London School of Hygiene & Tropical Medicine

Two major new projects providing an alternative approach to address the growing threat of antimicrobial resistance (AMR) to public health have each received £1.7 million grants under the Cross Research Council Tackling AMR Initiative.

Both projects, led by the London School of Hygiene & Tropical Medicine, will look at human relationships with antibiotics and the social context of drug resistance, bringing multidisciplinary perspectives to identify more holistic solutions than have been traditionally proposed. A third School-led study has been awarded an initial £200,000 from the same scheme to explore policymakers' perceptions of antimicrobial resistance in Pakistan.

Antibiotics are primarily used to treat infections in humans and animals, but these drugs have also been applied more widely, for example in growth promotion for farming livestock and even for crop farming. Adding to the issue, it is estimated that 50% of human antibiotic usage has no clinical benefit. This widespread use has contributed to the growing threat of drug-resistant infections, known as antimicrobial resistance (AMR). In 2016, the O’Neill report estimated that 700,000 people a year are killed by drug-resistant strains of common infections, TB, HIV and malaria. The report, commissioned by the UK government, suggested that by 2050 this figure could rise to 10 million, responsible for more deaths than from cancer.

Antimicrobials in Society

The wider roles that antimicrobials play in society have been overlooked in favour of a focus on clinical effectiveness. Over the next four years, The Anti-Microbials in Society (AMIS) Hub will develop and promote fresh perspectives on antimicrobial drugs through a web portal and interactive activities. Researchers from the AMIS Hub will also undertake studies in Thailand and Uganda to understand how antibiotics are interwoven in every-day life.

Clare Chandler, Associate Professor in Medical Anthropology at the School, co-director of the Antimicrobial Resistance Centre and Principal Investigator for The AMIS Hub said: “At the moment, approaches that are designed to reduce use of antimicrobial medicines tend to focus on the behaviour of individual users and prescribers. If we want to explain the increasing use of antibiotics we need to look more widely, at their roles in the economies and societies of our time. We hope that the AMIS Hub will enable better-informed decision making to reduce our reliance on these drugs at this crucial time for public health.”

Tackling drug-resistant TB

The second project takes an innovative approach to tackling transmission of drug-resistant tuberculosis (TB) within health facilities in South Africa. The design of health facility buildings, the organisation of service delivery, and the movement of health workers and patients often do not take account of the risk of transmission of drug-resistant TB to other patients and to staff. In addition, recommended measures for TB infection prevention and control are often not put into practice. To understand this, researchers will examine these practices in health facilities, and investigate health workers' and patients’ perceptions of infection risk and accountability for prevention measures.

The study will take a ‘whole systems’ approach, drawing from expertise across disciplines including anthropology, epidemiology, health systems research, mathematical modelling and health economics, to propose inter-disciplinary solutions to preventing transmission of drug- resistant TB.

Alison Grant, Professor of International Health at the School and Principal Investigator for the drug-resistant TB project said: “Drug-resistant TB is a major threat to public health internationally, and is a serious problem in South Africa. We need to find and treat people with drug-resistant TB earlier, to prevent onward transmission. We aim to find out how much transmission of drug-resistant TB occurs in clinics, why existing recommendations are not put into practice, and how much could be gained if transmission in clinics was stopped."

Collaborative working

Researchers from both projects hope that their interdisciplinary approaches will provide an innovative framework, foster further research into AMR and enable policymakers to prioritise investments and successfully devise health system strategies.

Professor Richard Smith, Dean of the Faculty of Public Health and Policy said: “I am delighted that we obtained two major grants, and a very promising third pilot study, that will tackle the wider social factors behind antimicrobial resistance. The research will provide critical insights in to promoting the sustainable use of antimicrobials.”

Dr Chandler leads The AMIS Hub with colleagues from Mahidol University and the Ministry of Public Health, Thailand and the Infectious Diseases Research Collaboration, Uganda. The study looking at infection and prevention control for drug-resistant TB is led by Prof Grant, with colleagues from LSHTM; co-PI Dr Karina Kielmann at Queen Margaret University, Edinburgh; the Africa Health Research Institute, South Africa; the Institute of Development Studies, Sussex; the Universities of Cape Town and KwaZulu-Natal, South Africa; and University College London.

The funding was awarded under the GCRF Tackling Antimicrobial Resistance: behaviour within and beyond the healthcare setting call. These grants are funded by the Economic and Social Research Council working in partnership with the Department of Health.