WIF Practice Webinar Tuesday 25 Au 2020 AGENDA 11:00 Welcome - - PowerPoint PPT Presentation

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 the Fleming Fund Catriona Waddington, Global Lead for Health, 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 – Scottish Water George Ponton, Head of Research & Innovation Scottish Water 11:40 Water company perspective – Thames Water Howard Brett, Wastewater Policy & Strategy Manager 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, the UK’s response and the Fleming Fund

Catriona Waddington Global Practice 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.

AMR: the numbers

• 700,000 deaths “caused by” AMR each year
• 10,000,000 AMR-related deaths predicted by

2050

• 1,293,847 deaths from COVID-19, as of 13

November

• 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

• Dr. Andrew C Singer

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

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

Antimicrobials

• Antibacterial
• Antiviral
• Antifungal
• Antiprotozoal
• Anthelmintic

Metals Pharmaceuticals Herbicides Pesticides Biocides

Which chemicals drive AMR?

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)

Non-pathogens Pathogens

Resistant Pathogens Acquired Resistance

Horizontal Gene Transfer Mutation

xx xx Susceptible (dead) xx

AMR Selection

Intrinsically Resistant

Multi-drug Resistance

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/10.1093/femsec/fiy195/5114257 doi/10.1007/s40726-018-0076-x

The Importance of Changing Microbial Niches on AMR

https://bit.ly/337cxcf

Gut WWTP Environment

Δ Niche → Δ Microbial Community → Δ AMR

The Chemical Environment in Wastewater

10.1016/j.envint.2017.10.016

Influent Effluent

1 ug/L 1 ug/L

Mobile ARGs Risk is easily achieved with treated sewage in <9 days

Rivers: Kennet & Lambourn Treatment: 2ppm STP Effluent Time: 9 days; Measure: IntI1

2,500,000 L ~5 L sewage effluent

Wastewater By the Numbers

9000 WWTPs in UK 110 Billion L/d sewage effluent 10 Million bacteria/L sewage effluent

THEN:

1.1 Million Trillion bacteria discharged in sewage effluent/day in the UK

IF:

11,000,000,000,000,000,000 AMR

Combined Sewer Overflows By the Numbers

345 million L of sewage is treated/d (typical city) 25% of flow is diverted to CSO in a 24h period 86.5 million L of sewage is diverted through CSO 1 billion bacteria are in L of untreated sewage 86.25 million billion bacteria are diverted to the river from 1 CSO event = 9% of the bacteria released in 1 day from all 9000 STPs in UK

IF: THEN:

86,250,000,000,000,000 AMR

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)

• 2. Source reduction of wastewater, itself
• A. Sustainable Drainage Systems - retroactively

implemented and enforced in all new developments

• B. Water conservation – reduce dry weather flow
• C. Repair leaking pipes - groundwater ingress
• D. Misconnections – equivalent to small scale CSOs
• 3. Model & Innovate
• A. Model environmental exposures; identify

where hazards remain high

• B. Innovation WWTP treatment to alleviate

hazard.

Holly Tipper

Andrew Singer acsi@ceh.ac.uk @OxonAndrew

Water company perspective

George Ponton

Head of Research & Innovation

Scottish Water

AMR – a Scottish perspective

George Ponton – Head of Research and Innovation Water Industry Forum

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

ARBs, ARGs and/or Antimicriobials?

ARBs, ARGs > antimicrobials (?)

Potential ARGs?

Three principal products…..

Exposure routes

Biosolids to land –

Assumes uptake to crops? Environmental reservoir? (Most ARGs originate from soil bacteria)

Wastewater –

Treated and untreated Direct exposure through recreation Environmental reservoir Other inputs

Potable Water Assumed (very) low risk given disinfection

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!

What would we like to know?

• Treatment is always better than no treatment, but:
• Is the sewerage service just a conveyance or does it ‘enhance’ AMR impact through species transfer
• How important are the treatment ‘environment’ changes – temperature, pH, oxidation, bacterial community

etc – as stressors to encourage horizontal gene transfer (HGT)

• Relevance of potential (known) co-selection agents such as metals and biocides (beyond antimicrobials)
• Does treatment type matter?
• Importance of Minimum Inhibitory Concentration (MIC) of antimicrobials in effluent and biosolids
• Or sub- MIC selection?
• Biosolids treatment
• Anaerobic digestion
• Hydrolysis
• Pasteurisation
• Liming

What we are doing

• UKWIR – have just completed a comprehensive literature review
• To be published shortly
• Several companies have PhD studentships and /or have supported

academia, eg REHAB project

• Collaborative investigation by companies and outside of, but

coordinated by, UKWIR – part of CIP3

• Characterise relevant ARB pathogens within and exported from

STWs

• Measure indicators of variables for risk of HGT
• Aiming to understand:
• The effect of transition through treatment (numbers,

proportions, diversity)

• If there is any influence of treatment type (10 STWs)
• If AMR dynamics can be explained by physiochemical

and biological parameters

• Originally planned commencement March but delayed…..
• Completion and reporting 2022

AMR & other emerging issues

Rowan Byrne

Marine Technical Lead

Mott MacDonald

Plastics Innovations Solutions Rowan Byrne Technical Principal - Marine Ecology Marine Plastics Lead

IEMA Sustainability Leader Awarded 2020 rowan.byrne@mottmac.com November 2020

23 November 2020 Mott MacDonald | Plastics 2

Plastic statistics

Marine Litter has increased by 135% since 1994, with plastics

increasing by 180%

There is currently a

plastics patch twice the size of Texas

floating in the Pacific

8 – 13 million tonnes

• f plastic entering the
• cean each year

Unless action is taken, prediction that oceans will contain more plastic

than fish by 2050 Plastic bottles take 450+ years to break down and eventually

become microscopic

More plastic made in the first decade of the 21st century than the whole of the 20th century

Quantification + Categorisation: Weird and Wonderful Finds

8

Ecological enhancement Complexity is good for Biodiversity.

• In ecological enhancement

complexity is good for

• biodiversity. Urbanisation

is recognised as a major pressure on biodiversity. Ecological enhancement involves undertaking management interventions at the design stage to improve the ecological potential of these structures, or to improve the ecological value of existing structures.

• Setting aside space to create woodland, wetland, wildflower

meadows or other habitats of value to wildlife

• Using native plants in the landscaping design, which are of value in

their own right and as habitat for other wildlife

• Green roof on one or more buildings, providing habitat for plants

and animals typical of brownfield sites

• Climbing plants on walls within the new development which can

provide shelter and foraging opportunities for wildlife. Inclusion of bird and bat boxes within new buildings

• Use of sustainable urban drainage systems which double as wildlife

habitats, for example, swales and balancing ponds An alternative finance the enhancement of a nearby site of nature conservation interest or even the creation of new habitats on other land of low current ecological value. Complex surfaces create more habitat for ecological niches to form and be building blocks for Features being used as measures to enhance site biodiversity include:

Shark Skin-Like Surface Fights MRSA highly adapted Pattern to resist attachment of living

• rganisms
• Shark Skin-Like Surface Fights MRSA
• Surfaces covered in a micropattern mimicking the ridges of shark

skin could reduce the spread of drug- resistant Staphylococcus aureus and other superbugs in hospitals.

• Surfaces were sampled for remaining contaminations either

immediately following exposure to MSSA and MRSA or 90 minutes after being exposed. The Sharklet micropattern reduced transmission of MSSA by 97% compared to the smooth control, while copper was no better than the control. The micropattern also harboured 94% less MRSA bacteria than the control surface, while the copper had 80% less.

• Shark skin itself is not an antimicrobial surface, rather it seems

highly adapted to resist attachment of living organisms such as algae and barnacles. Shark skin has a specific roughness and certain properties that deter marine organisms from attaching to the skin surface. We have learned much from nature in building this material texture for the future.”

Shark skin is covered by tiny flat V-shaped scales, called dermal denticles, that are more like teeth than fish scales. These denticles decrease drag and turbulence, allowing the shark to swim faster and more quietly. The study showed that Sharklet harboured 94% less MRSA bacteria than a smooth surface, and fared better than copper, a leading antimicrobial material. The bacteria were less able to attach to Sharklet’s imperceptibly textured surface, suggesting it could reduce the spread of superbugs in hospital settings.

Plastic Vectors & Pathogens

PATHOGENS PLASTICS AS VECTORS FOR TRANSPORT OF PATHOGENS & SUPPORTING HABITATS

• Every piece of plastic that holds water is a potential breeding ground for
• insects. The more plastic there is lying around, the greater the number
• f breeding places.

EXAMPLE ZIKA VIRUS

• In May 2015 outbreaks of Zika fever were detected in Brazil. The

symptoms of Zika virus disease include fever, rash, conjunctivitis, and muscle pain. The World Health Organization called the Zika outbreak “a global public health emergency” and recommended preventing the accumulation of garbage – such as plastic and car tires – in open areas and covering water reservoirs to keep mosquitoes out.

• There is a direct link between plastic debris and the risk of infectious
• disease. This is a major problem especially in slums in tropical areas.

Floating plastic can also be a source for the spread of pathogens, including cholera bacteria. Investigations into the relationships between plastic and pathogens are just beginning and we have only recently become aware of the plastisphere.

• Polyethylene, polypropylene and polystyrene microplastics

carried Vibrio spp

Erik Zettler clears away some sea life to access the samples of plastic that he and Linda Amaral-Zettler keep immersed in seawater to

• bserve how microbial communities establish and develop on them
• ver time. Photo by Shanna Baker

Municipal wastewaters pathogenic viruses Covid-19 sewage monitoring scheme success

• Municipal wastewater harbours a great variety of

pathogenic viruses . Extensive research has been undertaken on the persistence of human enteric viruses (e.g. noroviruses, enteroviruses, adenoviruses, rotaviruses, hepatitis A/E viruses), transmitted via the faecal-oral route, in wastewater and in the aquatic environment . Enveloped viruses (e.g. coronaviruses), which rapidly inactivate without a host, have also been found in wastewater.

• Temporal changes in viral concentrations in wastewater

can therefore indicate the presence or absence of a virus, related outbreaks in the population, and their effect on public health.

• Hence, domestic wastewater monitoring may be an

important tool to assess and mitigate viral outbreaks in a

• community. In this review, we aim to critically assess the

recent efforts on using wastewater surveillance to represent public health, with a focus on SARS-CoV-2 surveillance.

Oct 23rd 2020 Early warning system’: DEFRA claims Covid-19 sewage monitoring scheme success A programme to detect coronavirus in sewage is now sharing data with NHS Test and Trace, with plans to roll the scheme out further, after early results successfully demonstrated that fragments of genetic material from the virus can be detected in wastewater, the government has announced. DEFRA and the devolved administrations are setting up a working group to identify SARS-CoV-2 in sewage, following a growing body of research claiming that wastewater plants can be used to identify outbreaks in local communities.

DEEP DIVE INTO THE PLASTISPHERE & DANGEROUS HITCHHIKERS

PLASTISPHERE The plastisphere is the layer of microbial life that forms around every piece of floating plastic. These are bacterial colonies that consist of more than a thousand different organisms. German research from 2016 showed that various bacterial species of the genus Vibrio can attach themselves to floating microplastics. Vibrio bacteria are known as pathogens that can cause infections in both humans and animals. Vibrio cholerae causes cholera in humans. Plastic waste and microplastics are not, or are barely, biodegradable and so they can remain in the environment for a long time acting as vectors (a means of transport) for pathogens. In this way, plastic can spread microorganisms, including pathogens, in the sea but also in the air. Almost all microplastics examined showed weathering and the formation of a ‘plastisphere’.

Work, using DNA and RNA analysis to determine the type and abundance of microbes in a sample and to gather

• ther clues about Plastispherians

A scanning electron micrograph shows a single-celled alga attached to polyethylene that was immersed in seawater off Woods Hole, Massachusetts. Image by Erik Zettler

Pit formers, & Microbial Communities

• In 2011, during SEM visits to the plastisphere, the microbial ecologists discovered “pit formers”—microbes

that appear to be creating craters on the plastic’s surface—on samples they collected from the open ocean.

• It was the first time pit formers had been noted on plastic from a natural environment. They believe pit

formers are degrading plastic, though so far have no evidence that they’re consuming it (and Amaral-Zettler quickly notes that pit formers are definitely not the solution to the world’s plastic debris problem).

• Their larger investigation into microplastics has also yielded other surprises: they’ve learned that microbial

communities on microplastics are significantly different than populations in the surrounding seawater, and from one piece to the next.

• There hasn’t been more homogenization of communities. They chalk that up to the fact that each piece of

microplastic in the ocean could have a different life history.

• Where it comes from—a sewage plant or the back of a boat, for example—how much ultraviolet radiation or

wave action it’s been exposed to, or whether it’s been swallowed and expelled again by an animal could all influence the microbial community.

• What’s more, life in the plastisphere is dynamic, with competition and predator-prey interactions, and—as
• n any island property—is limited by resources such as nutrients like nitrogen, phosphorous, potassium, and
• carbon. Which is why the goal of determining how long a piece of plastic has been in the ocean is not a

straightforward equation.

Pit formers up close & microbial reefs

A scanning electron micrograph shows pit- forming microbes on the surface of a piece

• f plastic collected in the open North
• Atlantic. Image by Erik Zettler

The goal of determining how long a piece of plastic has been in the

• cean is not a straightforward equation.

Results show “relatively predictable” patterns in how a community establishes and then develops, particularly over the first few months. Having a rough idea of how long plastic has been in the water can, in turn, help guess where a piece of plastic might have travelled from. A variety of single-celled organisms make up the microbial reef seen here on a piece of plastic from the

• pen ocean. (Courtesy of Erik Zettler)

Quantification + Categorisation: Weird and Wonderful Finds

8

This all happens on the surface of plastics…

• Plastics influence the spread and control of

microbes

• Microbes will be part of the solutions to plastics

and health benefits

• Microbes are indicators of changing health of

the environment

• Microbes evolve adapt and change to

anthropogenic influences and survive and die depending on mix of environmental and human influence

• This all happens on the surface of plastics
• Plastics are not the enemy

Thank You

Rowan Byrne Marine Ecology-Technical Lead Marine Plastics Lead EVT Sustainability Lead. IEMA Sustainability Leader Awarded 2020 rowan.byrne@mottmac.com

AMR & Covid-19

Sarah Dobson

Health Specialist

Mott MacDonald

AMR & SARS-CoV-2

Opportunities for shared learning.

23 Nov 2020

AMR & COVID-19

COVID-19

Global pandemic

AMR

Global health threat

Current number of deaths: 1 333 742 globally Current number of confirmed cases: 55 326 907 globally

(as of 19 Nov 2020) Source: WHO Coronavirus Disease (COVID -19) Dashboard

~700,000 deaths each year globally (2016 low estimate) Predicted number of annual deaths: 10 million globally by 2050 of which 3 million due to drug-resistant E-Coli. Estimated attributable deaths 33,000 per year in the EU/EEA * (data 2015) Rapid rise in vancomycin-resistant isolates

• f E. Faecium in the EU/EEA, from 10.5%

in 2015 to 18.3% in 2019.

Both COVID-19 and AMR can wipe out decades of development gains

Mott MacDonald 23 November 2020

Half content layout subtitle

AMR predicted to account for 100 trillion USD lost from world production over the next 35 years

Mott MacDonald 23 November 2020

AMR – the cost of preparedness

Price tag for global action on AMR estimated by the World Bank at $9bn per annum The Bank argues that putting resources into stopping resistance now is one of the highest-yield investments any country can make. In addition to its critical importance for controlling AMR, the capacity- building agenda will reduce the risks of pandemic infections of all types, increase preparedness, and enhance numerous facets of public health.

Mott MacDonald 23 November 2020

AMR – Similarities to COVID-19

​ Ø The organisms (and their resistant genes in the case of AMR) can easily spread through movements of people + animals i.e. geographically and ecologically. Ø Can cross over into different species. Ø Organisms causing infection for which there is limited or no effective treatment Ø Impacted by WASH Ø Secondary infection and antibiotic resistance in patients with COVID-19 Ø Widespread use of biocides for disinfection of private and public spaces

Mott MacDonald 23 November 2020

Adapting to change in the Health Sector

q Around 63.5% of estimated infections caused by resistant organisms per year associated with health care in EU/EEA). (longer hospital stays and greater cost). q Infection prevention and control (IPC) key to controlling transmission of resistant infections and viruses such as SARS-CoV-2 (COVID-19). q Mott MacDonald has been involved in some early thinking on the opportunity to build in preventative requirements at design, construction and operation stage of hospital building e.g. single occupancy patient rooms, air filtration etc. Healthcare facilities do not typically have wastewater treatment plant at the point of discharge to municipality drainage line, but the

• ptions should be analysed.

COVID-19 Response / AMR requirements

​Weaknesses

§ Not enough diagnostics, lack of investment § Lack of national standardized guidelines for surveillance of secondary bacterial infections § Infection Prevention and Control failures – supply chain

​Strengths

§ Specialists together for joint decision making § Unprecedented synergy private, academic, government

Mott MacDonald 23 November 2020

• More effort is required to create surveillance systems that

provide data sufficiently accurate to influence policy and

• action. This applies also to antibiotics and resistant genes

circulating in the environment. Oct 2019 - Charles Clift Centre on Global Health Security : review on progress on recommendations in O’Neil report. Need for the standardised monitoring of water samples e.g. for E.Coli or Enterococci

Standardised monitoring is required

Mott MacDonald 23 November 2020

Waste-water surveillance for COVID-19

​Routine wastewater surveillance of viral RNA in wastewater ​Presence in a community / trends over time (is it increasing/decreasing). Trends follow the same pattern as clinical case reporting (demonstrated in Ile-de-France).

​Earlier identification of outbreaks  earlier implementation of mitigation measures  reduced impact

Ø Sewage monitoring is being established across the UK to detect new outbreaks of COVID-19: https://www.gov.uk/government/news/group-to-measure-for-coronavirus-prevalence-in-waste- water Ø Scottish Environment Protection Agency has begun analysis of the first samples of waste water ​Wastewater surveillance is important in Global Polio Eradication Initiative

Mott MacDonald 23 November 2020

Waste-water surveillance - AMR

​Routine wastewater surveillance could be used to monitor for potential harmful increases in antimicrobial- resistant bacteria and AMR genes Ø Antibiotics as an emerging contaminant within water supplies. Ø Antimicrobial usage is a major driver of AMR gene outflow from hospitals into the sewage

• environment. (Lancet: Nov 2019).

Wastewater treatment plants

Ø Can act as reservoirs and environmental suppliers of antibiotic resistance. Ø Hotspots for horizontal gene transfer – spread between bacterial species Ø Antibiotics, disinfectants and metals can form a selection pressure for antibiotic resistance, even in low concentrations *.

​* Antti Karkman et al. Antibiotic-Resistance Genes in Waste Water. Trends in Microbiology. Volume 26, Issue 3, March 2018, Pages 220-228

​ ​

Mott MacDonald 23 November 2020

Is the Health Sector signalling a legal change ?

​Response to the COVID-19 Pandemic – legal requirements for public health measures ​Outbreaks of resistant organisms traced to a particular source may have legal implications.

​World Health Organisation and UN General Assembly 2016 : Global Action Plan on AMR ​UK Government:

v 2019 World economic forum in Davos. Commitment on reducing environmental impact of AMR v 20 year vision for AMR (2019-2040). Current 5 year action plans (2019-24) ​ To contribute to the global effort through: ​ A lower burden of infection, better treatment of resistant infections, and minimised transmission in communities, the NHS, farms, the environment and all other settings. Collectively strengthening policy and practice, ever improving understanding through research and surveillance, developing effective regulation and advocacy to contain and control resistance.

​

Mott MacDonald 23 November 2020

Contained and Controlled : UK Govt 20 year vision

​…minimise the potential threat of antimicrobial resistance and the dispersal of the drivers of resistance in the environment by promoting: − effective waste and waste water treatment and handling; − low use antimicrobial aquaculture practices; and − environmental stewardship by manufacturers of antimicrobial products

Five-year UK national action plans prioritise actions based on the latest information about what the biggest risks are and which interventions are most effective in addressing them.

In both the cases of AMR and pandemic preparedness, the failure to invest in preventing the challenges of emerging infectious diseases has proven tragically costly

Newsletter of the Antibiotic Resistance Coalition (ARC)

https://mailchi.mp/b519d7460143/march- 2020-arc-newsletter#covid

Thank you

Q&A SESSION

THANK YOU FOR ATTENDING & THANKS TO ALL OUR SPEAKERS FOR THEIR CONTRIBUTIONS