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But there’s nothing I can do about antimicrobial resistance Catriona Waddington and Toby Leslie

Wrong! Catriona Waddington and Toby Leslie, from International Health, offer ‘speedy boarding’ for the global response against AMR. This six-point guide is designed to help everybody within Mott MacDonald – and anybody else, for that matter – to play an active part.

What is AMR anyway?

Antimicrobial resistance happens when microorganisms (bacteria, fungi, viruses, parasites) change when they are exposed to antimicrobial drugs. As a result, the medicines become ineffective.

Mott MacDonald is project managing the Fleming Fund for the UK government, which aims to strengthen the knowledge and ability of microbiologists in developing countries. As contributors to this project, we believe the fund should be the tip of the iceberg for Mott MacDonald’s commitment to fighting the growing threat of AMR.

1. Dovetail with climate change

The easy comparisons with climate resilience allow AMR to strengthen the case for action. The two certainly shouldn’t compete for airtime. Both can be defined as market failures, whereby the commercial outlay by producers and consumers fails to compensate for the damage felt by society. They can both feel like a distant or future problem that we, as individuals, are powerless to influence. In both cases, the planet and the whole of humankind are affected.

There are language similarities too. For example, have you ever measured your AMR footprint? If you ate eggs and bacon for breakfast, how many antibiotics went in to raising the chicken that laid the eggs and pig that produced the bacon? If you like cut-flowers, the chances are that an antimicrobial has been used to prepare and transport them. A lot of the best practice around environmental control and water management applies to AMR just as much as climate change and microplastics. Population growth and the “rise of the middle class” increases demand for protein in the diet – and the production of this results in more greenhouse gas emissions and use of antimicrobials.

Eating less meat, of higher quality, is your each-way bet for AMR and climate change (not to mention your budgets and taste-buds).

2. Connect the thinking

Sticking with that rationale, if we all incorporated AMR into everyday risk assessments, as we do for climate change, then the issue would rise up the agenda and become part of business as usual. As an engineering firm, we’re used to problem solving. How can we ensure AMR is a consideration when funding new hospitals? Or when designing a sewerage system? Or when developing smart solutions for measuring water quality in lakes or rivers? How do we include AMR-related hygiene within our safety procedures?

The challenge is global, yet the approach needs to be tailored because the solutions are mostly local. Sadly, we are in a Global North and Global South polarised world, united through challenges like climate, AMR and migration but divided by poverty, inequality, and access to essential services, including water, sanitation and quality medical care. For our international development team, who interact regularly with farming communities, health facilities and water management; AMR is becoming front of mind during both the design and implementation stages. We don’t want to take away livelihoods or reduce nutrition, so before the use of antimicrobials in farming is banned, we need connected thinking to provide solutions that ensure protection of livelihoods, nutrition, and animal welfare.

3. Be a warrior, not a worrier

It’s easy to feel powerless against something that’s often described as ‘apocalyptic’ in the press. However, we have seen how individual actions around climate change and plastics are creating momentum. To this last point, speaking to children and raising the volume in schools is proven to reach the ears of politicians.

Capitalism may have helped to cause AMR, but given its sensitivity to public opinion, it may also offer a solution. Outside of the legislators, institutional investors may have more power than any other stakeholder to make a difference in this space, simply by putting pressure on assets under their management. When was the last time you lobbied your pension or insurance provider? Or raised your hand in a shareholder meeting?

A firm like Mott MacDonald also has influence in many different spheres, whether clients, legislators, financiers, pressure groups or public bodies. We have an opportunity to become the connective tissue between them all, raising awareness on AMR and the need for a coordinated response.

4. Don’t play the blame game

There’s a temptation in AMR to point the finger at different contributors to this growing problem. Politicians blame the farmers, who blame the doctors, who blame pharma, who blame the investors demanding a quick profit and politicians again – and round we go. The reality is that there’s no silver bullet to solving AMR – it will need cooperation and commitment from all these stakeholders.

Empathy helps reveal the situation and promotes open discussion. Conflict promotes a “trench warfare” mentality. Let’s look at the facts. Farmers, especially in the Far East, are responding to a massive demand for affordable meat and fish. Many would use fewer antibiotics if presented with the evidence and the incentive for change. Pharmaceutical companies lack motivation to fast-track expensive new drugs, at lower prices, especially when those drugs may become obsolete very soon. The economics must add up, if we’re to curb this market failure.

5. Love your bugs

We must never see microbes as the enemy! In fact, none of us would be alive without them, as they help to keep life on Earth in equilibrium. It’s we pesky humans who are upsetting the balance. Rather than fearing bacteria, viruses and parasites, we should embrace them as a golden opportunity to make a difference to the lives of millions of people. In developing countries, especially, better health has a direct impact on education, economic growth and social inclusion. With the rapid rate of change in technology, there is vast scope for innovation to achieve remarkable outcomes.

6. Make it mainstream

Perhaps the most important thing any of us can do is to make AMR part of everyday conversation. In truth, the acronym doesn’t sound as scary as Ebola or Marburg. Yet, common bacterial infections are the diseases that are predicted to kill far more people if AMR continues on the same path. Imagine no treatment for pneumonia, or a simple cut that results in an untreatable infection. Or if we can’t provide key medical procedures such as cancer chemotherapy, caesarean sections or hip replacements without the risk of infection and complications. We all have friends and loved ones who have survived one of the above.

That’s got to be worth talking about… and protecting in the years to come.

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