills fungi in the same way could lead to human diseases becoming resistant to that new drug before it even reaches the market.
That lack of regulatory coherence is an area that some MPs have identified as a key risk that needs to be better understood and addressed.
Julian Sturdy MP, who chairs both the APPG on Antimicrobial Resistance and the APPG on Science and Technology in Agriculture is concerned that the impact on human health is not always fully considered when approval is given to the use of new treatments for agriculture.
"Simply put, we must underline how precious a resource antimicrobials are,” he tells PoliticsHome. “Consequently, we need to protect them by optimising appropriate use across all sectors (only using antimicrobials where they’re actually needed), avoiding use – in agriculture or animals – of antimicrobials that could be needed for human health, while taking measures to prevent infection wherever possible.”
It is a point that is echoed by the Policy@Manchester report which calls for more joined-up risk assessments when licensing any new agricultural compound that works in the same way as a human medicine.
The researchers also call for a more coherent approach that recognises the global nature of the challenge faced.
“COVID-19 sharply demonstrated that diseases are not limited to a single nation, and tackling antimicrobial resistance requires global cooperation,” they write. “As a start, international bodies like the UN, WHO, and the EU should provide detailed guidance on the use of antimicrobials in agriculture.”
A Department of Health and Social Care spokesperson told PoliticsHome that such international cooperation was already taking place reflecting the global nature of the challenges faced and building on learning from the COVID-19 pandemic.
“We are committed to tackling the global threat of antimicrobial resistance (AMR), both at home and abroad,” a government spokesperson told us. “We are also working closely with global health partners to preserve global health security and will help chart a path forward at the United Nations High-Level Meeting on AMR next year.”
The University of Manchester’s researchers also argue that part of the solution may lie in supporting more research into the effectiveness of alternatives to antibiotics such as “phage therapies.” These use bacteria-specific viruses to combat uncontrolled and undesired bacteria.
The experts believe that regulatory divergence from the EU now presents a new opportunity for the UK to establish itself as an international leader on the use of phages, initially focusing on agriculture, where there are fewer regulatory hurdles for research.
The piece in On Resilience also identifies other areas where the overuse of antibiotics is increasing the risk of resistance developing. One of the key areas identified is dentistry. During the COVID-19 lockdowns, dentistry was the only part of the NHS to increase antibiotic prescribing and UK dentists now prescribe more antibiotics than NHS hospitals.
A government spokesperson told PoliticsHome that a recently released toolkit has been shared to reduce unnecessary and inappropriate antimicrobial prescribing in dentistry. However, the Manchester researchers argue that objective can only be achieved as part of a wider focus on improving access to safe and effective dental care.
Throughout the publication, it is clear that AMR is too large a challenge for any one sector or organisation to tackle alone. A series of fragmented and individual interventions will simply fail unless they form part of a coherent strategy that is built on a thorough understanding of the drivers that lead to resistance developing in the first instance.
That demands collaboration, leadership, and investment. However, with millions of lives at risk, it is a challenge that we cannot afford to fail.
Read the full Policy@Manchester report, On Resilience, by academics at The University of Manchester here.
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