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Antimicrobial Resistance: Addressing the Risks – RAND Europe Evidence Submission

Core Content

This document presents RAND Europe's evidence submission to the UK Public Accounts Committee (PAC) regarding the implementation of the UK National Action Plan (NAP) for antimicrobial resistance (AMR). The submission outlines the UK's current capabilities and challenges in addressing AMR, focusing on three key themes: reducing the need for and exposure to antimicrobials, investing in innovation, supply, and access, and enhancing surveillance and collaboration.

Main Points

1. UK's Strengths in AMR Addressing

• The UK has a strong foundation in research and science, including genomics and vaccines.
• It is a global leader in AMR-related capabilities such as genomic surveillance and cross-sector collaboration.
• Innovative programmes like PATH-SAFE and the National Biosurveillance Network have enhanced AMR surveillance and generated knowledge on effective practices.
• The UK has supported initiatives like the Global Antimicrobial Resistance Innovation Fund (GAMRIF) and CEPI to drive innovation in AMR.
• The NHS Antimicrobial Products Subscription Model is a pioneering approach to incentivize private-sector R&D.

2. Surveillance Infrastructure and Capabilities

• The UK has developed genomic surveillance systems, demonstrated by the success of the COG-UK consortium during the pandemic.
• Wastewater surveillance is being explored as a tool for population-level AMR monitoring.
• The UKHSA's Pathogen Genomics Strategy and the Genomic Medicine Service support advanced surveillance capabilities.
• The PATH-SAFE programme tested cross-government and One Health surveillance methods, providing valuable insights into AMR in the food system and environmental contexts.

3. Cross-Sector Collaboration and Leadership

• The UK has invested in multi-sector collaboration across human health, animal health, and the environment.
• Initiatives like PACE, the Medicines Discovery Catapult, and CEPI provide platforms for public-private partnerships.
• The Biological Security Strategy identifies AMR as a national security risk, reinforcing the need for a coordinated, One Health approach.
• The UK is among the first to address inequalities in its AMR NAP, aligning with global health goals.

4. Challenges and Gaps

• Scientific Gaps: There is limited understanding of how environmental factors influence AMR in humans and the mechanisms of resistance gene transfer.
• Implementation Gaps: Even with established science, the best ways to implement AMR interventions are unclear, particularly in scaling up genomic surveillance during emergencies.
• Funding and Scale-Up: Many successful pilots require further investment for full implementation and scale-up, but securing such funding remains uncertain.
• Silos and Coordination: Despite progress, sectoral silos and data-sharing challenges persist, requiring cultural and operational shifts to improve coordination.

5. Recommendations

• Prioritisation: Use value of information frameworks and consider the readiness, feasibility, and resource availability when deciding which initiatives to fund.
• Implementation Research: Invest in research to identify what works best in practice, reducing inefficiencies and waste.
• Leadership and Coordination: Ensure clear leadership and coordination mechanisms to facilitate cross-sector collaboration and streamline AMR responses.
• Preparedness and Biosecurity: Expand the biosecurity framing of AMR to better align with national security priorities and conduct exercises like red-teaming and serious gaming to improve readiness.

Key Information

• The UK's AMR NAP is aligned with its research and innovation strengths, including genomics and vaccines.
• PATH-SAFE has demonstrated the value of cross-government and One Health surveillance but requires further investment and evaluation for long-term impact.
• The subscription model for antimicrobials is a key example of a demand-signalling ‘pull’ incentive to encourage private-sector innovation.
• The 2024–2029 AMR NAP builds on previous plans and includes performance indicators for innovation, outcomes, and collaboration.
• The UK is a global leader in AMR policy but needs to address gaps in animal health and environmental AMR.
• AMR-related morbidity and mortality in the UK are rising, with resistant infections now surpassing pre-pandemic levels.

Conclusion

The UK has significant strengths in AMR research, surveillance, and cross-sector collaboration. However, to fully realize the benefits of its investments, the country must address scientific and implementation gaps, prioritize effective initiatives, and improve coordination across sectors. AMR should remain a top priority for investment due to its growing impact on public health and national security.