Interdisciplinary, international, and interconnected: Research at the LSHTM Antimicrobial Research Centre seeks to inspire through integration
The newly launched Antimicrobial Resistance Centre at the LSHTM seeks to pioneer interdisciplinary research and guide action on AMR, one of the most significant challenges to global health today. At the AMR Centre launch event, researchers came together to illustrate current work, and stimulate new projects.
Introductory reviews by Professor Anne Mills, Dr Richard Stabler, and Dr Clare Chandler on the scale and scope of the problem identified that we need to break out beyond the ways that we currently research AMR. Working together and crossing boundaries should push researchers to challenge themselves, in order to find effective solutions to the challenge at hand.
These ideas were developed over two panel discussions, chaired by Professors Sharon Peacock and Kara Hanson. The issues were brought together in the keynote speech on the challenges of AMR, by Professor Dame Sally Davies, recommending where we go from here.
Panel 1: Disciplinary pillars
The AMR Centre encompasses five major disciplinary approaches to AMR research. Watch the presentations on each disciplinary pillar here:
From parasites, to bacteria, to viruses, the core work of biological and pharmacological sciences investigates microorganisms in laboratory conditions. For AMR, this means learning about the mechanisms of resistance, and above all discovering new antimicrobials to fight disease. Dr Sam Willcocks underlined how the AMR Centre will facilitate lab-based research to reach out beyond conventional boundaries.
Clinical and veterinary sciences demonstrate the incredible impact of antibiotics, as Dr Heidi Hopkins pointed out. From meningitis to malaria, diseases causing a high burden of morbidity and mortality across human and animal populations could be treated safely and effectively. Initiatives such as ‘One Health’, bringing physicians, veterinarians, and ecologists together to understand AMR across human and animal populations; more collaborative work like this is needed in future.
Epidemiology and modelling is the study of disease incidence, distribution, and control, and the use of statistical and mathematical models to identify these processes and pick up patterns in the ways AMR develops. Dr Laith Yakob explored drug resistance studies, such as that of HIV patients to the first line drug Tenofovir, or constructing tools like drug resistance maps, such as those against malaria in Sub-Saharan Africa, as examples of epidemiological work in AMR. These can alert people to which antimicrobials to avoid locally.
AMR is not a short term problem. Humanities and environmental sciences are key providers of contextual and critical insights into understanding how AMR develops over time. To really appreciate the problem, Dr John Manton reminds us that we should consider the environmental and cultural contexts of AMR, and investigate the cultures and values behind the ways people perceive it. The plurality of methodological tools across disciplines such as history, geography, philosophy, literary and cultural studies have special scope to re-imagine existing investigation techniques through innovation.
AMR presents a lens through which to look at the welfare and ethics of disease burden around the world, and the role of government and industry in shaping policy, proposed Henry Lishi Li. AMR could lead to a loss of $100.2 trillion in the global economy over the next 30 years. Economics, social, and political sciences can help to make known the bigger picture behind AMR. Economists can examine the incentives driving individual behaviour, and anthropologists can analyse the roles of antibiotic medicines in societies beyond behaviour. Political discourse analysis can ask pertinent questions. For example, what does the apocalyptic approach to describing the issue of AMR highlight and obscure?
Panel 2: Interdisciplinary projects
Considering the many ways to approach AMR, there LSHTM projects were presented, providing a brief glimpse into research attempting to bring expertise across different disciplines together.
AMR surveillance work crosses many different contexts: communities, health systems, political systems, and more. Dr Anna Seale led a team to map out ways to strengthen existing capacity to detect AMR in low and middle income countries, and the costs of this. Clinicians, microbiologists, health economists and anthropologists came together to draft a protocol, based on field visits to Malawi, Kenya, Vietnam and Ethiopia. They showed that improving clinical surveillance of AMR is an area where a little investment can go a long way in low and middle income countries: leadership, human resources, and effective laboratories are important to combine for improved local, national, and international level outcomes.
Preventing health care associated infections is one way to tackle AMR at the root. Increasing numbers of people develop another infection as a result of seeking treatment at health care facilities, leading to the use of antibiotics prophylactically – to prevent anticipated disease. Dr Susannah Woodd’s team in the Soapbox Collaborative have been looking at the situation and how to improve it. Antibiotics are often used as a prophylactic for women in labour, particularly in the developing world, where high rates of maternal and neonatal mortality persist. In a world where 38% of delivery facilities across 54 developing countries do not have access to clean water, the problem of AMR resistance is deeply complex when faced in developing countries, and needs coordinated action.
Genomics and diagnostics can inform us when to use antibiotics or not. For example, in meningococcal disease, simply carrying the bacterium is not sufficient. Research by Professor Martin Hibberd’s team looks at how people who have certain genes are particularly susceptible to the disease, as certain genes are an important mediator in enabling the bacteria to protect itself more effectively. So instead of antibiotic treatment, a vaccine based treatment may be more appropriate to preventing meningococcal disease. This is important work into exploring alternatives to antibiotics to curtail AMR.
AMR: The challenges – Keynote
AMR claims at least 700,000 lives around the world each year, primarily in the developing world. The day’s discussion highlights the need to get more insights from social and behavioural studies to understand how to change people’s practices. Funding is a challenge, but commitments are increasing. The landmark meeting on AMR at the UN General Assembly this year will hopefully lead to stronger commitments. AMR is an issue that is global in scope, that requires solutions that are global in scale – and the time to act is now.
Where do we go from here?
Joining the dots between pathogenic processes, the lived experience of antibiotic use and resistance, developing better health systems, and understanding how to change people’s practices is a monumental research challenge. Next steps for the AMR Centre are to come together and break new ground, in order to inspire the innovation and ingenuity required to meet it. Sign up and join in now if you can.
With thanks to Gargie Ahmad, studying for MSc in Demography and Health at LSHTM, for preparing this brief.