The water sector's vital role in combating antimicrobial resistance

Davey Jones Bhavik Barochia Over 20,000 antibiotic resistance genes (ARGs) have been identified across more than 1,400 bacterial pathogens, and these genes can move between species as bacteria take up DNA from their environment. This intrinsic complexity, combined with projections suggesting AMR could cause more deaths than cancer by 2050, places the water industry at a critical juncture where it can transform from a passive observer to an active partner in the fight against this growing threat. A recent stakeholder workshop, bringing together representatives from water utilities, regulators, public health bodies, and academia, has revealed both the significant potential and current limitations of the UK water sector's response to AMR. The findings, captured in a comprehensive report by The EPSRC Digital Health Hub for AMR, Arup, Bangor University, and UKWIR, paint a clear picture: while the water sector possesses crucial infrastructure and data access that could enable AMR research and surveillance, it is not yet positioned as a leader in coordinated action. The environmental AMR challenge Water bodies and wastewater systems can inadvertently become reservoirs and transmission routes for resistant bacteria and their genetic material. Wastewater treatment plants, where household, healthcare, and industrial effluents converge, represent potential 'hotspots' for mixing different microbial populations. Recent research suggests that treatment processes might even spread resistance through bioaerosols emitted at treatment facilities. The implications extend beyond environmental concerns. Sewage sludge often contains traces of antimicrobial compounds and resistance genes, raising questions about agricultural reuse and potential entry into food chains. There are also critical knowledge gaps around risks to wastewater treatment operators and communities exposed to untreated sewage. Current landscape and opportunities The workshop revealed both consensus and fragmentation within the sector. While participants agreed on AMR's significance as a growing threat, they highlighted the lack of formal mechanisms to coordinate activity across the diverse actors working at the intersection of water, health, and environment. This has resulted in duplicated effort, limited data sharing, and slower innovation adoption. However, significant opportunities exist. The Chemical Investigations Programme (CIP), now in its fourth phase, continues to support water companies in monitoring emerging risks and developing standardised methods. Alongside broader research initiatives, including wastewater-based epidemiology programmes and academic collaborations, the sector is building capability in AMR detection and quantification. Strategic recommendations The workshop participants developed recommendations across four key areas that could transform the sector's approach: Cross-sector collaboration: Creating structured platforms for regular communication between water utilities, public health agencies, environmental regulators, and academic institutions. This includes developing frameworks for secure data sharing and establishing multi-agency advisory groups. Policy and regulation readiness: Engaging proactively with evolving regulatory frameworks, including updates to the Urban Wastewater Treatment Directive and the UK 5-year Action Plan for AMR. The sector has an opportunity to shape its own regulatory approach rather than simply respond to requirements. Targeted monitoring programmes: Investing in improved detection of antimicrobial resistance genes in wastewater and receiving waters, using this intelligence to target capital investment in treatment upgrades and implement best practices to minimise environmental release. Research and evidence: Supporting pilot studies and long-term research to evaluate AMR exposure risks, develop standardised monitoring methods, and transition from research to practical implementation. The path forward Currently, about 20 deaths are directly attributable to AMR related infections each day in the UK, while another 96 are associated with it – these numbers are predicted to rise over the next few decades. However – through active monitoring of AMR, the water industry could collectively help to save lives and reduce the burden of AMR on the national health service. With growing policy momentum and increasing regulatory focus on environmental AMR, the water sector stands uniquely positioned to make a meaningful difference in this global health challenge, helping to break the infection cycle. The industry's extensive infrastructure network, robust data collection capabilities, and proven track record of innovation in water quality management provide a strong foundation for leadership in environmental AMR surveillance and mitigation. By strengthening cross-sector collaboration, improving data integration, and investing in targeted monitoring, the water industry can move beyond its traditional role as infrastructure provider to become a crucial partner in proactively protecting public health. The sector has already demonstrated its ability to adapt and respond to emerging challenges – from implementing COVID-19 wastewater surveillance to advancing sustainable treatment technologies. This transition represents not just a responsibility but a significant opportunity. Water companies that embrace their role in AMR mitigation will be better positioned for future regulatory requirements, can demonstrate clear environmental and social value to customers and stakeholders, and contribute to building more resilient public health systems. The expertise developed through AMR monitoring and management will also enhance broader water quality capabilities and strengthen the sector's contribution to the One Health approach. The question is not whether the sector will need to engage with AMR, but how quickly and effectively it can position itself as part of the solution. With the right collaborative frameworks, investment in monitoring capabilities and commitment to cross-sector partnership, the UK water industry has the potential to become a global leader in environmental AMR management – protecting both public health and demonstrating the vital role of water services in society's wellbeing. The full report, Antimicrobial Resistance and the Water Sector: Current Landscape and Recommendations, is available to read here: https://www.digitalamr.org/amr-publications.