Antimicrobial resistance (AMR) is predicted to be the leading cause of death globally by 2050, with a predicted cumulative cost of $100 trillion.

The University of Exeter’s pioneering research has transformed understanding of the evolution, ecology and transmission of drug-resistant microbes in the environment and directly informed and influenced AMR policy and practice.

Our work includes contributing vital parts of the evidence base that underpins UK policy and practice and the government 5-year AMR strategy.

Professor William Gaze and colleagues have influenced policy and informed strategic thinking about the role of the environment in the development and spread of AMR. This subject was largely ignored in previous strategies — in the government’s 2013-2018 AMR Strategy, for example, the word ‘environment’ was mentioned only 5 times in the 43 page document.

In contrast, the current 2019-2024 UK government AMR strategy embeds the environmental dimensions of AMR at the heart of its policies. According to the Senior Policy Advisor on AMR and Pharmaceuticals at the UK Department for Environment, Food and Rural Affairs (Defra),

“Prof Gaze’s research was a primary source in helping us understand the important problem of the environmental dimension of AMR and his activity and research has directly informed government policy development in this area, notably contributing vital parts of the evidence base which underpins the UK government 5-year AMR strategy”

The Beach Bum Survey helped to drive this shift in emphasis. It was the only study on AMR and water cited in the 2019-2024 strategy, out of >1,000 papers published on this theme in the previous 5 years. Being the only study to integrate environmental AMR surveillance, exposure risk assessment, and evidence of environmental transmission to humans it has gained widespread recognition nationally and internationally. It has been cited by Professor Dame Sally Davies, who was the UK Chief Medical Officer (CMO) from 2010 to 2019 and is currently the UK’s Special Envoy on AMR.

Advice  has underpinned national policy at the highest level. In addition to research, Prof Gaze contributed a summary of scientific evidence of AMR in the environment to inform the CMO’s priorities on the environmental dimensions of AMR and has also advised the UK’s Review on Antimicrobial Resistance, which was commissioned in July 2014 by the UK Prime Minister.

Prof Gaze was one of four academics invited to speak at the Houses of Parliament as part of the UKRI AMR research strategy refresh in 2019 and is currently one of four academics, and the only environmental AMR researcher, on the UKRI cross-council AMR steering committee, which is informing future research agendas.

The ECEHH team’s contributions to guide policy, regulation and practice in the UK have been facilitated by a Natural Environment Research Council (NERC) Knowledge Exchange Fellowship and a Joint Programming Initiative on AMR (JPIAMR) network grant. By working in partnership with Defra, the Environment Agency (EA), and the water and pharmaceutical industries, these projects facilitated the cross-sectoral knowledge exchange necessary for policy development.

Dr Anne Leonard and Professor William Gaze are now working with the Environment Agency to trial environmental AMR surveillance methodologies pioneered in the Beach Bum Survey, demonstrating a direct impact on agency surveillance practice and illustrating the implementation of a key policy objective described in the UK AMR Strategy.