Together against AMR

Associate Professor Naomi SykesNaomi Sykes is Associate Prof in Zooarchaeology at the University of Nottingham (from Jan 2018 will hold the Lawrence Chair in Archaeology at the University of Exeter).
Her research focusses on human-animal-environment interactions and how they inform on the structure, ideology, impact and well-being of societies, past and present. Her approach is to integrate archaeological data with wider scientific evidence (especially DNA and stable isotope analysis) and discussions from anthropology, cultural geography, (art) history and linguistics.

Every year the World Health Organisations runs a week-long antimicrobial resistance (AMR) awareness campaign1, highlighting the major risk to global health represented by AMR. This week, social media has been flooded with reminders about the scale and complexity of the problem we are facing, with stats predicting the cost – in terms of human life, food security and to the global economy – that AMR will bring. Infographics abound on twitter concerning the many and varied causes of AMR and how we, as individuals, can make a difference through behavioural changes. Indeed, this year’s theme for AMR awareness week is ‘Seek advice from a qualified healthcare professional before taking antibiotics’, a theme designed to tackle the widespread misuse of antibiotics, such as taking them for viral infections – like colds and flu – on which they have no impact.

The need to consult with trained healthcare professionals is certainly important. But what happens in situations where people have limited access to qualified healthcare professionals? Or if those healthcare professionals are the very individuals responsible for over-prescribing antibiotics? These are two issues, amongst many others, that have been raised in the recently published Scoping Report on Antimicrobial Resistance in India2 document. The report was launched on the 2nd November in Delhi at an India-UK meeting3, which took place one year after the countries agreed to work collaboratively to fight AMR, committing £13 million of funding for a joint research programme.

The mapping document represents the first step in the collaborative process. It reviews the state AMR research in India, outlines current understandings, knowledge gaps and highlights future research priorities. The second step, is to act upon the document’s findings…Easier said than done! The scoping report sets out, with great clarity, the factors driving AMR resistance: they are the forces of evolution, they are environmental, they are economic, they are cultural, they are interconnected and they are multi-scalar. And none of them can be countered by a single discipline, or by a single country alone. ‘Wicked’ problems such as AMR require imaginative, collaborative solutions.

Sandpit delegates, mentors and funders.To find such solutions in the light of the scoping document was, essentially, the brief for the UK-India sandpit event held 7-10th November at Lake Damdama, an hour to the south of Delhi (or sometimes three hours, depending on traffic). The sandpit was attended by 40 researchers, 20 each from the UK and India, who were selected through a competitive process. The delegates were drawn deliberately from across the disciplinary spectrum with representatives from medicine, veterinary science and microbiology through to engineering, economics and anthropology, and more besides. The idea was to bring as many insights and perspectives as possible to bear on the intractable problem of AMR. But how to get such a diverse group of people to work together, understand each other’s thinking, share expertise, co-produce new strategies for addressing AMR in India and then write convincing funding pitches – all within 3.5 days? A task almost as daunting as AMR itself. Cue involvement from Christine and Lucy from the Centre for Facilitation, who with support from 8 academic mentors (3 UK, 5 India – including Dr Sumanth Gandra, co-author of the scoping document) helped the participants perform together like a well-oiled machine.

Inexplicably, over an intensive 3.5-day process of non-stop activity, the group was transformed from 40 individuals with an equally large number of approaches, to nine high-quality interdisciplinary UK-India teams. Each team had developed an innovative research vision that took a ‘systems approach’ to AMR, giving consideration to multiple drivers and their inter-connections.

On the final day of the sandpit, all nine teams were interviewed as part of the funding shortlisting process. The quality of all the proposals was astonishingly high – a testament to what can be achieved when people unite to tackle a common problem. It is my hope that, by AMR awareness week 2018, this ethos of research collaboration and the teams that are ultimately funded through the UK-India scheme, will have begun to generate new results that will move us forward, together, against AMR.

1 http://www.who.int/campaigns/world-antibiotic-awareness-week/en/

2 https://cddep.org/wp-content/uploads/2017/11/AMR-INDIA-SCOPING-REPORT.pdf

3 https://www.gov.uk/government/news/uk-india-working-together-to-address-antimicrobial-resistance

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