World Antimicrobial Awareness Week: AMR and Politics

It’s World Antimicrobial Awareness Week! And did you know AMR might kill us all? The British Society of Antimicrobial Chemotherapy do, and they’ve partnered up with interested politicians to drive AMR up the political agenda. But how? 

Jame is joined by Dr Helen Callaby, Dr Nick Brown and Dr Danny Chambers MP to discuss the workings of the UK’s All Party Parliamentary Group on AMR, the BSAC parliamentary internship, how to get involved in pushing AMR up the political agenda, and more!

Transcript

Jame: 0:18

Hi everyone. Welcome to the Idiots Podcast. That's infectious disease insight of these specialists. I'm Jane. That's Danny. This is Helen, and that's Nick. And we are going to tell you everything you need to know about infectious disease. Danny, Helen, Nick, how are you all doing?

Helen: 0:32

Good. Thank

Nick: 0:33

Great.

Jame: 0:34

Good to have you all here. Full introductions now starting with Dr. Danny Chambers, who is the liberal Democrat MP for Winchester, and a member of the all party parliamentary group on antimicrobial resistance. Hence fourth termed a MR so that we don't have to say it all the time. Dr. Nick Brown is a consultant medical microbiologist at Cambridge University Hospital, NHS Trust former president of the British Society for Antimicrobial chemotherapy or BSAC Currently the bsac Director of Public and Professional Engagement, and Dr. Helen Clabby, infectious Disease and Medical Microbiology specialty Registrar, and currently doing a PhD at the University of Dundee and a BS a Parliamentary intern. Welcome to you all.

Helen: 1:13

Thank you. Nice to be on the show.

Jame: 1:15

so Helen, this was your idea, so let's go straight to yourself. Why have we decided to have this episode on antimicrobial resistance?

Helen: 1:27

So we wanted to do something to Mark World Antimicrobial Awareness Week, and we thought making use of your podcast would. Be a good way of raising awareness of antimicrobial resistance and just talking a little bit about what is done in parliament, what's it done at, and helping to engage with that.

Jame: 1:47

But Helen, I don't understand. Everybody knows about antimicrobial resistance. Surely this is a solved matter.

Helen: 1:53

If only, but we've still got a massive problem with antimicrobial resistance. So there's lots of kind of facts floating about, but we think that probably that. Annual deaths that are directly attributable to a MR globally over 1 million, so probably 1.14 million. And there was actually a global antibiotic resistance surveillance report, a glass report that came out very re recently. It was just published in October. And that's shown that actually about one in six bacterial infections are now recorded, resistant to an antibiotic.

Jame: 2:28

Are any particular bugs, more culprit than others?

Helen: 2:33

A good word. I think we're particularly worried about gram-negative bugs. Southeast a Asia, Eastern Mediterranean, then it's up in bacteria in Africa.

Jame: 2:45

Sobering news, but of course those are all I can't help but notice not Britain. So presumably we are doing much, much better than everybody else.

Helen: 2:53

We're not doing quite as good as areas like Denmark, Norway, Sweden. We are doing well. But.

Jame: 3:04

Ah, well with this being such a significant problem Danny, I imagine that we are throwing absolutely loads of funding towards this potentially catastrophic, world changing issue.

Danny: 3:18

If you can name a catastrophic world changing issue that we're throwing loads of funding at, I'd be really pleased to hear about that. But I wouldn't say I'm pleased happen to be on a podcast called Idiots. I did my master's in infectious disease epidemiology and I wish I'd thought of this. I love a pun and this is brilliant. So

Jame: 3:37

Oh, this is the show for you then? Inside of two specialists.'cause normally it's just me and My partner in crime call, but when there's more than one, it becomes three or these, or those, or et cetera, et cetera, et cetera.

Danny: 3:50

Oh, that's great. I'm going to subscribe as we speak, so that's excellent.

Jame: 3:54

much. One more of us, one less of them but yes funding issues.

Danny: 3:59

yeah, there's funding issues for everything, and what we're trying to do is. No longer is the moral Im imperative for doing something, justification enough'cause the government is under such financial strain that also has to be an economic argument for it. So whether you're talking about anything, for example, like I'm quite passionate about free school meals for a variety of reasons, including equality of opportunity. It's no longer enough just to say, if kids are gonna school hungry, they're not gonna do as well in school. You've got to frame it in a more economic argument. This study showed that if you gave universal free school meals, it generate 95 billion into the economy. And and 18.5 billion, that, that is kids getting better grades than they would've done and paying more tax. There's also slightly less childhood obesity, which means it costs the NHS less. You're less likely to end up in welfare for the rest of your life, but also you're less likely to go to prison Yet apparently we can't afford to give a free school meal so that's the sort of roundabout way of saying how when we come into something like antimicrobial resistance, remember very few mps of any sort of science training,

Jame: 5:01

Am I right in thinking that you're one of the few. Or maybe they're all concentrating into this group because they are interested.

Danny: 5:07

Yeah, I guess the A PPG for a MR has people who either have training in it, so they're doctors or like me, or there's also people who actually have a specific interest in health and maybe global health because it appears like a niche problem to a lot of people, but the World Health Organization has said for years since. About 2017, that the three biggest threats to global public health and climate change, risk of pandemics and antimicrobial resistance, and climate change is now affecting daily lives. We've had a massive pandemic. I'm hoping that we can push a MR up the political agenda because it's third on that list, and the other two are very much at the forefront of political thinking.

Jame: 5:48

I guess it's, its turn now when you phrase it that way. Do you know what I mean? But it's very similar to climate change, I suppose, in that it is a thing which kills a few people all over the place, and that then means that the effect of it is not really concentrated into your local environment. Do you know what I

Danny: 6:05

I think you're spot on because it's a bit like climate change. I think many people, mps and the public probably perceive it as something that will happen at some point in the future, somewhere else, to somewhere else. And. And even when we've had the 20 host years on record occurring this century, and even when we're having trouble producing food in the UK directly'cause of climate change. And even when we got livestock diseases like blue Tongue that didn't exist in the UK 10 years ago.'cause they were only in the Southern Mediterranean, now they're in the UK because of climate change. It the, it's not seen as a kind of urgent. Threat and we've got, wars to compete with when it comes to funding. We've got an NHS that's collapsing and the number one issue for most people politically is the state of their local NHS services. And so what we're trying to do, certainly as the A PPG and as an individual in politics, is to sort of reframe these things, to have an economic argument and to make them relevant to today's priorities. So to give you an example. I think I'm the first MP to ask the Prime Minister about antimicrobial resistance at Prime Minister's questions. And it is in respect to the situation in Ukraine.'cause about 80% of wounds picked up in Ukraine have got bacteria that resistant to antibiotics. And, it's becoming a limiting factor to getting soldiers back in the front line. And so framing it as a national security and a defense point of view, which is high up the agenda at the moment, the more money is being made available for that means that you're more likely to get. In funding and support rather than framing it as a future public health problem. Now we know that's not the case, but if you are a government minister or a civil servant running a department and you're deciding where limited funds go to anything that's affecting defense and national security, it's easier to get funding for it at the moment compared to future public health problems.

Jame: 8:06

Let's talk then about where the funding isn't going. Can you talk a little bit about the Flaming Fund as an example?

Danny: 8:13

Yeah, that's something I'm particularly disappointed about people don't know. The Fleming Fund is a British led global initiative to help monitor and tackle antimicrobial resistance particularly in developing countries and. It showed that the UK was,, at the forefront of leading on this specific issue along with many other health issues actually. And unfortunately, the Fleming fund is being cut, and it's related to the fact that the overseas development budget is being. Cut from 0.5% to

Jame: 8:45

up in that?

Danny: 8:47

Yes. And so there's, it's quite hard to and obviously they're looking at their priorities. And at the moment, one way that the overseas development budget is being spent, which has been to the last few years is that also, refugees and asylum seekers who are being put up in hotels that is currently coming up the overseas development budget, right? So it's not all going to initiatives overseas. It's being spent here in the UK on what are being explained as overseas problems. And as, as you know, as that bills hit 7 million pounds a day to keep people in accommodation, it's all coming away from what were global health. Programs. And so what I've been trying to do, and about two days after the us cut the USA budgets, I managed to secure a debate on how that would affect UK public. Health directly. And we also had a debate in parliament. I think it was last week, about the effect of the global fund being, cut by the uk, which is the fund that tackles tb, malaria, and and HIV. And the way we have to frame it is to show that these provide really good value for the UK taxpayer in many ways. So, for example, many of these global health challenges directly affect the uk, and UK is better off both economically and from a health point of view, being able to identify these diseases, tackle'em before they get here, whether it's early surveillance for pandemics or whether it's preventing the, people arriving here of HIV if they're, if being treated in their own countries. And it's, also recognizing that global health is completely interlinked. If there's a novel pathogen that has the potential to cause a pandemic, and about 70% of those actually come from animal infectious diseases. Or if there is. A new bacteria that is resistant to antibiotics in another part of the world, it'll be in our hospitals very quickly, within hours, if not days. And so these are immediate and direct threats to the uk. Even if you don't care about global health, it's in our interest to, to fund and carry out this type of research. And that's the message we're trying to get out there. Have both the urgency and also I think as well, like many of your listeners who work in the type of roles they're doing, there's, when we cut the overseas development budget last time, from 0.7 to 0.5, there's a lot of UK jobs affected by this, you know, UK research groups, people working on neglected tropical diseases losing their funding. The, there's a lot of university research groups that are directly affected by overseas development funding being cut. So it's not the perception that the media tend to give is that we're just giving loads of money from the UK to other countries to spend as they wish is very inaccurate. It's often UK research and science and jobs that is actually delivering this kind of work and expertise.

Jame: 11:47

And all this is before we, you talk about the moral lament of, actually pushing out good into the world and all that sort of business.

Danny: 11:53

completely.

Jame: 11:54

Well disheartening. But thank heavens we have this A PPG on a MR Nick, why don't you tell us about the all party parliamentary group on a MR and how it's

Nick: 12:05

Sure. So the all part of Parliamentary Group or a PPG has been in existence for just over 10 years now. I guess, as the name suggests, it has to have representation of all the major political parties. So it really is a, no single political affiliation. And it has to have a serving MP as the chair. It can include people from both House of Commons and House of Lords, and we have a number of people from the Lords who are very active members. Many of those have science background and just as an example, we currently have. Both Barron s Bennett, who used to be the leader of the Green Party, and Lord Darzi, who of course from Imperial in London, who is a colorectal surgeon and led onto

Jame: 12:52

Of review

Nick: 12:52

recent Darzi report and very active members of the A PPG. But I think Danny's absolutely right, that over the years that the A PPG has been in existence, we've seen peaks and troughs in terms of political engagement with a MR. Clearly back in the early 20 teens David Cameron, when Prime Minister was very much engaged and commissioned what became the O'Neill review of a MR. And then through Dame Sally Davis as the UK Special Voy on a MR. We had the UN general Assembly which debated a MR for the first time, I think in 2016. Perhaps after that and particularly. After the pandemic, priorities changed and a MR sort of fell a bit in terms of priority, I think.

Jame: 13:40

Yeah. And that's interesting actually because there was the paper I'm thinking of is from The Lancet in 2019, which was a big survey. It predates the glass report, which was where we first got some really juicy statistics about exactly how many people. We're dying of antimicrobial resistant infections. And I think that would've had a bit more impact had we not had our hands full the following year and year after that. And then when the glass report came out in, was it May this year? I was hopeful perhaps foolishly so, that the. Statistics in that report would've showed some sort of improvement, and I couldn't have been more wrong. Everything was unmistakably worse, and that implies very strongly that a bit like climate change we are not really preparing ourself for what is a slow rolling apocalypse that has the potential to fundamentally change the way that we live our lives. You know, everything from surgery to chemotherapy to agriculture of both animals and and crops.

Nick: 14:46

So the A PPG is owned by the members for parliamentarians. BSAC provides the support to the committee in terms of helping to arrange the meetings, the practical side Gathering people to gather providing scientific input, arranging for outside speakers, when that is appropriate, suggesting topics that perhaps might be be good to cover. So, so yeah. So it's quite a wide ranging role, but just to emphasize that it, it's A group of parliamentarians. It's their group, not B sacs.

Jame: 15:19

Yes. You're sort of advising and they say I want an expert on candida, iris, and you find

Nick: 15:24

Yes. Agreed. Yeah.

Jame: 15:26

Helen, could you tell us a little bit more about the internship that you are doing with the A PPG right now?

Helen: 15:32

Yeah, so BS a C for the last, I think, three or four years. Offer an internship, tEAMED as a BSAC parliamentary internship, which you can do alongside your PhD. So I'm a medical doctor by background, but it's not targeted solely at medical doctors. It's across anyone that doing a PhD in antimicrobial resistance. So one of the other interns on the program does. Aquaculture people do all different aspects of the wider one health remit of a MR and it's set up to give you an opportunity to experience that intersection between science and policy. So we're quite good in research and in academia for getting to know our own area, get really into something. I see it as the next stage how you can then try and make sure that all that information that you've gathered. Is then put to somebody that can do something with it. Or directly placed shadowing one of the mps, so Danny Chambers, who I am working with at the moment, and then there's a couple of intern with Dr. Becky Cooper, who's the labor MP for Worthing. She was actually a public health doctor before she went into politics, so she's kind of. And Banner Bennett, who may or may not be coming on the show shortly. So the remit of it is not prescribed, so you can take your focus. So my focus is diagnostics because that's what I'm doing my PhD on. So I go to Danny and say. This is what's happening in the world of a MR and diagnostics at the moment. I think this is really important and I'll have a look with his parliamentary assistant to see what's coming up in kind of the politics world over the next few weeks and see how we can fit a MR into that and make sure that it is a targeted area.'cause unfortunately for me, not everyone wants to talk about a MR in politics all the time, but there are little angles that you can say, actually this is really important. And it gives you quite a lot of, I think I'm gaining quite a lot. For it in terms of how you make your research and your findings accessible to politicians as well. And then we meet as well once a month with the other BSAC interns and with Nick and with. The policy affairs lead just to keep on track what everyone's doing you mentioned at the start, James. Is a MR only a problem for people in different parts of the world, or is it still a problem for us? But I think it's really important for us to realize that actually AMR is a problem for us in the uk. Even in kind of the short time that I've been training as a doctor, I've seen. Way more drug resistant pathogens than I had at the start of my training.

Jame: 18:08

Yeah I can say a little bit on that actually. As a relatively newly appointed consultant, infectious disease. With a focus on stewardship on my local area. I don't live in a place where there's massive amounts of a MR, which makes it paradoxically difficult to persuade people that they need to care about it. But the, the fact is that until really late in the game, you are never really going to notice these drug resistant pathogens unless you're an infectious disease physician or a microbiologist, or an epidemiologist, or a pathologist. And then you're going to be called for all of those cases and you're gonna see them all the time. That's still never gonna be more than a handful of the patients that are flowing through your hospital at any one time. I think in a way we are kind of being a little bit protected by the introduction of tazobactam and I think one thing I've really noticed with the current generation of ID physicians who have all started training since about 2019 is that they don't remember what it was like to not have that as an ultimate backup. So they've got Keef Abi, they've got Keal, they've got a bunch of other antimicrobials, which are the new in the pipeline ones. And some of them are available on the subscription model and some of them aren't, but you can usually get a hold of them. When I started training, I remember when the antibiotic that you would get at the end of everything was Colistin and people couldn't take that for more than three or four days without their kidneys completely packing in. So you basically had that time period to cure them or they were dead. And I saw people die all the time with that. So I've had a tiny little experience of. Using antibiotics of last resort and them not working and the patient dying. And that's not an experience that I wish to repeat. But if we keep on going in this way, that's exactly where we're gonna end up. There's nothing magical about this. The Keal and Keef, avi, we know that we've got resistance evolving to those

Nick: 20:09

yes I think you're absolutely right and I think it's worth emphasizing as well that of course, antimicrobial resistance is not new. Fleming described it in his Nobel prize winning acceptance speech. And then the data from Seattle in the late 1950s showed resistance rates in staph Aureus to be 50, 60% to a variety of different commonly used antibiotics at that time. But of course, the, that there was mitigation in that we always had. A new antibiotic to use instead. Our practice has evolved over the years changing from empirical treatment with one antibiotic to another as resistance has developed. And I think that the situation we've got ourselves into at the moment is. Clearly because there are no new antibiotics coming to market. We are slightly protected, as you've said in the UK at the moment because pan resistance is relatively uncommon, though occasionally seen in some parts of the world that is much more common than it is here. You know, we still have agents that we can turn to. But how long will that remain the case?

Helen: 21:17

I think it's important to note on that point as well, Nick, because I was quite surprised by this until I'd spent a bit of time working in other. Countries or visiting other countries, but actually they can't access these newer agents in the way that we can because they simply can't afford them. So that's another huge issue. With the cuts to the Fleming fund and the cuts to Garvey, sometimes those drugs would get funded through those organizations. That's obviously not gonna be the case if those organizations aren't funded, but although we can say here or we. We can potentially get, we could potentially get that might work for our patients. That's not the case in all parts of the.

Jame: 21:56

Yeah. And we've actually got a previous episode a collaboration with Microbe Male, a South African podcast talking about this called Bugs Without Borders. Danny, were you interested in diagnostics before Helen turned up and started rabbiting on at you? Like did you have a particular interest that meant that you got married up in a glorious alliance?

Danny: 22:13

Yeah, kind of. I met some guy, I, he's got his own company in Cambridge who. Manufacturers rapid diagnostic tests, and he donated thousands of them to us. So we drove a whole load of ambulances to Ukraine back in at Easter time, and actually the guy who who helped facilitate it was a previous intern from bsac. Brilliant guy called Scott. He's a military doctor. And so we managed to take all these rapid diagnostic tests to Ukraine and, and we should be able to identify the bacteria that are causing some of these. These infections and the best treatment for them, which would be really interesting because it also provide us with surveillance data as well for, these new novel pathogens have already been seen in Poland and in Germany as well. So it won't belong till in NHS, but. I think anyone who has, sent off a swab and, two or three days later got the lab report back and, there's maybe 10 resistance and one susceptible you. That's, thank God for that. And it's happening more and more often. You can't help but get a massive interest in rapid diagnostic tests. One of the other challenges in veterinary practice is Because people are paying for a service that, for example, I don't know you. You go and see a horse that's got a wound, you stitch it up, you think it'll probably be all right without antibiotics. It'll probably be fine. It might not be. It takes you having a few years of experience to better talk someone through that and say, look, there's a chance this will end up needing antibiotics, but I don't think it will. We won't bother giving them now, because when it does get infected and you have to go out and they have to pay for a repeat visit and then they have to pay for the antibiotics anyway, and then maybe have it flushed again. They're complaining to your boss saying, well, he didn't gimme the antibiotics. I wanted the, I used to always get them, every time I got a wound, I used to just better go and pick up antibiotics without even having a vet out years ago. That vet's done something wrong? And it's changing the entire culture of veterinary practices so that when the owner then goes and complains to your boss that you didn't give antibiotics the first time you saw the wound, they go, well, no, that's absolutely fine. That's what they should have done. You're not getting a discount. That was good practice. You know? And they can't then go to another vets either and go, well, I'll register next door.'cause they would've given me the antibiotics. And I think that, I know, gps find the same people come in just saying, well, I want something, I want a tablet, I want, you know, and you're saying, well, it's probably a viral infection that I don't care. I want my antibiotics. That we all get these pressures and we have to very much unite, across the professions. Both to stand our ground, but in not an antagonistic way. Make sure we genuinely educate and engage with people so they understand that these are drugs of last resort and when they're gone. It's not just that people will die from infections, it means pretty much all our medical advances. And the last 70, 80 years are gone. it is not just about people getting a cut and then getting sick. It's all these other interventions that are saving lives that are just gonna become too risky to justify.

Jame: 25:23

Agree a hundred percent. Surgical prophylaxis, cancer, chemotherapy, all those new fancy mAbs and nibs that we have people on for various autoimmune and inflammatory diseases. All of those make you more susceptible to infection and antibiotics are there as your. Solution to that, but not if we use them all up and they're all gone because then going on a biologic is much more risky the thing that made surgery possible in the 19th and 20th centuries was the invention of anesthetic and I suppose cleaning the site before you go and cut'em open. Yeah, fine, but also. Antibiotic prophylaxis, making the environment temporarily unfavorable to colonization and subsequent infection danny, do you want to say something about One Health at the moment and sort of chat about that aspect of things? I knew you had a couple of points you wanted to make.

Danny: 26:18

Well, I'm really pleased that one health is being pushed up the agenda. There's very few examples of medicine where veterinary is a head of human medicine. We're normally, a couple of decades behind some and eventually advances in human medicine filter down to veterinary

Jame: 26:39

to treat all creatures great and small, and not simply the hairless apes that that,

Danny: 26:43

exactly. But one of the few sort of examples I think is this one health agenda, which, when I was at university starting in 2001, we had one health bank into us. I think you, because you're looking at agriculture, you're looking at, one of the first. Examples of antimicrobial resistance we learn is about the how worm has become ineffective in livestock if you don't use'em in the right way. And then there's some areas of the world where they've been overused and you can no longer keep livestock because the, it's just not viable, and that, and I think you see that evolution of those. Parasites. Particularly different types of nematodes very quickly, like in a couple of years, sometimes if they're used in the wrong way. So it's almost a more visible impactful, quicker development of resistance and. I remember being very frustrated once a few years ago, being at a conference when one of the speakers was a doctor and they said About One health. And so my ears picked up. They go, that's the thing that the vets do. And they're like, no, it's something we're all, it's, it hasn't been communicated about. And so I think the fact that. One Health is coming in that vernacular, that's a human animal and environmental health is so completely interlinked. Whether they looking at everything from food production to, risk of pandemics is. It is a really positive thing. And this the A PBG and a MR plus BSAC providing interns are absolutely vital to this. I think, given the global urgency of tackling this issue. And given government priorities. At the moment, and given that we're coming at the back of a pandemic, I think it's the right time to really push on this. And you can only do that if you've got resources. And what I'm learning as a fairly new mp, I've only done it for just over a year, is, you know, we've done over 10,000 pieces of casework. That's when constituents contact you problems. It might be they're stuck abroad about a visa or they've got a problem of HMRC or their kids can't get the mental healthcare they need. Every day, you're, you cannot get through all the work you need to. And when there's these other issues that you're passionate about, like a MR, it's really hard to get the head space and the time to do productive work on that. And to have someone like Helen in our office when I've, agreed. Like this week on Wednesday, I'm speaking at university on a keynote speech, ONAL resistance. Helen's written, at least the first draft of that speech for me, which I would not have time so it just wouldn't happen. And so it's really adding that extra capacity that as an MP I can use my profile to drive it up the agenda, but I can only. Get correspondence, publish in nature about this issue or in the Guardian or in the Times recently if someone else is helping deliver that capacity to make it happen and having the foresight and the time to think it's antimicrobial Awareness Week. We should be writing op-eds about this for the newspapers. We should be doing some social media in that, which we absolutely should, but I can guarantee it would be Tuesday or Wednesday, halfway through Antimicrobial Awareness Week, I'd be oh. Dammit, we haven't done anything on anti yet. It's like, let's try and get something out. You know what I mean? Whereas, you know, Helen was planning this two weeks ago, so it's gonna be brilliant. So that's the, that's how important it's to have anyone who wants to get involved in politics, adding capacity to MP's offices is to drive something that's not directly related to their constituency is very vital, I think.

Jame: 30:09

I suppose the drive is always going to be to take care of those immediate issues for your constituents, and not necessarily this big picture stuff, but like you say, this big picture stuff is all important.

Danny: 30:19

It's all important and, but, and it's also, most people don't recognize that, you know me talking about antimicrobial resistance in Ukraine is important both globally and in the uk. You get comments on your Facebook page. Go, why are you talking about Ukraine? We elected you to represent Winchester. What are you wasting your time doing that for you? So you have to do two things. There's one you have to show that you are focusing on problems in Winchester. And two, you also need to better communicate that the work you are. Doing that has effect on global public health also does affect everyone. And antimicrobial resistance is a really good example of, a problem somewhere else in the world is a problem here and it can be a problem here within hours.

Jame: 30:58

Yeah, right here, right now. It's funny, the pandemic should have let people know that stuff far away can be at your door fairly quickly. But it doesn't seem to have really penetrated. Everybody would just rather forget about it, us included. We started the show basically to escape from our working lives. But here we are as a society studiously trying to ignore this problem. But to paraphrase, I forget who said the original quote. You might not be interested in a MR, but a MR is interested in you. Let's finish by talking about a couple of other things that BS a are doing. Nick, do you want to tell us about gams sas, which people may have heard of if they've gone to the any of the BSAC seminars and the

Nick: 31:45

So, these are examples of education, raising awareness for. The wider healthcare community. So we've talked obviously about political engagement, informing and gaining traction from the political arena gaza, which is the global Antimicrobial Stewardship accreditation scheme aims to improve practice in antimicrobial stewardship from a top down approach. A group of experts develop standards for antimicrobial stewardship. It could be applied. In healthcare settings across the world and hospitals who apply for accreditation are then assessed by an ex an expert external team to see if they meet those standards and they can be awarded a level of accreditation according to how well established a MS is within their setting.

Jame: 32:42

And is that like a, when you say your setting, you're talking about. High, middle, low

Nick: 32:47

the aspiration was that it will be truly global

Jame: 32:50

and the accreditation you get, is it a, is it a s tier, A or tier,

Nick: 32:55

It's A, level 1,

Jame: 32:56

B, C, D?

Nick: 32:57

and

Jame: 32:58

There?

Nick: 32:59

three Is the best and you can be awarded a a center of excellence as well, particularly if you are disseminating best practice to other hospitals in your area. So far we've got mid twenties numbers of hospitals who've been accredited from across the world and perhaps slightly surprisingly, a number within the UK and Ireland. And some in the US as well. But Egypt have really embraced the Gaza program and have an aspiration

Jame: 33:28

Yes the government's really taken it on and asked

Nick: 33:30

well, something like that. Yes, absolutely.

Jame: 33:32

enroll in it, is that

Nick: 33:33

And BSAC have recently signed a memorandum of understanding with a, an accreditation body in Brazil to roll that out throughout South America as well. So it appears to be

Jame: 33:45

America, not just Brazil.

Nick: 33:46

Absolutely, yes. Yeah. So, it's gaining traction, that's top down trying to engage. Senior managers and hospital senior executives in antimicrobial stewardship as well as those leading the programs themselves. Leap which is leadership to embed at antimicrobial stewardship practice is the other way around. It's a bottom up approach. The idea here is that we improve education for. People who are at the front line, not necessarily infection specialists but people who are dealing with patients day to day so that they are aware of best use of antimicrobials and can improve their own personal practice, be they healthcare assistants, nurses on wards clearly some medically qualified staff might want to be engaged as well.

Jame: 34:37

Is it aimed at people like myself who are wanting to run antimicrobial stewardship stuff?

Nick: 34:42

More the less highly qualified staff. Yes. Those people who are dealing with patients face-to-face on a daily basis, but who do have engagement with use of antimicrobials. Nurses, for example, who are administering drugs to pharmacists who are reviewing prescriptions day to day. Others who are listening, of course, can get involved in both of these programs. I I forgot to mention that everybody should be a member of BSAC and membership is free. But by being involved in the society we have, an open invitation for people who would like to get more involved in this sort of program by mentoring, delivering, training becoming assessors. There's a huge number of options that people can take up.

Jame: 35:28

I see. That's brilliant. Thank you very much. Guys, at this point if we finished everything that we were going to say, is there anything else that any of you want to add in at this point?

Helen: 35:37

I think it's worth noting as well, just when Danny was talking about what he gains from the BSAC internship, but it is just, so there is a lot that you learn from doing it as a researcher as well from what goes on in politics that doesn't necessarily translate down towards Bs A. So it, it's a mutual exchange. For instance, I dunno if you're aware Jane, but, MR is on the National Risk Register as a chronic risk to biosecurity, which is not probably something most people working as a clinical infection doctor would realize or really think about, but it.

Jame: 36:11

that. Huh? Is that one of the things which the UK has to watch out for because it could affect our way of life, something like that? Or?

Helen: 36:18

Yeah, so basically any sort of threats to the uk, it's not just infection related. There's loads of things like cyber crime. Basically things that the UK keeps a register off. So the National Risk Register, and once a MR is framed under that, then it opens up. Avenues that you can think of actually. How can we look at working on AR A MR and how can we protect against it a little bit more? I think it sounds a little bit more scary when it's on the chronic risk register and it's a national threat to global security, but it's things like that when you're working as an academic that you probably wouldn't think of in terms of funding streams and who you are needing to tell your information to. So I think really just opening the communications as a two-way stream is a really good remit of the program.

Danny: 37:07

I think as well we should also look at how, we can, politicians can communicate politicians who care about science. The level of scientific literacy in parliament. On average is very low. There are some exceptions to that, obviously, But we need to work out, whether you care about climate change, dealing for pandemic you care about, healthcare in general. How do we stop electing politicians who just don't believe in science? It's a challenge for those of us with science degrees to try and communicate in a more relevant way. But I also think that it shows the importance of scientists and researchers engaging with politics because I think possibly before I got involved, massively you probably think politician politics is done by politicians and science is done by the scientists and science is too important to be left just to the scientists. Like we need we need proper engagement. And I would say if you. If you are watching television and you're watching the news and you're watching, the handling of the pandemic, and you're screaming at the tv like, why aren't they doing this? Why aren't they doing that? Get involved on any level, whether it's doing like the internship that that heaven's do at the moment, or even getting involved in politics directly. It's really important that. Push those things up the agenda. Even writing to your MP saying you care about things like climate change, you care about science. It's the fact that, at the moment the polling would indicate Nigel Faroh will probably have the biggest majority, biggest party in Parliament,

Jame: 38:42

perhaps if you rephrase them as foreign microbes invading our British soil, you'll care a lot more.

Danny: 38:47

Well, actually one of the most fun op-eds I wrote was for the Daily Express, and it is about the impact of bacteria. In Ukraine that are not respond to antibiotics. And we could talk about that. Flesh heating, foreign bacteria, threatening our NHS. You know, suddenly that was a really interesting article. But I think what we've just touched on is as scientists, we communicate in a way that is very measured and very accurate. So I might, for example, I'm talking about climate change, let say. The majority of the evidence would indicate that a significant proportion of climate change is probably due to human activity. And then you get someone going, well, that's absolute nonsense of climate. It's always changed and they sound so confident. And although we are talking about data and evidence, we sound to someone who doesn't understand scientific language in the scientific process as being quite cautious, unsure, uncertain, and not confident. And I just mentioned before about the next election, we might have a government who don't believe climate change should exist. They don't believe in net zero. this anti-science sentiment affects all of us directly and it's up to everyone involved in healthcare and science to. Push back on that and communicate it, whether it's to individual patients, whether it's getting right into your local paper, whether it's lobbying your local MP or getting involved directly by either standing for Parliament or getting jobs in Parliament or in politics and public affairs and charities to make sure that the seriousness of things like climate change and antimicrobial resistance, which are very much linked anyway, are A, on the agenda and B. Believe that it's real because it is that's the level we're operating on here.

Jame: 40:39

Or even set up a, a podcast.

Danny: 40:41

Yes, no, definitely

Jame: 40:43

But ideally, not one that's exactly the same as this one's, I like, we like being number one. Danny, Helen, Nick, thanks for coming on the show.

Danny: 40:52

Thanks for having us.