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A scientist checking a petri dish under a magnifying glass

Improving the global response to antimicrobial resistance

Throughout the world, antimicrobial resistance (AMR) poses a significant public health threat, as many common infections are becoming untreatable.

Antimicrobial Resistance – or AMR – is one of the biggest health threats facing the world today. The Fleming Fund fulfils a vital role in creating a clearer global picture of the problem by supporting LMICs in their response to AMR, primarily through increasing their capacity to collect and use data.

Professor Dame Sally Davies

Chief Medical Officer for England

Better intelligence is urgently needed to strengthen the global response to the problem. This is especially important in low- and middle-income countries, where people are most vulnerable to the impact of drug resistant infections.

As a response, the UK government announced the Fleming Fund in 2015, in 2016 the fund launched the Country Grant, Regional Grant and Fellowships programme, designed and managed by Mott MacDonald.

AMR in numbers

700,000 - current number of people worldwide who die from drug-resistant infections annually

10M - number of people worldwide predicted to die from drug-resistant infections annually by 2050

US$100trn - estimated economic cost of AMR through lost global production between now and 2050

Source: The Review on AMR, sponsored by the UK Department of Health and Social Care


Antimicrobial resistance occurs when bacteria come across antibiotics but evolve and adapt to survive the exposure. These bacteria then multiply over time, becoming commonplace, meaning ordinary medicines are no longer effective as treatment.

The underlying causes of resistance are complex but are largely driven by global overuse of antibiotics in healthcare and in commercial farming of animals and fish. Overuse has resulted in some strains of bacteria, often referred to as “superbugs”, that are now resistant to nearly all treatment. Because antibiotics underpin almost all medical care, including cancer treatment, organ transplants and many types of surgery, drug resistance jeopardises the core of modern medicine.

Reliable data around the scale of the problem and trends in resistance is needed to reduce inappropriate usage of drugs, help provide better treatment and prevent infections. Accurate information will help improve patient health care, guide national health policies and identify emerging threats. It is a major challenge to improve data collection in low- and middle-income countries, where capacity to build and sustain public health surveillance systems is low.


The Fleming Fund is a development programme that supports national governments in 24 low- and middle-income countries to establish their own AMR public health surveillance systems. Public health surveillance is the systematic collection, analysis and interpretation of health data that is used to shape public health policy. By improving surveillance systems and national laboratory capacity, the programme’s long-term aim is to slow and then reverse the global spread of antimicrobial resistance.

Through a series of country and regional grants, we are allocating funding to strengthen surveillance and improve AMR data use. Meanwhile, we’ve also set up a fellowship programme to provide mentorship for national scientists and clinicians working on AMR initiatives in human, animal and environmental health.

AMR is a global problem that needs local sustainable responses. The grants are therefore constructed to support the development of in-country surveillance systems, which will be designed, owned and operated by the countries themselves for long-term drug consumption and drug resistance monitoring.

The five main investment areas for Fleming Fund Grants include:

  1. Laboratory infrastructure
  2. Capacity building
  3. Strengthening surveillance systems
  4. Improved AMR data use
  5. Appropriate use of antimicrobial medicines.

Specific project activities include equipping bacteriology labs, training staff to undertake quality assured resistance testing and improving data systems and analytics to support government health policy development.

The fund demonstrates Mott MacDonald’s mission of opening opportunities with connected thinking by bringing together a diverse range of expertise across multiple sectors. The Fleming Fund draws upon our development expertise, water and environmental sustainability knowledge and medical and health systems experience.


Our team brings a combination of grant management experience and technical expertise, which has been instrumental in designing a programme of this reach and magnitude.

Following detailed assessments and planning, the fund has entered the implementation stage. Since February 2018, we’ve assessed more than 170 human and veterinary laboratories across 24 countries. Together, with the countries themselves, we’ve designed and awarded grants in nearly half of our beneficiary countries. In addition to setting up a London-based management team, we’ve also established four regional hubs in Mott MacDonald offices in Ghana, Uganda, Thailand and India.

We've selected fellows in nearly one-third of our beneficiary countries and formed partnerships with 17 world-class universities to act as mentors. We've also awarded several regional grants to consortia to search archives within these countries for existing AMR data, and to support African and Asian AMR leadership.

Long-term, our direct beneficiaries will include national governments, global surveillance systems (like the World Health Organization’s GLASS system) and policy makers who will benefit from national AMR surveillance. National laboratories, personnel within the health systems and patients will also profit from improved data and analysis. Indirectly, billions of people worldwide stand to benefit from an improved AMR response that slows and reverses the threat of antimicrobial resistance.

Visit the Fleming Fund website www.flemingfund.org

Search #ActOnAMR to learn more about what we are doing to tackle antimicrobial resistance.

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