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What got you interested in antimicrobial resistance?

I read in a UK government report that by 2050, antimicrobial resistance will kill more people than cancer and cost more money than the current size of the world鈥檚 economy. Even routine medical procedures could become hazardous. And that鈥檚 before considering catastrophes in food production.

How does antimicrobial resistance affect food?

In many countries, antibiotics are used in low doses to promote growth and enable farmed animals to be kept in close quarters. These practices are perfect for boosting resistance in microbes. If resistance spreads, entire industries and animal populations could collapse.

鈥淚 want to be thinking the thoughts that no one else in science is thinking鈥�

I looked at all this and realised that even if there was a billion-dollar fund for new antibiotics, it would not sort out the problem; it might just buy us an extra decade. We need a new approach 鈥� a step change like the one antibiotics gave us when they first came in.

So how are you trying to achieve this?

I pulled together a steering committee of wonderful advisers, and eventually secured significant funding from the UK鈥檚 Engineering and Physical Sciences Research Council. This and further funding is enabling me to build something very special: the .

What areas is NAMRIP working in?

We have projects that look at alternative medicines such as bearberries, which have been used in folk medicine to calm cystitis. We want to see if bearberries can replace antibiotics in some cases. We are also using honey with an added enzyme to combat chronic infections 鈥� this works well on biofilms, which tend to withstand antibiotics. In addition, destroys multi-drug-resistant bacterial strains such as E. coli and MRSA.

We are also developing a paper-based urine test, much like a pregnancy test, that would tell you what infection you have straight away. It would enable doctors to prescribe a targeted, narrow-spectrum antibiotic rather than risk promoting antimicrobial resistance with a wide-spectrum drug, and be cheap enough for distribution across poorer nations.

Who is working on these projects?

We have health scientists from many fields, and clinicians. We have social scientists and geographers with a range of interests from waste-water treatment to interventions in Africa. We have a huge number of life scientists working on many aspects of microbes, engineers wanting to build devices, chemists, mathematical modellers, and business people working out the economics of interventions. I want these people working together in new ways, thinking up new things.

What new approaches are you coming up with?

Take hygiene. For effective cleaning, we鈥檙e supposed to wash our hands for at least 20 seconds in hot soapy water 鈥� but in the UK, the average is 6 seconds in cold water. It鈥檚 not enough, and despite all the advertising, you can鈥檛 change people鈥檚 behaviour. Our answer is to change the water. I co-invented a device called StarStream. This produces a stream of water, like that from a tap, but we introduce tiny air bubbles into the water and then hit them with ultrasound 鈥� making pure cold water as effective as hot soapy water. We鈥檙e now setting up trials to see how well it works in acute hospital wards.

How does it work?

Have you ever wondered why brooks and streams babble? The sound comes from bubbles, which are like underwater bells. As with any musical instrument, if you shout at a bubble at the right frequency, it will ring back. When ultrasound hits these bubbles, they ring, making their walls wriggle and creating a mechanical scrubbing action. That excited me because this phenomenon requires no chemicals, making it tougher for microbes to develop any resistance to it. What鈥檚 more, bubbles driven by sound automatically find any crevices and clean them too.

I heard it was tough getting this off the ground. I tried to get funding from lots of places, but kept getting knocked back: the idea of cold-water cleaning was just too odd for people. In a last-ditch attempt, I wrote to the Royal Society in relation to its Brian Mercer Award for Innovation, and they funded it for 拢250,000.

My co-inventor Peter Birkin and I then talked to other researchers, who explored three different aspects of its use 鈥� cleaning bones for transplants, removing dental bacteria from teeth and cleaning surgical steel to remove stubborn substances such as biofilms and the prions that cause Creutzfeldt-Jakob disease. These were tremendous successes: StarStream cleaned all that stuff. Then, on the commercial side, a manufacturer started building prototypes.

Where else are you trying to tackle antibiotic resistance?

In farming. For example, an enthusiastic NAMRIP geographer told me that about half the UK dairy herd experiences lameness at some point in any given year. To prevent infections spreading deep into the foot, farmers should place a wooden block under the healthy part to take pressure off the wound. But often farmers go straight to antibiotics.

I wondered whether we could avoid antibiotics by making a better-shaped, comfortable clog with drainage channels underneath the abscess that could pull the pus away. I got the geographer and a guy who loves 3D printing in a room together and outlined the idea. We got a cow鈥檚 leg from the butcher, scanned it and built a shoe. Now we are planning meetings with farmers, vets and farriers to trial it. One day, 3D printing will be dirt cheap. When that happens, I want every farmer to have a 3D printer: scan the hoof, print the shoe, job done. No antibiotics needed.

Your notion of what a scientist should do seems very broad鈥�

Oh, yes. I go to some conferences full of sessions that report on similar papers from different teams tackling the same problems in the same way. I never wanted to do that. I want to be thinking the thoughts that no one else in science is thinking, and doing rigorous, fundamental research. I love some of my published papers: I sweated blood over them and I want to be buried with a handful of my favourites.

But if you publish a paper, put it on a shelf and it鈥檚 only ever read by six or 600 people, you have not done enough. You鈥檝e passed the ball and you鈥檙e relying on somebody else to find your paper, read it, build a device and put the economic case together. Hell, that鈥檚 not even half the job. If you鈥檝e made a discovery that can help the world, you have to find the person who can help, hand them the ball and say 鈥減artner with me, we can change the world鈥�.

It鈥檚 important that at NAMRIP, nobody just stops at the point where a paper is published. We can save millions of people. We have to do it.

This article appeared in print under the headline 鈥淩esistance fighter takes the battle to microbes鈥�