Genomic surveillance for AMR: A One-Health approach.

Using genomic sequence approach as an evidence-based solution for antimicrobial resistance (AMR) challenge: A participatory surveillance platform that will investigate the impact of antibiotic use in livestock farming on human AMR to improve health and agriculture systems responses to the socio-economic costs of this grand challenge.

Dr. Jolly Musoke

Health systems are challenged globally based on detrimental socio-economic, and human development implications caused by antimicrobial-resistant (AMR) organisms, owing to unregulated use and sub-optimal antibiotic concentrations in the agriculture sector which are significant drivers of AMR. It is estimated that by 2050, AMR will cost $300 billion to $1 trillion annually. Sub-inhibitory concentrations and poor regulation of antibiotic use promote the emergence of AMR and a reservoir of antibiotic-resistance genes. The same antibiotics are shared and used within the animal and human health sectors, thus there is a need for the One Health approach to combat this AMR challenge. Therefore, our solution will address the multi-factorial gaps by investigating the use, type, and concentration of antibiotics (sometimes unregulated) in livestock farming, selected vulnerable role-players, along with the impact of antibiotic use in the food supply chain, the community, and hospital-acquired infections.

Our solution addresses the deceleration of the continuous trends in AMR so that the adverse impacts on society and the economy can be controlled. The solution will be beneficial to all stakeholders including governmental and non-governmental agencies, researchers, providers, public health practitioners, pharmaceutical companies, hospital administrations, policymakers, agriculture industry leaders, and members of society. This will be achieved by establishing a governance mechanism for antibiotic use to bring harmony to strategic and operational planning. Although the cost of abiding by the guidelines and frameworks can be high, it is well established that the return on such investment will unquestionably have significant positive outcomes as like-minded projects have done beforehand. It will also provide hope that the adverse impacts of antimicrobial resistance can be mitigated and may not lead to irreversible results for society as a whole.

The "public good" our solution provides is enormous but most importantly, it will decelerate the risk posed by AMR on public health. Other benefits are as follows;

1. The evidence-based information curated from this exercise will provide solutions concerning the use of antibiotics in the agriculture sector and the implications on human health for their in-principle commitment to promoting such niche knowledge in the policy cycle.

 2. It will increase awareness and educate the populace on the proper use of antibiotics. Both the farmer’s and livestock’s health status will be ethically communicated to the community and advised when to seek medical assistance.

3. It will decelerate the continuous trends in AMR, hence the adverse impacts on society and the economy can be controlled. This will be achieved by establishing a governance mechanism for antibiotic use to bring harmony to strategic and operational planning. Although the cost of abiding by the guidelines and frameworks can be high, it is well established that the return on such investment will unquestionably have significant positive outcomes. 

4. It will provide hope that the adverse impacts of antimicrobial resistance can be mitigated and may not lead to irreversible results for society as a whole.

Antimicrobial resistance has been a global challenge for over 5 decades, and scientists have been trying different approaches to combat this grand challenge. Our solution will have a tangible impact on our target population because it is an evidence-based solution that deploys a one-health research approach in real-time, coupled with the use of advanced technology and data-driven that is void of controversies. The majority of our target populations are rural dwellers and hospital patients who are considered underserved and vulnerable. Having said that, our solution will increase awareness and educate the populace on the proper use of antibiotics. The human, animal, and environmental health status will be ethically communicated to the community and advised when to seek medical assistance, thus decelerating the continuous trends in AMR, and its adverse impacts on society and the economy can be controlled through policies that will enforce the controlled use of antibiotics amongst human and animal populations.

Stakeholder community collaboration is central to this project. To build capacity in the communities and on farms, information via day training sessions will be provided. In these workshops, raising awareness and education on AMR will be performed. In addition, more responsible use of antibiotics for optimum health of people, animals, and the environment will be promoted. To scale up our impact over the next three years, we will make sure that we scale up our research populations across the province and make the solution spread wide by communicating our findings at the local and national levels via all available platforms of communication.

To this end, we strongly believe that our solution will be communicated to all the stakeholders so that policies that guide the use and administration of antibiotics will be reinforced and regulated in both human and animal health sectors, thereby achieving the primary goal of One-Health for optimal human and ecological outcomes in an interactive environment of animals, plants, and humans.

There is a need to address AMR from a “One Health” perspective and to consider social and ecological factors that drive AMR to better mitigate the problem.  For our solution, an exploratory study will be conducted to monitor and evaluate our success. We plan to look into this under different themes which include; The interventions from government and non-government sectors, the behavior of individuals or institutions towards the intervention, correct behavior reinforcement, financial resources, training, assessment, and awareness of AMR, management with training, collaboration and co-ordination, partnership, engagement/commitment, regulations/guidelines, data provision/collection, the capacity of the system where the intervention takes place, financial resources (including funding and financed training, knowledge/skills of main actors, adequate premises and equipment, and novelty/innovation amongst others.

The current barriers we are experiencing are limited capacity for funding, mobility, capacity building, and human resources i.e. manpower.

1. Funding: Our study was initially designed to cover the whole province of the Free State but due to lack of funding, we decided to scale it down so we could be able to handle it, using one or two postgraduate students to be involved in the study. However, if we receive funding we plan to scale this up and go by our initially designed project of tackling the grand challenge on a bigger scale in the province.

2. Mobility: We are restricted from reaching out to a larger population as intended, especially in the rural communities owing to a lack of funding for the project car and its maintenance (fueling, servicing, paying the driver).

3. Capacity building: We are also limited in resources although, we have planned to outsource the resources (A mini sequencer and inbuilt software for the identification and analyses of high-throughput sequence data)in the meantime, to achieve our goal. However, if we could get funding for these resources it would enhance the efficiency of our center and more solutions could be provided to improve public health.

We are applying for this Trinity Challenge to secure funding so we can contribute to bringing about solutions to the grand challenge of AMR using our research expertise. We are faced with the challenge of funding to execute to project. We strongly believe this funding will help overcome the barriers to mobility, capacity building, and meeting the fieldwork expenses

Our team will collaborate with personnel from the Department of Agriculture, Land Reform and Rural Development (DALRD), Division of Veterinary Services where we will receive assistance in gaining access to all the selected farms in the rural communities and gaining familiarity with the farmers in the Free State province.

We will also collaborate with the Agriculture Research Council, Biotechnology Platform (BTP), where all the sequencing work will be carried out.

Also, other collaborators from the selected hospitals in the province, who will assist in collecting samples from the patients in their hospitals.