Antimicrobial Resistance and the Water Sector

This report, based on a June 2025 multi-stakeholder workshop in London, explores how the UK water sector can address antimicrobial resistance (AMR) as part of a One Health approach.

Background

• AMR is a growing global health threat, already causing 1.27 million deaths annually (2019) and projected to cause 10 million deaths per year by 2050 if unaddressed.

• Water systems are both pathways for AMR spread (via effluent, sludge, rivers) and potential intervention points through monitoring and treatment.

• Wastewater treatment plants, sludge use in agriculture, and pharmaceutical/industrial discharges are highlighted as major hotspots.

Stakeholder Landscape

• Key actors: water utilities, regulators (Ofwat, EA, SEPA, NRW), government departments (DEFRA, DHSC), academia, public health agencies (UKHSA, NHS), pharma industry, local authorities, and advocacy groups.

• Fragmentation, weak coordination, and limited formal mechanisms hinder effective collaboration.

Water Sector’s Influence

• Seen as an enabler of AMR research and monitoring, though not yet a leader.

• Four strategic areas of influence: policy, monitoring, technology, and research.

• Ongoing initiatives include the Chemical Investigations Programme (CIP) and pilots like PATH-SAFE.

Evolving Opportunities

• New tools: metagenomics, digital PCR, wastewater-based epidemiology, AI, geospatial modelling.

• Need for regulatory reform (e.g., Urban Wastewater Treatment Directive, bathing water regulations) to include AMR monitoring.

• Stronger UK–EU–international alignment and national coordination required.

Recommendations

Five priority areas for action:

1. Strengthen cross-sector collaboration – Create structured platforms linking water, health, environment, and research.

2. Improve data sharing and integration – Build open-access repositories; link wastewater/river AMR data to public health reporting.

3. Build regulatory and policy readiness – Engage water companies in shaping future AMR standards.

4. Support targeted monitoring – Focus on high-risk discharge points; develop proxy markers; expand testing capacity.

5. Address research and evidence gaps – Assess risks to workers and communities, evaluate treatment technologies, and standardise methods.

Conclusion

The water sector should shift from a passive role to being an active partner in AMR mitigation, leveraging its infrastructure, data access, and regulatory momentum. Proactive collaboration, innovation, and integration into national AMR strategies will be critical to safeguard public health.