A recent paper published in Global Health Action presents key findings from research investigating stakeholder perspectives on the UK’s implementation of its Antimicrobial Resistance (AMR) National Action Plan between 2019 and 2024, with a specific focus on environmental AMR.

AMR is a growing global health concern, responsible for millions of deaths annually. It occurs when microorganisms that cause infections evolve to resist treatment with antibiotics and other antimicrobials. When such treatments become ineffective, even common infections can become life-threatening.

While clinical AMR is often linked to the misuse of antibiotics and poor infection control practices, environmental AMR encompasses how treated and untreated wastewater, agricultural runoff, and animal waste contribute to the spread of resistance. Understanding these dimensions is essential, as AMR in the environment could be playing an important role in driving clinical resistance.

Tackling AMR effectively requires a 'One Health' approach, an integrated strategy that brings together human, animal, and environmental health sectors. The extent to which environmental AMR contributes to clinical infections is still not fully understood. Evidence suggests that environmental exposure may be an important driver and therefore demands targeted policy attention.

Stakeholders consulted for the study included researchers, environmental regulators, and representatives from the wastewater industry. Their insights revealed two dominant themes, including risk associated with environmental AMR and the need for further evidence, as well as barriers to policy action.

While the risks associated with clinical AMR are well recognised and addressed through specific targets in the UK’s National Action Plan, the environmental aspects are largely limited to broad goals around improving evidence and understanding. Stakeholders, particularly from regulatory bodies and industry, emphasised the need for more data to assess the risks from the impacts of wastewater on AMR compared to other pollution sources.

A key concern was that ambiguity around surveillance methods and targets, contributing to policy inaction. Agata Pacho, Assistant Professor, LSHTM and one of the authors of the study, highlighted: “There is a strong call for the development of a cost-effective, easy-to-implement, and reproducible monitoring system for environmental AMR. Such a system should be grounded in scientific research and supported by clear regulatory goals.”

While the call for more research was a recurring theme, the study also underscored the importance of leveraging existing evidence to inform policy and guide action based on the precautionary principle.