The environmental dimension of antimicrobial resistance: informing policy, regulation and practice.

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Antimicrobial resistance (AMR) is the phenomenon that leads to treatment failure of infections caused by pathogenic organisms such as bacteria. The Chief Medical Officer Professor Dame Sally Davies has compared the threat posed by AMR to that of climate change and global terrorism. If current trends continue it is estimated that AMR infections will be the leading cause of death by 2050 with a cumulative cost to society of $100 trillion. This Knowledge Exchange Fellowship focuses on AMR in bacteria and specifically the role of the environment in increasing resistance seen in clinical pathogens. AMR is ancient, having evolved in environmental bacteria over millions or billions of years. Resistance mechanisms that evolved over evolutionary time have been mobilised from environmental bacteria to human pathogens through a process known as horizontal gene transfer. Levels of AMR are high in environments impacted by human and animal waste and it is known that significant exposure risk to AMR bacteria occurs in environments such as coastal bathing waters. However, the relative importance of environmental exposure and transmission is currently uncertain as is the nature of evidence required to inform policy and regulation.This KE Fellowship aims to facilitate knowledge exchange relating to AMR in the environment from, and between, academia, government and industry with the objective of informing policy making, regulation, mitigation and risk reduction strategies. There is demand from Defra, the Environment Agency (EA) and industry for knowledge exchange in this subject area due to its rapid prioritisation by organisations such as the UN and WHO and the probability that increased regulation may occur in the future. Defra and the EA are the policy making and regulatory agencies that are tasked with considering the evidence relating to AMR in the environment and are key partners as are the pharmaceutical and water industries. Knowledge exchange will also take place with a wider range of stakeholders, for example the insurance industry is concerned with potential liabilities associated with environmental transmission of AMR. A series of reciprocal knowledge exchange placements will take place with Defra, the EA, the pharmaceutical and water industries focusing on evolution of AMR driven by environmental pollution, land scape scale dissemination of AMR and environmental transmission to humans. These three areas are covered by multiple research projects within Dr Gaze's lab who is uniquely placed to fulfill Knowledge Exchange activities due to the scope of his research portfolio which includes three cross-council initiative AMR grants. His research group is one of the largest working on this subject internationally. He has advised UK government and the United nations and has strong links to the pharmaceutical and water industries. Three workshops will take place at the beginning, middle and end of the Fellowship to prioritise KE, assess progress and produce policy recommendations respectively. An environmental AMR network will be set up alongside a website with resources for the network and data on each of the scientific issues. A key activity will be to work with the EA to develop protocols and targets for environmental surveillance as current efforts are largely research based and are not comparable as each lab uses different methodologies. This is a key goal of Defra and the EA and they have offered significant time to co-develop a surveillance strategy with the academic community through this Fellowship. Outputs will include policy recommendations co-designed by all partners, and a report and scientific publication highlighting knowledge gaps and current barriers to policy implementation.