Impact case study database

Appointment as Chief Scientific Advisor to the Food Standards Agency

Poppy’s research into the assessment and communication of risk, and a systems approach to food security, was fundamental to the FSA’s decision to appoint him as the first CSA in August 2014. Catherine Brown [ 5.1], FSA Chief Executive (2012 to 2017), cited the importance of Guy’s risk assessment and food security research [ 3.2]. She was “ particularly attracted by the international focus of his research, evidenced through many international collaborations and publications, because we were moving the FSA to recognise the global nature of the food system and away from a more parochial UK/European focus historically… His focus and body of work on food systems wider than the traditional microbiological focus of the FSA’s science leadership was very important in enabling us to embrace new aspects of science – particularly data science and social science.”

Poppy has contributed to the work of other CSAs across government with “ his research-led expertise taken from a published body of work on risks in challenging areas such as GM crops and food safety,” confirms the CSA for the UK Government as a whole, Sir Patrick Vallance [ 5.2]. He said: “ These have been exemplars for environmental and public health risks which many of the CSAs need to oversee in their departments.” Throughout six years in post, Poppy played a significant role in reshaping the process of science-based policymaking across government, achieved substantial progress in addressing specific public health challenges, influenced high-level policy and legislative debates, and increased public understanding of food-related health risks.

Embedding a systems approach to food security within UK Government policymaking

Poppy’s systems approach made significant contributions to restructuring the scientific advisory functions of the FSA. According to FSA Director of Science Steve Wearne [ 5.3], a “ key influence of Guy’s research-led expertise was in the focus and methodology for the triennial review of FSA’s scientific advisory committees in 2016.” Poppy’s recommendations led to the creation of the FSA Science Council (SC), an independent expert committee designed by Poppy to provide strategic insight and advice on the FSA’s use of science. The SC has since provided guidance on key principles of risk analysis, which were agreed by the FSA Board following input from Poppy, based on his risk research. The new SC has “ fundamentally changed the FSA’s capabilities”, says Wearne, giving the FSA access to a broader range of interests and expertise. Chair of the FSA board Heather Hancock [ 5.4] said: “ *I have seen a much more targeted and focussed approach of the SC, which has made a real difference to the FSA.*”

Poppy reshaped the FSA’s scientific advisory committees’ objectives, resulting in some being disbanded and new committees being formed. Hancock said: “ Guy influenced the outcome by repositioning the committees to be more appropriately designated forums, which provide agility by allowing flex in the membership for new food risks that arise.” [ 5.4] The impact goes beyond the FSA: Chief Medical Officer Prof Dame Sally Davies [ 5.5] describes the new advisory structure led by Poppy as “ much more structured and effective” which “ has made a big impact (on) our evidence-based work and is absolutely essential in ensuring high-quality evidence flows”. She said: “ Guy has … broadened the field of the committee, which has made a vast difference. Specifically, FSA submissions are more science and evidence based than they were before e.g. the written submissions to me and ministers.” The committee restructure allowed Poppy to recruit more multidisciplinary academics, reflecting the ethos of the whole system approach. Poppy had a central role in the FSA’s recruitment campaign. Videos featuring Poppy received 14,120 views via platforms like LinkedIn, leading to 86 high-quality applications for 40 roles. This resulted in the recruitment of 40 new experts covering risk, AMR and regulatory approaches to emerging new food security challenges post EU exit. Wearne said: “ Through this refocussing … the FSA is now as prepared as it can be – whatever the nature and timing of the UK’s exit from the EU. Guy’s research on GM helped to get a handle on the future capacity and capability within the FSA both internally with staff and also in terms of the external advisory support.” This fed into the FSA’s successful bid to the Treasury for additional funding of £30m over three years, he added. [ 5.3]

Poppy’s research around GM crops, risk analysis and dynamic systems approach to food security has shaped the FSA’s new horizon-scanning capabilities. Hancock and Wearne confirm that Poppy’s research [ 3.4, 3.5] has helped steer an 18-month SC programme, culminating in the 2019 RAND Europe report of a new strategic surveillance system. Its conclusions, including the more effective use of data and novel risk assessment methodologies, “ will determine the future approach to horizon scanning and the methodologies used”, according to Wearne [ 5.3]. FSA Chief Executive Jason Feeney [ 5.6] said: “ *Guy’s work on horizon scanning has contributed to a process of prioritisation of research whether it be through commissioning in house or through data mining.*” This has reduced the FSA’s science spend by GBP3,000,000 to GBP4,000,000 per year, he said.

Poppy’s “ work on food systems [ 3.5] and horizon scanning [ 3.4] was pivotal for the FSA in designing and delivering the work on ‘Our Food Future’”, Wearne said. This report (February 2016), explored public concerns on an increasingly complex global food system. Wearne states that Poppy’s research provided “ a sense that it was reasonable for FSA to connect personal health with food security… his accomplishment in interdisciplinary research was influential in stitching together a coherence in what was, until then, a disparate evidence-base” and “ led to range of publications and materials that are widely regarded and quoted in the field and which, even three years on, will provide foundational material for Henry Dimbleby’s major review of the food system for Defra.” [ 5.3] Vallance confirms that Poppy’s horizon-scanning work “ contributed to the cultivation and creation of policy for UK science, …helping shape and drive a new £50 million strategic priorities programme on UK food systems informed by his research” [ 5.2]. This programme, launched in October 2019, appointed Poppy as Programme Director. Poppy is a member of the cross-government group of CSAs, chaired by Vallance. According to Prof Sir Ian Boyd [ 5.7], CSA for Defra, Poppy has increased the government’s capabilities in behavioural sciences research, which has helped develop cross-department linkages. This, says Wearne, has given the FSA “ disproportionate influence” relative to its size by improving communication of FSA science to select committees [ 5.3].

Shaping the UK food policy response to exiting the European Union

The FSA will ensure that EU-level activities are repatriated to the UK. Vallance said: “ Guy has influenced the development of resilience planning informed by his research on the global food system”, noting his analysis of post-Brexit meat supplies in [ 3.6], “with the US offering the potential to become a main exporter to the UK, which brings issues relating to UK food standards and safety such as chlorine-washed chicken and hormone-treated beef. This expertise has been particularly impactful in Operation Yellowhammer planning and in emergency planning exercises.” [ 5.2] According to Hancock, “ the FSA has needed to completely redesign a risk analysis system that the UK can rely on outside of the EU” and Poppy’s contribution “ has enabled the FSA to build a system that will be resilient and robust”. She said: “ Guy’s ability to *anticipate where and when the challenges will arise, and then utilise his work in this area to assess the science and evidence, and therefore build a regime which accepts challenge (but does not bow under the weight of it), is critical.*” [ 5.4]

According to Boyd, Poppy has played an active role in developing the UK’s new Advisory Forum on Food and Feed to replace risk assessment by the EFSA [ 5.7]. As Feeney puts it, “ end-to-end risk analysis within the FSA had to almost be designed from scratch”. He said [ 5.6]: “ This work has placed the FSA, in terms of international best practice for risk management, in the top 2 or 3 countries in the world with all Guy’s work around risk analysis absolutely at the centre of this process [ 3.2] .” Poppy’s research on data standards on meat flows [ 3.6] informed wider considerations around imports and exports, says Wearne, and has “ *aroused significant interest from other national food regulatory bodies, notably in the US (FDA), Canada (CFIA) and provides the basis for significant future international collaborations, leveraging interest and investment on a global scale.*” [ 5.3] Feeney confirms that these novel approaches to risk were presented to the Codex (WHO and FAO) international food standards committee and that feedback from Codex said the FSA “ *is setting new benchmarks in terms of transparency and openness.*” [ 5.6]

Reducing food industry use of antibiotics in order to address AMR

Poppy’s research on AMR has made a significant contribution to reducing the food industry’s use of antibiotics in animals. His CSA Science Report on AMR in 2016 [ 5.8] provided the first evidence of AMR levels in campylobacter in broiler chickens. Poppy then played an instrumental role in bridging disagreements between the medical and agri/vet sectors. As Davies, UK Special Envoy on AMR, explains: “ *Guy has worked and published on evolutionary selection and trade-offs in resistance and has used his research expertise to nudge industry to accept the need to act. I have seen that Guy has persuaded the FSA to undertake more surveillance of AMR. He has driven the FSA to have fruitful discussions with industry on a different level to what had been achieved prior to his appointment.*” She said that Poppy’s framing of AMR as an evolutionary biology problem “ was important in convincing the FSA and industry to undertake long-term surveillance.” She used Poppy’s CSA Science report in her presentation to the UN Global Summit on AMR in 2016 at which global leaders, for the first time, committed to taking a “ broad coordinated approach to address the root causes of AMR across multiple sectors”. [ 5.5]

Poppy was acknowledged as a key contributor to Prof Lord Jim O’Neill’s Review on AMR, commissioned by the Prime Minister in 2014 and published in 2016. Hancock said: “ Without Guy’s intervention and the meetings that he had with Professor Lord Jim O’Neill, the role of food in either transmission or building resistance would have almost completely been overlooked. *The use of a ‘one health’ approach, driven by Guy, has made a material difference. Without this work being included in the O’Neill report, the FSA would not have achieved the significant impact it has had on antibiotic use in the primary production sector.*” [ 5.4] This impact was demonstrated in the 2019 Veterinary Antibiotic Resistance Sales and Surveillance report [ 5.9], which showed that sales of antibiotics for use in food-producing animals fell by 53 per cent from 2014 to 2018. Sales of ‘Highest Priority Critically Important Antimicrobials’ were down 68 per cent. Fresh meat product sales also increased with sale values of GBP2.7bn for fresh poultry and GBP1.7bn for fresh beef. This increase in trade reflects the use reduced antibiotics.

Influencing government policy debate around legal requirement for food hygiene ratings

Campylobacter, the leading cause of food poisoning in the UK, costs the economy GBP1bn a year. The need to reduce foodborne illness led to the introduction of the FHRS in 2012, designed to help consumers choose where to eat out, or shop for food, by providing clear information about business hygiene standards. In Wales and NI FHRS sticker display is mandatory by law but voluntary in England. Poppy’s CSA Science Report, December 2017, explored the scheme’s impact and resulted in a 2019 paper [ 3.7] that demonstrated its efficacy. Hancock said the research provided the FSA “ with the evidence-base for pushing forward with the final hurdle for persuading the Government to legislate FHRS mandatory display in England.” [ 5.4] Feeney added: “ *This will shift the balance from protecting 4-5 million people (in the devolved nations) to protecting 65 million nationally and will create practical ways of making a difference. The model developed in the paper offers estimates of savings to the Health Economy, which will be used in the case for mandation.*” [ 5.6]

Improving public understanding of food safety and risk through communication of science

Poppy has participated in Scientific Advisory Group for Emergencies (SAGE) exercises, assessing food safety risks and communicating those risks to the UK public including the 2020 COVID-19 SAGE (food and packaging). Vallance said: “ *His leadership and expertise in this difficult area is enhanced by his published work on risk assessment and how to manage and communicate complex risk decisions.*” [ 5.2] In August 2017 millions of eggs were pulled from supermarkets across Europe after the discovery that some had been contaminated with fipronil. Feeney notes for the FSA, this was a “ major incident”… “ Guy’s expertise on risk assessment contributed significantly to enabling the FSA to produce evidence quickly with appropriate messages for the public … Using his risk research, Guy set the interventions appropriately to reassure the UK population” [ 5.6]. As a result millions of food products were kept in UK food businesses, ensuring a major public health incident was avoided without significant economic impact.

Poppy has engaged with the media to communicate food safety risks to the public, appearing on the likes of BBC Radio 4’s Today Programme and BBC 2’s Victoria Derbyshire programme to discuss the issues including fipronil in eggs, cancer risks from acrylamide in burnt food and the safety of rare beef burgers. The thematic CSA Science Reports [ 5.10], which explain key issues in accessible language, were Poppy’s initiative and, combined, have had 219 unique downloads over the impact period [ 5.11]. Poppy also contributed to two ‘FSA Explain’ videos on Arsenic in Rice and AMR [ 5.12]. The latter was the FSA’s best performing video on Twitter with engagement of 2.1%, and the agency’s second best performing video on Facebook with an engagement rate of 4.6% (industry average is 1-2%).

Ensuring FSA prioritises policies that protect people with food allergies and intolerances

In September 2018 a teenager died as a result of an allergic reaction to food consumed which did not display allergen information on the packaging. A UK-wide consultation followed and, in May 2019, the FSA Board agreed on advice for Ministers that full ingredient labelling should be mandatory for all pre-packed foods for direct sale. In June, the Environment Secretary proposed new legislation to this effect, to come into effect by summer 2021. Hancock, Chair of the FSA Board, said at the time: “ This is an important step forward in our ambition for the UK to become the best place in the world for people living with food hypersensitivities.” [ 5.13] The recommendations adopted by the FSA Board were based on evidence that Poppy had presented, which showed the health outcomes that the FSA could achieve by prioritising food hypersensitivity. Hancock said: “ *From my perspective as Chair, the FSA could have been in a risky position if it had not used this evidence to increase the focus on food hypersensitivity. I would have found it much more difficult to deliver this important outcome from the Board without Guy’s input.*” [ 5.4]

Global public interest and recognition

AudioMoth is the first device to bring large-scale environmental acoustic detection within the means of conservation organisations and local-scale research projects, achieved with open-source hardware and software [ 3.4]. Its utility was immediately recognised on its launch in December 2017, with a rapid uptake of interest in the devices. The publication of reference [ 3.2] announcing AudioMoth coincided with a talk by University of Southampton PhD student Piña-Covarrubias at the 2017 Meeting of the British Ecological Society (BES), and a BES blogpost on her talk, and subsequently a blogpost by Sparkfun, the biggest electronics hobbyist website in America with 100,000 reads per day of their website. AudioMoth has also featured in two articles for the New Scientist magazine, and headlined two for Mongabay, a non-profit provider of conservation news with 2.5 million visitors per month. University of Southampton PhD students Hill and Prince showcased AudioMoth at the 2018 Conference on Illegal Wildlife Trade held in London, where they attracted interest in the devices from Prince William the Duke of Cambridge, and Jeremy Hunt then Secretary of State for Foreign and Commonwealth Affairs [ 5.1].

AudioMoth has won prizes from community forums, and commendation from the applied-science community [ 5.1]. It was a winning entry for the 2019 TECH HUB programme of the Google-funded WILDLABS web-forum, showcasing its role in tackling illegal trade in wildlife, and a finalist for the Con X Tech Prize, and micro-grant winner from the US-based Conservation X Labs. Reference 3.2 announcing AudioMoth became ‘Highly Cited’ in Web of Science (top 1% of field-weighted citations) within 18 months of publication. The Bayesian methods developed by the AudioMoth team, for optimal placement of the devices and localisation of the sound sources they detect, were commended in the editorial ‘Making an impact’ for the Remote Sensing in Ecology and Conservation 5-Year Anniversary Collection (June 2020), which includes reference 3.6 in its collation of the journal’s 13 best and most highly cited research articles.

AudioMoth features as a case study in outputs by scientists calling for policy change, and by NGOs and companies involved directly in conservation action [ 5.2]. AudioMoth is a case study in a 2019 call for international leadership and coordination to realise the potential of conservation technology, published in BioScience. The call declares that the “ AudioMoth acoustic device is one of the best existing examples of how technologist talent in a small independent team can achieve global scale, supported by service provision within the context of open innovation”. AudioMoth features as a case study in the 2017 WWF Acoustic Monitoring Guide to sensor selection and deployment, and in the 2017 annual report of the WILDLABS web-forum, whose members coordinate large group-orders of AudioMoth. The Puerto Rican company Sieve Analytics Inc., which host the global Automated Remote Biodiversity Monitoring Network, say on their website: “ We highly recommend the AudioMoth recorders. We have had extensive field experience with these recorders, and they produce high quality recordings. Since the recorders cost < $100 (USD), you can greatly increase your sample size”. Founder Mitch Aide “ sees the AudioMoth as a huge boost for acoustics research around the world, especially for developing-world researchers on small budgets” according to filmmaker Adam Welz reporting for YaleEnvironment360.

By April 2019, these diverse routes to global awareness had resulted in AudioMoths being deployed by 687 projects across six continents. Surveyed purchasers included universities (34% of devices), NGOs (23%), businesses (11%), and government agencies (1%), in a wide range of applications including monitoring of individual species and human-wildlife conflicts, marine surveys, ecosystem soundscape analysis, and university-level education. Purchasers were globally distributed, with clusters around the financial hubs of advanced economies, particularly in Europe (63%), North America (23%), and Australia (8%). Purchases made elsewhere included Central and South America (4%), Asia (2%), and Africa (<1%) [ 3.4].

Significance in democratising access

The centralised management alternative to the standard commercial framework dramatically reduces participation costs and technical barriers to acoustic monitoring; it serves conservation organisations, which can adapt the scheme to their specific needs, and individual citizens, who may need only a single device. Within 18 months of its first public announcement, 5,242 AudioMoth units had been sold to individuals and organisations worldwide in six group-purchasing campaigns [ 3.4]. The revenue of USD262,048 from these sales (all at USD49.99) had outstripped the setup investment in development, and manufacture and distribution costs (USD203,859), to generate a pool of funds worth USD58,188 [ 3.4]. The not-for-profit Arribada Initiative [ 5.3] manages these pool-funds, guaranteeing their reinvestment, at about USD10 per device, into further research and development of AudioMoth. For example, Arribada has committed GBP3,500 to a CASE partnership with the UoS NERC-INSPIRE DTP, for a PhD project running from 2019-2023 to test large-scale deployments of AudioMoths in Belize.

Fig. 1. A rising passion for the devices is demonstrated in average increases of 176 funded units and 11 backers per 100 days since the first campaign in October 2017 [ 5.4].

As of 31 December 2020, the total of funded group purchases stood at 13,894 AudioMoth units (revenue of USD0.7M) distributed to 1,611 campaign backers, following the 11^th campaign in July 2020. Googling ‘AudioMoth’ brings up 12,200 results as of 7 December 2020.

The centralised management framework and open-access architecture have already started to realise their scope for accommodating intermediaries between the designers and users of the product, by individuals and groups [ 5.5]. Independent users have posted on the web two AudioMoth manuals, designs for weather-proof cases, live tuition in scaling up acoustic surveys with AudioMoths (93 participants), and a Facebook page to organise Latin American group purchases (299 members by 7 December 2020). The German commercial organisation LabMaker UG, an assembly service for open-science instruments, now purchases multiple AudioMoths to sell on ready-for-use at a unit price of USD74. The Zoological Society of London has collaborated with the Arribada initiative to adapt the original AudioMoth for fitting to birds in flight. Their creation of ‘µMoth’, reducing the weight from 30 g to 5 g, is the first community-led and open-source development on the AudioMoth design.

Significance in diversity of conservation impacts

In the survey of AudioMoth applications to April 2019 for reference 3.4, 14% of the framework's end‐users posted on social media about conservation work using AudioMoths, with conservation action occurring largely away from purchase locations. For example, Africa was the source country for only two sales, but the deployment location for 23% of purchases.

AudioMoths have been used to recognise three species of katydid insects (Orthoptera) as new to science [ 5.6]. The Brazilian researchers at the Instituto Latino-Americano de Ciências da Vida e da Natureza, and the Museo de La Plata, identified their unique songs in the UNESCO World Heritage Site of Iguaçu National Park. The naming of two new members of the genus Xenicola, containing only two other species, and an 11^th member of the genus Anisophya, is especially important at a time of unprecedented losses of taxonomic and functional biodiversity, given the 2019 IPBES global assessment of biodiversity finding 1 million animal and plant species facing extinction, and an absence of data on half the world’s 8 million species, particularly amongst the insects.

A recently completed large-scale deployment of AudioMoth acoustic sensors across 360 tropical-forest sites is “ *crucial to developing conservation priorities for the highly endangered spider monkey (Ateles geoffroyi)*” [ 5.7]. The landscape ecologist at Imperial College London who leads this conservation effort attests that the AudioMoth data “ will allow us to model the threats to this species and design landscape management strategies to mitigate these threats. … The cost-efficient performance of the AudioMoth device, combined with its extremely small size, is a game changer for environmental monitoring. AudioMoth deployments make it possible to collect conservation evidence across vast areas on relatively small budgets, and for the first time to monitor the acoustic landscape of biodiversity on a regional scale in Costa Rica”. Exemplifying AudioMoth’s diversity of uses, the same team go on to describe how the devices have enabled them to develop a new adaptable, open-source acoustic bat call detection and classification tool for the Atlantic Forest of Brazil, one of the most threatened biodiversity hotspots, where they have deployed the devices across 50 sites. They further “ highlight the reliability of AudioMoth devices,” with a failure rate of less than 5%, and their subsequent repurposing for post-graduate teaching.

The British Trust for Ornithology (BTO) finds that “ AudioMoth’s efficient performance has substantially lowered the barriers for systematic acoustic monitoring at county, national and international levels. … This device is crucial to the world’s first end-to-end system for monitoring bats in the UK, currently being implemented in the British Bat Survey by the Bat Conservation Trust and BTO, but its development has much wider implications for international bat monitoring” [ 5.8]. They post AudioMoths to citizen-science volunteers, who deploy them in their local area with an onboard bat-detection algorithm. The returned secure digital memory cards of acoustic data then add to an emerging online display of bat distributions. The 2019 pilot identified over 2 million bat calls. BTO’s Senior Research Ecologist concludes: “ Without this conservation technology and its underpinning research, there would not have been a step change in our ability to monitor bat populations in the UK, that is so important for informing future work and policy on bat conservation.”

At the invitation of the Belize Forest Department in 2018, the AudioMoth team field-tested the optimal-deployment algorithm described in reference 3.6, in combination with the onboard gunshot-detection algorithm described in reference 3.5, across 10 km² of Tapir Mountain Nature Reserve. The resulting detection of 139 gunshots over the course of 12 months’ uninterrupted monitoring, with 95% detection probability, persuaded the Belize Forest Department that illegal hunting is an ongoing problem in the reserve. Recognising that they lack the workforce of forest rangers to patrol the reserve, they have called upon the University of Southampton AudioMoth team to expand the survey to an optimal configuration of devices across all 25 km² of the reserve. This deployment had just begun in January 2020 when all fieldwork was stopped by the coronavirus pandemic. It will restart upon lifting of current restrictions.

Numerous other citizen-science projects, consultancies, governments and NGOs have adopted AudioMoths, with frequently-expressed enthusiasm on Twitter [ 5.9]. AudioMoth is the acoustic sensor for the CetaKit equipment supplied to divers by the Florida-based Cetalingua Project to monitor marine mammal vocalisations. It is likewise the chosen sensor for the NASA-funded Soundscapes to Landscapes project run by a consortium of NGOs and Universities, which combines Earth-observing satellites with ground-based sensors to map bird diversity across Sonoma County California. AudioMoths are one of the recommended devices for the Silent Cities participatory monitoring scheme to test for changes in ambient sounds in response to Covid-19. AudioMoths are used by consultants to government, with for example Bowland Ecology deploying them to survey bats for Blackburn with Darwen Borough Council, resulting in a recommendation for the Council to seek a European Protected Species Licence from Natural England. They are used by governments, with for example Mexican startup Ornitronik developing AudioMoth casings, and logistics for their mass production, for CONABIO, the Mexican government’s national commission on knowledge and use of biodiversity. AudioMoths are used by numerous NGOs, including the Shropshire Mammal Group for monitoring local mammalian fauna; the Tropical Biology Association for teaching; Fundação Príncipe Trust for biodiversity assessment on the African island of Principe, particularly seabirds and the Critically Endangered and endemic Principe thrush ( Turdus xanthorhynchus); the Prusten Project for improving the efficiency of protection for Endangered tigers. Fauna & Flora International (FFI) has bought 20 sensors for monitoring the Critically Endangered cau vit gibbon ( Nomascus nasutus) in Vietnam. FFI’s Technical Advisor says: “ AudioMoth has the capability to revolutionise acoustic monitoring of environments, by making it affordable in principle and feasible logistically to flood large areas of inhospitable ecosystems with sensors” [ 5.10].

Background: Translation of research findings into clinical trials

Keevil’s early research showing the effectiveness of copper in killing E. coli, Listeria and superbugs formed the basis of two influential clinical trials led by the Copper Development Association (CDA) in the UK and US:

The UK trial (2010) [ 5.1] was funded by the CDA and based in Selly Oak Hospital – the site of Keevil’s studies into superbugs. Keevil was an advisor to the trial and four of his studies were cited as key evidence. The trial reported a 90% reduction in bacterial loading on copper-plated surfaces.

For the US trial (2013) [ 5.2] the CDA obtained funding from the Department of Defense, crediting Keevil’s studies in giving them the confidence to undertake a major trial involving three hospitals [ 5.3]. The trial demonstrated a reduction in infection rates of 58% in intensive care units which incorporated copper plating onto the surfaces of six frequently-touched near-patient objects.

Harold Michels, the Vice President of the CDA, stated: “ Professor Keevil’s research has not only stimulated others to conduct laboratory research on the antimicrobial properties of copper, but also served as a foundation to those conducting clinical trials. The net result is that he has proven that copper alloys kill numerous microorganisms that cause hospital-acquired infections… Professor Keevil has persistently and enthusiastically advocated for reducing and preventing hospital acquired infections and thus saving lives by the use of copper.” [ 5.3]

Installation of antimicrobial copper surfaces in hospitals and other healthcare settings

The list below is a snapshot of the nature and extent of global clinical impact of antimicrobial copper surfaces since 2014, as reported by the CDA, following Keevil’s studies and the subsequent trials [ 5.4]:

• Kitasato University Hospital, a newly remodelled, 1,000-bed hospital in Japan, installed antimicrobial copper door furniture throughout its internal medicine, dermatology, pharmaceutical, haematology and outpatient facilities, while Hitachi Medical Center in Tokyo installed antimicrobial copper beds and overbed tables in its convalescent wards. These were two of nine Japanese hospitals to incorporate antimicrobial copper into their wards in 2014, according to Australian news source ‘Hospital and Healthcare’.

• The Sir Robert Ogden Macmillan Centre, a cancer support and information centre that was opened in 2015, and based at Harrogate, installed antimicrobial copper touch surfaces throughout their facility to maximise patient safety.

• The 774-bed Hamburg Asklepios Clinic, a large hospital in Germany that treats 76,000 residents per year, installed antimicrobial copper as part of a refurbishment in 2015.

• Santiago Public Emergency Hospital, a leading Chilean hospital, in 2015 installed antimicrobial copper bed rails and handles, and replaced door handles, sinks and taps and overbed tables with antimicrobial copper equivalents. This followed a clinical trial in nearby Valparaíso, which cited Keevil’s studies.

• South Africa’s ‘Miracle Trains’ – Transnet’s Phelophepa I and II – provide mobile healthcare to more than 300,000 people in remote rural communities annually. In 2015 the 18-coach trains were equipped with antimicrobial copper door handles and cupboard doors.

• Grinnell Regional Medical Center, the largest hospital in Iowa serving 40,000 residents, took the decision in 2016 to install antimicrobial copper hardware and components throughout its facility.

Overall, in the two years after the 2013 trial, the CDA recorded 60 hospitals in 20 countries in Europe, South America, Africa, and Asia that had installed antimicrobial copper surfaces and furniture. Installations had predominantly taken place in clinical settings where patients are at high risk for infections, such as ICU rooms, paediatric and neonatal units, and cancer centres. [ 5.5].

In terms of the economic significance, drawing upon the 2013 trial, a health economics assessment by the University of York [ 5.6] found that the cost of replacing the six near-patient objects in a 20-bed intensive care unit can be recouped in less than two months. This translates to a 5-year saving of almost GBP2,000,000 if antimicrobial copper surfaces are fitted during a planned build or refurbishment.

Installation of antimicrobial copper surfaces in public venues, transport infrastructure and commercial settings

Keevil’s demonstration of the benefits of antimicrobial copper has led to its use in public settings and transportation. The CDA reported the installation in 2014 of antimicrobial copper drinking fountains in the world’s busiest airport, Atlanta (107m passengers in 2018) and antimicrobial copper handrails on Poland’s Solis Urbino bus (European Bus of the Year, 2017). [ 5.7]

Keevil has a longstanding association with electroplating firm Necon Technologies Ltd, who learned of his research while investigating legionella control through copper silver ionisation. Necon’s copper touch surface business, Copper Cover, has relied on Bill’s validation of their products to bring them to market, including a 2020 test for SARS-CoV2. The pandemic has seen the company coat more than 10,000 commonly touched surfaces in locations such as care homes, hospitals and schools. [ 5.8]

Later in 2020, the UK Department for International Trade (DIT) introduced Keevil to the UK supermarket chain Morrisons, who resultantly commissioned Copper Cover to trial the installation of copper touch surfaces in its staff rooms. Currently 1 in 5 infections are transmitted in supermarkets, and Morrisons serve 12 million customers each week across 494 stores throughout the UK [ 5.9]. The trial has led Morrisons to consider the permanent installation of antimicrobial copper surfaces on common touch points such as door push plates and trolley handles:

Informing government infection control policies in Europe and shaping new international regulatory standards for commercial products with antimicrobial claims

Following the approval of copper as an antimicrobial material by the US Environmental Protection Agency (EPA), which was based on Keevil’s research, Poland’s National Centre for Quality Assessment in Healthcare (NCQA) revised its accreditation standards for healthcare facilities. This included in 2017, Europe’s first official recommendation to incorporate antimicrobial copper touch surfaces as an infection prevention and control measure [ 5.10]. The new accreditation standards provide guidelines concerning the prevention of pathogen transmission by touch. Chapter IX ‘Infection Control’ states: “ Reduction of microbial transmission should be achieved, inter alia, using frequently-touched surfaces made from metals with antimicrobial properties, such as copper, brass and bronze, as per the US Environmental Protection Agency’s registration.”

Lubin Hospital, in South West Poland, subsequently installed copper alloy surfaces in its new operating theatres. In recognition of his contribution, Keevil was invited as the Special Guest at the ‘Safe Hospital for the Future’ Gala awards event in Warsaw, where he gave the keynote lecture on ‘Breaking the Chain of Infection’. The event was attended by senior members of the Polish medical community, including the Polish Deputy Minister of Health and the Director of the World Health Organization (WHO) Office in Poland [ 5.7].

In 2014, Keevil was an invited speaker at a meeting in the French National Assembly in Paris attended by French MPs, WHO officials and the French Patients Association (Le Ligne). At this meeting the introduction of antimicrobial copper alloy surfaces to reduce HAIs in French hospitals was discussed. This led to further successful trials of copper alloy fittings in long-term care facilities in 2018, supported by regional French government and the European Commission, and the decision to draw up a French standard, equivalent to the EPA standard in the US. France’s equivalent AFNOR (Standards Commission S95S, N36) adopted the dry method testing method developed at Southampton [ 3.1] to evaluate copper alloy and non-copper products with an antimicrobial surface claim for commercialisation. Keevil attended several AFNOR meetings, following on from the original French National Assembly event, and contributed expert advice based on his research. The new AFNOR standard (NF S90-700) was published in April 2019 and since led to the successful establishment of a new technical committee on Surfaces with biocidal and antimicrobial Properties at the International Organization of Standardization (ISO) in June 2020 [ 5.11]. The wet and dry testing methods developed at Southampton [ 3.1] have been translated into standard CEN/ISO test methods by the British Standards Institute [ 5.12].

Commercial impact arising from the government-approved certification of the Cu+ trademark for antimicrobial copper products

Keevil’s work has influenced the development of test standards, which the CDA states are “essential for international competitiveness of companies selling antimicrobial materials such as copper alloys’’ [ 5.7]. The new international standards, which regulate the commercialisation of products with an antimicrobial touch surface claim, have resulted in the certification of more than 450 copper-containing antimicrobial products on the market [ 5.7]. This includes a specific product line “KME Plus®” from KME, one of the world’s largest manufacturer of copper and copper alloy products. The company increased their revenue from USD1,440,000 in 2014 to USD1,980,000 in 2019, and directly refer to Keevil’s work in their official KME Plus® information brochure [ 5.13].

Health and commercial impact through copper-infused clothing

Copper Clothing Ltd was set up in December 2012 after the founder saw a demonstration by Keevil online showing the speed at which MRSA dies on copper compared to stainless steel. Keevil was commissioned by the company in 2014 to evaluate the antimicrobial properties of copper-impregnated fabrics, in products including bed sheets, pyjamas and socks. This paved the way for further R&D activities in the NHS and direct employment of a doctor at the company. Additionally, research led by Keevil has underpinned developments of their copper-impregnated facemask, with over 250,000 units now sold [ 5.14].

Increasing public awareness of the benefits of antimicrobial copper

Keevil’s advocacy of the benefits of antimicrobial copper have gone far beyond his numerous peer-reviewed papers and presentations at high-profile conferences. His proactive engagement with the international media has resulted in widespread coverage. In the UK this includes BBC News channels, the BBC’s One Show and Dara Ó Briain’s Science Club (19,732 views) while coverage abroad includes Le Figaro and Times of India. It was featured in 35 news stories from 34 outlets and reached an upper bound of two million followers on Twitter. A 2017 article by Keevil in The Conversation, which brought together all Southampton research in this area, reached an audience of 234,210 and was tweeted 487 times and shared on Facebook 14,700 times. Keevil’s 2020 Smithsonian Magazine article on ‘coppers virus killing powers’ was shared over 6,000 times on social media. Over the impact period, coverage of Keevil’s combined research reached an estimated hundreds of millions of people, measured by examples of media coverage provided by the CDA [ 5.7].

Impact on international biodiversity policy

1. The Intergovernmental Science-Policy Platform for Biodiversity and Ecosystem Services (IPBES) is an international body that provides policymakers and decision makers with objective scientific assessments of the state of ecosystem services and biodiversity, and the tools and methods for measuring and monitoring natural capital (i.e., an equivalent to IPCC for biodiversity). IPBES provides policy-relevant knowledge for governments, the private sector and local communities, as well as policy support (i.e. “ identifying policy-relevant tools and methodologies, facilitating their use, and catalysing their further development”). Since 2018, TESSA v.2 has been included within the IPBES Policy Support Portal which describes the toolkit as a policy support tool that can inform, assist and enhance development and implementation of policy instruments to better protect nature and promote its sustainable use. IPBES also highlights the toolkit as “ relatively low cost compared with many other tools, and does not require advanced technical skills” and “ applicable to users from developing and developed countries”. These extracts from IPBES summarise the overall importance of TESSA v.2 in the context of other ES tools and what the toolkit has allowed conservation practitioners to do that was not previously possible. [ 5.1]

2. Bird Conservation Nepal (BCN), a local environmental NGO in Nepal working with BirdLife International, used TESSA v.2 to assemble data on benefits provided by community-managed forests – preserving cultural values; creating employment and incomes; maintaining water supplies; enhancing resilience of ecosystems and economies; conserving traditional medicines; enhancing equality; and empowering women through fairer distribution of more diverse goods and benefits – and the key threats to their sustainability. With the resultant ES knowledge, BCN worked with the Department of Forest and Soil Conservation, and the Federation of Community Forestry Users Group to include community forest management into the country’s National Biodiversity Strategy and Action Plan (NBSAP). Utilisation of TESSA v.2 therefore resulted in biodiversity protection being incorporated into the Operational Plans (national policy instruments) of at least 45 community managed forests, to be implemented as priority actions. These community forests are distributed across the five main physiographic regions in Nepal and involved at least 10 of the country’s 36 Important Bird and Biodiversity Areas. The Department of Forest and Soil Conservation and BCN are also in the process of publishing an official Biodiversity Supplement to the Community Forest Operational Planning Guidelines (currently in press). This highlights the Department’s firm policy commitment to rolling out the revised Community Forest Operation Plans to 22,000 community managed forests as part of Nepal’s NBSAP, in order to mainstreaming biodiversity conservation and ecosystem services provision into community forestry in Nepal. This would ensure that 17 million hectares of community forests (28% of Nepal’s total forest area) are being managed sustainably, with benefits for biodiversity conservation as well as rural livelihoods of 2.24 million households [ 5.2].

3. The International Union for the Conservation of Nature (IUCN) governs the Global Standard for the Identification of Key Biodiversity Areas (KBAs), a set of guidelines for identifying sites that contribute significantly to the global persistence of biodiversity. The Science for Nature and People Partnership (SNAPP) Ecosystem Services and Biodiversity working group was established to integrate existing work on ecosystem services assessment with the IUCN KBA guidelines in order to “ provide a much-needed synthesis of the human well-being benefits associated with protecting globally important biodiversity sites” [ 5.3]. SNAPP organised a workshop in Myanmar in 2017 (48 participants from academia, NGOs and Myanmar government) to make recommendations on classification schemes and checklists for documenting ecosystem services and human wellbeing benefits of KBAs as part of the information compiled during KBA documentation (through the application of the global KBA standard). Peh presented the TESSA case study of Moeyungyi wetland reserve, Myanmar, in this workshop and tested the beta Global KBA Standard approach for documenting ecosystem services on Moeyungyi wetland using his ES knowledge of the site derived from using TESSA (beta) v.2 in 2015. Peh’s feedback through this pilot exercise was used by SNAPP to revise the ecosystem services documentation for KBAs [ 5.4]. Addressing the question on how quantitative ecosystem services assessment for KBAs can further support specific conservation objectives in Myanmar, the workshop’s final report stated that it is crucial that the conservation practitioners can “ *provide policy recommendations with TESSA analysis of [the] current state, alternative degraded state and alternative restored state [of the site]*” [ 5.4].

Impact on conservation strategies and action planning

1. TESSA v.2 sets out a practical, evidence-based approach to ecosystem service assessment which can be applied at a site of interest in any country for generating information to help with decisions about how land is used. RESTORE is a major partnership project between seven organisations across NW Europe, co-financed by the European Union Interreg IVB programme, which applied TESSA (beta) v.2 from 2014 to 2015 – particularly the new methods for assessing cultural ecosystem services – to identify and compare the benefits provided by different rehabilitation strategies at 10 mineral extraction sites in northwest Europe [ 5.5]. Specifically, RESTORE used the toolkit at Curfs quarry nature reserve, Netherlands, and found that current active management of the site “ has resulted in higher biodiversity and aesthetic value, and hence enhanced the annual number of visitors who have had enjoyed the landscape by 100% (from 2,690 to 5,390 people annually) when compared to less active management of the habitat; thus providing evidence for supporting the current management of the site as a nature reserve”. Similarly, RESTORE used TESSA (beta) v.2 at Wenduine clay pits, Belgium, in 2015 and showed that the current state of the site as a restored wetland, compared with farmland, “ has a higher experiential use of animals in the landscape (i.e. birdwatching) due to a higher biodiversity; and the overall benefits of the site may worth 17% more in monetary terms along a timeline of 50 years as wetland than as arable farmland” [ 5.5]. RESTORE states that these two ES assessments, together with eight others in the UK and Germany, have led to the development of “ a framework for restoring mineral sites to provide benefits for biodiversity, local people and local economies”; “ the best practice in quarry restoration”; and the case studies to “ showcase to EU policy-makers the delivery of environmental benefits in parallel with economic development” [ 5.5]. RSPB, a key partner of RESTORE states, “ TESSA can be one important tool in the decision-making process and can demonstrate that conserving sites for biodiversity conservation has additional benefits for people” and “ the results from TESSA will be useful in demonstrating the effects of conservation management”, particularly “when such management has been controversial or contested” [ 5.6]. These case studies provide evidence that TESSA v.2 is embedded into restoration policy and practice for better suited decisions.

2. TESSA v.2 aids land use planning, as demonstrated by the collaboration between UoS and the UK Environment Agency (EA) in 2017 to assess options to manage the water level of the River Itchen at its tidal confluence within Riverside Park, Southampton. The flow of the Itchen into the estuary is currently controlled by a sluice gate at Woodmill (a location within the park), which has reached a critical condition and is no longer economically viable to maintain [ 5.7]. The EA applied the TESSA framework to rapidly assess the Cultural Ecosystem Services (CES) of Riverside Park in its current state and under a proposed alternative management option, which centres around the decommissioning of the sluice gate and conserving the significant local cultural, economic and environmental importance of Riverside Park and the River Itchen [ 5.7]. The EA states, “ TESSA v.2 was selected over alternative tools as a low-cost, written step-by-step approach with a dedicated section focussed on CES assessment which was specifically designed for comparing the impact of contrasting scenarios at the site scale. The findings identify changes in the spatial hotspots of CES and highlight the spatially-specific sensitivity of local stakeholders to land-use change, and the current and future importance of local biodiversity, aesthetic qualities and values” [ 5.7]. The results from TESSA v.2 have proven useful for Environment Agency and Groundwork South, “ to understand the values and perceptions of local people, and directly contributed to the Woodmill Stakeholder Engagement Plan” [ 5.7].

Impact on capacity of ecosystem service assessment

1. The IUCN World Commission on Protected Areas embedded TESSA v.2 in a recent report as one of nine tools for conducting ecosystem service assessments in protected areas, KBAs and natural World Heritage Sites, recognising it as an important tool in the land use decision-making process. TESSA v.2 was shortlisted “ due to its free availability and applicability in the context of these areas”. This report is available to download from the IUCN website since July 2018 and has been referenced in seven IUCN policy documents and read 154 times on IUCN library system, 218 times on Mendeley and 1,031 times on ResearchGate. IUCN World Heritage Outlook distinguishes TESSA v.2 from other tools as a tool that “ *provides accessible guidance and low-cost methods to generate information that can be used to influence decision making [even if the users have no economic data from their sites]*” [ 5.8].

2. The intergovernmental Group on Earth Observation – Biodiversity Observation Network (GEOBON) has developed BON in a Box, an online platform to “ simplify the discovery of state-of-the-art tools for data collection, management, analysis and reporting biodiversity observations” and their experts selected TESSA v. 2 for inclusion on the BON in a Box platform in June 2017, with an aim “ to increase the capacity for biodiversity observations, data management and analysis through a simple discovery and technology transfer mechanism and promote interoperability through the convergence in use of tools and standards” [ 5.9]. The World Business Council for Sustainable Development and Natural Capital Coalition has also incorporated TESSA v.2 into their interactive database – the Natural Capital Protocol Toolkit – in July 2017 to facilitate businesses uptake of natural capital measurement and valuation [ 5.10]. Local NGOs have applied the TESSA framework and methods globally in at least 96 protected and unprotected areas in 26 countries to highlight the multiple benefits that people obtained from nature conservation. To date, the toolkit has received over 2,500 download requests from at least 69 countries, of which 26% from NGOs, 12% private sector and 11% government.

Impact on conservation capacity building

1. The Tropical Biology Association (TBA) conducted TESSA (beta v.2) training courses in Kenya twice in 2014. Eleven conservation practitioners from nine African countries attended these TBA training workshops. An immediate outcome of these courses was application of TESSA by the course participants for the first time in Cameroon, Ghana, Kenya, Malawi, Madagascar, Uganda and Zimbabwe. Feedback included “ I am already seeing the possibility of immediate application of the tools to generate answers to policy questions” [ 5.11]. A workshop participant has used TESSA to raise awareness and interest in the conservation of COPAL community forest (4,800 ha; 5,000 inhabitants) in Cameroon. TBA states, “ A long-term [sic] impact of TESSA’s application in Cameroon is that the local communities decided to keep their natural forest intact because they recognised the benefits the forest was bringing them. Further, the manager that TBA trained was also employed by the Cameroon forest department because of the expertise he had gained through the training and subsequent application of TESSA” [ 5.11]

2. The UN Environment TEEB programme also requested the training course, which was run by Tropical Biology Association and Liberia’s Environmental Protection Agency in June 2017 to build the capacity of 26 Liberian conservation managers and practitioners to enable better management of their natural resources. Feedback that reflected personal change among the participants included: “ TESSA has given me a new direction” and “ I can see how communities can benefit from services around them and how I can communicate this” [ 5.11].