Antimicrobial resistance: a call to arms

Engineers of all disciplines have a role to play in tackling antimicrobial resistance writes former chief medical officer Prof Dame Sally Davies

Why should we care about antimicrobial resistance? Until recently, I was the UK’s Chief Medical Officer and it was my job to protect the nation’s health. Antimicrobial resistance (AMR), which describes the phenomenon of infective microbes being resistant to the drugs used to treat them, is a clear threat to that. A review led by economist Jim O’Neill predicted that, without appropriate action, AMR will cause 10 million deaths per year worldwide by 2050 as we lose the ability to treat common infections.

SPECIAL REPORT: How engineers are battling anti microbial resistance

Much of the progress we have made in medicine over the last century is down to the existence of antimicrobials, particularly antibiotics against bacteria. Many medical procedures which increase the risk of infection or suppress the immune system depend on effective antimicrobials, including caesarean sections, routine joint replacement, chemotherapy, and cystic fibrosis care. Treatment for the ‘big three’ infectious diseases - tuberculosis, HIV, and malaria - is under risk as they too evolve resistance.

"AMR is not just a threat to human health and can’t be tackled in the medical sector alone"

But as I discovered, AMR cuts across many sectors. It is not just a threat to human health, and it cannot be tackled in the medical sector alone. Antimicrobials are used in food production, to protect health but also to promote growth in livestock animals. There is also an increasing focus on the environment as a potential reservoir and conduit for AMR. Antibiotics can enter the environment in several ways, such as through effluent from pharmaceutical factories and run-off from high-use farms and hospitals. When antibiotics enter waterways, evolutionary pressure leads to the emergence and spread of resistance. Researchers from the University of Exeter have found that surfers in the south west of England are three times more likely to harbour resistant organisms than non-surfers because they swallow much more seawater which contains high levels of resistant bacteria, most likely from sewage and waste pollution.

All of this means that AMR impacts many aspects of our lives. The O’Neill Review predicted that AMR will cost the global economy up to $100 trillion dollars by 2050. This is approximately equivalent to losing the UK economy from global output every year. The World Bank predicts there could be 28 million extra people driven into extreme poverty by AMR. It clearly threatens sustainable development, most notably the six UN Sustainable Development Goals (SDGs) of no poverty; zero hunger (AMR threatens global food security); good health and wellbeing; clean water and sanitation; decent work and economic growth; responsible consumption and production.

How can we stave off this threat? We need to:

• Improve infection prevention and control: if we can reduce the incidence of infections, we reduce the need for antimicrobials in the first place through hygiene measures and vaccination.

• Promote careful appropriate use, also known as ‘stewardship’ of antimicrobials: the more antimicrobials that are used, the higher the rates of resistant infections. If we can ensure that antimicrobials are used only when appropriate and necessary, we can minimise resistance rates.

• Improve diagnostics: better diagnostics will help identify the cause of an illness and the best way to treat it, avoiding the use of inappropriate or unnecessary antimicrobials.

• Improve surveillance; so we can better understand the threat and develop appropriate strategies to counter it.

• Eliminate substandard and falsified medicines, which contribute to resistance.

• Develop new drugs, so that we have a bigger arsenal to counter the reduced effectiveness of existing drugs.

• Support research and innovation, not just in new drugs but also vaccines, alternative treatments, behavioural science, the environment, and more.

None of these are simple tasks, and all of them will need to draw upon a wide range of expertise. That includes engineering skills, as the examples in this issue illustrate. Whether developing better wastewater treatment solutions, sterilisation techniques which do not contribute to resistance, nanoparticles which can target bacteria, or more hygienic farms which reduce the need for antimicrobials in food production, there is no shortage of demand for engineers to get involved.

We all have our part to play. I stepped down as Chief Medical Officer in September. In that role I worked with committed colleagues and partners to drive action against AMR in the UK and put AMR on the international agenda. Now, as the UK’s Special Envoy on AMR, the biggest contribution I can make is to keep calling for global action.

This is a problem which crosses borders and cannot be tackled by nations on their own. I engage with countries and organisations across the world, in the public and private sector, covering humans, animals, and the environment. AMR affects each and every one of us, and we all need to take action.

So I urge all of you to step up. AMR is pervasive and I suspect that many of you work in areas which can impact resistance in some way. If each of you uses your expert knowledge and skills to help tackle AMR in whatever way you can, we can help preserve the miracle of modern medicine and all that it gives us.

Professor Dame Sally Davies is UK Special Envoy on Antimicrobial Resistance. Before this, she was Chief Medical Officer for England.