Turning the tide on antimicrobial resistance

Holistic health

The close linkages between human, animal and environmental health have become internationally recognised.

A much more holistic approach to combating disease and promoting good health, termed ‘One Health’, was developed in the 2010s and has provided the framework for all major health policies from the 2020s onward. Applied to AMR, the One Health approach addressed factors such as:

• human encroachment on the natural environment and the interactions between people, domesticated animals and wild animals
• the effects of environmental changes on disease transmission and people’s susceptibility
• the system-wide effects of commonplace practices, such as using antibiotics to promote growth in farmed animals, treating minor ailments with antimicrobial medicines, and disposing of pharmaceutical waste in the environment

Governments committed to understand their national contributions to the problem and agreed to address the challenges through a joined-up, multi-sector approach. All countries have implemented national AMR action plans, with development agencies and donors providing funds to help low- and middle-income countries.

Focal areas have included:

• access to basic health services
• improved hygiene through universal provision of clean water and sanitation
• research to understand how drug-resistance evolves and how resistant microbes are transmitted
• limits on producing and using drugs responsible for the rise of AMR
• tighter legislation and regulation on the use of all antimicrobial drugs
• prohibition of antimicrobials in agriculture for any use other than targeted treatment of livestock infections
• tighter controls on the trade in wild animals

Inspiring change: One Health: integrated thinking for disease control

Inspiring change: Antimicrobial resistance explained in 120 seconds – watch the video

Project delivery: Fleming Fund – Improving the global response to antimicrobial resistance

Healthier lifestyles

Research has long shown the importance of environmental and lifestyle factors in determining people’s health, including their susceptibility to infectious diseases.

As part of a One Health approach, in the 2020s national and local governments prioritised healthy lifestyles and disease prevention.

Through public education campaigns, governments reinforced the importance of basic hygiene, including handwashing, and encouraged people to dispose of their unwanted medicines via pharmacies rather than in household waste.

Governments legislated to reduce air pollution and improve water quality. They also worked with local authorities and the health and education sectors to improve people’s physical fitness by encouraging exercise – measures included provision of more local leisure facilities, more parks and open spaces, and greener, safer streets that encouraged active travel. And they tackled diet, influencing a global trend towards better-balanced and more sustainable eating habits, which improved overall health.

Dietary changes combined with innovation in the food industry, increased consumer awareness and more efficient supply chains has reduced food waste, enabling the farming industry to focus on developing safe, humane and sustainable food production. This included increased diversity in crop strains and animal breeds, which has improved resilience to disease outbreaks.

More active, healthier populations have reduced rates of illnesses needing medical treatment. In particular, rates of childhood pneumonia and diarrhoea caused by bacterial infections have been significantly reduced.

Our tools: Moata Safe Stroll

Improved healthcare

As a result of healthier lifestyles, there is less strain on hospitals and healthcare services. Globally, better fitness and diets have reduced the incidence of all forms of illness.

This has created a virtuous cycle: people in better health are less susceptible to secondary and repeated infections; they are less likely to be hospitalised for treatment; they are at reduced risk of acquiring new infections while in hospital; and fewer new pathogens are introduced into hospitals. All of which has cut the use of medicines.

Healthcare systems have been strengthened, giving all people access to minimum levels of care: they can consult a doctor, receive vaccination against common diseases, and get clinical or hospital care when required. The focus has not just been on cities; provision has extended to rural areas as well, providing universal health coverage for all basic ailments. As a part of this far-reaching reform, training and guidance for doctors and medical staff have been updated to discourage prescription of antimicrobial medicines unless essential.

Better adherence to disease prevention and control principles in healthcare facilities drives down the rates of hospital-acquired infections and the associated need for treatment and use of antimicrobials.

Over-the-counter sales of antimicrobials has been banned. The disposal of surplus drugs and pharmaceutical waste into the environment has become tightly regulated.

Inspiring change: Fit for the future? Adaptive thinking for new clinical needs

Project delivery: Giving Pakistan the tools to fix its public health system

International collaboration

Progress in health and healthcare are among the achievements of worldwide collaboration, led by World Health Organization’s governing body, the World Health Assembly (WHA), which has aligned all of its 194 member states to achieve the goal of reducing AMR.

All countries are held accountable for making progress, which the WHA shares to promote best practice, insight and innovation. The COVID-19 pandemic showed the importance of global coordination in tackling infectious diseases. International collaboration between the public and private sectors and academia has improved understanding of AMR and achieved five key successes: improved awareness; surveillance; infection prevention; optimal use of antimicrobials; and sustainable investment in tackling AMR. Transparency and data-sharing between countries has provided an accurate global picture of the scale of AMR, informing interventions around the world.

Cross-sector dependencies and synergies have been recognised, resulting in collaboration between industries and organisations to meet national AMR reduction targets. Collaboration is particularly strong between the water, wastewater, farming, food and health sectors, providing a joined-up approach to meeting national AMR reduction strategies.

AMR is a policy priority, with governments collaborating to develop, implement and enforce laws and regulation on antimicrobial development, production, distribution, use and disposal. These are supported by guidelines developed by the WHA and pharmaceutical companies.

Innovation funding has given rise to much-needed new treatments for diseases that were becoming drug-resistant. These include non-antimicrobial treatments, which enable infections to be fought without contributing to the long-term problem of AMR.

Evidence-based action

The global community embraced data as a means of understanding and guiding action on AMR. All around the world, funding has been focused on equipping countries with the required expertise and laboratory capacity to gather and monitor AMR data, which is shared between governments, donors and research organisations.

This has been enabled by digital transformation, which accelerated as a result of the COVID-19 pandemic: governments, health departments, aid agencies and businesses all recognise the value of data for understanding diseases and their effects. Data gathered from health systems and more widely is used to inform decisions about how best to safeguard human health and the economy.

Data harvesting, analysis and modelling have shed new light on correlations between health industry practices, demographic conditions, the design and operation of infrastructure, farming practices, and more. Insights have been used to focus effort internationally and locally – activities have been tailored to the unique circumstances of each country and region, including affordability, the maturity of local healthcare systems, and local manifestation of AMR. Data has been collected on the effectiveness of mitigation and control strategies, with results used to guide subsequent action.

With the aid of digital solutions, short- and long-term wins have been achieved. Artificial intelligence has been used to predict transmission patters, enabling authorities to respond swiftly to control the spread of disease outbreaks. Lessons are learned from each outbreak to inform subsequent disease prevention and control measures. And data has revealed how climate change is affecting the spread of infectious diseases and AMR, providing valuable early indicators to inform strategy and planning.

Inspiring change: The Fleming Fund is strengthening AMR surveillance in 22 countries. Read how.

Cleaner water, better sanitation

AMR was exacerbated by poor hygiene and sanitation, and there has been renewed effort to provide universal access to clean water.

Improved hygiene drives down common illnesses, subsequent hospitalisations and the associated use of antimicrobial drugs. This has been accompanied by a holistic approach to water resource management [see our vision] contributing to a steady reduction in pharmaceuticals in wastewater and the wider aquatic environment. Regulators, water providers and stakeholders in industry and farming have collaborated to limit chemical, pharmaceutical or farm waste entering waterways.

Spurred by regulation, wastewater utilities have implemented monitoring systems to measure AMR-related contaminants in wastewater and licenced discharge. Data provides real-time information about the health of local populations – early warning of new disease outbreaks and accurate indication of prevalence, helping shape policy and action.

Plastics in fresh water and the oceans were found to have a role in incubating microbes and in circulating them – plastic pollution is a vector for AMR transmission. When removed, plastic particulate samples were swabbed to monitor microbial levels in wastewater, providing an ‘early warning system’ of outbreaks and feeding into global AMR data. The fight against AMR was one of the drivers of a successful reduction in plastic pollution.

Project delivery: Learn how 4M people in Dhaka, Bangladesh, gained access to clean drinking water

Project delivery: A systems approach to water resource management is benefiting all stakeholders in two UK catchment areas

Our tools: Find a suite of digital solutions addressing water quality, treatment, sewer overflows, rainwater run-off and pipeline and network planning by exploring our technology platform, Moata

Pandemic-resilient infrastructure

The COVID-19 pandemic showed how infectious diseases rapidly spread via transport systems and contact between people in buildings and public spaces.

A new discipline, infrastructure epidemiology, emerged which applies four core principles to reduce disease transmission on planes, trains and buses, terminals and stations, offices, hospitals, schools and shops. The principles are: minimise access; minimise exposure time; minimise contact with shared surfaces; and optimise hygiene and sanitation. The approach has been widely adopted by operators of economic and social infrastructure. Use of more hygienic materials in vehicles, buildings and products, better management of people’s movements, improved facilities management and more flexible operation, all supported by digital innovation, have helped to reduce transmission risk.

Inspiring change: Infrastructure epidemiology – pandemic-resilient infrastructure

Project delivery: We worked on a pilot project to safely re-open a major UK sports venue following the 2020 nationwide lockdown

Our tools: STEPS models pedestrian dynamics and can be used to help identify areas of congestion where infection risk may be greatest

Inspiring change: Time to tackle the superbugs – How to protect your people and your organisation from the growing threat of AMR