Stakeholder views on the implementation of the UK’s Antimicrobial Resistance (AMR) National Action Plan (2019–2024) in relation to AMR in the environment

Abstract

•Background: Antimicrobial resistance (AMR) in the environment is an important component of One Health AMR research and is increasingly incorporated into AMR National Action Plans (NAPs), including the UK’s AMR NAP ‘Tackling antimicrobial resistance 2019–2024’. However, implementation of the environmental commitments has yet to be evaluated. •Objective: In this study, we aimed to understand UK stakeholder perspectives on the delivery and implementation of the environmental components of the UK’s AMR NAP 2019–2024, with a particular focus on wastewater, which could be used to inform the 2024–2029 NAP. •Methods: We undertook semi-structured, qualitative interviews with informed UK stakeholders to discuss how the NAP had been implemented and future directions relevant to environmental AMR. •Results: Two main themes emerged from the interviews: 1) the perception of ‘risk’, and 2) barriers that have hampered policy action. Some wanted more evidence to inform policy and mitigations, particularly concerning the relative risk posed by different pollution sources in driving and maintaining AMR in the environment, and the risk posed by transmission of AMR from the environment to humans. Where evidence was lacking, several academics and regulators proposed that policy action could be justified based on the precautionary principle. •Conclusions: Although we do not know the impact environmental exposure plays in driving clinical AMR infections relative to other sources, evidence suggests that exposure to environmental and wastewater sources may play a role, and thus requires policy interventions. Government leadership is critical for ensuring the uptake of environmental AMR research to inform mitigation and interventions based on the precautionary principle