2.3 One Health integration of AMR surveillance
One Health integration in existing AMR surveillance systems
A recent study reviewed AMR surveillance systems reported in the scientific literature that analysed and reported prevalence or incidence data periodically since 2007 (Diallo et al., 2020). Up to 71 surveillance systems were identified from 35 countries worldwide. Of these 71 surveillance systems, 53 targeted AMR in humans, 12 targeted AMR in humans and animals, and six exclusively targeted AMR in animals. These included monitoring bacteria of zoonotic origin, including Campylobacter spp., Salmonella spp. and commensal bacteria (E. coli).
Among the 12 surveillance systems that targeted AMR in humans and animals, the review identified a few examples of integrated animal and human AMR surveillance, available in Canada (CIPARS), Denmark (DANMAP), the Netherlands (MARAN) and Sweden (The Public Health Agency of Sweden 2020). But overall, One Health integration in AMR surveillance is lacking.
The value of One Health integration
Integrated surveillance systems built on a One Health approach provide a more complete picture of AMR and AMU. Depending on the objective and its design, they can facilitate analyses of trends over time and space, and of relations among sectors. More details are provided in the module Introducing a One Health approach to AMR.
Integration ideally works in multiple dimensions, within and among sectors and levels, including vertical alignment within public health initiatives and horizontal coordination among strategies for human and animal health, food production (animal and plants) and may involve relevant aspects of plants and the environment. In practice, integration is more likely to be a ‘mosaic’ within and among sectors, as the production systems in the animal and plant sectors are widely diverse, and their products are used in many different industries. For example, the animal sector alone comprises more than 50 sectors, including dairy, poultry, meat and crustaceans (IACG, 2018).
Activity 6: The AMR country progress tool
In this activity you are going to familiarise yourself with the AMR country progress tool [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] , which provides data from individual countries’ self-assessment regarding different aspects of AMR, such as whether they have a NAP or surveillance systems.
On the left-hand side of the tool, select ‘2019-20’ for survey year, and select ‘4.1: Multi-sector and One Health collaboration/coordination’ as the question. This first question relates to the level of collaboration/coordination in the countries.
Each country is classified according to the level of multi-sector and One Health integration that occurs using a five-point scale, from A (no formal multi-sectoral governance or coordination mechanism on AMR exists) to E (integrated approaches used to implement the AMR NAP with relevant data and lessons learned from all sectors used to adapt implementation of the action plan).
The next six questions (4.2.1–4.2.6) relate to whether specific sectors are actively involved in developing and implementing the AMR NAP.
- What level of multi-sector and One Health collaboration/coordination occurs in your county?
Answer
The answer will depend on your country. Countries are colour-coded based on their answer, which is grouped into one of five categories:
- A.(red) – no formal multi-sectoral governance or coordination mechanism on AMR exists
- B.(orange) – multi-sectoral working group(s) or coordination committee on AMR established with government leadership
- C.(yellow) – multi-sectoral working group(s) is/are functional
- D.(light green) – joint working on issues including agreement on common objectives
- E.(dark green) – integrated approaches used to implement the AMR NAP with relevant data and lessons learned from all sectors used to adapt implementation of the action plan.
- What sectors are involved in developing and implementing the NAP in your country? Use the ‘question’ box to change the question to questions 4.2.1–4.2.6 and see whether these different sectors are actively involved in developing and implementing the AMR NAP in your country.
Answer
This could be human health, animal health, plant health, food production, food safety and environment. Changing the question to questions 4.2.1–4.2.6, you can see whether or not these different sectors are actively involved in developing and implementing the AMR NAP in your country. Countries are colour-coded based on their answers to these questions: yes (blue), no (red) and no information received (grey).
2.2.4 Understanding the epidemiology of AMR
