Corporate report

UKHSA Advisory Board: Update on UKHSA Antimicrobial Resistance Programme

Updated 11 September 2025

1. Purpose of the paper

Here we provide an update on UKHSA AMR Programme’s activity against the spread of antimicrobial resistance (AMR). We summarise actions to tackle AMR implemented in the first year of the UK 5-year action plan for antimicrobial resistance 2024 to 2029 (NAP 2024-2029). The previous paper was presented to the Board on 16 September 2024. Advisory Board feedback will ensure activities are appropriately ambitious yet achievable, aligning with UKHSA’s 3-year strategy.

2. Recommendations

The Advisory Board is asked to:

• note activities under way to tackle AMR in the first year of implementation of the UKHSA AMR programme in support of the 2024 to 2029 NAP.
• comment on and provide steer and feedback on work across the organisation and externally and on the key challenges facing the UKHSA AMR programme in carrying out its ambitions within the wider system.

3. Background

In 2021 it was estimated that globally 4.71 million deaths were associated with antimicrobial resistance (AMR) and projected to rise to 8.22 million by 2050 (GRAM study group, The Lancet, 2024). The UK has been at the forefront of mitigating AMR risk, with some of the most comprehensive surveillance, reference microbiology, and AMR focused public-health programmes in the world. Average resistance to antibiotics in the UK is lower than in some comparable countries, though some European countries have lower levels. UKHSA remains abreast of the developing international surveillance picture and continues to identify areas for global collaboration, in the light of challenges to global funding, which are discussed further in the main body.

Whilst prevalence of Gram-negative bloodstream infections (GNBSI, significant drivers of AMR) fell sharply at the start of the COVID-19 pandemic mostly due to reductions in E. coli BSI, this has subsequently recovered and now exceeded the levels seen pre pandemic in 2019. Further work is ongoing to understand the epidemiology of the AMR associated infections throughout and beyond the pandemic – as this is essential for development of effective infection interventions. Much of this can be achieved through data-linkage between existing data sets but for some information, particularly community cases (which equate to approximately 65% of the burden of GNBSIs), bespoke surveillance is required. The enhanced surveillance capabilities of the programme are essential to monitoring the impact of AMR interventions and – coupled with strong stakeholder engagement and collaboration – to informing decision-making in the system on the development, roll-out and evaluation of novel interventions.

UKHSA is committed to supporting the Government’s 20-year vision for AMR by implementing the 2024 to 2029 National Action Plan (NAP) and the UK AMR 20-year vision. The UKHSA AMR Programme’s key pillars in support of the NAP 2024 to 2029 are:

1. Improving the use of big data and threat detection
2. Maximising Whole Genome Sequencing (WGS) capabilities to understand and track resistance
3. Modelling, development and evaluation of population level interventions to drive best investment in innovative solutions
4. Strengthening infection, prevention and control (IPC)
5. Translating research into tangible policy outputs and public health actions
6. Embedding tackling health inequalities throughout all our activities. The structure of the AMR programme and its input into NAP delivery via defined outcome areas is summarised in Annex 1.

4. First year of UKHSA AMR Programme implementation

We have established a robust implementation plan through an iterative, cross organisational approach that takes into consideration interdependencies, emerging challenges and opportunities. Work is progressing well across all workstreams and currently, of the 2024 to 2029 NAP deliverables, 63 are on track, 18 are yet to start, 6 are completed, 2 have been cancelled and 13 are at risk, however appropriate mitigations have been established to address the risks. The programme continues working at pace, closely collaborating with national and international health organisations to strengthen AMR surveillance, guidance, policy, and detection of emerging threats.

The National Audit Office (NAO) Investigation into how government is addressing antimicrobial resistance in winter 2024 to 2025, and the subsequent Public Accounts Committee (PAC) hearing in March 2025 have represented high-level accountability and assurance exercises that have demonstrated our unique value in contributing to NAP delivery and beyond, but also that further work is required, as laid out in the recommendations from both exercises (Annex 2, which we continue to report on with a cross-government approach).

4.1 Advancing Epidemiology and Analytical Tools

UKHSA launched a new data dashboard in February 2025, including data on healthcare associated infections (HCAI) and AMR in bacteraemia and bacteriuria. Mandatory surveillance of Gram-negative bloodstream infections (GNBSI) continues to be published as part of monthly data tables and summary, quarterly epidemiological commentary, and annual commentary. The fourth Joint UK One Health Report on AMR and antimicrobial use is in development and scheduled for publication in 2026. AMR related data continues to be ingested into UKHSA Enterprise Data Analytics Platform (EDAP), including AMR data from Second generation Surveillance System (SGSS) in July, ethnicity linkage data and data from the additional fields from HCAI data capture system (DCS) in August 2025. This activity continues to support the aim of EDAP to deliver a strategic single platform for data enrichment, data analytics and data science, for HCAI, AMR and will support provision of streamlined and timely surveillance outputs to influence the system. 

Following the development of national guidance for prompt intravenous-to-oral switch (IVOS) in paediatrics and neonates (led by UKHSA) to supplement the existing adult guidance, an audit was rolled out under the Commissioning for Quality and Innovation (CQUIN) framework (2024 to 2025 financial year) to assess the proportion of patients (adult and paediatric) receiving IV antibiotics that met the IVOS criteria. The CQUIN indicator was launched at a national webinar to NHS clinicians, and this has strengthened UKHSA collaborations with NHS England to improve patient interactions within the healthcare system, the impact of this collaboration has been increased empowerment of frontline teams to take increased ownership of antimicrobial stewardship efforts to enhance outcomes for the youngest and most vulnerable patients. This will be further underpinned by the outcomes of the CQUIN.

4.2 Integrating Health Equity into AMR Surveillance

There has been clear progress in integrating ethnicity and indices of multiple deprivation into mandatory surveillance and reporting, which supports wider goals around tackling health inequalities. The latest English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) report (published in November 2024) includes disaggregated data on antimicrobial use and resistance by factors associated with health inequalities: age, index of multiple deprivation, geography (antimicrobial use and resistance data) and ethnicity (AMR data).The 2025 ESPAUR report is in development and will be published in November 2025. Additionally, since the 2023 publication, the annual epidemiological commentary on bacteraemia and C. difficile has included age-standardised incidence by ethnicity and index of multiple of deprivation which has highlighted groups with relatively higher risk and require further investigation. Research on health inequalities in incidence of bacteraemia has also been published as a peer-review publication. These analyses are expected to provide insights into groups for whom targeted interventions should be considered.

Finally, a UKHSA analysis to elucidate the association between non-COVID-19 related sepsis and health inequality risk factors amidst the pandemic in England, has been included as part of the evidence review for the National Institute for Health and Care Excellence’s update to the Sepsis guidance. This demonstrates direct impact on national guidelines embedding health inequalities factors.

4.3 Bioinformatics

The first year of the current UK AMR NAP has seen advancement of our bioinformatics capability – including piloting implementation of long read sequencing and analysis of pathogen genomes to better track AMR-linked mobile genetic elements. Embedding genomics capability into existing workstreams has continued, for example reference laboratory identification of genetic determinants of resistance in isolates. Bioinformatic analysis of this new stream of reference laboratory genomics data, identified a novel mobile genetic element driving spread of a particular genetic mechanism (blaOXA-23) and has now been accepted for peer-reviewed publication in Microbial Genomics. More generally, this technology is expected to provide more detailed and accurate characterisation of hospital outbreaks, allowing more efficient resource allocation for IPC within the NHS. This capability can replace several typing tests used in diagnostic laboratories, and in most cases improve turn-around times.

4.4 Research, Innovation and Discovery in AMR

Since 2021, UKHSA has led on impactful research in the AMR space, this is demonstrated by contribution/authorship of at least 550[1] publications on AMR topics, including 466 articles in peer-reviewed journals. See annex 3 for a summary of financial year 2024 to 2025 publications and annex 4 for summary of available grant award data. The new UK AMR NAP has a strengthened focus on research prioritisation and includes a ‘top 10’ list of research priorities for AMR, which has strongly informed UKHSA research activity, including outstanding examples of (inter)national partnerships that produce high value insights on AMR (annex 5). A specific UKHSA research prioritisation framework has also been developed to inform research priorities within the organisation in the light of knowledge gaps and having both these frameworks in place will vastly contribute to focus and direct research efforts into the main AMR gaps. Now in its 3rd round (launched April 2025), the HCAI and AMR National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) is an important research collaboration, with a workstream aligned with NAP (and wider) research priorities. See annexes 6 and 7 for  HPRU planned work to address knowledge gaps and achieve impact.

UKHSA has contributed to the development and evaluation of novel AMR interventions through the Open Innovation in AMR platform, which works with the Pathways to Antimicrobial Clinical Efficacy (PACE) consortium to provide wraparound microbiology support for innovative companies with novel therapeutic approaches. UKHSA has recently joined the PACE Delivery Partner network to provide additional evaluation models to the research and development community. These models include high throughput screening technologies for a range of bacterial and viral pathogens, supporting new antimicrobial discovery and functional immune profiling, to support the development of new vaccine strategies for pathogens impacting on antibiotic use and stewardship.

New intellectual property includes 5 patent applications and contribution to the establishment of a spin out company, iFAST Diagnostics, who are currently carrying out a clinical trial for rapid antibiotic susceptibility tests for bacteremia. A Licence Agreement with iFAST Diagnostics ensures that UKHSA receive royalty payments of up to £500,000, and a separate UKHSA patent around the use of iFAST for bacteriophage susceptibility will allow commercialisation of that technology as it is developed, for example, through the phage service, externally funded projects or establishment of a joint venture to commercilalise a combntaion of phage and companion susceptibility test. This technology is also being explored by UKHSA to support rapid identification and deployment of bacteriophage, as part of an integrated pathway addressing the translational gap for phage therapy in the UK. Additionally, UKHSA has been awarded an MRC grant to explore modifications of azoles, looking to develop improved drug candidates for treatment of Candida auris and a second SOUTH Africa-MRC funded award to discover new antifungals from natural products.  

Research using the Modular Hospital Ward at Porton continues to investigate how the built environment influences pathogen transmission. This facility provides a safe and controlled setting to test hypotheses and assess the effectiveness of interventions without posing a risk to patients. For example, a recent study investigated bioaerosol production and bacterial dispersal from hospital toilets. The study identified transmission routes that had not been previously considered and demonstrated that some current infection control guidance may inadvertently increase risk. Importantly, the findings were directly translatable to a hospital experiencing a prolonged outbreak leading to revised protocols and interventions. The research group continues to use outputs from this research programme to influence healthcare practices in the NHS, including input emerging findings into the New Hospital Programme.

4.5 Modelling activity

Work in this area continues to strengthen our understanding of the cost-effectiveness and estimated impact of AMR interventions, with models in development to inform both national and European policy decisions and guide resource use. Further modelling work aims to project future trends in resistant infections relating to expected changes in the population, which aims to better characterise the ambition of NAP targets 1a and 1b (annex 8). Results have been used by the NAP Surveillance Targets Review Group and are being presented at the 59th Antimicrobial Prescribing, Resistance and Healthcare Associate Infection meeting to inform ongoing monitoring and review of the NAP human health targets. Work led by UKHSA in collaboration with the 4 UK Nations is focusing on the development of a metric to communicate mortality due to infections with AMR organisms, initially applied to resistant E. coli bloodstream infections recorded in England in 2023. The latter will greatly support communications to the public and professionals about the consequences of AMR.

UKHSA is an important collaborator in the IMPACT AMR transdisciplinary network of national and international researchers and stakeholders seeking to address key policy questions around AMR mitigation investment priorities through the development of an evaluation framework to compare the impact of interventions, with UKHSA colleagues leading one of the workstreams and active contribution from UKHSA on the remainder.

4.6 Public and Professional Engagement

UKHSA leads on professional and public engagement, underpinned by an important NAP target, alongside a number of NAP commitments. UKHSA leads this activity with collaboration across the system and UK nations, aiming to align approaches where possible. In the first year of NAP, UKHSA coordinated delivery of the first 4 nations public AMR survey of 5,914 adults, facilitated by Ipsos. Each nation received a UK wide and individual nation level data report to inform intervention and campaign development. Important findings are currently being drafted into peer reviewed manuscripts. Important insights from the analysis can be found in annex 9.

Based on survey findings, UKHSA launched a new public awareness campaign aimed at 18 to 34-year-olds. The mascot, Andi Biotic was created to front the campaign, which includes online videos, social media and print assets. Evaluation of the campaign is ongoing, however initial results are encouraging with Instagram posts achieving an average engagement rate of 2.8%, 1.5% higher than the channel average, and Facebook receiving over 40,000 organic video views.

The Antibiotic Guardian  campaign has now reached over 212,000 pledges and held the 2024 to 2025 Shared Learning and Awards event on 9 June which had 75 entries and 127 attendees from both UK and international organisations, providing shared learning or case studies for longer term use or sustainability UKHSA’s WAAW activities for 2024 received high levels of engagement with 906 individuals registering for a webinar launching the WAAW toolkit, which was visited 4,061 times from its publication in September to the end of 2024. Planning for World Antimicrobial Awareness Week (WAAW, 18 to 24 November) continues, with national activity being coordinated by UKHSA.

In collaboration with NHSE and City St. George’s University, UKHSA led delivery and evaluation of the TARGET AMS training programme to primary care staff across England, using a regional cascading model. Five out of 7 NHSE regions participated. Surveyed clinicians found the training valuable; follow-up showed increased confidence and patient engagement influencing prescribing decisions. Interrupted time-series analysis revealed a sustained reduction in antibiotic dispensing, saving over £317,000 monthly, with further monthly savings accruing. The programme’s timely, budget-conscious delivery using existing infrastructure proved scalable, prompting NHSE support across 10 ICBs and integration into local incentive schemes – demonstrating its national and international potential for stewardship impact.

To address lack of knowledge about AMR in young people, UKHSA lobbied the Department of Education to include AMR into the review of the English relationships education, relationships and sex education (RSE) and health education; this addition was accepted by ministers and published in July 2025.

4.7 AMR and Climate Change

Climate change poses a global threat also in terms of AMR and UKHSA has been at the forefront of this work, leading on specific commitments in this area of the NAP. UKHSA have been collaborating with the university of Leeds to determine interactions of the climate change or AMR syndemics and scope future interventions that will mitigate the impacts of climate change and AMR on health. UKHSA are moving to conceptualise the causal pathways concerning the risk of AMR in the UK arising from climate change, and to determine indicators that will enable these relationships to be measured, for the development of future targeted interventions.

4.8 Embedding Evaluation of Impact in UKHSA AMR activities

In 2024, a new AMR Evaluations team was established to better characterise the impact of the AMR and HCAI Divisions work, including and beyond the NAP Since its inception, the team has initiated a wide-reaching impact evaluation of the surveillance outputs produced by the division to ascertain what is working well, the usefulness of the outputs to our stakeholders and what could be improved. An Evaluation guide has been prepared to help embed evaluation across the division with various impact metrics being collected across all projects via the division’s new SharePoint impact tracker.

4.9 Global AMR

An assessment of UKHSA’s unique expertise and capabilities has identified opportunities for collaboration and knowledge sharing in global AMR efforts to strengthen UKHSA’s Global offer. UKHSA continues to contribute to World Health Organisation’s (WHO) activities, including submission of AMU and AMR annual data (where data are now comparable regionally on WHO’s new AMR Dashboard), through our feedback on the development of the next Global Action Plan for AMR, WHO’s Global AMR report (2023-26), the WHO toolkit for low-and middle-income countries and the establishment of an Independent Panel on Evidence for Action Against AMR. Training on antimicrobial resistance, utilisation and stewardship interventions has been provided to various cohorts of Fleming Fund fellows through a series of in person workshops. UKHSA are supporting directly 2 Nigerian national experts through phase 2 of the Fleming Fund, which runs until March 2026 and focuses on using AMR data for health policy, antimicrobial procurement, treatments and improving guidelines. UKHSA continues to input into relevant international documents, such as the UK positioning on the Pandemic Accord. UKHSA has initiated support to the Caribbean Regional Public Health Agency via the CARA project with the development of laboratory capacity and surveillance reporting, as well as providing AMR molecular training. UKHSA also continues to support relevant AMR international commitments, such as Transatlantic Taskforce on Antimicrobial Resistance TATFAR, and works on strengthening surveillance systems and integrating the data for global reporting. UKHSA is identifying challenges and opportunities arising for our Global AMR activities from the announced cessation of the Fleming Fund activities, including building on established working relationships within International Health Regulation Strengthening and UK Overseas Territory partner countries. Over the upcoming year will be review plans for further development of our Global AMR activities and ways to maximise UKHSA expertise for best impact.

5. Key challenges and risks for the UKHSA AMR Programme

The UKHSA delivery of the NAP is carried out against the backdrop of an evolving global instability scenario, that includes conflict in various parts of the world, increased migration and the effects of climate change, that collectively contribute to increasing the spread of infection and AMR. The key challenges and risks are outlined below.

5.1 Rise in drug resistant infections trends

In the UK, there continues to be a risk that the increases in drug-resistant infections could impact the delivery of the NAP commitments and the human health targets. UKHSA predicts the incidence of drug-resistant and gram-negative blood stream infections will continue to rise due to increasing age, medical comorbidities, and population demographic changes. Therefore, preventing an increase in these infections from the 2019 baseline remains ambitious. A new, UKHSA led, UK wide Human Health Target review group has been established to actively review trends and NAP targets trajectories over the course of the NAP (Annex 8).

5.2 NHSE/ DHSC Merger

NHSE (NHS England) is our closest partner in the delivery of the NAP, with many interdependencies with NHSE on NAP workstreams deliverables. The announced merger of DHSC (Department of Health and Social Care) and NHSE may cause a period of uncertainty. The UKHSA Health protection and regional teams play a vital role and work very closely with ICBs (Integrated Care Boards) in supporting programmes to control HCAI and AMR. Whilst these changes present some uncertainty, the UKHSA regional teams will be critical in helping partners navigate this evolving landscape.

5.3 UKHSA AMR cross-organisational data and analytical collaboration

The UKHSA AMR Programme includes a significant contribution from CDO (Chief Data Officer) group, particularly for surveillance data and digital assets that underpin NAP deliverables. We have engaged proactively with CDO, and leadership and management teams have been involved in the programme since the development phase of the current NAP. Recognising that CDO work across digital, technical and analytical outputs and the continued capacity constraints across UKHSA, we will work to ensure there is greater clarity regarding which CDO analytical teams are working on AMR and what specifically, to ensure clear remits and responsibilities for outputs, avoiding duplication, identifying shared skillsets and areas for collaboration, to ensure UKHSA’s prioritisation and optimisation of resources.

6. The Funding for AMR

Whilst there is no formal financial mechanism to capture AMR spend across UKHSA, information gathered for the NAO investigation indicated steady funding across UKHSA during the previous AMR NAP and first year of the current NAP (Annex 10). All parts of UKHSA continue to prioritise activities in this area supported by coordinated business planning facilitated by the UKHSA AMR internal Programme team, HCAI and AMR Divisional Business Operations and increasingly engaging with CMA Portfolio Board for Capital Departmental Expenditure Limits (CDEL) investment. Within CMA Group (AMR and HCAI Division), there was a reduced revenue allocation during 2025 and 2026 and additional pressure via absorption of in-year pay increases. Beyond 2026, there has been a bid within the Spending Review Phase 2 for new CDEL funding for the remainder of the NAP to enable investment in surveillance and digital assets that underpin NAP outcomes. This is currently not confirmed. Guidance on Resource Departmental Expenditure Limits (RDEL) was that additional funding was unlikely through the spending review due to pressures across UKHSA and the wider economic environment. Whilst NAP commitments had been designed to ensure scope to deliver within available resources, that had been against the original baselines of 2024 and 2025 and prior to the in-year reductions and pressures (absorption of in-year pay awards). To note should there be a flat cash settlement for 2026 and 2027 and beyond, this generates a risk to UKHSA maintaining capacity for current commitments. Whilst CDEL investment projects focus on increasing automation of reporting, timescales associated with such projects would realise those efficiencies until late 2026 and 2027.

7. Future of the UKHSA AMR Programme and Strategic priorities

7.1 UKHSA Systems leadership

UKHSA continues to work towards both planned work and emerging strategic priorities, providing leadership nationally and internationally. The announced merger between DHSC and NHSE poses risks and challenges, but also new opportunities to strengthen the healthcare system and specifically AMR structures and systems, with UKHSA playing a crucial role. The renewed focus on AMR and stronger awareness of the magnitude of the problem, as demonstrated by the recent NAO investigation and the subsequent PAC enquiry, provide the organisation with a strong mandate in addressing AMR as a priority and directing UKHSA activities and resources on AMR where they are most needed.

7.2 Building and translating evidence into effective interventions

Understanding what really works and how and determining impact and cost-effectiveness of interventions are important to reduce the spread of infections and of AMR. Over the next 5 years we aim to close this evidence gap, translating knowledge into tangible outputs for policy and public health action to inform large scale, innovative population interventions. Alongside modelling and research work which are already under way in this first year of the NAP, from September 2025, UKHSA, in collaboration with DHSC and NHSE, will launch a new NAP interventions group. The group will be co-led by UKHSA and NHSE and will take an evidence-based approach to development, delivery and review of interventions in England, to further strengthen our ability to drive the ambitions of the NAP and monitor the impact on public health outcomes. The group will review the outcomes and impact of the interventions carried out during the lifetime of the NAP and capture learning for future action.

7.3 Testing our ability to respond to future pandemics and AMR threats

Learnings from the COVID pandemic and the continuing rise in the threat posed by various organisms have led to the Government decision to lead a cross-government pandemic preparedness exercise. UKHSA plays a crucial role in Exercise PEGASUS, which will take place over the Autumn 2025. We have actively advocated for the inclusion of AMR and plan to use learning from the exercise to scope the feasibility of conducting a bespoke cross-government national preparedness exercise with a more significant AMR dimension in the future.

7.4 Focus on key actions recommended by NAO and PAC

The recent NAO audit and PAC inquiry provided clear indication of where our efforts are most needed to advance tackling AMR and where they will make the greatest impact. The importance of retaining the focus on AMR as a global threat directly speaks to UKHSA strategic approach and provision of international action and support. Equally, UKHSA already actively contributes to research and development of innovative tools and diagnostics and will continue to focus on discovery, also via its work on research development and use of bacteriophage as an alternative to antibiotics. The UKHSA modular hospital ward has been recognised as vital and we will continue to develop this in order to promote it as a best practice approach across the healthcare system when building or refurbishing wards. Finally, the UKHSA AMR Programme will prioritise enhancement of human health data collection, sharing data and analyses across the system and within a One Health approach with the animal, food and environment sectors.

---

[1] Figure extracted from CRIS, which is likely to be an underrepresentation.