WIF Practice Webinar Tuesday 25 Au 2020
AGENDA 11:00 Welcome Peter Drake, CEO Water Industry Forum 11:05 Introduction to AMR, the UK’s response and Catriona Waddington, Global Lead for Health, the Fleming Fund Mott MacDonald 11:15 Why is AMR relevant to the water industry? Dr Andrew Singer, Senior Scientist UK Centre for Ecology & Hydrology 11:30 Water company perspective George Ponton, Head of Research & Innovation – Scottish Water Scottish Water 11:40 Water company perspective Howard Brett, Wastewater Policy & Strategy Manager – Thames Water Thames Water 11:50 AMR & other emerging issues Rowan Byrne, Marine Technical Lead Mott MacDonald 12:05 AMR & Covid-19 Sarah Dobson, Health Specialist Mott MacDonald 12:15 Q&A with the speakers 12:30 Close
Welcome & Introduction Peter Drake CEO Water Industry Forum
Introduction to AMR, the UK’s response and the Fleming Fund Catriona Waddington Global Lead for Health Mott MacDonald
Introduction to AMR, Catriona the UK’s response and Waddington Global Practice the Fleming Fund Leader for Health, Mott MacDonald
Audience poll: vote now! Have you or your immediate family (parents, sibling, partner, children) used antibiotics to deal with a serious health issue (including surgery and cancer treatment) in the past 5 years? Yes/no.
• 700,000 deaths “caused by” AMR each year • 10,000,000 AMR-related deaths predicted by 2050 AMR: the • 1,293,847 deaths from COVID-19, as of 13 November numbers • 58,000,000 people died globally in 2019 (65%+ antibiotics consumed in agriculture/aquaculture)
Water systems and AMR: the global picture • 2020-30: environmental contamination warrants additional investment (WASH is #1 priority) • Widely accepted that water systems are a vector for resistance • Proportion of contribution to total burden of resistance not known • Unclear how many effective interventions exist that are specific to the water systems dimension • Questions of investment proportionality and collateral benefits • High concentrations at few locations versus low concentrations at many locations
The UK and AMR • Global UK leadership (with US until 2016) • National Action Plan 2019-2024 • “Pull” incentives: tendering for payment model pilots to incentivise pharmaceutical companies • UK Special Envoy on AMR • Fleming Fund
Why is AMR relevant to the water industry? Dr Andrew Singer Senior Scientist UK Centre for Ecology & Hydrology
Why is AMR relevant to the water industry? A technical introduction to AMR and the key issues and problems that the water industry faces regarding AMR Dr. Andrew C Singer
Why are we worried about antimicrobial resistance? Problem: Increasing prevalence of drug-resistant infections Perceived Cause: Inappropriate and overuse of human antibiotic use Actual Cause: #OneHealth: Complex result of antimicrobial use in humans, animals, agriculture, pollution & co-selection. https://bit.ly/3fmhJy1
Which chemicals drive AMR? Antimicrobials • Antibacterial • Antiviral • Antifungal • Antiprotozoal • Anthelmintic Metals Biocides Pharmaceuticals Herbicides Pesticides Co-selection: Exposure to a non-antimicrobial can select for antimicrobial resistance
AMR, Pollution and the Environment
The Challenge of Halting the Spread of AMR (in one slide) Susceptible Intrinsically Acquired Resistance (dead) Resistant xx xx xx Non-pathogens AMR Selection Mutation Horizontal Gene Transfer Multi-drug Resistance Pathogens Resistant Pathogens
How to quantify AMR in the aquatic environment? 1. Clinical- Relevance (qPCR or culture) • Obvious relevance & high risk • Limited scope • Not future proofed 2. All ARGs (metagenomic/bioinformatics) • Not always obvious relevance & variable risk • Widest scope • Future proofed 3. Mobile ARGs (integrons/transposons/plasmid) • High relevance & high risk • Addresses current risk of spreading doi/10.1007/s40726-018-0076-x doi/10.1093/femsec/fiy195/5114257
The Importance of Changing Microbial Niches on AMR Gut WWTP Environment https://bit.ly/337cxcf Δ Niche → Δ Microbial Community → Δ AMR
The Chemical Environment in Wastewater 1 ug/L 1 ug/L Influent Effluent 10.1016/j.envint.2017.10.016
Mobile ARGs Risk is easily achieved with treated sewage in <9 days ~5 L sewage effluent Rivers: Kennet & Lambourn 2,500,000 L Treatment: 2ppm STP Effluent Time: 9 days; Measure: IntI1
Wastewater By the Numbers IF: THEN: 9000 WWTPs in UK 1.1 Million Trillion bacteria 110 Billion L/d sewage effluent discharged in sewage effluent/day in 10 Million bacteria/L sewage effluent the UK AMR 11,000,000,000,000,000,000
Combined Sewer Overflows By the Numbers THEN: IF: 345 million L of sewage is treated/d (typical 86.25 million billion bacteria are diverted to city) the river from 1 CSO event = 9% of the 25% of flow is diverted to CSO in a 24h period bacteria released in 1 day from all 9000 STPs 86.5 million L of sewage is diverted through in UK AMR CSO 86,250,000,000,000,000 1 billion bacteria are in L of untreated sewage
Holistic View on What Should be Done 1. Source reduction of AMR-driving chemicals A. Health care - vaccination, infection prevention & control, rapid diagnostics, shorter course length B. Meat production – improved biocontainment and biosecurity . C. Manufacturing – transparent & auditable antimicrobial production pipeline (discharge limits) 3. Model & Innovate 2. Source reduction of wastewater, itself A. Model environmental exposures; identify A. Sustainable Drainage Systems - retroactively implemented and enforced in all new developments where hazards remain high B. Innovation WWTP treatment to alleviate B. Water conservation – reduce dry weather flow hazard. C. Repair leaking pipes - groundwater ingress D. Misconnections – equivalent to small scale CSOs
Holly Tipper Andrew Singer acsi@ceh.ac.uk @OxonAndrew
Water company perspective George Ponton Head of Research & Innovation Scottish Water
AMR – a Scottish perspective Water Industry Forum George Ponton – Head of Research and Innovation
Outline • AMR – how concerned should we be? • What are we doing about it? • It’s not just our problem! – taking a partnership approach
Pharmaceutical life-cycle – intervention points
AMR - It’s not just our problem! One Health Breakthrough Partnership
One Health Breakthrough Partnership – Associate Partners
Conclusion • AMR is an issue – but it’s not reflected in drivers for WW systems • There are gaps in our knowledge – but do we have time to close them? • We need to take a multi-sector and stakeholder approach • Building more assets isn’t the answer – carbon, £ and does it work?
Water company perspective Howard Brett Wastewater Policy & Strategy Manager Thames Water
AMR and the Water Industry Howard Brett, Thames Water & UKWIR Programme lead, Wastewater
Water Industry Context • Our Primary function is protection of public health – clean water and sanitation • Almost all improvements driven by legislation/policy – heavily regulated • Bathing waters, UWWTD, Drinking Water Directive, Water Framework Directive….. • Extent and pace of implementation driven by justification and cost-benefit • So what of AMR? • Recognised as major public health issue • Environmental AMR and contribution to overall impact unclear – primary focus elsewhere to date • Our role and contribution to environmental AMR unquantified • Costs – definitely. But quantum? Benefits? • So: • Why (Global, Govt etc) Benefits • What (Govt, Regulators, Academia) Costs • How (Industry, Academia, Regulators) Costs • When (Regulators, Industry) Affordability and practicability
Exposure routes Three principal products….. Wastewater – Biosolids to land – Potable Water Treated and untreated Assumes uptake to Assumed Direct exposure crops? (very) low risk through recreation Environmental reservoir? given Environmental (Most ARGs originate from soil bacteria) reservoir disinfection Other inputs Potential ARGs? ARBs, ARGs and/or ARBs, ARGs > antimicrobials (?) Antimicriobials?
What do we know? • Assessment of contribution – if you look for it in effluent, you’ll find it • Source apportionment • Absence of robust contextual research and epidemiology to properly inform – when does the hazard present as risk? • ‘Beach Bums’ survey – interesting and relevant but limited • Considerable work looking at prevalence in and downstream of STWs – but context? Other environmental inputs, eg agriculture (~20% pigs carry ESBLs ) • • Could we treat like any other pollutant – define acceptable ‘load’ or concentration – or by process? • Vary with uses downstream? – ‘wild swimming’? Rowing? • How to set standards – is there an ‘infective dose’? (of what? How to measure?) • ARBs, ARGs, or the antimicrobials –or all? • Treatment is another stressor/selection process – how effective? • Is there scope for ‘upstream’ interventions ? • In short…not much!
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