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A key knowledge gap is the significance of environmental exposure of AMR to humans, relative to health and food pathways. However this issue is complicated by the fact that relatively rare gene transfer events from environmental bacteria may lead to pandemic spread of AMR in human associated bacteria. The threshold for environmental levels becoming of concern in terms of acute exposure risk needs to be assessed, although studies such as that by Leonard et al., (2018)[3] suggest that environmental exposure and transmission does occur. Better understanding of the drivers for resistance propagation and persistence is required, and we need to identify which resistance determinants should be of most concern.