Progress on the UK antimicrobial resistance strategy

From: Department of Health and Dr Felicity Harvey CBE, Director General for Public Health.

Antimicrobial resistance (AMR), especially resistance to antibiotics, is a growing problem and there is now a risk that the practice of modern medicine will not be possible in the next 20 years because we have run out of effective antibiotics. I, like Dame Sally Davies, our Chief Medical Officer (CMO), am determined that will not happen, not just for us, but for future generations.

In September 2013, we published the UK Five Year AMR Strategy with the goal of slowing the growth of AMR by taking an integrated approach across human and animal health and the environment at both national and international levels. An early priority has been to agree a set of measures against which we could track progress towards our goal.

The Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infections (ARHAI) and Public Health England (PHE) have worked with us to develop measures which include resistance trends in selected drug-bug combinations and improvements in the quality of prescribing in primary and secondary care.

In November we will publish our first annual progress report and a detailed implementation plan with a focus on deliverables. The annual report will describe progress across the areas that we have identified as the priorities for action in this first phase. These are better data and information, behaviour change, improved diagnostics and new treatments, enhanced research and analysis and stronger international collaboration. We, and our partners, are making good progress in each of these areas.

Progress DH has made

We have undertaken a range of analyses and modelling of the burden and potential impact of AMR on health, the NHS and the consequent economic and social costs to inform the wider programme and help assess the likely effectiveness of potential interventions to reduce AMR. We will be publishing these later this year.

To improve diagnostics we are working with experts including the Chief Scientific Officer at NHSE, Medical Microbiology experts in PHE and academia, National Institute for Health Research (NIHR) and the Medical Research Council (MRC) to establish what is needed on the ground, where there are gaps and how we can make sure that the right tests are available in the right settings across the health system.

Research is crucial to our understanding of the molecular basis of the emergence of spread of AMR, the significance of transmission pathways between the environment, humans, animals and the food supply chain in promoting the transfer of resistance in human and veterinary pathogens to help target our interventions. We also need research to help develop new drugs, alternative therapies and improved diagnostic technologies.

In April, two NIHR Health Protection Research Units, focusing on Health Care Associated Infections and AMR were established, between PHE and academic partners. A new AMR Research Funder’s Forum, led by the MRChas been set up to co-ordinate AMR related research and promote joint action to better understand the relationship between AMR in humans and animals.

The UK has been at the forefront of action internationally working with other governments and global organisations including the World Health Organization (WHO) and the World Organisation for Animal Health (OIE), to drive forward coordinated action at an international level.

I am enormously proud of our achievements on the international stage. Together with Sweden, we have led the development and adoption of a new WHO resolution on AMR. The Resolution provides a mandate for development of a WHO led global action plan by May 2015. We will have a key role in influencing and contributing to the development of the action plan and continuing to support the global movement to tackle AMR.

Progress our partners have made

To provide better data and information, PHE has been working with a wide range of bodies to strengthen our national surveillance programme, improving our ability to monitor trends in resistance and integrate data on how antibiotics are used in hospitals, GP surgeries and other healthcare settings. In September, it will publish its first annual report providing a baseline from which to monitor future trends and assess the impact of our interventions.

PHE is stepping up its work with partners across the human health and social care system, holding a workshop with experts in the summer to develop an integrated plan to deliver system wide change. NHS England, NICE and Health Education England are all supporting work to change behaviours and improve the quality of antibiotic prescribing.

The Veterinary Medicines Directorate of Defra and the Responsible Use of Medicines in Agriculture Alliance (RUMA) are undertaking comprehensive sector engagement activities to consider the issues and share good practice.

Much more to be done

However, I am not complacent and while I recognise the significant achievements on the international front, there is much more that needs to be done to deliver real change nationally to improve our infection prevention and control, better control the use of antibiotics and to support the development of new classes of antibiotics, diagnostics and new treatments.

We already have good support from the Royal Colleges and the Faculty of Public Health. This, together with RUMA’s strategy and action plan, issued in April this year, demonstrate that we in the UK are of one voice and truly working together to tackle this important issue.

We can only achieve the goal of the strategy if we continue to work together in this way. The progress report and action plan we publish in the autumn, will provide more detail about what we have and what we intend to achieve together. I call on you now, professionals, health care workers, academics and industry to keep the fight against AMR as a priority in your organisations and to continue to work with us to make those changes that need to happen to deliver our goal.