Policy paper

UK 2024 to 2029 antimicrobial resistance national action plan: 1-year progress report

Updated 24 September 2025

Introduction

The UK national action plan Confronting antimicrobial resistance 2024 to 2029 (‘the 2024 to 2029 AMR NAP’) was published on 8 May 2024.

The 2024 to 2029 AMR NAP contains outcomes and commitments that aim to make progress towards the UK 20-year vision for antimicrobial resistance to be contained, controlled and mitigated by 2040. The 2024 to 2029 AMR NAP has 9 strategic outcomes organised under 4 themes, outlining action to be taken across 4 sectors:

• human health
• animal health
• agriculture
• the environment

The 2024 to 2029 AMR NAP included a commitment to publish a short report summarising progress made annually. This 1-year progress report provides the update on activity during the first year.

The threat of AMR

The use of antimicrobials underpins modern medicine. Without effective antibiotics, even minor surgery and routine operations could become high-risk procedures if serious infections cannot be treated. Microorganisms that become resistant to antimicrobials, so-called ‘superbugs,’ do not respond or respond less well to available treatments. The emergence and spread of these superbugs affects:

• animal health
• food security
• the economy
• sustainable development

Accordingly, AMR is captured as a chronic risk in the UK National Risk Register 2025 and is highlighted as a biological risk in the UK Biological Security Strategy (BSS) published in 2023. This strategy sets out the vision that by 2030, the UK is resilient to a spectrum of biological threats, including AMR. 

On 26 February 2025, the National Audit Office (NAO) published the Investigation into how government is addressing AMR report summarising its investigation into how government is addressing the risk of AMR in England, including through national action plans. The NAO report highlights that there are “huge foreseeable consequences for the world, including UK citizens, if humanity fails to address increasing resistance”.

The NAO report made recommendations for the government to consider during delivery of the 2024 to 2029 AMR NAP:

• how delivery of its current targets and commitments can be more successful than in the 2019 to 2024 AMR NAP, including through the use of strengthened performance monitoring and deadlines for implementation
• whether targets for no increase in a range of human infections are stretching enough to make a contribution to the vision of reducing the burden of infection
• how the results of the new NHS antibiotic subscription model will be tracked, evaluated and made public, including any effects on the research and development of new drugs
• what the aquatic environment is currently contributing to rising AMR, particularly wastewater treatment and spills, and, as a result, whether new commitments or targets are needed in this area
• how maximum beneficial impact can be achieved from the classification of AMR as a chronic risk and whether there is value in publishing the government’s full list of chronic risks so that universities, funding bodies, businesses and other institutions can better understand the public sector’s priorities for research and innovation
• whether a national preparedness exercise with a significant AMR dimension should be carried out

A subsequent Public Accounts Committee (PAC) hearing took place on Thursday 27 March 2025, which scrutinised how well government is implementing plans to respond to the AMR risk, through the lens of its work examining systemic existential risks that that government must address. The PAC hearing was informed by the findings of the NAO report.

The PAC report on its investigation was published on 13 June 2025. The government response to the PAC recommendations was published in August 2025 - see pages 19 to 26 of the Treasury minutes - August 2025.

About the UK 2024 to 2029 AMR NAP

The 2024 to 2029 AMR NAP takes a collaborative, One Health approach to addressing AMR. It was developed in partnership with stakeholders and informed by:

• a public call for evidence on AMR
• lessons learned from COVID-19
• progress made on delivering the previous NAP, including through academic evaluation

The 2024 to 2029 AMR NAP includes 9 strategic outcomes supported by 30 commitments across 4 themes. The 30 commitments in the 2024 to 2029 AMR NAP are underpinned by 503 deliverables assigned and owned by delivery partners across government including:

• Department of Health and Social Care (DHSC)
• Department for Environment Food and Rural Affairs (Defra)
• Food Standards Agency (FSA)
• NHS England
• UK Health Security Agency (UKHSA)
• Veterinary Medicines Directorate (VMD)
• Animal and Plant Health Agency (APHA)
• the devolved governments of Northern Ireland, Scotland and Wales

The 2024 to 2029 AMR NAP also includes a set of top 10 research priorities to help guide policy generation, investment in research and evaluation, and delivery of actions to address AMR across all sectors. 

About this progress report

The 2024 to 2029 AMR NAP is supported by a robust governance system, including monitoring and evaluation of progress. Oversight is provided by a UK-wide, intersectoral AMR Strategy Board. This is informed by appropriate governance structures in England, Scotland, Wales and Northern Ireland.

This progress report is informed by case studies demonstrating progress from across the UK to confront AMR. Case studies are organised by the following themes and outcomes (as set out in the 2024 to 2029 AMR NAP).

Theme 1 - reducing the need for, and unintentional exposure to, antimicrobials

Tackling AMR requires a focus on preventing infection in humans and animals, to reduce the need for antibiotics. Therefore, strengthened infection prevention and control (IPC) is a core element of the 2024 to 2029 AMR NAP. AMR also requires action across society, and raising public awareness on appropriate use of antibiotics is crucial to confronting AMR through encouraging individual behavioural actions. Finally, surveillance is a vital tool in:

• understanding the extent of and risks associated with AMR
• informing appropriate policy interventions to prevent, assess and respond to infection outbreaks
• monitoring and evaluating the impact of interventions

This theme has 3 outcomes:

1. Infection prevention and control and infection management - this outcome aims to reduce exposure to antimicrobials through a whole-systems approach to IPC, improved diagnostics and treatment in different settings (humans, animals, agriculture and the environment).

2. Public engagement and education - this aims to empower and engage the public on the risk of exposure to antimicrobials.

3. Strengthened surveillance - this aims to improve understanding of AMR through capability to measure, predict and understand how resistant microorganisms spread across and between humans, animals, agriculture and the environment.

Theme 2 - optimising the use of antimicrobials

Ensuring there is appropriate prescription, use and disposal of antibiotics - across the human, animal and environmental sectors - is fundamental to confronting the challenge of AMR. Activity under this theme includes working with professional groups with responsibilities for prescribing antibiotics and exploring the benefit of clinical support tools.

This theme has 2 outcomes:

4. Antimicrobial stewardship and disposal - this aims to improve the use of antimicrobials to preserve future effectiveness.

5. AMR workforce - this aims to raise awareness with the workforce in human health, animal health and agriculture to improve the optimal use of antimicrobials.

Theme 3 - investing in innovation, supply and access

This theme aims to ensure the UK approach to confronting AMR is evidence-based, innovative and prioritises tackling health inequalities. AMR impacts groups differently and the interventions required to meaningfully tackle AMR must therefore be tailored to different groups, settings and circumstances. The top 10 research priorities fall within outcome 7. Efforts to tackle health disparities and health inequalities are recognised for the first time in the 2024 to 2029 AMR NAP, with outcome 8 focused on better understanding and addressing disparities in tackling AMR.

This theme has 3 outcomes:

6. Innovation and influence - this calls on the life sciences sector to prioritise the development of new approaches to diagnose and treat infections, the development of vaccines to prevent infections as well as the development of new antimicrobials.

7. Using information for action - this aims to enable decisions to be based on robust surveillance, scientific research and data sets to provide the best information for decision making. This section also sets out the top research priorities from policy makers.

8. Health disparities and health inequalities - this aims to improve the information available to identify where the burden of AMR is greatest. This will help to target future interventions where they will have the greatest impact.

Theme 4 - being a good global partner

The last theme relates to working internationally to tackle AMR. From COVID-19, we know that pathogens do not respect borders. AMR will not be solved domestically without international action.

This theme has the last outcome:

9. AMR diplomacy - confronting AMR is a worldwide problem that requires global action. This outcome aims to fulfil the ambition to have sustained engagement via G7, G20 and other multilateral groups, technical networks and bilateral relationships that will contribute to worldwide action on AMR.

Each case study listed within this report specifies which outcome or research area within the 2024 to 2029 AMR NAP it relates to. The case studies provide examples of the breadth of work being carried out across the UK to meet the commitments and targets by 2029.

Theme 1 case studies

Theme 1 focuses around reducing the need for, and unintentional exposure to, antimicrobials.

‘Andi Biotic’ national public awareness campaign

This case study falls under outcome 2: public engagement and education.

UKHSA is running an ongoing public awareness campaign (launched in April 2025) to help keep antibiotics working. In the digital campaign, ‘Andi Biotic’ aims to tackle common misconceptions by delivering key messages to 18 to 34 year olds, including that antibiotics:

• shouldn’t be taken for colds or flu
• shouldn’t be saved for later
• should always be taken as directed by healthcare professionals

The mascot ‘Andi Biotic’ was created to front the campaign, which has appeared across online videos, social media and print media. The campaign aims to raise awareness around the need to protect antibiotic usage for the next generation through sustainable behaviours. By May 2025, the campaign had achieved 75,000 video views on social media (without paid advertising).

Secondary school education on AMR

This case study falls under outcome 2: public engagement and education.

To empower young people to make informed choices and ensure positive behaviours around antibiotic use and AMR, it is vital that young people are educated not just on the appropriate use of antibiotics but also on the impact of AMR for them and society.

During the Department for Education (DfE) review of their 2019 relationships and sex education and health education guidance, UKHSA advocated for the inclusion of AMR into secondary education health and wellbeing curriculum content. As a result, AMR, vaccination and immunisation has been included in the revised Relationships education, relationships and sex education (RSE) and health education statutory guidance for secondary school children in England. Schools are required to implement this guidance from September 2026.

The UKHSA e-Bug programme has been included as a wider resource to support the implementation of the revised guidance and UKHSA will continue to liaise with DfE to support the development of teacher training materials and educational resources.

Public-private data-sharing for AMR surveillance

This case study falls under outcome 3: strengthened surveillance.

The UK has well established surveillance programmes for AMR in animals. However, most of the clinical samples from animals that are tested for AMR in the UK go to private veterinary laboratories and the results do not feed into government surveillance programmes. This limits the ability of the government to swiftly detect, assess and respond to emerging One Health AMR threats, as well as to understand the prevalence and burden of AMR in animals.

From 1 April 2024 to 31 March 2025, working with APHA, academic partners and the private sector, VMD led a project within the National Biosurveillance Network to understand barriers and identify incentives for private veterinary laboratories to share AMR data with government.

This important work will continue into the second year of the 2024 to 2029 AMR NAP and focus on addressing the barriers to public-private data sharing for AMR surveillance. The project will improve government capabilities to measure and understand AMR in animals to better inform the UK response in this sector.

Outcomes from PATH-SAFE programme

This case study falls under outcome 3: strengthened surveillance.

The Food Standards Agency Pathogen Surveillance in Agriculture, Food and Environment Programme (PATH-SAFE) concluded in March 2025 and completed several important projects.

One project saw the Centre for Environment, Fisheries and Aquaculture Science (Cefas) explore the use of bivalve molluscan shellfish (BMS) as sentinels for AMR and pollution monitoring. Using advanced molecular and chemical techniques, Cefas found BMS effectively accumulate contaminants like AMR genes, norovirus and pharmaceutical residues - highlighting their potential for environmental surveillance. Cefas also developed rapid testing methods and hydrodynamic models to support risk-based monitoring.

Piloting AMR surveillance in healthy cats and dogs

This case study falls under outcome 3: strengthened surveillance.

VMD has been working with Scotland’s Rural College (SRUC) to developing a research project to address important evidence gaps in companion animals. In June 2025, in partnership with SRUC, VMD launched a multi-year surveillance pilot to investigate approaches to determining the prevalence of AMR in healthy dogs and cats across the UK. This aligns with recommendations from the Public Accounts Committee on AMR, which highlighted the urgent need to strengthen surveillance in animals and follows UKHSA’s AMR in the Community (AMRIC) study on AMR carriage by healthy people.

The study aims to assess the feasibility and cost-effectiveness of different approaches to surveillance in these species, while also improving our understanding of antibiotic-resistant bacteria in UK pets, and the associated risks to public and animal health. 

Theme 2 case studies

Theme 2 focuses on optimising the use of antimicrobials.

Antimicrobial prescribing and medicines optimisation in England

This case study falls under outcome 4: antimicrobial stewardship and disposal.

NHS England launched initiatives to support health professionals to prescribe antibiotics only to patients who need them. This minimises unnecessary exposure to antibiotics and reduces the threat of resistance developing. These initiatives are guided by the principles of behaviour change science encapsulated in the capability, opportunity, motivation, behaviour (COM-B) model explained in ‘Achieving behaviour change: a guide for national government’ on the Behaviour change: guides for national and local government and partners page.

Evaluation of the impact of the initiatives show progress towards the 2024 to 2029 AMR NAP target 4a that by 2029, the UK government aim to reduce total antibiotic use in human populations by 5% from the 2019 baseline.

Specific examples of the progress being made towards meeting the target are as follows:

• 1.1 million fewer antibiotic prescriptions were dispensed from general practice in England in 2023 to 2024 compared with the previous year. This reduction equates to a reduction of 3.2% on 34 million prescriptions, equivalent to a £6.3 million reduction in annual antibiotic drug expenditure
• total antibiotic prescribing in hospitals decreased by 1.4% from 2023 to 2024
• days of intravenous antibiotic treatment per hospital admission decreased by 4.85% from 2023 to 2024, coinciding with NHS England policy interventions to encourage timely intravenous-to-oral switch. This reduction equates to a drug expenditure saving of £6.5 million per year, and 970,000 hours of nursing time
• 10% of antibiotics in primary care are consumed by 0.5% of patients, who experience 10 or more acute episodes of infection per year

NHS England blood culture pathway optimisation

This case study falls under outcome 4: antimicrobial stewardship and disposal.

Blood culture (testing of blood samples) is considered the ‘gold standard’ investigation for the detection of microorganisms, including bacteraemia, in a patient’s blood. Optimising the blood culture pathway is essential in ensuring the best outcomes for patients with severe bloodstream infections, including sepsis, and helping to ensure appropriate use of antimicrobials through antimicrobial stewardship (AMS).

Blood culture pathway optimisation (BCPO) has helped to improve patient care for those with severe bloodstream infections, with faster and more accurate diagnosis, through education, training and action plans. The benefits for patients include reduced bed days and improved patient experience.

NHS England is completing a national audit of BCPO to establish baseline performance across England, the first of its kind. Engagement with the audit has taken place at a national level, through meetings and webinars to develop action plans locally with systems that support continuous improvement in the clinical pathway. A call for action letter was also sent to all regional medical directors to drive BCPO improvement.

NHS England also developed an e-learning package in collaboration with the British Society of Antimicrobial Chemotherapy (BSAC), which, by May 2025, had been completed by 993 staff members. This case study is improving diagnostic abilities and the ability for healthcare professionals to prescribe more appropriately.

Senior antimicrobial stewardship nurse for care homes in Scotland

This case study falls under outcome 4: antimicrobial stewardship and disposal.

NHS Tayside adopted a novel approach to AMS through the creation of a senior AMS nurse secondment role dedicated to care homes. This aligns with the 2024 to 2029 AMR NAP ambition to embed AMS across all health and social care settings.

The role supports the prevention, recognition, diagnosis and management of urinary tract and catheter associated urinary tract infections (UTI/CAUTI) for people living in care across the region. Early outcomes have observed an increased knowledge, awareness and application of the principles and practice of AMS across the care home workforce resulting in a reduction in the number of hospital admissions for UTI/CAUTI from care home residents.

The role has garnered local and national interest, which led to the collaboration with the Care Inspectorate and NHS Education for Scotland in the delivery of an educational session open to all care home staff in early 2025. The initiative has been shortlisted for the Das Pilay Memorial Award at the 2025 UKHSA Antibiotic Guardian awards. The Antibiotic Guardian awards are part of the UK public health campaign Keep Antibiotics Working launched by Public Health England (now UKHSA) in 2014. The campaign encourages individuals to pledge responsible antibiotic use to help combat AMR.

Royal College of Veterinary Surgeons Knowledge Antibiotic Stewardship Awards

This case study falls under outcome 4: antimicrobial stewardship and disposal.

The Royal College of Veterinary Surgeons (RCVS) Knowledge Antimicrobial Stewardship Awards in 2025 celebrated veterinary practices that made impactful strides in reducing antibiotic use while maintaining animal health and welfare. This year’s winners improved stewardship by targeting critical areas such as minimising highest priority critically important antibiotics (HP-CIA) prescriptions and refining antibiotic protocols for dental procedures. Highly commended veterinary teams focused on reducing post-operative infections, responsible prescribing for diarrhoea cases and focusing on antibiotic use in equine castration.

The veterinary teams employed strategies including:

• culture and sensitivity testing
• team reviews
• disinfection protocols
• interventions based on the ‘plan, prevent, protect’ principle
• client education

Collectively, these efforts highlight the commitment of the veterinary sector to drive improvements in antimicrobial stewardship.

A knowledge and skills framework for health and social care in Scotland

This case study falls under both:

• outcome 4: antimicrobial stewardship and disposal
• outcome 5: AMR workforce

NHS Education for Scotland, in collaboration with the Scottish Antimicrobial Prescribing Group (SAPG) and Glasgow Caledonian University, have created a new framework to support the education of health and social care staff and students in Scotland. Containing and controlling antimicrobial resistance: a knowledge and skills framework for health and social care in Scotland provides a tool to assess AMR and AMS throughout the care pathway. It highlights where in the journey staff can contribute to keeping antimicrobials and those in their care safe. Through embedding AMS training for healthcare staff and students, the project is helping ensure current and future generations of health professionals are better equipped to appropriately prescribe to patients.

Theme 3 case studies

Theme 3 focuses on investing in innovation, supply and access.

All-Wales AMR Educators project

This case study falls under outcome 5: AMR workforce.

The All-Wales Antimicrobial Resistance Educators (AWARE) project is an interprofessional virtual community for healthcare professionals working in AMS in Wales, including:

• antimicrobial pharmacists
• pharmacy technicians
• nursing staff
• medical microbiologists

The community creates and shares teaching and training resources on a dedicated, free-to-access AWARE project website.

AWARE’s flagship activity is an intensive, weeklong, in-person course for healthcare professionals specialising in AMS, IPC or infection, held at Swansea University. The course ran in October 2024 and was attended by delegates from across Wales who took part in a wide range of lectures, workshops and laboratory sessions covering infection and antibiotic-related issues across a wide range of medical specialties.

AWARE runs an annual survey to capture the education and training carried out by the community across Wales. This shows the AMS training delivered in NHS Wales health boards increasing year on year, reaching 2,785 individual healthcare workers and students as recorded in the most recent annual survey conducted in 2024. AWARE also collaborated with the Royal College of Pathologists on an international webinar series that ran over June and July 2024, which was shortlisted for an Antibiotic Guardian award in November 2024.

AWARE involves the wider health and care professional workforce, not just those on the front line. Projects like AWARE aim to embed a culture of appropriate prescribing and use of antibiotics across the wider health and research sector in the UK.

Subscription models

This case study falls under outcome 6: innovation and influence.

Investing in new antimicrobials is not commercially attractive because in order to slow the development of resistance, they are subject to strict controls restricting their use. This means sales could be low, and it’s difficult for companies to see a return on their investment.

In August 2024, the UK launched the Antimicrobial product subscription model for branded antibiotics that treat pathogens in the critical group of the World Health Organization (WHO) priority pathogen list. This scheme draws on the experience of an earlier pilot and has been expanded to include all 4 nations of the UK.

During 2025, products will be assessed by a panel of clinical experts convened by the National Institute for Health and Care Excellence (NICE), using a new evaluation criterion and scoring mechanism. Contract award offers are expected in spring 2026. Additionally, in April 2025, NICE launched a programme of work to consider how the evaluation criteria and scoring mechanism could be adapted to cover other antimicrobial products, such as antifungals.

Development and evaluation of novel interventions

This case study falls under outcome 6: innovation and influence.

UKHSA continues to support the development and evaluation of novel interventions for difficult to treat infections and AMR through the Open Innovation in AMR platform. The platform works with the Pathways to Antimicrobial Clinical Efficacy (PACE) consortium to provide microbiology support for innovative companies with novel therapeutic approaches, who have been awarded funding through the first round of PACE grants.

The collaboration is entering an exciting new phase, with UKHSA becoming part of PACE’s delivery partners network, to share world-leading methods and approaches developed at UKHSA with innovators worldwide. This may include infection models, advanced screening technologies, functional immunology, fermentation and reagent production, including work at high containment. The Open Innovation platform continues to support the evaluation of a range of non-traditional therapeutic approaches, such as bacteriophage contributing to the interdisciplinary training of a new generation of researchers in antimicrobial development. This work will help develop a range of tools to treat infection, which will help confront AMR through preserving the effectiveness of antibiotics. It also contributes to question 8 of the 2024 to 2029 AMR NAP’s top 10 research priorities:

• What methods can be used to prevent, treat and manage infections without antimicrobial medicines?

Moving infection diagnostics forwards

This case study falls under outcome 6: innovation and influence.

As outlined in the 2024 to 2029 AMR NAP, effective infection diagnostics have the potential to reduce AMR through guiding the appropriate prescribing of antibiotics. Patients would also benefit from targeted infection diagnostics at the point of care.

A series of collaborative events brought together experts (including patients) to define clinical needs for infection diagnostics and guide the industry in developing appropriate infection diagnostic tests.

The events were organised by:

• NHS England
• National Institute for Health and Care Research (NIHR) Leeds Biomedical Research Centre
• British In Vitro Diagnostics Association (BIVDA)
• Association of British HealthTech Industries (ABHI)

Overall, the events aim to identify current barriers and potential solutions to infection diagnostics being used more widely within the NHS.

So far, the 4 events have:

• initiated the development of target product profile (TPP) for infections including urinary tract infection (UTIs), respiratory tract infection (RTIs) and sepsis
• leveraged £5 million in research funding for innovative diagnostics by informing the PACE-AMR 2024 Diagnostic Innovation funding call, a pioneering partnership between LifeArc, Medicines Discovery Catapult (MDC) and Innovate UK
• changed planned innovation evaluations of manufacturers, to ensure they produce information that is fit for purpose
• developed solutions to reduce the time from innovation to embedded use in the NHS

Speakers at the events have included Professor Sir Chris Whitty, Professor Dame Sally Davies and Professor Dame Sue Hill. These events are working to bridge the gap between patients and innovators to promote a more patient-centric approach to diagnostic development to benefit patients. Bringing together industry, researchers and the NHS strengthens relationships and promotes collaboration in the area of infection diagnostics, to support the development and adoption of effective diagnostic tests.

Livestock associated methicillin-resistant Staphylococcus aureus (LA-MRSA) updates

This case study falls under outcome 7: using information for action.

LA-MRSA is a type of MRSA commonly associated with livestock. It differs from other types of MRSA, such as hospital or community-associated strains which cause the majority of human infections. LA-MRSA can be transmitted to people from animals by either direct contact with livestock or indirectly. Human cases are most commonly found in people who work with livestock.

The UK carries out passive scanning surveillance which looks for LA-MRSA in clinical samples from diseased animals submitted to government laboratories, but this does not provide representative data. To enhance One Health surveillance, UKHSA started providing quarterly updates to the Defra Antimicrobial Resistance Coordination (DARC) Group on LA-MRSA detections in humans in November 2024. This includes LA-MRSA causing clinical disease in people, as well as incidental findings from routine screening. This data includes whole genome sequencing results and allows for risks to human health to be regularly reviewed. Decisions on further surveillance requirements are based on this review. 

Farm waste and AMR

This case study falls under outcome 7: using information for action.

As part of a Defra-funded research project, APHA has conducted a pilot study investigating the survival of antimicrobial resistant bacteria in farm waste. The study investigated the metagenomic structure of agricultural waste and evaluated the effects of anaerobic digestion (AD) and on‐farm slurry lagoon treatments on microbial diversity and AMR gene abundance.

Researchers compared samples from AD plants with samples from farm slurry storage areas.

The results showed that AD plants had more consistent bacterial communities, while farm slurry lagoons had a wider variety of bacteria types. Most importantly, samples from AD plants contained fewer genes that make bacteria resistant to antibiotics. In contrast, storing slurry on farms had little effect on reducing these resistance genes.

This suggests that AD treatment could be more effective at reducing antibiotic-resistant bacteria than traditional farm storage methods. However, more research is needed to confirm these findings.

Overall, the study revealed trends showing differential impact of treatment type on both microbial communities and AMR gene profiles. This pilot work provides initial data to better understand the effectiveness of agricultural waste treatments in relation to AMR, ultimately informing mitigation measures with One Health impact.

AMR pathways between people, animals and the shared environment

This case study falls under outcome 7: using information for action.

In Northern Ireland, Department of Agriculture, Environment Rural Affairs (DAERA) are funding and collaborating with researchers at Queen’s University Belfast (QUB) and Agri-Food and Biosciences Institute (AFBI) to understand the drivers and effects of AMR and how it spreads between animals, people and their shared environment.

Example work includes understanding AMR in waste and bathing waters by:

• identifying sources of faecal contamination in rivers that affect freshwater and marine bathing water quality
• detecting antimicrobial-resistant bacteria and veterinary pathogens within these waters
• assessing whether these organisms are related to those found in humans, domestic animals or wild animals

To develop strategies to reduce antimicrobial usage (AMU) and AMR, researchers are also:

• determining the extent of AMR in foxes and badgers
• establishing relationships between agricultural animals and wildlife and tracking trends in the environment
• exploring the AMU patterns in vets and pet owners and AMR profiles in pets and their owners

Data reporting on factors associated with health inequalities

This case study falls under outcome 8: health disparities and health inequalities.

Additional data has been reported in UKHSA’s annual English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) report on AMR burden and antimicrobial consumption by factors associated with health inequalities. This highlights the higher AMR burden rates seen within the Asian or Asian British ethnic group, and in the most deprived populations of England.

Research is currently underway at UKHSA, funded by a NIHR Senior Clinical and Practitioner Research Award, to identify modifiable risk factors and effective interventions that can be implemented or scaled up to reduce inequalities in the incidence of antibiotic use and exposure.

Theme 4 case studies

The fourth and final theme focuses on being a good global partner.

UN High-Level Meeting on AMR

This case study falls under outcome 9: AMR diplomacy.

The adoption of a political declaration at the United Nations General Assembly (UNGA) High-Level Meeting on AMR in September 2024 was not only a major accomplishment under the 2024 to 2029 AMR NAP, but a landmark global achievement. UN member states came together to agree an action oriented political declaration on AMR (PDF, 214 KB), taking a One Health approach.

The declaration includes 40 commitments addressing access, governance, finance (targeting the Global South) and surveillance. It also includes an overarching target to reduce the global deaths associated with bacterial antimicrobial resistance by 10% by 2030 against the 2019 baseline of 4.95 million deaths.

The declaration includes a pledge to establish a ‘global independent scientific panel’ to provide evidence-based guidance on AMR by 2025, championed by the UK. The adoption of the declaration highlights the UK’s role in leading global AMR diplomacy to tackle one of the world’s biggest challenges alongside global partners.

ECOFF settings for aquatic and human pathogens

This case study falls under outcome 9: AMR diplomacy.

Cefas has played a leading role internationally in establishing epidemiological cut-off values (ECOFFs) for aquatic and human health pathogens, particularly under its designation as a UK Food and Agriculture Organization of the United Nations (FAO) Reference Centre for AMR. The team has co-ordinated multi-laboratory studies across 3 continents to generate ECOFFs for significant aquatic pathogens such as Yersinia ruckeri and Vibrio parahaemolyticus.

This work involved carefully testing bacteria to see how much antibiotic they could withstand before becoming resistant. The team did this using 2 standard methods:

• minimum inhibitory concentration (MIC) tests (which measure the lowest amount of antibiotic that stops bacteria growing)
• disc diffusion tests (which show how well an antibiotic prevents growth on a plate)

They repeated these tests under different conditions, such as at 28°C and 35°C, to see how temperature affected the results. By analysing this data, they were able to set clear ‘cut-off’ points that inform us whether bacteria should be considered resistant or susceptible.

This work fills an important gap in international testing guidelines, making resistance monitoring more reliable and helping to ensure antibiotics are used responsibly in aquaculture.

Cefas’s ECOFF-setting initiatives have been published. See:

• Smith P, Le Devendec L, Jouy E and others Epidemiological cut-off values for Yersina ruckeri disc diffusion data generated by a standardised method, Diseases of Aquatic Organisms 2024, volume 158, pages 21 to 25
• Smith P, Joseph A, Baker-Austin C and others Epidemiological cut-off values for Vibrio parahaemolyticus calculated from minimal inhibitory concentration data generated at 35 and 28°C, Diseases of Aquatic Organisms 2024, volume 160, pages 127 to 134

Researchers from NIHR biomedical research centres support evaluation of prize-winning diagnostic technology

This case study falls under the 2024 to 2029 AMR NAP priority research question 9: How can we drive innovation of new products for tackling AMR?

The DIagnoSing Care hOme UTI (DISCO UTI) study, led by researchers at the NIHR Southampton Biomedical Research Centre (BRC), is investigating new ways to accurately diagnose and treat UTIs in care homes and aims to improve targeting of antibiotic treatments and reduce the overall amount of antibiotics prescribed. 

The PA-AST System test developed by Sysmex Astrego, which was awarded the £8 million Longitude prize for tackling antibiotic resistance, is being evaluated as part of this study. The PA-AST System test can diagnose a UTI from a urine sample to reveal:

• whether the infection is bacterial within 15 minutes
• which antibiotics would work to treat it within 45 minutes

Researchers from the NIHR Leeds BRC have been evaluating the PA-AST System as part of the Platform for UTI Diagnostics Evaluation (TOUCAN) study, which is evaluating new rapid tests for diagnosing UTIs in GP practices. Supporting the evaluation of innovative technologies such as the PA-AST System will help build the evidence for the effectiveness of diagnostics across different settings.

NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance

This case study falls under the 2024 to 2029 AMR NAP priority research question 7: How can we optimise the use of antimicrobials?

The 2020 to 2025 NIHR Health Protection Research Unit (HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London recently developed a bedside tool to predict the likelihood of a patient having a bacterial infection. The decision support system can provide individualised antimicrobial dosing for patients using a handheld device such as a mobile phone or tablet at the patient’s bedside. It also includes a patient engagement tool that helps patients and healthcare providers to work together to make decisions.

The HPRU also developed an AI tool that can reliably predict a patient’s health outcomes depending on their antibiotic treatment. This artificial intelligence (AI) model can support clinicians with decision-making by providing estimated outcomes for stopping or continuing antibiotics in the intensive care unit (ICU). This helps clinicians to understand when it is appropriate to stop antibiotic treatment.

Finally, the HPRU developed an additional tool that supports clinicians to make decisions about whether to switch from intravenous (IV) antibiotics to oral. Oral administration is preferable for numerous reasons, for example, switching from IV to oral administration:

• can reduce the side effects experienced during prolonged exposure if done as early as possible
• is more comfortable for the patients
• allows for easy discharge from hospital

These tools will enable rapid and accurate diagnosis at the point of care which supports clinical decision making, leading to more timely and effective treatment, and ultimately reduced antibiotic consumption.

‘Tackling infections’ - a multi-year, multi-million-pound transdisciplinary funding scheme to tackle AMR

This case study is an example of a trans-disciplinary research call aimed at addressing multiple 2024 to 2029 AMR NAP priority research questions.

UK Research and Innovation (UKRI) supports research and innovation in the UK to tackle large-scale, complex challenges. As part of UKRI’s themes forming its 5-year strategy, UKRI launched its tackling infections theme which will run from 2023 to 2029 to prepare for future disease epidemics and halt the ‘slow motion pandemic’ of AMR.

As part of the tackling infections theme, a UKRI research call, co-funded by NIHR and Defra, will provide up to a total of £15 million in funding for ambitious transdisciplinary research to tackle AMR across a broad range of areas. The window to submit applications closed on 23 September 2025. Funding decisions will be announced in April 2026.

Conclusion

The recent NAO and PAC investigations into the risk of AMR highlight the urgency of the 2024 to 2029 AMR NAP.

As such, delivery partners across government will continue to closely monitor and evaluate progress to meet the 2024 to 2029 outcomes and commitments.

Through this work, the UK is taking on the challenge of confronting AMR, to preserve and develop these essential medicines for generations to come and help us address one of the most pressing challenges we face this century.