64.Antimicrobials can enter the environment through waste–including human, animal and farming waste, as around 70% of antibiotics are excreted in urine.
65.Waste can also come from pharmaceutical companies producing antimicrobial medicines, and is a particular concern in some countries, as our witnesses described:
Dr Williams: What is happening? Is a company flushing out the tanks and discharging antibiotics into the environment, and then bacteria breed in that environment?
Dame Sally Davies: Some of it is active pharmaceutical ingredients, the preliminary ingredients that are made generally in China and India, and some is the manufacturing. I do not believe it is our big companies. Much of it is generics companies in those countries.
66.AMR is no respecter of international boundaries - therefore this has implications for the UK, just as overuse of antimicrobials in humans and animals abroad does.
67.We heard from many of our witnesses that not enough attention has been paid to this area. Sally Davies said that more research was needed, a view which was echoed by the Chief Veterinary Officer:
We need to understand more about how that interaction between the animal, waste, the environment, water and humans drives resistance and what the key pathways are.
68.Professor Peter Borriello, Chief Executive of the Veterinary Medicines Directorate at DEFRA agreed on the need for better surveillance:
In terms of integrated surveillance and surveillance particularly in the DEFRA areas of responsibility we need to do more. What is particularly true for AMR is that monitoring certain compounds in the environment was not something that was considered that important in the past, so there are not systems to build on; we are having to start de novo …
69.He added that from 2019, the Environment Agency will be measuring two more commonly used antibiotics, as they will be a better marker than those currently being measured. We also told that the pharmaceutical industry has agreed discharge targets which will be formally announced shortly. Professor Dame Sally Davies highlighted particular concerns relating to the environmental impact of fish farming, although Professor Borriello argued that concerns about fish farming in the UK in this regard were unfounded.
70.Perhaps the most striking illustration of lack of progress in addressing issues relating to AMR in the environment was given by Gwyn Jones, Chairman of the Responsible use of Medicines in Agriculture Alliance (RUMA). He told us that after dairy farmers had been issued with advice not to feed calves with milk from cows who have been treated with antibiotics, they then faced questions on how the milk should be disposed of–there was no scientific evidence available to guide them on how best to do so.
71.We recognise that AMR is a global issue requiring co-ordinated international action, including on environmental contamination by antimicrobials. We expect the Government’s new strategy to give greater focus and emphasis to this little-understood but important area. The strategy should include commitments to establish safe discharge levels for human waste, agricultural waste and pharmaceutical manufacturing waste, and to introduce systems to monitor and enforce them.
Published: 22 October 2018