Call for evidence outcome

Government response to results of antimicrobial resistance (AMR) call for evidence

Updated 16 August 2023

Introduction

In January 2019, the UK government published its 20-year vision for antimicrobial resistance (AMR) to be contained and controlled by 2040. The vision recognises that a global problem as significant and complex as AMR requires a long-term course of action that progressively strengthens our understanding of AMR and what works to contain and control it.

In support of the vision, the government also committed to develop a series of 5-year national action plans (NAPs). These will each prioritise actions and direct resources based on the latest information on the biggest risks, and which interventions are most effective in addressing them.

The first 5-year national action plan was published alongside the vision in 2019. The NAP focuses on 3 key ways of tackling AMR: 

• reducing the need for, and unintentional exposure to, antimicrobials
• optimising the use of antimicrobials
• investing in innovation, supply and access

In November 2022, a call for evidence on AMR was launched to inform the development of the next 5-year NAP on AMR, which will run from 2024 to 2029. Rather than a formal consultation on specific proposals, the call for evidence sought ideas and evidence to inform policy development. In addition to this call for evidence, the government is consulting with a wide range of stakeholders across and beyond government to inform the NAP’s development.

Submissions of evidence from all interested parties were invited. The call for evidence survey was open from 23 November 2022 to 20 January 2023 and responses were received from several different sectors, including human healthcare, farming, veterinary medicine and agriculture, and from within and outside the UK.

The Department of Health and Social Care (DHSC) analysed the responses to identify themes and trends. A high-level summary of the results, including commonly emerging themes, is included in the results below. The findings from this call for evidence will inform further, in-depth engagement with stakeholders, including on potential priorities and interventions for consideration.

The call for evidence asked questions designed to understand changes in the risk landscape, progress on tackling AMR to date, and key interventions the government should consider.

A total of 200 responses were collected. 2 responses were discounted as inappropriate, and 3 responses were submitted directly to DHSC, not using the online survey platform, and therefore are not captured in the quantitative analysis.

This section summarises the call for evidence responses, organised by each question in the call for evidence. Quotations from responses have been included to support and illustrate key points.

Demographic questions

Table 1a: capacity in which respondents answered the survey

In what capacity are you responding to this survey?	Percentage
On behalf of an organisation	60
As individuals sharing professional views	29
As individuals sharing personal views and experiences	11

Table 1b: respondent’s sectors of work

What sector do you work in?	Percentage
Public	35
Private	23
Non-profit	19
Other	23

Table 1c: areas in which respondent’s services operated

Where does your organisation operate services?	Percentage (respondents could select one or more options)
England	69
Scotland	40
Wales	39
Northern Ireland	33
Outside of the UK	30

Table 1d: respondent’s primary area of work

Which of these best describes your primary area of work?	Percentage
Human healthcare	57
Farming (animals)	8
Animal healthcare (veterinary)	6
Food safety	2
Other	27

These results illustrate that responses were received from organisations and individuals from a range of different sectors, primary areas of work and localities. However, the number of respondents between these areas did differ and those individuals or organisations who responded to the call for evidence may not be representative of those sectors as a whole.

Consultation questions

From your experience, how has the scale of the threat of AMR changed since the National Action Plan was published in 2019?

The threat of AMR and our ability to respond to it is affected by several factors. These include population size and demographics; trade patterns; and major global events, for example the coronavirus (COVID-19) pandemic and the war in Ukraine. The first 2 questions in the call for evidence were about the scale and nature of the threat of AMR.

Table 2: respondents’ views on the scale of the threat of AMR

Statement	Percentage agreement
The threat of AMR has increased	81
The threat has stayed the same	11
The threat has reduced	1
Don’t know	7

The majority of respondents (81%) said that the threat of AMR has increased since 2019. Only 1% of respondents said that the threat had reduced. This is explored further in the question below.

In your opinion, what are the top 3 drivers of AMR?

Inappropriate antimicrobial use, in humans, animals, and crop production, was the most commonly cited theme identified as a key driver of AMR. This included references to poor prescribing practices that could contribute to antimicrobials being prescribed for an inappropriate duration of time or for infections that are not susceptible to antimicrobials.

Other examples given included “overuse of drugs in human and animal medicine and in food production”, or more specific drivers, for example “lack of facilities to weigh ailing animals” contributing to an insufficient infrastructure to appropriately use antimicrobials in animals.

Other themes which emerged include:

• international travel and trade, which can facilitate the spread of infections and therefore AMR across the world
• lack of infection prevention and control, which means infections may spread between people, animals, and the environment
• lack of diagnostics, as diagnostics can ensure infections are diagnosed and treated quickly and appropriately to prevent emergence of AMR
• increased rates of infection, which increases the number of infections which can become resistant and increased use of antimicrobials which drive resistance
• environment, as spread between humans, animals and the natural environment through air, soil, water and surfaces can drive AMR
• lack of innovation, which is needed to bring new therapeutics and technologies used to tackle AMR to market

Which of these areas would you most like to see prioritised over the next 5 years?

The 3 ways of tackling AMR in the current NAP are:

• reducing the need for, and unintentional exposure to, antimicrobials
• investing in innovation, supply and access
• optimising the use of antimicrobials

Respondents were asked to select which of these options they would like to be prioritised. Respondent could select all, several, one or none of the above categories.

Table 3: respondents’ views on priority areas for tackling AMR

Statement	Percentage agreement
All 3 areas prioritised	91
Reducing the need for, and unintentional exposure to, antimicrobials	40
Investing in innovation, supply and access	31
Optimising the use of antimicrobials	22
Did not respond	7

The majority of respondents (91%) said that all 3 areas should be prioritised (by selecting a ranking for all areas). Reducing the need for, and unintentional exposure to, antimicrobials was the most commonly selected individual option (40%), but all areas were selected by a large proportion of respondents.

Are there any actions you think are required to tackle AMR that do not fall within one of these categories?

Table 4: the proportion of respondents who agreed that ‘further action is required to tackle AMR which don’t fit into the 3 current NAP categories’

Further action is required to tackle AMR which don’t fit into the 3 current NAP categories	Percentage agreement
Agreed	66
Did not agree or did not respond	34

The majority of respondents (66%) agreed that additional actions are required to tackle AMR, that do not fit within the 3 categories in the current NAP.

Please specify actions you think are required to tackle AMR

The 66% of respondents who thought there were actions outside the listed categories that are required to tackle AMR were asked to specify what additional actions are required. Responses frequently referenced innovation, for example development of new antimicrobials or diagnostics. Public education was also commonly cited as important to build support for AMR work and drive changes in public behaviour that impacts AMR.

Respondents also felt further work was needed to develop, deliver and increase the use of diagnostics in both humans and animals, illustrating a need to build upon existing work and take more nuanced approaches to future strategy.

A number of other themes were identified in several responses, including infection, prevention and control, antimicrobial use in agriculture, and the environment.

Other, more specific themes were also identified. Respondents recommended improvements to medical case management. For example, ‘sharing of good practice’, suggestions to ‘track, analyse and identify’ antimicrobial infections and ways to adapt responses to different settings. Responses also flagged a need for changes to drug regulation often recommended ‘incentivisation and a clear and supportive path to the licencing of medicines’.

Within the UK, what are the key successes we should look to maintain or develop in responding to AMR?

Development of the next NAP will seek to learn from current and previous government action on AMR. Since the publication of the national action plan in 2019, the UK has made significant progress in tackling AMR. This question sought to understand the successes that have been made to date and where there are opportunities for further development.

When answering this question, responses described successes to date and areas where future work should focus to deliver successes. Themes of innovation, animals and agriculture, optimising antimicrobial use, reducing antimicrobial use, and international activity were noted in over a quarter of answers. Respondents provided examples of successes that should be built on: for example, “building on the reduction in antibiotic use in food-producing animals and learning from how it has been achieved” and “the UK investment supported the progress of many innovative products to combat AMR”. There were also examples of areas that could be developed: for example, “develop and increase specialist antimicrobial roles” and “research into novel methods including phages”.

Public awareness, diagnostics, and infection, prevention and control also emerged as themes, appearing in over 15% of responses.

There was a wide range of other significant themes including surveillance and the antimicrobial purchasing project. The antimicrobial purchasing project, piloted by NHS England and NICE, is a subscription-style payment model for antibiotics which pays pharmaceutical companies upfront for access to their antibiotic product, based on the product’s value to the NHS, as opposed to the volume used. 

Within the UK, what are the areas that require more focus or development to address AMR?

Despite the substantial progress made on AMR in the past decade, there is much more to do. Given financial pressures and limited resources both within and outside of government, the call for evidence sought views on the most important, realistic and tangible actions we can take to have the most impact on AMR.

Research was most commonly identified as the area the UK requires more focus to address AMR. Responses detailed the need for more research capacity, for example “boosting the medical academic workforce” and “investment incentives … are required to ensure there is a robust pipeline of antimicrobials”. Respondents also suggested supporting future ways of working, such as “long-term, collaborative contracts between industry and academia”. Implementation was also frequently mentioned, for instance adapting the regulation of new therapeutics to enable innovations to actually be used.

Diagnostics was identified in over 25% of responses to this question. Responses included a range of rationales and recommendations from optimising “the pathway working in which infections are diagnosed” to “faster turnaround time for diagnostics” and “funding for bacterial vs viral infection diagnostics”.

Public awareness also featured in over 25% of responses. This is expanded upon in the question “Do you believe that there is sufficient public and professional awareness of AMR?” towards the end of this response.

Issues around prescribing, medical education (particularly the need to “widen… teaching and training” across fields and specialisms) and preventative medicine were commonly cited. These themes highlight the need to prevent infections from arising and to provide guidance and both train staff and the public to use antimicrobials appropriately.

Within your sector, do you think the UK has sufficient capacity and capability to tackle AMR?

The NAP includes several commitments to improve the professional capacity and capability for tackling AMR. THis sought to understand whether the UK has the required workforce and skillsets to best tackle AMR.

Table 5: proportion of respondents who agreed that ‘the UK has sufficient capacity and capability to tackle AMR’ within their sector

The UK has sufficient capacity and capability to tackle AMR	Percentage agreement
Agree	53
Disagree	39
Don’t know	8

The majority of respondents (53%) did agree that the UK has sufficient capacity to tackle AMR within their sector. However, a large proportion (39%) disagreed. Further information can be found below.

Please explain your answer

The 39% of respondents who disagreed with this question were asked to explain their answer. The top themes identified to explain why the UK would not be equipped to tackle AMR were funding, including for “the next generation of antibiotics” and global investment to fix “the broken market for antibiotics”, and “workforce” capacity and capabilities. Responses flagged the need for “AMR specific roles” and a lack of “workforce capacity within AMS (antimicrobial stewardship), IPC (infection prevention and control) and generalist health and social care”.

Other significant themes included training, research and AMS. Responses highlighted a need for workforce planning, support and addressing of skills gaps, investment in specific fields of research and additional “support for antimicrobial stewardship” and “capacity and capability”. Training and stewardship both indicate the need to have sufficient capacity and capability to ensure antimicrobials are being used properly, whether that is training for doctors to prescribe more effectively or education for patients to ensure they take antimicrobials as prescribed.

What additional capacity and capability is needed in your sector to effectively tackle AMR?

Since 2019, several capabilities required to tackle AMR have changed. This includes the UK’s sequencing capability, surveillance capabilities, diagnostic lab capability, and antimicrobial stewardship activity. The call for evidence sought to understand what additional capacity and capability is needed, as this may have changed since the publication of the current NAP.

When asked specifically what capacity is needed to effectively tackle AMR, funding emerged as the most prevalent theme. Responses ranged from needing “more funding available for university research” to “funding for diagnostic testing”. Responses recognised the need for capacity and capability across sectors, including human and animal health and the environment.

Surveillance and research also emerged as common themes, highlighting the need for more robust data and tools to tackle AMR across humans, agriculture and the environment. This included new areas of work, for example “increased capacity and capability in drug discovery and development” as well as additional focus or expansion of existing work, for example “additional capacity to monitor AMR in food”.

Workforce and training emerged in a large number of responses. This ranged from expanding research, improving prescribing practices and preventing infections.

Other themes reiterated the importance of situating AMR outside of the clinical settings: education, cross-organisational link-up, antimicrobial stewardship and dedicated resource. Diagnostics was also raised frequently.

In your opinion, what are the key barriers to making progress on tackling AMR in your sector?

Funding again emerged as a common theme. Respondents made recommendations identifying a need for “coordinated and focused funding”, “invest[ing] in infrastructure” and to “address[ing] market failure in antimicrobial development”.

The research pipeline and market failure were specific areas which were identified as a barrier to tackling AMR. This could include the need to change regulatory processes or incentivise drug development.

There were a number of broader themes identified. Education was commonly cited, including “public awareness and understanding” and “need for mandatory training for all front-line health and care staff”.

Resource (such as staff or infrastructure), cross-organisational link-up (for example between NHS trusts, government bodies or independent organisations), and availability of tools were also cited.

What, if anything, do you think we can learn from other countries responses to AMR?

AMR is a global challenge, and no one country can tackle it alone. The UK plays a leading role advocating for and taking action to tackle AMR in several multilateral arenas. As part of this leading international role, we helped secure the UN Declaration on antimicrobial resistance at United Nations General Assembly in 2016. The UK recognises there is also much to learn from other countries efforts, both successes and challenges and gave the respondents an opportunity to provide examples of beneficial international work.

There were many excellent and useful case studies identified in responses to this question. Case studies offered insights into improvements in key areas that the UK could seek to learn from. Good examples for health system structure included the Netherlands’ “One Health initiative”, Estonia’s “joined-up patient and healthcare portal” and Sweden’s “collaborative national approach”.

More broadly respondents identified a need to continue to invest in other countries and expand activity on prevention of infection and education.

Examples of UK successes as a global leader on AMR were also commonly flagged, including the antimicrobial purchasing project, with respondents stressing that “as a global leader on AMR, the UK must ensure all learnings are shared across sectors”.

In your opinion, which of these tools should be prioritised for adapting to use in tackling AMR?

The COVID-19 pandemic saw an unprecedented level of cross-disciplinary working with government, industry and researchers collaborating to respond to a significant public health challenge. The toolbox we used to tackle COVID-19 will be similar for AMR. As reported by the Academy of Medical Sciences, diagnostics, surveillance, therapeutics and vaccines are crucial aspects of the AMR response and can draw on the COVID-19 experience. Respondents were given these 4 tools (vaccines, therapeutics, surveillance, and diagnostics). They were asked which of these tools should be prioritised. Respondents could select one or all tools.

Table 6: respondents’ views on tools, which should be adapted for use in tackling AMR

Statement	Percentage agreement (respondents may select one or more options)
All tools should be prioritised	85
Diagnostics	36
Surveillance	24
Therapeutics	18
Vaccines	11

The majority of respondents (85%) said all the suggested tools should be prioritised (by selecting a ranking for all tools). This indicated 15% of respondents were unsure, do not feel all these areas should be prioritised or thought there are other areas which should be prioritised as they did not rank all of the given options. Of the options, diagnostics was the tool which the most respondents felt should be prioritised (36%). However, there was support for prioritisation of each of the other tools individually.

In your opinion, are there any other tools that should be adapted from use during the COVID-19 pandemic for tackling AMR?

Table 7: proportion of respondents who agreed that ‘there are other tools that should be adapted from use during the COVID-19 pandemic for tackling AMR’

There are other tools that should be adapted from use during the COVID-19 pandemic for tackling AMR	Percentage agreement
Agree	60
Disagree	9
Unsure or did not respond	31

The majority of respondents (60%) agreed that there are other tools that should be adapted from use during the COVID-10 pandemic to tackle AMR. Only 9% of respondents disagreed. Further information on this can be found below.

What tools should be adapted from use during the COVID-19 pandemic for tackling AMR?

Respondents were asked to expand on which tools should be adapted from use during the COVID-19 pandemic for tackling AMR. Key themes included prioritisation of AMR similarly to COVID-19. Respondents noted that prioritisation of AMR needs to include efficient policy development and implementation, streamlining and linkup of organisational responsibilities and progress in the development of new tools, as well as changes to the processes by which they can be developed.

Specific tools which were mentioned included diagnostic tests and vaccines. Adaption of COVID-19 diagnostics included wider development: “repurpose [of] diagnostic infrastructure” and use and development of “point of care diagnostics”. Vaccines were mentioned as a way of preventing infections and therefore preventing resistance from evolving. Respondents also highlighted that the awareness of the “value and power” of vaccines should be capitalised on by learning from changes the research pipeline. This enabled “rapid development of vaccines” as well as general “streamlining [of] the clinical trials process”, which could accelerate development of all categories of antimicrobials.

Respondents highlighted the importance of data access, linkage and sharing and recommended adapting these processes for AMR. For example, by developing a “platform showing real life data about the drug-resistant bacteria isolated with source and location”. Specifically, this linked with recommendations around adapting and improving surveillance systems.

Do you believe the changes in ways of working within your organisation due to the COVID-19 pandemic have affected efforts to respond to AMR, such as delivery of the current national action plan (NAP)?

COVID-19 put severe strain on healthcare services and diverted resources from the silent pandemic of AMR to the urgent COVID-19 response. This may have also altered the risk landscape. For example, different patterns of healthcare use during COVID-19 restrictions led to increased prescribing of antimicrobials in certain settings (such as dentistry). Also, COVID-19 potentially made patients more vulnerable to hospital acquired infections. Questions 13 and 14 sought to understand these changes and their impacts.

Table 8: proportion of respondents who agreed that ‘changes in ways of working within your organisation due to the COVID-19 pandemic have affected efforts to respond to AMR’

Changes in ways of working within your organisation due to the COVID-19 pandemic have affected efforts to respond to AMR (such as the delivery of the current NAP)	Percentage agreement
Agree	51
Disagree or were unsure	49

While the majority (51%) of respondents agreed that changes in ways of working due to COVID-19 have impacted efforts to respond to AMR, a large proportion (49%) disagreed or were unsure. Further information on this can be found in the answers below.

In what way have changes in ways of working within your organisation due to the COVID-19 pandemic affected efforts to respond to AMR the response to AMR or delivery of the NAP?

Respondents who agreed that COVID-19 had changed their ways of working were asked to expand upon their response. The most commonly identified theme was a reduced priority of AMR activities. Responses detailed how priority had decreased on multiple levels from system-wide reductions in AMR funding and de-prioritisation of AMR research to patient and staff level impacts. One respondent summarised “When staff are pressured, they take the path of least resistance”.

Respondents highlighted changes in prescribing rates due to virtual prescribing. This was reflected both positively and negatively. For example, “fewer face to face clinical appointments leading to antimicrobials being prescribed less discriminately”. This was reflected across different settings, including dentistry.

Other significant themes mirrored responses on tools which should be adapted from COVID-19 including organisational responsibilities and structure and diagnostic capability.

Are there other ways in which the COVID-19 pandemic has altered the AMR risk landscape?

Responses to this question highlighted both positive, negative and neutral changes to the risk landscape.

Increased awareness was highlighted positively in the context of capitalising on current health focus to push messaging on AMR and using the NHS to improve awareness. For example, “increased public awareness of the challenges associated with infectious disease”. Respondents felt that public awareness of infection, prevention and control, for example the impacts of behaviours including handwashing, should be used to “push the messaging to AMR”. There were also negative impacts due to the spread of misinformation and mistrust, anti-vax mentality and microbe fatigue.

Respondents noted an increase in non-COVID infections in part due to reduced population immunity and disruption to routine immunisation and care. For example, a respondent flagged that COVID-19 impacts on care “increased the burden of [tuberculosis] TB in the UK and resulted in more cases of multidrug resistant tuberculosis”. Respondents also suggested there had been missed opportunities to capitalise on embedding of infection, prevention and control practices, and impacts from wider factors such as increases in poverty and inequalities.

Respondents highlighted a wide range of behavioural changes have affected the AMR risk landscape. Examples given included increases in pet ownership which can increase exposure to animal-borne infections, exposure to AMR in the environment from activities such as wild swimming, and changes in health seeking behaviours and awareness contributing to some changes to prescribing practices. Increased prescribing was noted to be influenced by patients feeling “unable to access care” and removal of “face to face element of diagnosis” leading to self-diagnosis or increased prescribing by clinicians. These changes in health service efficiency were largely attributed to increased pressure throughout the pandemic and continue to impact “health worker fatigue” and “social care staff retention rates and the overall ability to effectively deliver infection and prevention control”.

Are there other global events, such as supply chain disruption or the conflict in Ukraine, that have changed the UKs ability to respond to AMR?

Table 9: proportion of respondents who agreed that ‘other global events, such as supply chain disruption or the conflict in Ukraine, changed the UKs ability to respond to AMR’

Other global events, such as supply chain disruption or the conflict in Ukraine, changed the UK’s ability to respond to AMR	Percentage agreement
Agree	49
Disagree, were unsure or did not respond	51

The majority of respondents (51%) disagreed, were unsure or did not respond to this question. However, 49% of respondents agreed that global events have changed the UK’s ability to respond to AMR. Further information and examples of this can be found below.

How have other global events changed the UK’s ability to respond to AMR?

Over half of respondents did not answer this question. Of those that did respond, supply chain disruption was commonly cited. Specific global events such as Brexit, the conflict in Ukraine and infection outbreaks were commonly cited. Responses highlighted the fragility of supply chains and reliance on global manufacturing. For example, it was noted that “reagents and lab equipment take at least double the time than before to arrive” and that the recent streptococcus A outbreak has demonstrated “the inadequate supply of laboratory consumables, PPE and medicines”.

Resourcing was also highlighted as a challenge. The economy, reduced funding, and staffing shortages were all common themes and were seen to exacerbate existing health issues and inequalities. For example, “exposing our population to an increased risk of both infection generally and severe infection” and resulting in an “unwillingness of UK to invest in countries where largest problems”.

In your opinion, what are the best measures of success in tackling AMR?

The current NAP contains measurable ambitions on reducing infections in humans, reducing antimicrobial use in humans, reducing use of antibiotics in food producing animals and reporting percentage of prescriptions supported by diagnostic tests. These ambitions allowed progress on these areas to be quantified but may not be the most appropriate measures of success for future activity. This question sought to understand whether these measures were effective and what alternatives might look like.

There was general support for existing measures, with the exception of the current target for the use of diagnostic tests. The main 3 types of measures suggested by respondents were on patient outcomes (such as infection rates and mortality), use of antimicrobials, and innovation.

Use of antimicrobials included volume of antimicrobial use and prescribing rates. However, there was also support for measures focused on “improvements in the patterns of antimicrobials use”. Respondents discussed the need to understand who, what, when and why antimicrobials are prescribed, rather than simply setting targets to decrease overall prescribing.

Respondents also distinguished between diagnostic tests and diagnosis more broadly, including measures of improving care pathways. Therefore, they identified a need to measure increases in “diagnostic uptake”, “diagnostics for UTI” and “better diagnostics” within diagnostic tests. However, within the diagnosis theme respondents highlighted need to include measures of wider diagnostic evidence (for example “diagnostic evidence of a fungal infection”) and a need to “focus on improving diagnostic pathways”.

Themes related to measures of innovation included availability of novel therapeutics. This included both measuring the “increase in the numbers of new antibiotics” and of “new, innovative products”. Innovation also included recommendations for increasing other therapeutics, such as phage therapy, and technologies, such as diagnostics.

Outside of these 3 categories, responses recommended measures of improvement to surveillance and awareness.

Do you believe that there is sufficient public and professional awareness of AMR?

During the COVID-19 pandemic, public awareness of infection spread increased, along with prevention and control measures and acceptability of point of care diagnostics. Awareness can be critical to driving change and tackling health issues, including AMR.

Table 10: proportion of respondents who agreed that ‘there is sufficient public and professional awareness of AMR’

There is sufficient public and professional awareness of AMR	Percentage agreement
Agree	5
Disagree or were unsure	95

The majority of respondents (95%) disagreed or were unsure that there is sufficient public and professional awareness of AMR. Further information and examples can be found below.

What should be done to increase awareness of AMR?

Within responses from the 95% of respondents who answered that there is not enough awareness of AMR, campaigns were the most common suggestion for increasing awareness, raised in 33% of responses. This was often linked to public advertising. Responses ranged in detail, with some offering specific actions, such as “including AMR as a cause of death on death certificates” or recommending campaigns to “maximise public trust”. Across responses, it was highlighted that awareness-raising activities should include different sectors and levels.

Other popular themes included training for professionals, such as healthcare workers, education in schools, drawing links between AMR and COVID-19 and medical guidelines. As AMR is a complicated issue, it was suggested that education and awareness activities should look at “at human factors and behavioural science” to provide clear, actionable messaging and avoid misinformation.

Other evidence

A number of respondents chose to provide additional evidence, including on. research, implementation of diagnostics, point of care testing and infection, prevention and control. For example, “probiotic cleaning”.

Others reiterated their view that there is a need for improved cross-organisational working and leadership on AMR, for example, “the UK should lead the way in sequencing and data sharing”. AMR in the environment was also flagged, potentially indicating respondents felt this has not been adequately represented in other questions. AMR can spread through the environment through air, water, soil and surfaces. While this is currently recognised, the full extent to which environmental AMR causes infections in humans is not fully understood. This is an area that could merit further exploration.

Next steps

Anonymised responses to this call for evidence have been shared with key stakeholders. Findings from this call for evidence will be interpreted alongside other evidence collected through the NAP development process and used to inform policy development.

The 2024 to 2029 NAP will continue being developed in consultation with a broad range of stakeholders across different sectors. It will build on the achievements of the 2019 NAP, while recognising where there is more for us to do, and it will be aligned with global plans and frameworks for action.

The NAP will set out challenging ambitions and actions for the next 5 years that will set us on course for achieving our long-term national and international ambitions for tackling AMR

The 2024 to 2029 national action plan will be published in 2024, subject to ministerial agreement across UK government and in Northern Ireland, Scotland and Wales.