Antimicrobial Resistance (AMR) is global problem, the annual World AMR Awareness Week (Monday, 19 November until Monday, 24 November 2025), led by the World Health Organisation to combat antimicrobial resistance, raises awareness about drug-resistant infections and promoting responsible antibiotic use across human, animal, and environmental health.
Wastewater surveillance is the missing link in our response to AMR
Antimicrobial resistance (AMR) is often treated as a clinical issue - something that happens in hospitals, among patients and within the confines of healthcare. But in fact, AMR is ecological, economic and deeply embedded in the systems we rely on every day. Wastewater surveillance offers a way to see the full picture. Our Hub’s co-directors Professor Davey Jones (ÑÇÖÞÉ«°É) and Dr Andrew Singer (UK Centre for Ecology & Hydrology) share their thoughts on this topic below.
Dr Andrew Singer: Wastewater as mirror and warning system
We’ve spent decades focusing on antibiotics, but they’re not the only drivers of resistance. Metals, biocides, herbicides and even common pharmaceuticals can select for resistance genes - many of which are clinically relevant. These compounds enter our wastewater systems through agriculture, industry and domestic use, creating a chemical soup that shapes microbial evolution. Going back in time - as soon as antibiotics became commercially available, they were used liberally, not just in medicine, but in livestock, aquaculture and even citrus farming. The economic incentives were clear – but the long-term consequences, less so. Wastewater surveillance allows us to trace those consequences, decades later, in the genes flowing through our rivers and treatment plants. It can also help reveal how resistance emerges and spreads long before it reaches us.
Perhaps most importantly, wastewater surveillance can reveal the feedback loops between our environment and our health. Recent research shows that hospital wastewater is particularly rich in antimicrobial resistance genes (ARGs), with each facility exhibiting a unique resistance profile - which means our sewer systems are quite literally, evolutionary incubators. And yet, most surveillance systems still focus narrowly on clinical isolates, missing the broader picture.
Professor Davey Jones: The UK water sector’s untapped potential
The UK water sector is sitting on a goldmine of public health intelligence. Wastewater treatment plants are convergence points for human, animal and industrial waste. They’re also hotspots for ARGs, which can mix, evolve and spread through microbial communities in pipes, sludge and effluent.
The business case is clear: AMR costs the UK £180 million annually. Wastewater surveillance offers a cost-effective, population-level early warning system. It captures the total AMR burden (not just infections), and provides actionable insights for stewardship, infection control, and environmental protection.
But the sector isn’t yet positioned as a leader in coordinated AMR action. A recent industry stakeholder workshop with various water industry organisations revealed fragmented efforts, limited data sharing and a lack of formal mechanisms for cross-sector collaboration. We need structured platforms that bring together water utilities, public health agencies, regulators and researchers. We need to invest in targeted monitoring, standardised methods, and integrated dashboards that support real-time decision-making.
The water industry has already proven its ability to adapt – we’ve seen this with COVID-19 surveillance. Now it must step up again. With the right frameworks, the UK water sector can become a global leader in environmental AMR management - protecting both public health and the ecosystems we depend on.
Final thoughts
Public awareness of this remains low. Most people don’t realise that what goes down the drain can help shape national health policy. That’s why education and outreach are critical. Even initiatives such as citizen science projects - where individuals contribute samples, time, or local knowledge, can be transformative. They help build trust and expand our surveillance reach.
The question is how quickly we can scale this. The UK has the infrastructure, the expertise and the urgency. What we need now is coordination, investment, and public engagement. We need to combine environmental science, public health insight and water sector innovation to build a surveillance system that’s fit for the future.
