Impact case study database

Exeter’s research and knowledge exchange activity has transformed the strategies designed to combat AMR, and influenced national and international policy and practice, in organisations including the United Nations, WHO, UK Research and Innovation and the UK government.

4.1 Impact on UK government and industry strategy, policy and practice

Prof 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 [ 5.1]. 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” [ 5.2].

The Beach Bum Survey [ 3.6] 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 [ 5.2]. 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 [ 5.3], who was the UK Chief Medical Officer (CMO) from 2010 to 2019 and is currently the UK’s Special Envoy on AMR.

Advice provided by Prof Gaze has underpinned national policy at the highest level. In addition to research conducted by Gaze and collaborators, 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 [ 5.4]. Professor Dame Sally Davies also acknowledged this work as being greatly informative to her [ 5.3] . Gaze has also advised the UK’s Review on Antimicrobial Resistance, which was commissioned in July 2014 by the UK Prime Minister [ 5.5]. 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 [ 5.6]. He 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 [ 5.6].

Prof Gaze’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. The EA Theme Expert said: “ This network leads the way on developing ideas for environmental AMR surveillance and has brought together key individuals from government organisations and Defra agencies including PHE, VMD, APHA and the EA to discuss this issue for the first time”. “ Interactions with WG and his group have played a key part in development of policy and practice in this area [ 5.7]

Leonard and Gaze are now working with the Environment Agency to trial environmental AMR surveillance methodologies pioneered in the Beach Bum Survey [ 3.6], demonstrating a direct impact on agency surveillance practice [ 5.7] and illustrating the implementation of a key policy objective described in the UK AMR Strategy.

4.2 Impact on EU policy on AMR

The Exeter team has worked with the European Environment Agency (EEA) and European Commission Joint Research Centre (JRC) to inform policy and regulation on AMR and the environment. The team’s research [ 3.2, 3.3] resulted in two antimicrobials (trimethoprim and sulfamethoxazole) being included on the EU Water Framework Directive's Priority Hazardous Substances Watch List (EU) 2020/1161 [ 5.8]. This lists potential aquatic pollutants that should be carefully monitored by EU member states to determine the risk they pose to the aquatic environment, and whether they should be subject to EU Environmental Quality Standards (EQS).

The Water Industries and Pollution Expert at the EEA, who is involved in Water Framework Directive policy formation, said that the research on sulfamethoxazole and trimethoprim “ informed the discussion for the new watch list, as can be seen in the meeting paper acknowledgements and JRC’s technical report acknowledgements" [ 5.8]. This is evidence of Exeter’s direct impact on the formulation of EU policy about the regulation of antimicrobial pollutants, based on their ability to drive the evolution of AMR. This will result in changes in environmental surveillance for potentially hazardous chemicals.

4.3 Contributions to global AMR policy via the United Nations

Prof Gaze is either the sole adviser, or one of a handful of advisers globally, on this subject to UNEP, WHO and FAO. He is now a member of the UNEP Expert Group on AMR and Environment; sits on the WHO/FAO pesticides and fertilizers working group, contributing on AMR and environment issues; and is part of the European Food Safety Authority's working group on AMR in livestock production environments.

Prof Gaze and colleagues’ research has also informed international AMR policy directly, with several citations in international policy documents such as the WHO / UN Food and Agriculture Organization (FAO) report on AMR in the food chain in 2019 [ 5.9]. Research carried-out by the group has also underpinned WHO recommendations: the Beach Bum Survey [ 3.6], for example, helped guide the WHO recommendations on scientific, analytical and epidemiological developments relevant to the parameters for bathing water quality in the European Bathing Water Directive (2006/7/EC) [ 5.10].

Prof Gaze was the lead co-author of the United Nations Environment Programme (UNEP) Frontiers Report on AMR and the Environment, published in 2017 [ 5.11a]. Gaze presented the UNEP Frontiers Report at the 3rd meeting of the UN Environment Assembly in Nairobi in 2017, at which countries around the world, including the UK, made a commitment to combat antimicrobial resistance from an environmental perspective for the first time [ 5.11b]. This marked the first time that the importance of the environmental dimension of AMR was highlighted at a United Nations Environment Assembly.

The UNEP report [ 5.11a] was one of only two natural environment AMR citations in the UN Interagency Coordination Group’s (IACG) final report to the UN secretary general, which is the most significant AMR report produced to date [ 5.12]. Its key conclusion was: "Antimicrobial resistance is a global crisis that threatens a century of progress in health and achievement of the Sustainable Development Goals." The IACG was formed following the 71st Session of the United Nations General Assembly, at which Member States adopted the Political Declaration of the High-level Meeting on Antimicrobial Resistance. This declaration, to which Gaze made a significant contribution highlighting the importance of the natural environment, recognises the magnitude of this global problem and provides a consensus about the actions needed to prevent a post-antimicrobial era.