Collaboration and clinical research are critical in combating the global antimicrobial resistance (AMR) threat. The challenges are many but with growing recognition of this world-wide issue comes hope.
In this podcast you will hear how the global research community is coming together to tackle the problem on multiple fronts by taking a much broader view on AMR. Antibiotic stewardship, vaccines, better public health and new diagnostics all have a role to play.
You will also hear how the NIHR plans to play its part by establishing innovative platform trials, which will help to accelerate research into drug resistance and development of new antimicrobial agents. This approach, tried and tested in the COVID-19 pandemic, will create new opportunities for academic researchers and the life science industry to work smarter, faster and more collaboratively.
The views and opinions expressed in this podcast are those of the host and guests and do not necessarily reflect those of the NIHR or the Department of Health and Social Care.
Transcript: https://docs.google.com/document/d/135jA6ncSn8UlsMa3H5vIHq_cYdLSqo9NJH6gTjRBPsk/edit
Collaboration and clinical research are critical in combating the global antimicrobial resistance (AMR) threat. The challenges are many but with growing recognition of this world-wide issue comes hope.
In this podcast you will hear how the global research community is coming together to tackle the problem on multiple fronts by taking a much broader view on AMR. Antibiotic stewardship, vaccines, better public health and new diagnostics all have a role to play.
You will also hear how the NIHR plans to play its part by establishing innovative platform trials, which will help to accelerate research into drug resistance and development of new antimicrobial agents. This approach, tried and tested in the COVID-19 pandemic, will create new opportunities for academic researchers and the life science industry to work smarter, faster and more collaboratively.
The views and opinions expressed in this podcast are those of the host and guests and do not necessarily reflect those of the NIHR or the Department of Health and Social Care.
Transcript: https://docs.google.com/document/d/135jA6ncSn8UlsMa3H5vIHq_cYdLSqo9NJH6gTjRBPsk/edit
Introduction:
Welcome to our Clinicians in Conversation podcast series, part of the NIHR; the National Institute for Health Research podcast program.
In this episode, we are talking about antimicrobial resistance and you will hear from Professor Andy Ustianowski and Professor William Hope, who are joint national specialty leaders for infection at the NIHR Clinical Research Network.
They will be discussing the challenges antimicrobial resistance presents and how the research environment in the UK is uniquely placed to support clinical research in this area.
Andy Ustianowski:
Welcome to this NIHR podcast exploring research into antimicrobial resistance. My name is Professor Andy Ustianowski, I'm an infectious disease clinician and researcher based in Manchester. And today I'm joined by Professor William Hope.
William Hope:
Hello, Andy. Thank you. I'm William Hope and I am the Dame Sally Davies chair of AMR Research at University of Liverpool. Like Andy, I'm a infectious diseases clinician and spend most of my time in AMR research and especially the development of new antifungal and antibacterial agents. Very pleased to be here.
Well, it's nice to have you and what a perfect person, because I'm going to ask you some questions if that's all right. William, what do you understand by the term AMR or antimicrobial resistance and how big an issue is it?
So I think Andy, one of the problems that we have is that people understand different things by this term. It's used widely now. In the most narrow sense it's when an antimicrobial agent. that's an antiviral, an antifungal, an antibacterial. stops working, and there might be any number of reasons for that. But there's quite a narrow view or definition, and it's maybe a more helpful definition, as really was first described by Lord O'Neill in his report of taking a much broader view of the problem. And so people say that they don't do AMR research. But when you think about a vaccine or preventing antimicrobial usage that is, for us anyway, evidence of AMR research. So it's a very broad, a very broad definition, Andy.
And would you think it's fair to say it's a priority both clinically but also in terms of research?
I think that since I've been practicing infectious diseases, drug resistance was something that was considered sort of rather unsavory and dirty and an inconvenience, but has really transformed in the last 10 or 20 years to the recognition that antibiotics and antimicrobial agents underpin all of modern medicine. They underpin all of the advances in medical therapies for other diseases and advanced surgical techniques. And without these, we just can't treat patients the way that- patients can't receive the very best care. So antimicrobials are absolutely critical for the functioning of our health care systems and by that idea of adequate functioning of our society as well. So an absolutely fundamental problem.
So what's required to address and improve the antimicrobial resistance problem?
People are starting to talk about tackling the problems at multiple fronts. In terms of human health I think there's a recognition that we need to use antimicrobials precisely and judiciously or not at all, if possible. So we need to look after what drugs and antibiotics that we have so we need to steward them. And we also need to develop new compounds to meet the ever evolving challenge of drug resistance. And we need to have, um, I guess, a social and an economic construct by which we can keep managing this problem together.
It's not going to be something that's solved. It has to be managed. And really, we're on the edge of a number of these different things. We’re really just barely managing. We're not in front of the problem anywhere near as much as we should be.
And what about the development of new antibiotics? Where does that fit into all of this?
The problem with development of new antibiotics is that there really have not been any developments of any new classes in recent times. And one of the reasons for that is because, well, it's very difficult for a start. Something that kills a microbe, but that doesn't kill the host of that microbe is in is no small feat.
But really, the issue at the moment is we tend to assume that antibiotics are here forever and we undervalue them economically. And the economic framework or incentives to develop new antibiotics are not present at the moment.There's no way that companies and investors are willing to put the money in in the first place because of the very poor returns on their investments.
So the economic market is not favorable for the development of new drugs, and that's out of kilter with the sort of unmet medical need or the societal imperative to develop new antibiotics. So there are a number of things that are being done to try and fix that, and it's very important that those programs are successful.
No, I agree, and obviously it's not all about antibiotics, do you think we need further advances in research in diagnostics and public health, et cetera, where does that all fit in?
So this is where taking a much broader view, Andy, of drug resistance is helpful. It's not just about, there's no point spending one or two billion or pounds developing a new drug that's immediately lost because of the injudicious use. So we have to learn how to use these new drugs or these new assets very carefully, and we have to develop the structures around the drugs that help them to be used. So diagnostics is one example, not using antibiotics through vaccines or public health measures.
So having clean water and safe food is another example of that, but also learning how to use these drugs, using them for the benefit of not only patients but populations as well. We tend not to do that in a very refined or sustainable or resilient manner because we've always had the option of getting another drug, and so those options are starting to run out and we need to develop all of these other tools and strategies around drugs.
And I believe we probably need to encourage a better understanding of the whole issue around antibiotic use, antimicrobial resistance, et cetera, by the whole group of different people, whether that's patients, public health care practitioners, health care services, et cetera. And would you agree?
Yes, I think that that is true. So people don't understand how profound this problem is. They understand about superbugs and they understand that you shouldn't have antibiotics for a viral sore throat.This is a problem that is as fundamental to the climate emergency. It cuts across all facets of our society, and we need much better engagement from the public and policymakers to help solve this incredibly complex problem.
So the key area I want to explore is really what are the NIHR’s plans and what can listeners potentially do to contribute?
The NIHR has the advantage of being a large connected network so we can operate at scale, it's managed to do that very successfully in the recent pandemic by operating together using a variety of innovative approaches such as platforms.
They could be adopted for, we're planning to adopt them, for drug resistance, research into drug resistance. The NIHR has the most fantastic linked expertise in terms of its data surveillance and its microbiological and clinical expertise for the development of new antibiotics, and it has the most astounding, expertise in these other things that we've been mentioning. So vaccine research and diagnostic research. So we're incredibly well placed to tackle AMR in the broadest sense Andy.
And I think our unified health care system is a definite advantage to doing research in antimicrobial resistance. What are your views on that?
So the UK is uniquely placed, isn't it, this is not about a zero sum game, it's not about a ‘winner takes all’. It's that we, and antibiotics and antimicrobials are about what it takes for us all to live safely together, and that means we all have to work together to do that.
It's not about individual rights. It's not about the individual always winning. There's a trade between individual rights and, you know, resilient systems or countries with resilience that can use these drugs for the here and now, but also have drugs for tomorrow. And so I think the UK seems to be well placed in terms of providing leadership for those sorts of issues.
No, I agree. I think we've got the the structures, we've got the baseline and then all the learnings that we've had from the COVID pandemic, which we can bring into this to really exploit new ways of approaching antimicrobial resistance, whether that's looking at antimicrobial agent development, which could potentially be accelerated, whether it's looking at diagnostics and pathways and ultimately health economics and implementation science. There's a huge amount that we potentially could do and the learnings from COVID have included, as you mentioned, platform studies. But there's a huge number of other adaptive trial designs that we could innovatively use to address antimicrobial resistance. And so if we have someone from commercial pharma or someone from academia listening here, what would you say to them in terms of what they can do, what we can do and how to approach us in the UK to bring their studies and their products to us?
Well Andy, I think one thing about the field at the moment is that everybody's issue is different. It's actually strikingly different in terms of whether that's a diagnostic or a new drug that might be a traditional agent or it might be a non-traditional agent, it might be a vaccine. So I think that both of us are here to work with companies on a one to one basis. And so we would very much value direct contact where we can talk about those issues and either direct people to where we know that there are expertise or if not work together to develop new pathways to get those products advanced through clinical research in the UK.
Absolutely. I mean that those one-on-one conversations are often the most important thing. The other portal into the clinical research network and the UK generally is the business development and marketing subset of the CRN. And so that would be a good port of call, either directly to William or myself or to the BDM part of Clinical Research Network, and they can chaperone and assist and support someone in viewing whether they come to the UK and subsequent from that.
So I think there's exciting times ahead of us. I think there's an awful lot that we can do. I think this is really a major focus and it's something that I think we will do a lot in and we would love to work with people, whoever they are, who have similar interests or have potential products that we can bring into this whole arena. Any last comments from you, William?
Well, Andy, I couldn't agree more. So we're here to help. We're here to work with people. We take a, of course, a strong national view, but we also have well-established international links, and it very much takes a global view of this problem, we're here to help.
Great. Well, lastly, thank you so much, William, for spending the time to talk to us and for the listeners for listening. I hope it's been useful for you. Thank you.
Thanks. Thanks, Andy.
To find out more about how the NIHR supports AMR research, visit the NIHR website. This was an episode of the NIHR Clinicians and Conversation Podcast series. Thank you for listening.