Powering the UK’s approach to Antimicrobial Resistance
This report provides a critical assessment of the UK’s efforts to tackle the mounting global threat of Antimicrobial Resistance and proposes ideas for reform.
Antimicrobial Resistance (AMR) is one of the defining challenges of our time. An increasing number of infections caused by bacteria, fungi, parasites and viruses are becoming resistant to antimicrobial drugs and antibiotics, threatening to turn routine procedures and treatments like c-sections and chemotherapy into life-critical endeavours.
The UK has been at the forefront of efforts to battle AMR, recently publishing its 2040 Vision for tackling AMR and 5-year national action plan, and announcing a novel reimbursement model to accelerate investment in antibiotic development. Achieving sustained transformation, however, requires action across several fronts and ongoing cooperation with governments and industry alike. With the COVID-19 pandemic radically reshaping the world and testing the resilience of healthcare systems worldwide, it is crucial not to lose sight of the silent pandemic that is AMR.
This Reform Ideas has been kindly sponsored by Beckton Dickinson (BD).
The AMR challenge
AMR is a pressing global threat which has been at the top of the global policy agenda for decades. While significant progress has been achieved action is not advancing at the speed or scale required to avert a crisis. The global supply of antibiotics is dwindling, deep-seated market failures are impeding the development of novel vaccines and treatments, and much of the potential offered by data and diagnostics is going untapped.
Already, a third of urinary tract infections in England display resistance to drugs, and 60,000 ‘superbugs’ emerged last year. AMR requires immediate and sustained action.
The legacy of the COVID 19 pandemic
The burgeoning COVID-19 crisis has come to reshape nations’ economies and healthcare systems. It has seen countries radically expand their diagnostic testing and surveillance capacities and prompted the fastest vaccine deployment in history. It has highlighted the importance of robust infection prevention strategies in the containment of the virus and created greater awareness of the role of prevention amongst the general public. As the pandemic continues to unfold, concern exists that inappropriate use of antimicrobials, disruptions to vaccination services and the rapid spread of multi-resistant organisms in hospitals could come to further exacerbate drug-resistance. As such, the same prioritisation and policy impetus given to COVID-19 must be given to AMR. If unchecked, AMR will “have the same impact on people’s lives and the economy that COVID-19 is having,” according to former Chief Medical Officer, Dame Sally Davies, in this report.
While the focus is rightly on replenishing the dying pipeline of new antibiotics, responding to the challenge of AMR requires a multifaceted approach. Realising the potential of vaccines to address AMR, building awareness of the importance of infection, prevention and control practices amongst the general public & professionals, and using data effectively to monitor drug resistance across healthcare settings and to prevent AMR from spreading, are all crucial components in this response. As underscored by the pandemic, use of proven diagnostics, especially tools that provide close-to-real-time information and can be performed close to where patients access care, could help guide antibiotic prescribing and preserve antibiotics for the future.
Creating the impetus for change
Action against AMR is being hampered by a lack of public understanding of the long-term implications and challenges brought about by rising drug resistance. The Department of Health and Social Care should boost its awareness-building efforts by supporting work that showcases the stories and real-life experiences of patients and families living with drug-resistant infections. The Department should also explore the potential of community-led approaches for catalysing local action on AMR. Finally, to enact long term change and ensure prioritisation of AMR in the policy agenda, clearer lines of accountability of AMR within Government must be established.
The Department for Health and Social Care, in partnership with relevant local and international stakeholders, should develop an engagement plan to strengthen policymaker’s, healthcare professionals’ and the public’s understanding of the impact of vaccines on antimicrobial stewardship and their role in addressing AMR. These efforts should be built on robust analyses and modelling of the health and economic impacts of immunisation on antibiotic use, and improved surveillance data on the effects that vaccine uptake has in limiting the burden of AMR.
NHS England and NHS Improvement, in collaboration with the National Institute for Health and Care Excellence, should urgently commission a national assessment of the clinical and cost-effectiveness of tools like point-of-care diagnostics to inform future reimbursement models. The assessment should consider tests’ performance across health and care settings, as well as additional dimensions of value such as clinical outcomes and impact on clinical workflows. Specific measurements to assess the value these tools
provide with regard to their impact on AMR should be explored.
The AMR Diagnostic Partnership Board should focus on improving existing practice and closing well-recognized gaps in clinical care. One such example would be to support the widescale adoption of the national standards for blood culture processing issued by Public Health England and the pathways produced by National Institute for Care Excellence (NICE Pathways) across NHS Trusts.
Health Education England should evaluate strategies to ensure that the extensive technical and clinical expertise of hospital staff in relation to point-of-care testing is leveraged in the community. This could take the form of specific training and certification of primary and community care staff, the creation of self-audit tools and checklists to ensure the safe and proper use of devices, or the provision of specialist advice upon request. Existing structures, such as point-of-care testing committees within NHS Trusts, could also be employed to facilitate communication between hospitals and the primary and community care sector.
The Department for Health and Social Care should support the development and use of open source analytic tools, like OpenPrescribing, to enhance AMR surveillance and national antimicrobial stewardship efforts. To improve access to high quality health-service and clinical data for health research, NHS Digital in England, and national information technology organisations in the devolved administrations, should conduct an audit of existing data sources relevant to antimicrobial and diagnostic stewardship, and define appropriate information governance frameworks to support their use. Furthermore, the Department should make available specific funding streams to fund data science and applied clinical informatics research projects across the country.
Public Health departments in England and the devolved countries, should work with charities and local patient organisations to create an awareness and education campaign highlighting the experiences of individuals living with drug-resistant infections and their families. This should be accompanied by a suite of accessible information resources on AMR patient safety, including standardised information about specific drug-resistant bacteria, the infections they cause, regional data on resistance, and healthcare-associated infections in hospital. Outcomes from this campaign should be independently evaluated and learnings shared.
The Department of Health and Social Care should support a national fund to pilot, evaluate and develop pragmatic and scalable community engagement approaches to tackle AMR. A mixture of philanthropic contributions plus a levy on funded antimicrobial drug discovery research could be used to finance the fund, with monies ring-fenced. Activities and projects should be delivered locally and as a partnership between local government, academic institutions, grassroots organisations, civil society and patient advocacy groups. Processes and outcomes need to be evaluated with civil society partnerships, using a range of methodologies, and a focus on sharing best practices.