British Society for Antimicrobial Chemotherapy– Written evidence (NLR0015)

1. About the British Society for Antimicrobial Chemotherapy

1.1.  The British Society for Antimicrobial Chemotherapy (BSAC) represents one of the world’s most influential networks of infection specialists, including, but not limited to, infectious disease physicians, microbiologists, pharmacists, researchers, and nurses. We possess more than 50 years of experience in leading on infection education, surveillance, and research. Dedicated to saving lives through the appropriate use and development of therapies, especially antibiotics, we support thousands of scientists, healthcare professionals, and policymakers, across the world every year through our activities.

2. AMR as a National Resilience Risk (Inquiry Questions 1–4)

2.1.  Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi, or parasites evolve in ways that make medicines, such as antibiotics or antifungals, less effective or completely ineffective. This means infections become harder to treat, spread more easily, and carry a higher risk of severe illness or death. The World Health Organization warns that AMR “…threatens the very core of modern medicine and the sustainability of an effective, global public health response to the enduring threat from infectious diseases…Few replacement products are in the pipeline. Without harmonized and immediate action on a global scale, the world is heading towards a post-antibiotic era in which common infections could once again kill.” [1]

2.2.  COVID-19 preparedness and resilience failures: lessons for AMR preparedness: Module 1 of the UK COVID‑19 Inquiry, examining the resilience and preparedness of the UK[2], identified several structural weaknesses that shaped the national response. Many of these vulnerabilities such as fragmented surveillance, limited surge capacity, unclear cross‑government coordination and inconsistent risk communication, are the very same weaknesses that AMR will expose, only more slowly and with far fewer tools available to respond. Once resistance is entrenched, the tools simply do not exist, which makes structural preparedness even more critical. Unlike COVID‑19, AMR offers no prospect of a rapid pharmaceutical rescue.

2.3.  COVID‑19 healthcare system failures: lessons for AMR preparedness: The COVID‑19 Inquiry has also shown how fragile the UK’s operational resilience becomes when infection pressures rise. Healthcare systems were overwhelmed and came close to collapse, with beds, staff, equipment and space stretched far beyond sustainable limits. Millions of operations were cancelled and diagnoses were delayed. The workforce endured intolerable strain with long‑lasting consequences for wellbeing, and infection prevention and control guidance proved insufficiently robust, requiring major revision under crisis conditions[3]. These findings are directly relevant to AMR. Unlike COVID‑19, AMR will not arrive as a sudden surge but will erode capacity slowly until collapse becomes unavoidable. It will create chronic, not acute, pressure on the same systems, making long‑term surge planning essential. This requires antimicrobial stewardship (AMS) to be embedded across every part of the health and care system, not as a specialist function but as a core resilience capability that underpins safe care, protects the workforce, and preserves the effectiveness of the treatments on which modern medicine depends.

2.4.  AMR is not simply a health challenge; it is a threat multiplier that deepens existing vulnerabilities across societies and economies. A rise in resistance is driven by the overuse and misuse of antimicrobials in humans, animals, and agriculture, compounded by inadequate sanitation, weak regulatory systems, and environmental contamination. These risks do not remain localised. They move across borders through international travel, globalised healthcare, and interconnected supply chains, importing AMR pressures directly into the UK.

2.5.  AMR also amplifies wider global stressors such as climate change, biodiversity loss, conflict, and forced displacement. This creates “compound risks” that destabilise systems simultaneously. Together, these pressures strain health services, disrupt food and medical supply chains, undermine economic resilience, and weaken national security. In this context, AMR is both a symptom and a driver of global instability. These risks are well articulated in the Wilton Park report, Through the Kaleidoscope, which provides a multidisciplinary assessment of how AMR intersects with health security, national resilience, and international stability and warns that “without ongoing innovation, health systems and national security could face catastrophic consequences, including the inability to manage infections in civilian populations or maintain operational readiness in defence forces.” [4]

2.6.  Analysis from Green Finance Institute reinforces this picture of interconnected, mutually reinforcing risks. The report highlights that nature‑related financial and economic pressures, driven by land and sea‑use change, pollution, biodiversity loss, and climate change, are already creating systemic instability, with potential GDP impacts exceeding those of the Global Financial Crisis. Crucially, it warns that the growing likelihood of an AMR‑driven pandemic could generate an economic shock greater than COVID‑19. These findings underline that AMR is embedded within the same landscape of converging environmental and economic risks, and that none of these threats are unfolding in isolation.[5]

2.7.  AMR as a risk to human health and the NHS: AMR threatens the foundation of modern medicine: routine surgery, cancer chemotherapy, neonatal care, maternal health, and intensive care all depend on effective antibiotics. Resistant infections are rising in the UK. In February 2025, the National Audit Office reported a 13% rise in serious antibiotic-resistant infections since 2018, despite a government pledge to reduce them by 10%, and warns that the UK remains a long way from controlling AMR, with risks tipping from chronic to acute[6]. The Public Accounts Committee, in its June 2025 report, similarly found that most targets within the UK’s AMR National Action Plan (2019–24) had been missed.[7] A scenario in which certain infections become routinely untreatable would generate cascading system impacts - overwhelming hospitals, reducing surgical capacity, delaying cancer care, and driving workforce and productivity losses.

2.8.  AMR as a biosecurity and biodefence threat: Antibiotic-resistant organisms, whether they arise naturally or are deliberately modified, pose significant risks if exploited as biological weapons. Resistant pathogens could be used to target vulnerable groups, disrupt essential services, or generate widespread fear as part of asymmetric warfare or terrorist activity. A further challenge is attribution: distinguishing between natural evolution, accidental release, or intentional misuse would be extremely difficult. This uncertainty could slow outbreak responses and heighten geopolitical tensions if biological incidents are misinterpreted as deliberate acts.4

2.9.  AMR is an economic risk: AMR threatens the agricultural, livestock, food and economic systems that underpin national resilience. It affects labour force participation, productivity, tourism and market stability. Global modelling indicates that without action, AMR will make the global economy US$1.7 trillion smaller by 2050. Conversely, improving access, stewardship and innovation could generate US$960 billion in global economic gains and US$680 billion in health benefits[8]. Aviva Investors warn that “investors need to be made aware they face material risks in companies that do not appreciate how fast AMR is growing, its impacts, and that risk is accruing for those ill-prepared for tighter restrictions on antimicrobial use[9]”. Modelling from Green Finance Institute shows an AMR-pandemic scenario could leave UK GDP 12% lower by the 2030s than it would otherwise have been. This impact exceeds those experienced during the Global Financial Crisis and surpass even the GDP shock of COVID‑19.5

2.10. AMR as a threat to national food security: The overuse of antimicrobials in farming and aquaculture contributes to the emergence of resistant bacteria that move through animals, soil and water. Resistant plant pathogens can reduce yields, damage staple crops, and trigger sudden supply shocks. Food systems could be intentionally targeted, including through the deliberate release of resistant pathogens into crops or livestock, with the potential to destabilise economies and fuel social or political unrest.4

2.11. A shrinking pipeline: Despite these risks, no major new antibiotic class has been discovered since the 1980s. Market failures discourage antimicrobial innovation because stewardship reduces sales volume, leaving the global antibiotic pipeline dangerously thin. World Health Organization analysis shows that the global pipeline has shrunk to around 90 candidates, compared with nearly 1,800 cancer drugs[10] - a stark illustration of how far antimicrobial research and development (R&D) has fallen behind other areas of medicine.

2.12. The brain drain risk: The antimicrobial research workforce has also been shrinking for decades. Only around 3,000 researchers work on antimicrobials globally, compared with more than 46,000 in oncology[11]. Industry trends mirror this decline: there has been a 35% reduction in antimicrobials under development by large pharmaceutical companies since 2021[12], representing a brain drain that threatens AMR scientific capability.

3. A Whole-of-Society and Whole-of-Government Response to AMR (Questions 5–7)

3.1.  A whole‑of‑society approach is essential to tackling AMR. Individual antibiotic consumption matters: the public must understand when antibiotics are appropriate, listen to clinical advice, and feel supported to use medicines responsibly. Healthcare professionals, in turn, need the training, confidence, diagnostics and system incentives that enable appropriate prescribing. This must be matched by stronger collaboration across human health, animal health, agriculture and environmental sectors, which face shared challenges around antimicrobial use and stewardship and have much to learn from one another.

3.2.  Alongside this, a whole‑of‑government approach is critical. AMR cuts across health, security, agriculture, trade, environment, research, and international development, and requires coordinated action across all these domains. Without this alignment, the UK cannot maintain the leadership it has shown internationally, nor ensure that domestic and global systems are resilient to the rising threat of AMR.

3.3.  Internationally, the UK has long been a leader in AMR. The O’Neill Review[13] and UK diplomacy across G7, G20 and UN forums helped elevate AMR as a global security and development issue. However, there is growing concern that AMR is falling down the political agenda. Public health and global health security efforts have predominantly focused on high‑consequence and emerging pathogens (such as COVID‑19, Ebola virus disease, mpox and H5N1), leaving AMR persistently sidelined - a neglect that carries significant implications for national and global preparedness and resilience[14]. AMR is not being sufficiently considered in major health reform and flagship strategies. For example:

3.3.1.   The National Cancer Plan for England (February 2026) does not address the role of infection or AMR in cancer care, aside from a brief reference in the Secretary of State’s foreword. This omission is significant given that people undergoing cancer treatment face antimicrobial‑resistant infections at rates up to three times higher than the general population[15]. AMR was not given the prominence it warrants within the National Security Strategy 2025, despite experts pushing for it to be included as a standalone priority. 

3.3.2.   The closure of the Fleming Fund, the UK’s flagship international AMR programme, has weakened global early warning systems and undermines years of UK leadership and investment. The Fund has been vital in improving laboratory capacity, surveillance and data sharing in over 25 low- and middle-income countries. It also underpinned critical research, including the GRAM studies, which provide the most comprehensive global estimates of AMR burden and future trends[16]. During COVID-19, Fleming Fund–supported laboratories helped to identify the variant first detected in South Africa, demonstrating how overseas surveillance capacity directly protects the UK by providing early warning of threats that inevitably cross borders. Its closure risks eroding essential biosecurity infrastructure, weakening global data systems that inform pandemic preparedness, and creating surveillance blind spots in regions where new resistant pathogens are most likely to emerge. This loss of capability leaves the UK less able to detect, track and respond to biological threats in time to prevent domestic impact, and jeopardises years of UK leadership and investment in AMR containment. A replacement mechanism must be established to prevent critical surveillance blind spots.

4. Communication, Public Understanding and Misinformation Risks (Questions 8–10)

4.1.  Communicating AMR risk is inherently challenging. AMR is scientifically complex, and often invisible to the public until crises occur, making it easy for AMR to slip down the agenda despite profound long-term consequences. Effective policy responses require interpretation of intricate scientific evidence, increasing the risk of misunderstanding or sidelining technical evidence.

4.2.  The complexity of AMR makes it especially vulnerable to misinformation and disinformation, which can erode public trust, weaken social cohesion, and undermine the effectiveness of preparedness and response measures. False narratives around AMR can quickly distort how people understand the threat, fuelling conspiracy theories, creating political or social division, and generating resistance to essential health interventions.4

4.3.  Recent media coverage on the Kent meningitis outbreak indicates that the public do have an understanding of the need for antibiotics and the value that they have in treating infections. However, public understanding on the decreasing efficacy of antibiotics and resistance is limited and not commensurate with the scale of the threat. Media, healthcare professionals and scientists all have a role in educating the public and sharing this knowledge in an accessible way that apportions understanding and responsibility, not blame or hopelessness.

4.4.  Communication underpins action. Alongside Dame Sally Davies, UK Special Envoy on AMR, BSAC is a partner of Lifeline – a public engagement and education initiative that brings the arts and sciences together to communicate AMR in an imaginative and impactful way by using musical theatre to share messages about public health protection. The show features real‑life healthcare workers and scientists, who perform on stage and share their own experiences of tackling AMR, helping to build trust with audiences. An article published in Nature Medicine[17] demonstrates that participating in the chorus led to increased optimism, action and leadership among these professionals in their own fields. Lifeline is making its debut in London this Spring and expects to tour across the UK to further raise awareness and engage audiences from all communities and backgrounds.

4.5.  Communication to healthcare students should be embedded in clearly defined undergraduate standards and curricula that make antimicrobial stewardship (AMS) explicit, ensuring all healthcare graduates develop core capabilities such as safe prescribing and infection management. Embedding AMS in education requires alignment across policy, regulators and education providers so that expectations are consistently defined, taught and assessed, and so that the future workforce is equipped to support national resilience efforts.

5. Cross-Cutting Security, Conflict and Global Leadership Issues (Questions 11–14)

5.1.  The difference between survival rates of military personnel and civilians from bacterial infections during the First and Second World Wars was penicillin. During the Second World War, the mass production of penicillin transformed the management of infection for both military personnel and civilian populations, becoming integral to operational readiness across the global conflict. Yet resistance to penicillin was documented as early as 1942, demonstrating how quickly microbes can adapt when antimicrobials are used intensively. Alongside this, the widespread use of sulphonamides, shaped by earlier German medical practice in the First World War, led to similarly rapid patterns of resistance during the 1940s. These early experiences show that conflict driven antimicrobial use can accelerate the emergence of drug-resistant infections, offering a historical lesson that directly informs contemporary preparedness and resilience planning.4

5.2.  A Nature article explains how political stability and health are closely interlinked.[18] Today, conflict zones remain critical hotspots for the emergence and spread of drug-resistant bacteria, driven by high infection rates, limited access to diagnostics, and heavy reliance on increasingly ineffective antibiotics. In Ukraine, it is reported that more than 80% of patients in some hospitals have been infected with resistant microbes.[19] These infections do not remain contained within borders. Medical evacuation, repatriation and population displacement all create pathways for resistant organisms to travel beyond borders and reach other healthcare systems, including in the UK. In Germany, wounds from the conflict have led to cases so resistant that no viable antibiotic treatments remain. Past conflicts in Afghanistan and Libya show that evacuation chains transporting injured soldiers create pathways for resistant microbes to enter NHS hospitals.[20]

5.3.  The Government’s announcement earlier this year of up to £1.5 million to support innovation in conflict wound care[21] is a positive step, and we understand this call has generated unprecedented interest from researchers and innovators. That level of demand shows the UK has the expertise and ideas needed to lead globally on this issue. The challenge now is to build on this momentum and ensure AMR is firmly embedded in national security planning, while continuing to invest in the science and partnerships needed to tackle this growing threat.

5.4.  The UK is well-regarded internationally for its technical and political leadership on AMR. It should continue to drive diplomatic progress by sharing technical expertise and using fora such as the G7, G20 and UN to push for ambitious yet feasible commitments – all of which will contribute to the global target agreed at the 2024 UN High-Level Meeting on AMR to reduce AMR-related mortality by 10% by 2030. Nowhere is safe until everywhere is safe, so the UK must continue to champion antibiotic innovation incentives that explicitly include global access and stewardship clauses, as demonstrated by the UK’s own subscription model and now being explored by other G7 countries. The UK can also support high-impact, low-resource interventions, such as the Global Antimicrobial Stewardship Accreditation Scheme.

2 April 2026