UK Five Year Antimicrobial Resistance Strategy 2013-2018 (published 10 th September 2013)

1. UK Five Year AntimicrobialResistance Strategy2013-2018(published 10th September 2013) Claire Boville – Department of Health European Antibiotic Awareness Day 2013 @ UCL Wednesday 20th November

2. CMOs Annual Report (published March 2013) The Chief Medical Officer (CMO) for England annual report set out: • the scale of the global antimicrobial resistance (AMR) issue, • its implications for public health and; • the need for urgent action at a national and international level to slow down and stem the spread of antimicrobial resistance. The report highlighted the need for: • action on a global scale to ensure better surveillance data nationally and internationally; • more work to preserve existing drugs and; • encourage the development of new antibiotics and rapid diagnostics. The UK Antimicrobial resistance strategy 2013-2018

3. Status of Antimicrobial Resistance in the UK • Multi-drug resistant bacteria are spreading in the UK and world wide. • Increasing levels of resistant Gram negative bacteria are the most pressing problem for the UK. • Levels of resistance to carbapenem antibiotics, the last line drugs used to treat infections caused by Gram negative bacteria, are low but increasing. Increasing resistance and a lack of new drugs means a risk of infections that cannot be treated and more deaths unless urgent action is taken. The UK Five Year Antimicrobial Resistance Strategy 2013-2018

4. What is needed? • Improvedinfection prevention and control, • Strengthened antimicrobial stewardship to conserve the effectiveness of the antibiotics we have, • Improve understanding of transmission pathways with a focus on human, animal and wider environmental aspects, • Develop better diagnostics and more targeted treatments, • Stimulate the development of new antimicrobials and novel Treatments. The UK Five Year Antimicrobial Resistance Strategy 2013-2018

5. UK Five Antimicrobial Resistance Strategy(2013-2018) • The UK Five year AMR strategy builds on the work of the first UK AMR Strategy (2000) and has an holistic “one health“ focus. • The strategy responds to the EU call to Member States to produce national plans to tackle AMR (2011 EU AMR Strategic Action Plan and the 2012 EU Council conclusions). • Its content was informed by: • developments in other international fora (including WHO), • the challenges set out in CMOs 2012 annual report; and • consultation with a wide range of technical experts and others The UK Five Year Antimicrobial Resistance Strategy 2013-2018

6. Strategic Aims The overarching goal of the Strategy is to slow the development and spread of AMR. It will do this by focusing activities around three strategic aims to: 1. improve the knowledge and understanding of AMR. 2. conserve and steward the effectiveness of existing treatments, 3. stimulate the development of new antibiotics, diagnostics and novel therapies. This will involve work in seven key areas for action, underpinned by work needed to strengthen the evidence base and improve our knowledge and understanding of AMR. The UK Five Year Antimicrobial Resistance Strategy 2013-2018

7. Seven Key Areas for Action • Improving infection prevention and control practices (PHE). • Optimising prescribing practice (PHE). • Improving professional education, training and public engagement (PHE). • Developing new drugs, treatments and diagnostics (DH). • Better access to and use of surveillance data (PHE). • Better identification and prioritisation of AMR research needs (DH). • Strengthened international collaboration (DH). Note: Defra/VMD leads on all animal health aspects. The UK Five Year Antimicrobial Resistance Strategy 2013-2018

8. Implementation • The DH, PHE and Defra/VMD lead work to implement the strategy. • A new Interdepartmental High Level Steering Group has been established to oversee implementation, working across all sectors. • We are working with and through a wide range of stakeholders to: influence opinion, galvanise support and mobilise action needed to effect positive change of the scale and pace required to avert a return to a pre-antibiotic era The UK Antimicrobial resistance strategy 2013-2018

9. Interdepartmental High Level Steering Group (HLSG) It is charged with: • developing an implementation plan to be published by April 2014, • developing detailed outcome metrics, to be published by April 2014 • publishing an annual report on progress outputs and outcomes each year from November 2014 The UK Five Year Antimicrobial Resistance Strategy 2013-2018

10. Outcome Measures The HLSG, working with expert advisors, will develop detailed measures in the following areas:- • trends in changes in resistance in key infections • assessing improvement in knowledge of antimicrobials and their use, • assessing improvements in the quality of prescribing in primary and secondary care compared to baseline, • monitoring use of antibiotics in animals – in particular, the 3 CIAs, • assessing global alignment in addressing AMR. The UK Five Year Antimicrobial Resistance Strategy 2013-2018

11. Priority areas for UK International Activity • Strengthen surveillance arrangements - improving our ability to quickly identify new AMR threats or changing patterns in resistance, • Extend the life of antibiotics by promoting better stewardship and conservation of antibiotic use in human, animal and wider environment, • Stimulate a sustainable supply of antibiotics and development of innovative alternative treatments, • Encourage collaboration to develop rapid and robust point of care diagnostics which can be used on a routine basis in clinical settings, • Develop the evidence base to better understand the links between resistance in animals and humans and transmission pathways, • Develop analysis of the economic burden of AMR for society, • Engage effectively with societyto promote the social responsibility, • Use of behavioural scienceand communication mechanisms for take action which will effect positive change. The UK Antimicrobial resistance strategy 2013-2018

12. European Antibiotics Awareness Day (EAAD) • Communication, Awareness raising and understanding of AMR is crucial to effecting positive change. • A central plank to this is our work to promote and support EAAD throughout the year. • We are expanding the reach and impact of this work, for example this year we have: • established a link to Self Care Week and engaged more community pharmacists • sought to increase local participation through local authorities; • secured greater involvement of veterinary colleagues The UK Antimicrobial resistance strategy 2013-2018

13. The Focus of AMR International work The UK international work programme will aim to deliver the following: • galvanise international collaboration to prevent the global spread of AMR (infection prevention and control, stewardship and conservation aspects), • garner support for a “one health” approach to tackling AMR and developing evidence on the AMR transmission interface between human, animal and wider environment, • Be instrumental in and take a leading role in work with UN and other key international bodies to develop innovative financing and regulatory (licensing) approaches which will help stimulate development of new antibiotics. The UK Antimicrobial resistance strategy 2013-2018

14. UK International Work We continue to: • press the EU and WHO to accelerate progress on implementation of AMR strategic action plans, • Secure political commitment to tackle AMR through a wide range of fora such as G8, G20 and World Health Innovation Summit, • Spearhead new initiatives to improve IPC, surveillance and stewardship capability in lower income countries and developing twinning projects across the Commonwealth The UK Antimicrobial resistance strategy 2013-2018

15. How we are doing this The UK is actively participating on AMR work in a wide range of international fora including: • Promoted AMR issues during UK G8 Presidency at Science Ministers meeting, • Sponsoring international Chatham House round table discussions on AMR • Working with WHO and other UN bodies (OIE, FAO, Codex) • Working with EU Commission on surveillance, research, legislative and drug pipeline issues to tackle AMR. • Working with the Commonwealth to support improved surveillance and infection prevention and control, • WISH Conference – CMO chairing the panel on AMR which will highlight areas requiring further international action, The UK Antimicrobial resistance strategy 2013-2018

16. We need to get to a point where: • good infection prevention and control measures to help prevent infections occurring in the first place become the norm in all sectors of human and animal health, • infections can be diagnosed quickly and the right treatment deployed, • patients and animal keepers fully understand the importance of antibiotic treatment regimens and adhere to them, • surveillance is in place which quickly identifies new threats or changing patterns in resistance, and • There is a sustainable supply of new, effective antimicrobials for human use. The UK Antimicrobial resistance strategy 2013-2018