The Prince of Wales has called for urgent action to combat antimicrobial resistance (AMR), which he says “threatens our health, our environment, our livelihoods and our future.”

Prince William, Patron of the Fleming Initiative, attended an event at The Royal Society in central London on May 16 to celebrate and support global efforts to tackle antimicrobial resistance and build stronger health systems, food security and climate resilience. 

Addressing the conference, the Prince of Wales spoke of how AMR’s threat to lives is “indiscriminate”, affecting all countries and all income levels. 

WATCH: Prince William’s speech on tackling AMR

“We stand at a critical juncture, where the interconnections between drug resistance, climate change and environmental degradation cannot be ignored,” he said.

“Rivers are polluted with antibiotics and oceans are filled with micro-plastics containing resistant bacteria. Meanwhile, deforestation is playing havoc with ecosystems, facilitating the emergence of new infectious diseases.”

“Unless we act now and together, the ripple effects of drug resistance will be felt across generations, jeopardising the wellbeing of our children and our grandchildren.”

The event, jointly hosted by the Government and the Royal Society, showcased the latest scientific and economic research into antimicrobial resistance, while serving as a platform for thought leaders and awareness-raising campaigns.

Prince William, as the UK’s future monarch, brings welcome support to an area where progress has stalled in the past decade, according to the World Health Organisation, in terms of the development of new treatments and innovation. Urgent action is now needed from all corners of the world, in a global ‘One Health’ approach, with participation from the human, animal and environmental health sectors.

How urgent an issue is AMR?

Antimicrobial resistance is a growing global threat. It’s estimated that drug-resistant infections already kill at least 1.2 million people a year. 

In the UK, there were an estimated 7,600 deaths directly from infections resistant to antibiotics in 2019, according to the country briefing from the Institute for Health Metrics and Evaluation (IHME) — similar to the number of deaths in the UK from stomach cancer. There were also around 35,200 deaths as an indirect result of infections resistant to antibiotics.

AMR occurs when bacteria, viruses, fungi, or parasites develop mechanisms to withstand the effects of antimicrobial drugs, like antibiotics, rendering them ineffective. Over the last few decades, this has been fuelled primarily by the overuse and misuse of antibiotics in healthcare, agriculture, and animal husbandry. 

Professor Dame Sally Davies, England’s former chief medical officer, has warned that the Covid-19 pandemic will ‘look minor’ compared with what the world faces from the growing number of superbugs, and that the issue is “more acute” than climate change. 

Dame Sally, who is now the UK’s special envoy on antimicrobial resistance, lost her goddaughter two years ago to a drug-resistant infection, aged 38, so has experienced first-hand the tragic impact AMR is having on lives. She has spent more than a decade raising awareness of the problem, and is currently part of the UN Global Leaders Group on AMR.

“My generation and older have used the antibiotics [and] we’re not replenishing them. We’re not making sure that our food is produced with as low usage as possible. And I owe it to my children and – if I have them – grandchildren and the next generations to do my best,” she told the Guardian.

AMR leads to longer illnesses, higher mortality rates, increased costs, and ineffective antibiotic treatments. The economic burden of AMR is huge; exacerbated by the inability to perform surgeries or therapies (such as chemotherapy) in the absence of effective antibiotics.  

The uncontrolled use of antibiotics in non-clinical fields such as agriculture, aquaculture and intensive farming is a huge concern — this is four times the volume of antibiotics that are used for humans. Causing further alarm is the threat of ‘superbugs’; the rapid spread of multi- and pan-resistant bacteria which cause infections that aren’t treatable with existing antibiotics. 

Penicillin started being used in the UK  in 1946, transforming medicine and ushering in the age of antibiotics. Since then, bacteria have evolved to become resistant to the original penicillin and many other antibiotics.

Superbugs such as methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacteriaceae (CRE), and extensively drug-resistant tuberculosis (XDR-TB) pose particular challenges for healthcare providers and policymakers, highlighting the urgent need for coordinated action.

What’s being done to tackle the rise in drug-resistant superbugs?

At the conference in London, Prince William shared his hope and optimism around solutions to tackling AMR, some of which already exist.

“We have many of the tools and knowledge needed to prevent, detect and respond to AMR. New technologies, including AI, provide us with significant new opportunities to improve surveillance and diagnosis. 

“And with the right kinds of investment and policies, we can incentivise innovation and research into new vaccines, diagnostics and medicines.”

One possible solution gaining increasing attention is ‘phage therapy’ or bacteriophages (viruses that attack bacterial cells) which were discovered around the same time as antibiotics, and are occasionally used in the treatment of life-threatening illness when all else has failed – for compassionate use. 

But with the use of phages comes major challenges around cost, licensing, and regulation. They’re a complex, deeply customised treatment, and according to the UK’s Times Science Editor Ben Spencer (speaking in the Times podcast The Story) “our health system isn’t currently set up for using live viruses”. The cost for finding a phage treatment virus for just one patient, for example, costs in the region of £1 million.

As we move faster towards highly specific, personalised medicine, it’s clear that key changes will be needed within our regulatory systems to ensure they’re better designed for a new age of medicine.

The UK’s National Action Plan

The UK government has implemented various initiatives and interventions to address the growing problem of AMR. In 2019, it published its first five-year national action plan on antimicrobial resistance, outlining strategies to improve surveillance, stewardship, and infection prevention and control across healthcare, agriculture, and the environment. 

Last week (8 May, 2024) the government published its second 5-year national action plan, setting out ambitions for 2024-2029, with nine strategic outcomes organised under four themes or sectors; human health, animal health, agriculture and the environment. 

The new commitments are to reduce use of antimicrobials in both humans and animals, strengthen surveillance of drug resistant infections, and incentivise industry to develop new drugs and vaccines.

Research and innovation

Recent developments in biotechnology, genetic engineering and synthetic chemistry have opened new avenues of research for innovative therapies to solve the growing issue of AMR. Collaborative efforts between academia, industry, and government agencies aim to accelerate the discovery and development of antimicrobial therapies.

Leicester University has recently set up a centre for phage research, and the House of Commons select committee for Science, Technology and Innovation has published a detailed report, following an inquiry into evidence on the safety and efficacy of using phages as alternative antimicrobials, as well as assessing the funding and structural challenges in their development.  

The Fleming Initiative 

In 2023, Prince William became patron of the Fleming Initiative, which aims to “break down barriers, draw on expertise, and drive positive global change to fight AMR.”

A new Fleming Centre will be opening in Paddington in 2028 and will be a place of “collective action”, bringing together world class scientists, clinicians, behavioural researchers and policymakers.  The vision is this will be the first of many centres that will be opened around the world. 

Explore more in our upcoming programme 

Our news-style programme, ‘Defending Our Health: Unravelling Antimicrobial Resistance’ will be presented by journalist and broadcaster, Sharon Thomas, and launch in September 2024. 

We are partnering with Antibiotic Research UK, the British Society for Antimicrobial Chemotherapy (BSAC), and AMR Industry Alliance to provide editorial interviews and thought leadership in the programme. It will also feature an exclusive interview with Professor Dame Sally Davies.

 

References and further reading:

Antimicrobial resistance: MPs call on UK government to maximise potential of bacteriophages | The BMJ

https://www.sciencemuseum.org.uk/objects-and-stories/alternatives-antibiotics 

https://www.theguardian.com/environment/article/2024/may/17/post-brexit-rules-on-antibiotic-use-on-farms-water-down-eu-laws-experts-say?CMP=Share_iOSApp_Other

https://www.whatisbiotechnology.org/index.php/science/summary/phage-therapy/phage-therapy-uses-viruses-that-attack-bacteria-to-treat 

Antimicrobial resistance now a leading cause of death worldwide, study finds | Antibiotics | The Guardian