Jenny Harries welcome address at the UKHSA conference
Speech delivered by Professor Dame Jenny Harries, UKHSA Chief Executive, at the UKHSA conference 2023 in the Royal Armouries Museum in Leeds.
I am absolutely delighted to welcome colleagues across the UK Health Security Agency (UKHSA), devolved administrations, local authorities, the NHS, Directors of Public Health, partners in industry, government, the charity sector and academia to this – the UKHSA conference 2023, the second instalment of our annual conference.
And welcome back to Leeds and the Royal Armouries Museum to those of you who joined us at last year’s conference. We had such positive feedback from last year’s event we couldn’t pass by an opportunity to return.
Conference comparisons
Now, topping last year’s conference is no small feat, but this year we have returned with gusto.
So let’s jump in with a few conference facts and figures.
Over the next 2 days you can explore:
- 5 keynote plenaries
- 34 parallel sessions, including research presentations, panel discussions and interactive workshops
- over 41 exhibitions – that’s compared to 25 last year
- and all based on almost 500 abstracts which were submitted for consideration for this year’s conference – over 100 more than the previous year
We’re showcasing even more external exhibitors and external delegates are up by over 200, which all means we’ve actually had to expand our territory across the Royal Armouries site – a major accomplishment for our External Affairs team. So a big thank you to them.
UKHSA reflections – 2 years on
Now as an organisation we have recently celebrated our second birthday, and like most 2 year olds we have been very energetic – flexing our muscles, stabilising our centre, proactively looking out for new opportunities with enthusiasm and testing out ideas for the future. And we have done a lot during this year.
I am very proud of the work of my colleagues across UKHSA – in all of our 9 regions, our 3 scientific campuses, our UKHSA teams working in, and alongside public health colleagues from Wales, Scotland and Northern Ireland and our staff at our brand new headquarters in Canary Wharf. They – you – have brought energy, professionalism and dedication to your work every day over the course of this past year and through your endeavours the health of communities in this country and abroad is better protected.
This is a great moment to publicly say thank you to everyone across our organisation – all of you in the room, those of you streaming through Pulse, and all of you either in the office or around our sites.
This year, we’ve launched our 10-year science strategy, our data strategy, and our first 3-year corporate strategy. Together these show our critical role:
- in supporting the UK life science agenda and its economy
- for delivering often unique clinical and scientific research and evaluation functions
- and – the part we are perhaps best known for – preventing health threats whenever we can, preparing and responding to those that do occur, and building the capabilities and technologies to protect this country in the future.
That protection can be anything from infectious disease risks through chemical, radiation and environmental threats to the harmful impacts of climate and extreme natural events.
As part of that strategy launch, we laid out 6 strategic priorities which are outlined behind me – 5 top priorities to protect our communities in different ways. And one to ensure as an organisation we remain focused – efficiently and effectively – on our people and the responsibilities of our mission to protect every member of every community.
Last year I spoke about the start of our organisation and the work we had planned for the year ahead – it was new and of necessity a little procedural.
But this year I have the privilege of a platform to highlight one of those key strategic priorities and the work which we in UKHSA do to combat a risk as large as the pandemic we have just endured.
Something which is a national threat to each one of us and our families, but importantly is also a problem which has different characteristics, which only joint working can solve, which everyone in this room can contribute to mitigating and where a loss of focus will mean huge loss of life – and that is the problem of antimicrobial resistance.
Often referred to by the previous Chief Medical Officer and now the UK Special Envoy on Antimicrobial Resistance, Dame Sally Davies, as the silent pandemic – or more recently, as the grand pandemic.
Put simply, antimicrobial resistance – or AMR – means that those products which have been developed to treat bacterial, viral, fungal and parasitic infections, become less effective – or ineffective – because the targeted organisms learn to adapt through a number of different mechanisms. This might be for example through genetic mutation or horizontal gene transfer. And as we know, the major driver for antimicrobial resistance currently is antibiotic use.
So we might all take a bit of inspiration from where we are today – here in Leeds – which has one of the lowest primary care total and broad spectrum antibiotic prescribing rates for a metropolitan area. And we might say we know what the problem is and we have programmes in hand – including the National Action Plan.
But as a society we have been unable to keep pace with the need to develop new antibiotics, antivirals and other antimicrobials.
I am anxious that we don’t always recognise what can sometimes appear as too complex a scientific conundrum – but what is actually a tangible real threat to us all. And a threat which needs our unwavering focus.
So at this point I’m going to use my platform to get a bit personal and introduce some of my family – photos only – not a reality show!
Great, great aunt Edith Simpson at the top of this slide was a nurse in the Queen Mary’s Military Nursing Service. There is a note here at the bottom of her picture in the Imperial War Museum about work life balance which I must remember – because she is said to have died in 1915 from overwork, nursing wounded soldiers returning from the trenches in the first world war. There were no antibiotics as we know them today either for those soldiers or for her when we think she developed septicaemia.
This is my father, Peter Higgins, who was a virologist in the first Public Health Laboratory Service. He was born in 1926. Lucky for him, in 1928, penicillin was discovered and in 1943 streptomycin – and the benefits of antibiotics started to be realised.
This is me, the endearing bundle to the right, born in 1958 and lucky enough to be a child between 1950 and 1960 in what has been referred to as the ‘golden age of antibiotic discovery’ – a period in which one half of the drugs commonly used today were discovered.
And this is my youngest daughter, Emma. She was born in 1993. There have been no distinctly new antibiotic classes developed for her entire lifetime but a growth in multi-drug resistant organisms continues apace.
As a society we have therefore discovered huge therapeutic resource and lost significant effectiveness in one single family generational cycle. This is why we should all be worried, not wearied, by the topic of AMR. And this is why we need to act more demonstrably, more decisively, more convincingly and more cohesively,
Why does this matter? What is the scale of the threat that we face? On a daily basis, across this country, and globally, antimicrobial resistance makes it difficult – and sometimes impossible – to treat patients and protect our communities.
ESPAUR report
UKHSA publishes the ESPAUR report every year – that is the English Surveillance Programme for Antimicrobial Use and Resistance Report. And while the use of antibiotics in England declined between 2014 and 2020 and the burden of antibiotic-resistant infections has gone down since 2018, the decline was driven predominantly by the COVID-19 pandemic and the changes it sparked in people seeking healthcare and spreading infection. But this trend has now reversed.
Antibiotic prescriptions
We know there was an 8.4% hike in prescriptions last year.
We know that a conservative estimate is that more than 58,000 people in England had an antibiotic resistant infection in 2022 – that’s a rise of 4% from 2021.
And we know that the number of people dying of infections resistant to antibiotics also increased last year, also by more than 4% – sadly more than 2,200 people lost their lives in the previous 12 months.
The chance of dying due to an antibiotic resistant infection within 30 days increased another percentage point in 2022 from 19% to 20% in 2022.
AMR SOS
So AMR should be front page news – and that is not just for the opportunities to improve health outcomes alone.
We know that globally in 2019, 1.27 million deaths were directly attributable to AMR, and Lord Jim O’Neill’s independent review of antimicrobial resistance in collaboration with the Wellcome Trust, published in 2016, found that if insufficient action is taken, the number of deaths across the world could rise to 10 million a year by 2050, and the cost to the global economy could be as much as $100 trillion.
There are some similarities of course between the real recognition of the risks of climate change to health and the threat of AMR – both incur significant costs from our collective inaction. Both appear to have crept up on us insidiously. Both have taken a long time to settle in people’s conscience to take action, but antimicrobial resistance is now, rightly, considered a chronic threat to our nation’s health and security – just like climate change – and both sit side by side on the government’s chronic risk register.
If we look towards that date of 2050, with little intervention or innovation, we won’t be able to deliver effective healthcare, routine operations, or protect people with weakened immune systems who really need help fighting off infections.
Without effective modern antibiotics, other antimicrobial treatments, vaccines and diagnostics, patients in the near future facing cancer treatment, colorectal surgery, hip replacements, caesarean sections or those harmed in war zones will be more likely to die from infections.
Perversely just when we start to develop personalised vaccines for otherwise complex cancer therapy, we may also find that what seemed simple lifesaving interventions in the form of antimicrobials in the past are no longer effective and it is infection that once again becomes the big killer.
So taking a One Health approach, in UKHSA we are focussing on 3 key ways to tackle AMR and I’m inviting you to answer the SOS too.
Firstly – by reducing the need for, and unintentional exposure to, antimicrobials.
Secondly, by optimising the use of existing antimicrobials, using surveillance and new analysis.
And finally, by investing in innovation, working right across the human, animal and environmental interface and anticipating the impacts and mitigations of climate change on AMR risk.
Of course, the first way to reduce the need for antimicrobials is to stop infections occurring.
Through the pandemic the whole population learned simple interventions to take to reduce the risk of transmission such as increasing ventilation, thorough handwashing. But education can be routine and can start young. UKHSA has a comprehensive schools education programme about AMR called e-Bug, one of several resources for professionals.
But one of the most successful public health measures ever is that of tackling vaccine-preventable disease through routine immunisation programmes.
Those such as pneumococcal and meningitis vaccines already make a huge contribution to slashing the number of infections spreading in our communities, reducing the need for prescribing of antibiotics and antivirals.
But vaccination can achieve more.
Vaccines and infection prevention
Through our recently launched Vaccine Development and Evaluation Centre (VDEC) we’re working alongside partners in industry, academia and public health on the science to proactively tackle pathogens head on.
We’re creating a favourable environment for the development and evaluation of vaccines to support the fight against antimicrobial resistance.
For instance, expediting the development and deployment of vaccines against Neisseria gonorrhoeae – a pathogen where we see high rates of antibiotic resistance.
We can use genome sequencing to reduce exposure to antimicrobials and the number of infections transmitted through chains of infection by virtue of more rapid and more accurate diagnosis.
Even though rates of multi-drug resistant TB are currently low and stable in the UK, we can use whole genome sequencing to rapidly predict antibiotic susceptibility and ensure patients get the right treatment at the right time, while reducing the emergence of sequential resistance.
Having strong infection prevention and control strategies is perhaps the best, and easiest way, to reduce the risk of transmitting serious disease, and our health and care settings are perhaps the most important environments.
At Porton Down, innovative work to properly understand environmental and human transmission risks, and how we can intercept effectively, is providing evidence based advice to professional frontline colleagues as well as to environmental programmes such as the new hospital programme.
For those of us who have been away from hospital wards for some time, the mock ward at Porton Down can be quite unnerving – there are real sinks, and sluices, beds and nursing stations to assess the risk of pathogens remaining on, or being transmitted across, the built environment. Of course the only thing not real in this picture is the patient in the bed – although they can – and do cough – on demand!
Stewardship
In local communities UKHSA health protection teams work closely with integrated care boards and directly with healthcare providers to put national surveillance and AMR guidance into a local perspective. Our teams provide bespoke analysis tailored to the local epidemiology and provide specific support for outbreaks.
And that is so important because it is local health and social care colleagues, including those practising and in training, who are the frontline defence for AMR prevention – both in ensuring safe practice in our health systems, whether supporting patients directly or overseeing appropriate prescribing and safeguarding of our antimicrobials.
Through our toolkits, through good practice, and through the Health Infection Society and UKHSA joint Foundation Course, we build better understanding of how and where infection starts and how to break chains of transmission.
The second area of attack is through good guardianship of our existing antimicrobials. To know we are using them effectively, we need good surveillance and to know where we can intercept with impact, we need excellent analysis.
With our partners in industry and academia, the ESPAUR reports – running over the last 10 years – have given a solid evidence base in England from which we can focus on identifying and filling evidence gaps, effectively use funding to enable research and research infrastructure, knowledge transfer and support disciplines needed to tackle AMR.
Globally, there is a need to expand microbiology laboratory capacity and data collection systems to improve our joint understanding of this important human health threat.
Through the Fleming Fund, the UK is already working with 25 countries to develop their surveillance and systems for infection and AMR.
And through building partnerships with governments and equipping them to collect and use data, we can encourage countries to use antibiotic drugs more appropriately and invest in strategies which tackle AMR.
Now there is one team in UKHSA – the AMR division – who over many years has provided really practical resources to many different communities to keep us using antibiotics safely. I’ve mentioned e-Bug for school children already. There is also the ‘Start Smart and Focus’ antibiotic stewardship toolkit for secondary care.
But given that the vast majority – 72% – of antibiotic consumption originates in primary care, one of the most important UKHSA toolkit’s is TARGET – helping GPs to prescribe optimally.
We can celebrate the fantastic work of those in primary care over the past 5 years to make strides in reducing prescribing. And celebrate those in secondary care for reductions in broad spectrum antibiotic use.
Staying on TARGET is even more important in 2023. Primary care prescribing is now back up to pre-pandemic levels.
And if you are not at school, or working in secondary or in primary care, the AMR division still has a toolkit for you – you, your friends, your family and all of your relatives can become antimicrobial guardians – and make a pledge (in whatever language you choose) with more than 158,000 others, to support safe use of antimicrobials.
Many people in this conference will be acutely aware that infectious disease persistently follows the very young and the very old, those already in ill health and those living in socio-economic deprivation.
As is often the case in public health, factors such as being in secure employment, health, education and geographical location all play important roles in the way we, as individuals, use and engage with healthcare.
UKHSA derives much of its AMR data from traditional laboratory-based systems.
But the pandemic has been a catalyst for a new health data revolution. Our UKHSA teams are enriching data pipelines, which require carefully threading together of various sets of secondary and tertiary data streams, enabling us to link patient ethnicity data to microbiological records.
We knew that people over the age of 64 had the highest rate of bloodstream infections caused by resistant pathogens, followed by babies under one.
But now, with good ascertainment, we are able to routinely analyse AMR data by ethnicity as well, and what’s more, we can further combine these anonymised data sets with improved geospatial data – mapping cases to unique property reference numbers, allowing the analysis of variation in infections, and AMR prevalence among the population like never before. We can see both the geographical distribution of the burden of antimicrobial resistance as well as the north-south differential in blood stream infections.
Health inequalities
These new data also highlight the stark inequalities in antibiotic resistance, with people in the lowest socio-economic group more likely to have a resistant infection compared to the highest group. We also know that these groups are more likely to be impacted by sepsis.
And we have found that people from Asian or Asian British communities are disproportionally impacted by antibiotic resistance.
So through this improved system, we can analyse those groups most at risk, identify where support and interventions need to be targeted, and importantly monitor where those interventions have been successful.
Invest
There is a striking imperative post-COVID to work differently with industry – on vaccines, but also on antimicrobials.
Many of our antibiotics are generic broad-spectrum derivatives of much older drugs – from my childhood – which are increasingly ineffective.
The significant investment required for new product research and development – and the low likelihood of success of new products – means that healthcare systems are not accustomed to investing the funds necessary to make developing new antibiotics worthwhile for industry.
Novel subscription style models of investment, trialled in the UK, enable a different way of working with pharmaceutical companies to develop antimicrobials for the NHS based on the value of their usefulness, rather than the number of units being sold.
UKHSA’s unique capabilities mean we can partner with academia and industry to support discovery and evaluation of new antibiotics and antibiotic alternatives such as bacteriophages.
And our collaborations with academia through the NIHR Health Protection Research Units are an exemplar of how we can drive research and innovation forward through partnerships – supporting our work to model the impact of AMR, evaluate interventions, and enhance surveillance.
We will still need to stay vigilant. A new injectable cephalosporin called Cefiderocol approved by the European Medicines Agency only in 2020 to treat difficult Gram negative infections, already has identified resistance – within the first 1 to 2 years of use.
Investigating and understanding resistance to newer antibiotics is an important area of development. Developing and deploying new diagnostics and precision therapeutics, strengthening collaborative networks and overcoming market barriers, we can work across the public sector, academia and with industry to move new products from discovery to market.
Risks of climate change
This time last year, at this conference, I launched our Centre for Climate Change.
It is within the context of climate change we will have to tackle the challenge of AMR which we will be highlighting in a new UKHSA report on the health effects of climate change due for publication later this year.
There is emerging evidence suggesting that AMR may be influenced by climate change: warming temperatures may accelerate bacterial growth, increase bacterial infection rates, increase the frequency of infections in healthcare settings and expand geographical distributions.
These processes increase the likelihood of horizontal gene transfer and thus the emergence of drug-resistant infections. More frequent and intense rain and flooding events in future will likely lead to increased agricultural runoff and pollutants in water, causing bacterial blooms and further opportunities for antibiotic resistant gene transfer.
All of this means that we cannot view the threat of antibiotic resistance purely through the lens of human disease and prescribing – we must work with partners to embed a One Health approach, to monitor and respond to emerging risks.
The third UK One Health Report will be released later this month – a collaborative report on antibiotic use, antibiotic sales and antibiotic resistance from the 4 UK nations, UKHSA and the Veterinary Medicines Directorate.
The report outlines the importance of microbes and antimicrobials in the interactions between human, animal and environmental settings. How pathogens which cross the food chain, such as salmonella, can be reduced or eliminated.
It gives essential insights into complex issues – for example why similar rates of resistance are found in some human, animal and food chain infections, while other pathogens show differential decreases in resistance between human and animal species.
Importantly, it brings together antibiotic stewardship across sectors, and highlights existing and new surveillance initiatives – including for example PATH-SAFE – pathogen surveillance in Agriculture, Food and Environment.
As we publish the UKHSA ESPAUR report today, and despite the innovation and achievement in recent years, we need to call upon ourselves to go further and faster than before.
We are fighting one pandemic on the back of another. And just like the last, it is not just about protecting our own health, but about securing the health of everyone in our communities.
Antimicrobial resistance is not a crisis of the future; it’s one that is very much with us right now. Unless action is taken, the availability of life-saving treatments will only diminish and our ability to drive down infections will decrease, most adversely impacting those in the poorest social circumstances.
There is an SOS call-out – but there are things we can all do. I am inviting you today to partner with UKHSA as we take on this crisis of our age.
Thank you.