Global action required to combat antimicrobial resistance

URGENT worldwide measures are needed to tackle drug resistant infections which are expected to claim more lives over the next 25 years than the number of people lost to cancer, a team of experts at The University of Manchester has warned.

In an article published by the University's Policy Engagement Unit, Policy@Manchester:- Dr Michael Bottery, Professor Michael Brockhurst, Professor Lucie Byrne-Davis, Professor Michael Bromley and Dr Wendy Thompson, who caution that increasing levels of antimicrobial resistance (AMR) mean many frontline medicines are losing effectiveness for treating many bacterial, viral, fungal, and protozoal infections such as malaria.

The authors set out several reasons explaining the origins of AMR including the use of antibiotics and antifungals in agriculture, a disjointed approach to regulation and licensing of antimicrobials, and a 25% increase in antibiotic prescriptions by dentists during the pandemic.

"Covid19 sharply demonstrated that diseases are not limited to a single nation and tackling antimicrobial resistance requires global cooperation," they write. "As a start, international bodies like the UN, WHO and the EU should provide detailed guidance on the use of antimicrobials in agriculture. This should include:- risk assessments on the likelihood of cross resistance evolving because of the dual use of the same types of antimicrobials across agriculture and the clinic."

The academics call on regulators to ensure that:- "before a new antimicrobial is permitted for commercial use, independent assessment has been made of the potential impact on clinical use." They add:- "In the UK, this will require cooperation between the Environment Agency, the Medicines and Healthcare products Regulatory Agency (MHRA) and the UK Health Security Agency; establishment of a cross-agency working group would help to facilitate this."

Drawing on their own research, they explain that the spike in antibiotic prescriptions in dentistry was driven by:- "system-level influences, which left dentists feeling frustrated that they were unable to provide safe and effective care in line with clinical guidance." They continue:- "Targets for optimising antibiotic prescribing into the future should be at the system (commissioner) level and should focus on improving access to; and the delivery of; safe and effective care for people with acute dental problems."

The authors recommend that the UK's future AMR strategy should be guided by research from The University of Manchester and others with the goal of:- "identifying new ways to help conserve the effectiveness of antimicrobials for future generations." They write:- "For their part, research bodies should aim to shape targets within, and support delivery of, the UK's national AMR action plan and the WHO's Global Action Plan on AMR, including through our global health research and education activities in low and middle income countries."

They conclude:- "Antimicrobial resistance is an existential threat, and 1 that is intimately entwined with the risks posed by climate change and overconsumption. For AMR, as with the climate crisis and resource scarcity, the solution lies in a mix of new innovations, and smarter guarding of current assets."

‘Culture shift: Tackling antimicrobial resistance from agriculture to operating table,' by Dr Michael Bottery, Professor Michael Brockhurst, Professor Lucie Byrne-Davis, Professor Michael Bromley and Dr Wendy Thompson is available to read on the Policy@Manchester website.

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Liverpool plays key role in new childhood vaccinations campaign

LIVERPOOL City Council's Public Health team has played a key role in devising a new multi media marketing campaign across England to remind parents and carers to get their children vaccinated against serious diseases.

The campaign features a powerful video told from the perspective of children and in their voices. "Our generation's risk of illnesses like measles and whooping cough is rising" they tell their parents and carers looking straight into camera:- "If we're not vaccinated, we're not protected."

The campaign theme and materials are based on insight and feedback from parents and has been developed by the UK Health Security Agency (UKHSA) in partnership with Liverpool City Council, NHS England, NHS North West and NHS Greater Manchester.

Uptake levels of childhood vaccines offered through the routine NHS vaccination programme in England have been falling over the past decade, including vaccines for whooping cough, measles, mumps and rubella, polio, meningitis and diphtheria; with England no longer having the levels of population immunity recommended by WHO that is needed to prevent outbreaks. Crucially, lower vaccine uptake within communities is directly linked to wider health inequalities.

In Liverpool, only around 71% of children are fully vaccinated with the 2 doses of MMR they need.

To counter this decline, the UKHSA is co-ordinating its national marketing campaign with a NHS operational MMR catch-up campaign. Areas with low uptake will be a focus for support and parents of children aged from 6 to 11 years will be contacted directly and urged to make an appointment with their child's GP practice for any missed MMR vaccines.

In addition to the TV advert, the campaign will be seen across a range of channels and formats including:- radio advertising, digital display, online and on social media.

The World Health Organization recently repeated their warning on the growing measles threat due to sub-optimal vaccination rates well below the 95% target, highlighting that more than ˝ the world faces high measles risk. This includes Europe, where it warns of the high probability of importation from areas experiencing high circulation and the fact that the seasonal peak of the virus could be seen in the coming months.

Dr Jenny Harries, CEO of the UKHSA said:- "We need an urgent reversal of the decline in the uptake of childhood vaccinations to protect our communities. Through this campaign we are particularly appealing to parents to check their children's vaccination status and book appointments if their children have missed any immunisations. The ongoing measles outbreak we are seeing is a reminder of the very present threat. While the majority of the country is protected, there are still high numbers of children in some areas that continue to be unprotected from preventable diseases. It is not just their own health that can suffer, but other unvaccinated people around them such as School friends, family and those in their community could also experience serious infections. Unless uptake improves we will start to see the diseases that these vaccines protect against re-emerging and causing more serious illness."

Councillor Harry Doyle, Liverpool City Council's Cabinet Member for Public Health, said:- "Immunisation provides lifetime protection against serious diseases such as measles, mumps and rubella and a high uptake level is vital if we are to prevent future outbreaks and epidemics. The current measles outbreaks in other parts of the country are a stark reminder of the consequences of a falling vaccination rate. I am proud that our Public Health team have played a key role in devising this powerful campaign, which will hopefully help drive an increase in vaccinations and give children immunity from serious diseases."

Professor Matt Ashton, Liverpool's Director of Public Health, said:- "The overall uptake rate for both doses of MMR in Liverpool is 71% and falls way short of the 95% target to prevent outbreaks. The World Health Organization recently repeated their warning on the growing measles threat precisely because of a reduction in vaccine take up and we need to make sure we do everything we can to mitigate the risks of serious illness in children. Getting vaccinated is free and easy, so we're urging anyone with a child who has not been vaccinated to make an appointment with their child's GP practice for any missed MMR jabs."