NRR is an assessment of the risks of civil emergencies facing the UK
over the next five years, and is produced every two years. The NRR
report is a public-facing version of a classified internal government
report called the National Risk Assessment (NRA). Civil emergencies are
events or situations which threaten serious damage to human welfare or
the environment in the UK, or threaten serious damage to national
What is the National Risk Register?
In producing the report, the government assesses how likely an event is, and what the impact of it might be. The report considers events that have at least a 1 in 20,000 chance of happening in the next five years, and that would require government intervention. The report also covers issues that are longer-term or broader than single events, but which also have the potential to adversely impact society. The threat of antimicrobial resistance (AMR) is one such longer-term issue.
AMR is a global health threat.
What is antimicrobial resistance and why is it a risk?
Antimicrobials are drugs used to treat an infectious organism, and include antibiotics (used to treat bacteria), antivirals (for viruses), antifungals (for fungal infections) and antiparasitics (for parasites).
When antimicrobials are no longer effective against infections they were previously effective against, this is called antimicrobial resistance. Regular exposure to antimicrobials prompts the bacteria or other organisms to change and adapt to survive these drugs.
Nowadays, fewer new antibiotics are being developed, meaning we have fewer options and stronger drugs in our antibiotics armoury have to be used to treat common infections once they become resistant. This means we are now facing a possible future situation where we will be without effective antibiotics.
The report states
that the cases of infection where AMR poses a problem are "expected to
increase markedly over the next 20 years". It estimates that if a
widespread outbreak were to happen, around 200,000 people could be
affected by a bacterial blood infection resistant to existing drugs, and
80,000 of these people could die. It also says that many deaths could
be expected from other forms of resistant infections.
What could the impact be?
Independent’s headline suggests that it is "superflu" which could kill
80,000, and that it is the "biggest danger to the UK apart from a
terrorist attack". The headline appears to conflate two parts of the
What about "superflu"?
The 80,000 figure appears to come from the estimates of the potential impact of a resistant bacterial blood infection reported above, not specifically "superflu". The report does note that flu pandemics would become more serious without effective treatments, but does not give an estimate of how many people antimicrobial resistant pandemic flu could kill.
Flu pandemics (not specifically antimicrobial resistant flu) are also one of the specific risks assessed by the report. They are given a maximum relative impact score of five out of five, which is the same score as catastrophic terrorist attacks.
The report estimates that pandemic flu could infect half of the UK population and lead to between 20,000 and 750,000 additional deaths.
A flu pandemic was estimated as having a relative likelihood of between 1 in 2 and 1 in 20, and was reported to "[continue] to represent the most significant civil emergency risk".
report did not specify how it got to the specific AMR impact figures,
but it does give its overall methods. The risks are identified by
consulting experts both within and outside the government, and devolved
administrations. For each risk the report selects a "reasonable worst
case" scenario, which represents something which would be a challenge
and could plausibly occur. The likelihood of an event (such as pandemic
flu) was based on information such as historical analyses and modelling
where possibly, along with scientific expertise. The impact score for an
event was assessed on a scale of 0 to 5 (0 least and 5 greatest) and
averaged across 5 areas:
How did the report assess the risk of AMR?
- illness or injury
- social disruption
- economic harm
- psychological impact
report notes that AMR is a global problem that needs international
action to be tackled. The report describes some of the actions being
What is being done about this threat?
- The government and devolved administrations are working with international partners to get support for joint action internationally.
- Government departments, the NHS and other partners are working together to implement the UK five-year Antimicrobial Resistance Strategy published in 2013.
- The impact of actions to reduce the spread of AMR is being measured and reported on by a cross-government high level steering group.
- There is an ongoing independent review of AMR, which is being chaired by economist Jim O’Neil. Two reports from this review have already been released. Further reports are expected in 2015, and in 2016 the review will recommend actions to be agreed internationally to deal with AMR.
can help cut antibiotic (or wider antimicrobial) resistance by
recognising that many common infections, such as coughs, colds and
stomach upsets, are often viral infections that will go away after a
short period without treatment (known as "self-limiting" infections).
These infections do not need an antibiotic, as they will have no effect.
What can you do to help reduce the spread of AMR?
If you are prescribed an antibiotic (or other antimicrobial), it is also important to make sure you take the full course as prescribed, even if you feel better before you finish the course.
This will reduce the chances of the organisms being exposed to the drug but then surviving, which encourages the development and spread of resistance to the drug.
Taking the course as prescribed will also increase the chances of you getting better. By not taking a full course, you may find that the infection comes back and requires further antibiotic prescriptions, which further increases the chances of resistant organisms developing.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.