The Centre is based on five disciplinary pillars
Biological and Pharmacological scientists at LSHTM work directly with microbes in laboratory conditions to learn more about the mechanisms of resistance, and above all, design effective new antimicrobials to fight disease. Through our global presence, scientists have links and access to drug-resistant strains of microbes from clinics and communities around the world, collected by researchers and collaborators for further study. We work on both neglected tropical diseases and emerging pathogens, as well as food-borne pathogens and hospital-acquired infections.
Observations in clinical and veterinary medicine are perhaps the most obvious manifestations of antimicrobial resistance. What is not obvious is the best way to respond to the dual needs of prescribing for individual patients or animals to tackle or prevent infection, as well as refraining from prescription in order to reduce drug pressure on microbial populations. Our research at LSHTM is at the cutting edge for tackling this challenge across different settings: we have substantial expertise in evaluating the roles of diagnostics and clinical algorithms for improving antimicrobial stewardship. Researchers also assess at the role of animals in the transmission of both antimicrobial resistance and antimicrobial residues.
Antimicrobial resistance is commonly encountered and addressed in its epidemiological and pathological dimensions, which are presented in policy terms as urgent technical and social problems. However, shifts in human land use, animal husbandry, and population distribution which underlie epidemiological intelligence and the pathological signs of AMR have broader cultural, spatial and temporal contexts, which are not always apparent in the policy field. Humanities and Environmental researchers at LSHTM illustrate the long history of social and technical interventions in human health and the burden of disease, they outline recurrent patterns, trace the impact of shifting behavioural and policy responses, and highlight local contingencies.
Epidemiologists and modellers at LSHTM are tackling AMR across different scales – from developing intervention strategy at the level of an individual healthcare facility to tracking the global spread of resistance. Surveillance is key to understanding the extent of AMR and to inform control policy that adapts to local conditions. This is an aspect that LSHTM researchers are keenly engaged with, including determining global prevalence of HIV treatment failure and providing online tools to assist researchers and public health practitioners around the world to have easy access to up-to-date information on local rates of resistance to drugs for TB or malaria. We use models in the UK and globally to inform which alternative drugs or control measures, and bundles of controls, are optimal – both to reduce disease burden and to maximise cost-effectiveness of interventions.
At LSHTM, researchers apply Health Economics, Anthropology, Sociology, Health Policy Analysis and Political Sciences to address AMR. Each discipline is necessary to understand and respond to the challenge of drug-resistant infection. Economists at LSHTM project the costs of inaction vs. action to national and global health systems and economy; propose incentive models for behaviour change; and evaluate the cost effectiveness and best resource allocation of diagnostic tools. Anthropologists and sociologists examine how human behaviour is affecting AMR and how different disciplines conceptualise and understand AMR. Political scientists study the barriers, opportunities, actors and factors that affect the development and implementation of legislation and harnessing political will. The School͛s breadth of research projects across these disciplines is well illustrated in the case of antimicrobial use and prescribing – a phenomenon that is closely linked to rising resistance.