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Assessing the UK’s 2024-2029 Antimicrobial Resistance Action Plan

By May 22, 2024No Comments

In May 2024, the UK released its second Antimicrobial Resistance (AMR) Action Plan.  Created by the health agencies of England and the devolved administrations, along with DEFRA and DEARA (NI),  the plan aspires to set out  “ambitions and actions for the next 5 years in support of the 20-year vision for antimicrobial resistance (AMR)”.

The vision was released in 2019 by the Department of Health and Social Care (DHSC).  By the end of the 2024-29 plan, the UK should be halfway to achieving its goal – for antimicrobial resistance to be “effectively contained, controlled and mitigated”.  The consequences of failure are stark and well-rehearsed – so will the current plan deliver?

There is much about the plan to welcome.  The focus on education and awareness is something for which BIVDA have long advocated; the irony of a population where schoolchildren are better sighted on the risks of AMR than their parents is more deadly than amusing.  Acknowledging, like COVID-19, that AMR is a global problem is vital.  And the clear recognition of the crucial role of diagnostics is welcome.

But for the UK’s 2040 vision to be achieved, this plan needs to be delivered.  And in our view, 2040 should be a backstop, not a target.  Every year the vision is not achieved costs lives.

Successful delivery of the 2024 action plan will require COVID-esque engagement, mobilisation, and collaboration by the government, industry, and the NHS.  With the NHS under unprecedented pressure, there is a significant danger that the NHS will prioritise the issues at their feet.  AMR cannot be tackled by treating it as a theme running through business as usual.  Nor is “innovation”, the regular buzzword for solutions, the answer.

Clinicians and caregivers have an incredibly tough job.  Diagnostics and clinical care pathways are there to support and inform decision-making.  The O’Neill review, commissioned in 2014 and delivered in 2016, suggested no antimicrobial prescription should take place without the support of a diagnostic test. BIVDA wholeheartedly endorses this view – that the availability of the right diagnostic, at the right time and place (which may be in a care setting or at home) is key.  But current pathways that “suggest” the use of a diagnostic test simply do not lead to uptake.  This must be reversed – the decision not to use a diagnostic test must be recorded and rationalised.  Without clear incentives and metrics, there will not be accountability or delivery.

A further challenge is ownership.  There is no single person accountable for AMR, leading to disjointed working and silos.  An AMR “tsar”, ideally a senior civil servant sitting across health, the environment, and farming/animal health, is needed to focus and coordinate workstreams.

Combined, these factors mean that successful delivery of the 2024 plan is dependent on ownership, political support, and clear central direction to deliver funding, incentives, and robust KPIs.  The absence of these will lead to failure.

While containing high level aspirations, the plan does not drill into details.  For example, the aim to reduce antibiotic prescribing by 5% does not set out a clear route map.  It talks about innovating new tests, not using those already available.  It does not set granular KPIs with ownership and accountability.

This view is not just that of the diagnostics industry. Following the release of the plan, the Council for Science and Technology chairs, Dame Angela McLean and Lord Browne of Madingley, wrote to the Prime Minister advocating the crucial role of diagnostics and stated  “The UK government should address ongoing challenges facing the diagnostics sector, including the route to adoption in the NHS, reimbursement models, regulatory pathways, as well as current workforce and manufacturing and supply chains in the UK.” Professor Jonathan Cooke, Imperial College, stated “We need to look at the overwhelming evidence for the value of CRP POCT in reducing antibiotic use”.  The Microbiology Society commented “The lack of tangible targets across all commitments is disappointing”.

Rather than innovate and regulate new tests, the government and NHS must adopt, procure, and use those readily available. There are significant numbers of diagnostic tests on the UK diagnostic market, available now to the NHS.  Tests which can tell which infection is present.  Prognostic tests which can tell whether a condition will or will not benefit from an antibiotic.  Tests which drive personalised medicine.  The immediate deployment of these tests will have a greater benefit, at an earlier stage and lower cost, than designing new tests.

Stakeholders, most particularly the NHS in England and the Devolved Nations and the DHSC, must immediately set ambitious metrics to measure the use of diagnostics.  Examples of best practice already exist, but the current diagnostics system is disjointed and complex, with decision-making in the UK more disparate and slower than in some other countries. There must be a system-wide approach with incentives, annual reviews of progress against the action plan, and against these metrics.

In closing, the plan is a welcome commitment from government on AMR.  But successful delivery depends on the detail below and an unswerving commitment to deliver.  The diagnostic industry can supply the tools to do the job.  But we are reliant on others to use them.

Ben Kemp