Members of Manchester’s AMR Network recently contributed to the Public Accounts Committee’s call for evidence on “Antimicrobial resistance: addressing the risks.” Of the 27 submissions received, four were submitted by members of the AMR Network—an achievement that underscores the depth and diversity of the University of Manchester’s expertise in this field. Spanning topics from the evolutionary dynamics of resistance and the social drivers behind prescribing, to the importance of dental care access and the growing threat of fungal pathogens, these four submissions illustrate the many fronts on which AMR challenges must be addressed. Together, they reflect Manchester’s commitment to driving evidence-based policy and practice in the ongoing fight against antimicrobial resistance.

Evolution at the heart of AMR—why it needs to be in policy

The submission led by Dr Will Smith makes the case that AMR is, at its core, an evolutionary problem—and that it must be tackled with an evolutionary mindset. Their evidence highlights how resistance can evolve within individual patients, not just between them, and argues that this within-patient evolution is often overlooked in national action plans. One key barrier is the lack of access to clinical isolates and associated metadata, which remain under lock and key in NHS biobanks. By improving access for researchers, we could unlock a better understanding of how resistance emerges in different infections and under different treatments, leading to more personalised and durable therapies.

The submission also calls for clinical trials to routinely test how quickly resistance evolves against new (and repurposed) drugs. This would allow treatments to be evaluated not only for their immediate effectiveness, but also for how long they are likely to remain useful. Without this, the health system risks investing in drugs that may quickly lose their potency in real-world settings. Lastly, the team makes the case for more serious investment in alternative antimicrobials—such as phages, bacteriocins, and engineered probiotics—highlighting their unique advantages in specificity, potency and resistance durability. These tools, shaped by natural evolution, offer an opportunity to shift the treatment landscape—if only the UK invests at every stage from discovery through to manufacture.

Read Evolution: the beating heart of AMR

Behaviour change in AMR—why knowledge isn’t enough

Health psychologists at Manchester—Dr Nia Coupe, Dr Rebecca Turner, Professor Lucie Byrne-Davies and Professor Joanne Hart—emphasise that behaviour change is central to tackling AMR, but too often poorly understood. While there has been welcome investment in training and education for healthcare professionals, their research shows that most training programmes still focus on delivering information, rather than supporting the actual process of behaviour change.

Drawing on evidence from social and behavioural science, the team argues that successful behaviour change requires more than knowledge. People also need the motivation, support, and social conditions that enable them to act differently. For instance, prescribers may know the guidance but feel pressure from colleagues or patients, or feel uncertain in complex clinical situations. Programmes that fail to address these realities are unlikely to shift practice.

The authors recommend that AMR policy should draw more heavily on behavioural science, aligning education and stewardship efforts with the real barriers that people face in the clinical environment. They also highlight the importance of supporting stewardship globally, particularly in lower-income countries, and urge stronger regulation of agricultural antibiotic use to prevent further erosion of drug effectiveness.

Read Behaviour change and antimicrobial resistance here

The dental crisis fuelling antibiotic overuse

Dr Wendy Thompson, a clinical academic and member of the British Dental Association’s Health and Science Committee, sheds light on the overlooked connection between dental care and AMR. Her evidence warns that poor access to urgent dental care is leading to overreliance on antibiotics as a stopgap solution. During the pandemic, antibiotic prescribing by dentists increased significantly as face-to-face care became harder to access—and worrying patterns have persisted since.

Antibiotics, she explains, are not a cure for toothache. Most dental infections require a procedure, not a prescription. But in the absence of timely treatment, dentists may feel they have no other option. This not only fails patients but contributes directly to resistance. Dr Thompson argues that the government’s current pledges on dental appointments don’t go far enough, especially in light of recent NHS figures showing millions of patients are still unable to access the care they need.

She calls for urgent reform of the NHS dental contract, the introduction of electronic prescribing in dentistry, and accountability measures to ensure appropriate antibiotic use. As more people turn to private dental care, stewardship efforts must also extend beyond NHS services. Ensuring universal access to urgent dental care, she argues, is not just a matter of oral health—it’s a frontline defence against AMR.

Read Impact of urgent dental care on AMR here

Fungal AMR—a growing threat to health and food security

The submission led by Dr Michael Bottery, comes from the Fungal AMR and One Health Network, a large interdisciplinary team spanning experts in mycology, plant pathology, public health, and policy. Their evidence highlights the escalating threat of antifungal resistance, which is becoming a serious challenge for both human health and global food security.

Fungicides used in agriculture, especially azoles, are driving resistance in environmental fungal populations. These resistant strains can then infect humans, making clinical antifungals less effective. This is particularly alarming in the case of Aspergillus fumigatus, where resistant infections carry higher mortality, and in the emergence of multidrug-resistant Candida auris, now a notifiable pathogen in the UK. The risk is compounded by the climate crisis, which is expanding the ecological niches for resistant fungal pathogens.

The team points out that while the 2024–2029 UK National Action Plan acknowledges some of these risks, it falls short of offering a clear roadmap. Unlike the US and EU, the UK lacks a comprehensive framework to assess and mitigate the dual-use risk of antifungals in agriculture and medicine. The submission calls for a national action plan specific to fungal AMR, as well as proper inclusion of fungal risks in UK food security and emergency preparedness strategies.

Read Fungal AMR—a growing threat here

Positioned for multidisciplinary impact on AMR

These submissions reflect how well positioned the University of Manchester is to support the kind of multidisciplinary collaboration that AMR demands. Tackling AMR requires more than new drugs or surveillance systems—it requires joined-up thinking that bridges biology, clinical practice, human behaviour, policy, agriculture, and the environment. Manchester’s broad research base spans all these areas, bringing together academics who work on microbial evolution, antibiotic stewardship, dental prescribing, fungal pathogens, health psychology, and beyond. While these submissions reflect distinct areas of expertise, they also show the University’s capacity to contribute meaningfully across the full spectrum of AMR research and policy. With a strong culture of collaboration and cross-sector partnerships, Manchester is well placed to help shape the integrated solutions needed to address one of the most pressing global health challenges of our time.

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