Antibiotic Research UK annual mini-symposium

On October 24th CE4AMR team members Nichola Jones and Jessica Mitchell attended the Antibiotic Research UK’s annual mini-symposium in London.  This charity, now in its fifth year offers small grants to fund research into all areas of antimicrobial resistance and campaigns to raise awareness of AMR.  Nichola and Jess were particularly interested to attend the mini-symposium as several posters and presentations included components of participatory and community engagement. Hence our team wanted to find out more about the UK-based AMR research in this area.  This ‘in conversation’ blog summarises the themes of an after-dinner chat between Jess and Nichola as they reflected on the work shown at the conference and how it compares to their LMIC-based projects.  Whilst the breadth of research presented was incredibly exciting, both felt that that there was great potential for CE to make more of a contribution to AMR research and practice. 

What was your overall experience of the mini-symposium? 

JM: it was great to see more examples of UK-based early career research into AMR.  Because my project team works in LMICs (mainly Nepal and Bangladesh), it can be easy to forget that similar challenges are occurring in high income countries as well.  The range of presented work was broad and so it was fascinating to see the different angles being exploited including the development of new screening methods, understanding pet owner’s knowledge of antibiotic treatments and mapping antimicrobial usage in the UK diary industry. 

NJ: I enjoyed hearing about the types of work being taken up in the UK – I have only worked in LMICs and too hadn’t considered that AMR would be such a focus point in a country such as the UK; with such well-developed regulations on both human and animal health. Seeing a room containing such a range of expertise, research experience and perspectives was exciting. Coming from a public health (rather than a STEM) background, I found the presentations around health promotion and patient support of particular interest.  

Considering CE4AMR works with low-middle income countries, what did you find different about the themes and discussions at this event? 

JM: Overarching themes don’t differ much at all from our conversations in Nepal.  AMR is a huge global issue which doesn’t adhere to borders, and with which the general public is currently not engaging enough.  What was different in this conference was the specificity of research ideas presented. These encompassed hospital-based best practice, understanding of resistance mechanisms, and community awareness of AMR.  Within our LMIC settings, we are often looking at broad questions around the level and diversity of antimicrobial usage, surveillance of AMR, and understanding the language communities use to discuss antimicrobial medications.   I think this broader focus has advantages in taking a One Health view of AMR.  One health refers to challenges that impact upon humans, animals and the environment, such as AMR, and thus require cross-sectoral collaboration to tackle.   In our LMIC focussed-AMR interventions we are still considering these fundamental, and perhaps quite basic, questions allowing us to take a more holistic approach to answering them.  We consider for example how wider society contributes to the lack of antibiotic usage data or why consistent AMR surveillance is so difficult to establish in a particular country.  Having these discussions gives us great context with which to address our problem.  In contrast, the work presented here was very focussed, and whilst there are undeniable benefits of addressing questions through a clearly defined lens, I couldn’t help but worry that the One Health approach wasn’t always at the forefront of this research. 

NJ: I would echo the response here. I too found that the conversation, while interesting and of course valuable to tackling AMR, did seem to be lacking a One Health focus. In our work; speaking with health providers and researchers in Nepal, we discuss using participatory methods in order to better understand the role that antimicrobials play in every-day life for a community and aim to generate community-led solutions to overuse of, for example, common antibiotics. The research presented was extremely interesting and showed me a variety of aspects to UK AMR research that I had not been exposed to in my role as a public health researcher. The research presented was thought provoking and made me wonder how I might, in future, go about incorporating more STEM subjects into public engagement research in the fight against AMR. The research, while resource intensive, may yield findings that impact AMR research in LMIC’s (although this was not the topic of the conference). Presenters referenced the use of resources such as advanced testing methods, well-documented (preferably digital) records, medical personnel or a combination of these – something which would be unsustainable in many LMIC’s. I reflected on the notion that, by working across disciplines, it may be possible to generate similar research in more resource-poor settings.  

Community and participatory approaches are championed as methods to engage lay audiences and create bottom-up solutions to AMR and other One Health challenges in LMICs.  Did you notice a difference in focus considering much of this research came from high-income countries? 

JM: There were some great examples of participatory research in some of the grant-funded projects however I don’t think this was showcased as well as it could have been.  One project in particular had committed a great amount of time to developing rapport with British dairy farmers in order to better understand their use of antimicrobials and how they record and monitor this usage.  It was interesting that the majority of audience questioning focused on the latter component of the research whereas from mine and Nichola’s perspective we would have liked to hear more about the engagement with farmers and methods used to build a trusting relationship where by sensitive and crucial information could be shared with the research team.  It would have been great to see more emphasis placed on the importance of this engagement method which could be re-used in multiple different AMR contexts and help other researchers collect the ground-level information they need from farmers. 

NJ: I would, again, agree with the points already made here. Upon hearing the presentation about farming practise, an immediate thought for both of us was that there was a huge potential to engage further with the community of dairy farmers in the UK, as well as report on the process of engaging with these participants. From my perspective; community engagement is an integral component to AMR research, and I would have enjoyed seeing this project consider the opportunity of reflecting on the processes of engaging with farmers. I felt as though there is a potential there for the researcher to reflect on her own experiences and how that process impacted the research outcomes – and perhaps share that information somehow for future research in other settings.  

The mini-symposium focused strongly on the need to better communicate AMR to the general public, what are some of the challenges you see in achieving this? 

JM: The keynote presentation within this symposium was in equal parts informative, fascinating and terrifying as it charted the emergence, detection and spread of several types of AMR within China, and how managing antimicrobial usage (particularly in agriculture) can mitigate this.  However, what struck me was that there is a lot of highly complex scientific information to share from this scheme of research which would be relevant to a broad range of audiences and the general public.  However, communicating AMR with the public is challenging as it is often viewed as a technical issue which can cause people to disengage.  It seems there is real need for a translation service within AMR to ensure our research is approachable and accessible to all audiences.  For Nichola and I this is always at the forefront of our minds as we work in an interdisciplinary team including artists, linguists, zoologists and anthropologists and the aim of our projects is to engage lay-audiences with AMR.  However, for a lab-based AMR researcher this may not be considered such a crucial aspect of their communication*.  One way round this could be to collaborate more broadly within AMR research, at the University of Leeds we have seen an explosion of AMR-related work across disciplines in the last few years and we are now working hard to link these projects and understand our common language between fields.   

NJ: I found that hearing the different ideas, methods and research undertaken with support from the charity to be both highly hopeful and worrying. I, as an AMR researcher, agreed with the consensus in the room that more must be done globally to bring AMR to the forefront of public awareness. As an interdisciplinary researcher, I have reflected upon how scientific research can sometimes be difficult to understand for those outside of STEM subjects. Public engagement, an area I feel is essential in reducing AMR globally, aims to generate public awareness and action based on medical and scientific facts regarding AMR. It may, therefore, present us with an opportunity to consider working multi-sectorally in order to best answer the question of communicating the problem of AMR to the public.  

*The recent Wellcome publication on ‘framing’ AMR is a really helpful resource in terms of guiding researchers on how to communicate AMR to the public.  Data is collected from across high- and low-income countries so findings are widely applicable to range of AMR projects.