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Otaigbe II. Policy entrepreneurs are integral in efforts to curb antimicrobial resistance in low and middle income countries. Front Public Health 2024; 12:1292660. [PMID: 38532974 PMCID: PMC10963478 DOI: 10.3389/fpubh.2024.1292660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/27/2024] [Indexed: 03/28/2024] Open
Affiliation(s)
- Idemudia Imonikhe Otaigbe
- Department of Medical Microbiology, School of Basic Clinical Sciences, Benjamin Carson (Snr) College of Health and Medical Sciences, Babcock University/Babcock University Teaching Hospital, Ilishan Remo, Ogun State, Nigeria
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2
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Rogers Van Katwyk S, Giubilini A, Kirchhelle C, Weldon I, Harrison M, McLean A, Savulescu J, Hoffman SJ. Exploring Models for an International Legal Agreement on the Global Antimicrobial Commons: Lessons from Climate Agreements. HEALTH CARE ANALYSIS 2023; 31:25-46. [PMID: 31965398 PMCID: PMC10042908 DOI: 10.1007/s10728-019-00389-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
An international legal agreement governing the global antimicrobial commons would represent the strongest commitment mechanism for achieving collective action on antimicrobial resistance (AMR). Since AMR has important similarities to climate change-both are common pool resource challenges that require massive, long-term political commitments-the first article in this special issue draws lessons from various climate agreements that could be applicable for developing a grand bargain on AMR. We consider the similarities and differences between the Paris Climate Agreement and current governance structures for AMR, and identify the merits and challenges associated with different international forums for developing a long-term international agreement on AMR. To be effective, fair, and feasible, an enduring legal agreement on AMR will require a combination of universal, differentiated, and individualized requirements, nationally determined contributions that are regularly reviewed and ratcheted up in level of ambition, a regular independent scientific stocktake to support evidence informed policymaking, and a concrete global goal to rally support.
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Affiliation(s)
- Susan Rogers Van Katwyk
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, ON, M3J 1P3, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Alberto Giubilini
- Oxford Martin School, University of Oxford, Oxford, UK
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Claas Kirchhelle
- Oxford Martin School, University of Oxford, Oxford, UK
- Wellcome Unit for the History of Medicine, University of Oxford, Oxford, UK
| | - Isaac Weldon
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, ON, M3J 1P3, Canada
- Department of Politics, York University, Toronto, Canada
| | - Mark Harrison
- Oxford Martin School, University of Oxford, Oxford, UK
- Wellcome Unit for the History of Medicine, University of Oxford, Oxford, UK
| | - Angela McLean
- Oxford Martin School, University of Oxford, Oxford, UK
- Department of Zoology, University of Oxford, Oxford, UK
| | - Julian Savulescu
- Oxford Martin School, University of Oxford, Oxford, UK
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Steven J Hoffman
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, ON, M3J 1P3, Canada.
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
- Oxford Martin School, University of Oxford, Oxford, UK.
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA.
- Department of Health Research Methods, Evidence, and Impact and McMaster Health Forum, McMaster University, Hamilton, Canada.
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3
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Palkovits M, Van Katwyk SR, Hoffman SJ. Embed Multisectoral Governance Mechanisms in the Pandemic Instrument for One Health Action. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2022; 50:71-81. [PMID: 36889347 PMCID: PMC10009389 DOI: 10.1017/jme.2023.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Despite recognition of the health threat posed at the human-animal-environment interface long ago, One Health has yet to be meaningfully integrated into global pandemic prevention, preparedness, and response. With the negotiation of the forthcoming pandemic instrument under the auspices of the World Health Organization (WHO) - which is inherently restricted by its own constitutional mandate of human health - One Health risks being sidelined once again. Genuine integration of a One Health approach into this treaty will require the institutionalization of formal One Health coordination mechanisms.
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4
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Léger A, Lambraki I, Graells T, Cousins M, Henriksson PJG, Harbarth S, Carson C, Majowicz S, Troell M, Parmley EJ, Jørgensen PS, Wernli D. AMR-Intervene: a social-ecological framework to capture the diversity of actions to tackle antimicrobial resistance from a One Health perspective. J Antimicrob Chemother 2021; 76:1-21. [PMID: 33057678 DOI: 10.1093/jac/dkaa394] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The global threat of antimicrobial resistance (AMR) requires coordinated actions by and across different sectors. Increasing attention at the global and national levels has led to different strategies to tackle the challenge. The diversity of possible actions to address AMR is currently not well understood from a One Health perspective. AMR-Intervene, an interdisciplinary social-ecological framework, describes interventions to tackle AMR in terms of six components: (i) core information about the publication; (ii) social system; (iii) bio-ecological system; (iv) triggers and goals; (v) implementation and governance; and (vi) assessment. AMR-Intervene provides a broadly applicable framework, which can inform the design, implementation, assessment and reporting of interventions to tackle AMR and, in turn, enable faster uptake of successful interventions to build societal resilience to AMR.
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Affiliation(s)
- Anaïs Léger
- Global Studies Institute, University of Geneva, Sciences II, Quai Ernest-Ansermet 30, CH -1211 Genève 4, Switzerland
| | - Irene Lambraki
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Tiscar Graells
- Global Economic Dynamics and the Biosphere, The Royal Swedish Academy of Sciences, Box 50005, 104 05 Stockholm, Sweden.,Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, 10691 Stockholm, Sweden
| | - Melanie Cousins
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Patrik J G Henriksson
- Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, 10691 Stockholm, Sweden.,Beijer Institute of Ecological Economics, The Royal Swedish Academy of Sciences, PO Box 50005, SE-104 05 Stockholm, Sweden.,WorldFish, Jalan Batu Maung, 11960 Bayan Lepas, Penang, Malaysia
| | - Stephan Harbarth
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Carolee Carson
- Canadian Integrated Program for Antimicrobial Resistance Surveillance; Public Health Agency of Canada, Guelph, Canada
| | - Shannon Majowicz
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Max Troell
- Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, 10691 Stockholm, Sweden.,Beijer Institute of Ecological Economics, The Royal Swedish Academy of Sciences, PO Box 50005, SE-104 05 Stockholm, Sweden
| | - E Jane Parmley
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada
| | - Peter S Jørgensen
- Global Economic Dynamics and the Biosphere, The Royal Swedish Academy of Sciences, Box 50005, 104 05 Stockholm, Sweden.,Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, 10691 Stockholm, Sweden
| | - Didier Wernli
- Global Studies Institute, University of Geneva, Sciences II, Quai Ernest-Ansermet 30, CH -1211 Genève 4, Switzerland
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5
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Avraam C, Lambrou AS, Jiang W, Siddiqui S. Antimicrobial Resistance and Livestock Trade for Low and Middle Income Countries: Regional Analysis of Global Coordination Policies. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2021. [DOI: 10.3389/fsufs.2021.650315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Antimicrobial resistance is a threat to global health, aggravated by the use of antimicrobials in livestock production. Mitigating the growing economic costs related to antimicrobial use in livestock production requires strong global coordination, and to that end policy makers can leverage global and national food animal trade policies, such as bans and user fees. Evaluation of such policies requires representing the interactions between competing producers in the global meat market, which is usually out of the scope of statistical models. For that, we developed a game-theoretic food system model of global livestock production and trade between 18 countries and aggregate world regions. The model comprises the largest producing and consuming countries, the explicit interconnections between countries, and the use of antimicrobials in food animal production. Our model allows us to provide policy insights beyond standard literature and assess the trade-off between trade, cost of a policy, and antimicrobials-induced productivity. We studied three scenarios: global increased user fees on antimicrobials, a global ban of meat imports from Brazil, and a decrease in China's meat consumption. We found that a user fee that increases the price of antimicrobials by 50% globally leads to a 33% reduction in global antimicrobial use. However, participation of developing and emerging countries in the coordination scheme is jeopardized, since they become less competitive for meat sales compared to developed countries. When meat imports from Brazil are banned globally, importers of Brazil's meat would turn primarily to the U.S. to supplement their demand. Lastly, meeting China's medium-term lower meat consumption target would not affect global antimicrobial use, but could increase China's antimicrobial use by 11%. We highlighted the importance of trade for the outcome of a policy and concluded that global cooperation is required to align the incentives of all countries toward tackling antimicrobial resistance.
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Abstract
Antimicrobial resistance (AMR), a central health challenge of the twenty first century, poses substantial population health risks, with deaths currently estimated to be around 700,000 per year globally. The international community has signaled its commitment to exploring and implementing effective policy responses to AMR, with a Global Action Plan on AMR approved by the World Health Assembly in 2015. Major governance challenges could thwart collective efforts to address AMR, along with limited knowledge about how to design effective global governance mechanisms. To identify common ground for more coordinated global actions we conducted a narrative review to map dominant ideas and academic debates about AMR governance. We found two categories of global governance mechanisms: binding and non-binding and discuss advantages and drawbacks of each. We suggest that a combination of non-binding and binding governance mechanisms supported by leading antimicrobial use countries and important AMR stakeholders, and informed by One Health principles, may be best suited to tackle AMR.
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7
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Rogers Van Katwyk S, Hoffman SJ, Mendelson M, Taljaard M, Grimshaw JM. Strengthening the science of addressing antimicrobial resistance: a framework for planning, conducting and disseminating antimicrobial resistance intervention research. Health Res Policy Syst 2020; 18:60. [PMID: 32513200 PMCID: PMC7278195 DOI: 10.1186/s12961-020-00549-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 03/17/2020] [Indexed: 12/12/2022] Open
Abstract
Antimicrobial resistance (AMR) has the potential to threaten tens of millions of lives and poses major global economic and development challenges. As the AMR threat grows, it is increasingly important to strengthen the scientific evidence base on AMR policy interventions, to learn from existing policies and programmes, and to integrate scientific evidence into the global AMR response.While rigorous evaluations of AMR policy interventions are the ideal, they are far from the current reality. To strengthen this evidence base, we describe a framework for planning, conducting and disseminating research on AMR policy interventions. The framework identifies challenges in AMR research, areas for enhanced coordination and cooperation with decision-makers, and best practices in the design of impact evaluations for AMR policies.This framework offers a path forward, enabling increased local and global cooperation, and overcoming common limitations in existing research on AMR policy interventions.
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Affiliation(s)
- S Rogers Van Katwyk
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, ON, Canada.
| | - S J Hoffman
- Department of Health Research Methods, Evidence, and Impact and McMaster Health Forum, McMaster University, Hamilton, ON, Canada
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States of America
| | - M Mendelson
- Division of Infectious Diseases and HIV Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - M Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - J M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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Rogers Van Katwyk S, Weldon I, Giubilini A, Kirchhelle C, Harrison M, McLean A, Savulescu J, Hoffman SJ. Making Use of Existing International Legal Mechanisms to Manage the Global Antimicrobial Commons: Identifying Legal Hooks and Institutional Mandates. HEALTH CARE ANALYSIS 2020; 31:9-24. [PMID: 32236833 PMCID: PMC10042894 DOI: 10.1007/s10728-020-00393-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Antimicrobial resistance (AMR) is an urgent threat to global public health and development. Mitigating this threat requires substantial short-term action on key AMR priorities. While international legal agreements are the strongest mechanism for ensuring collaboration among countries, negotiating new international agreements can be a slow process. In the second article in this special issue, we consider whether harnessing existing international legal agreements offers an opportunity to increase collective action on AMR goals in the short-term. We highlight ten AMR priorities and several strategies for achieving these goals using existing "legal hooks" that draw on elements of international environmental, trade and health laws governing related matters that could be used as they exist or revised to include AMR. We also consider the institutional mandates of international authorities to highlight areas where additional steps could be taken on AMR without constitutional changes. Overall, we identify 37 possible mechanisms to strengthen AMR governance using the International Health Regulations, the Agreement on the Application of Sanitary and Phytosanitary Measures, the Agreement on Trade-Related Aspects of Intellectual Property Rights, the Agreement on Technical Barriers to Trade, the International Convention on the Harmonized Commodity Description and Coding System, and the Basel, Rotterdam, and Stockholm conventions. Although we identify many shorter-term opportunities for addressing AMR using existing legal hooks, none of these options are capable of comprehensively addressing all global governance challenges related to AMR, such that they should be pursued simultaneously with longer-term approaches including a dedicated international legal agreement on AMR.
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Affiliation(s)
- Susan Rogers Van Katwyk
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, ON, M3J 1P3, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Isaac Weldon
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, ON, M3J 1P3, Canada.,Department of Politics, York University, Toronto, Canada
| | - Alberto Giubilini
- Oxford Martin School, University of Oxford, Oxford, UK.,Wellcome Centre for Ethics and Humanities, Oxford, UK
| | - Claas Kirchhelle
- Oxford Martin School, University of Oxford, Oxford, UK.,Wellcome Unit for the History of Medicine, University of Oxford, Oxford, UK
| | - Mark Harrison
- Oxford Martin School, University of Oxford, Oxford, UK.,Wellcome Unit for the History of Medicine, University of Oxford, Oxford, UK
| | - Angela McLean
- Oxford Martin School, University of Oxford, Oxford, UK.,Department of Zoology, University of Oxford, Oxford, UK
| | - Julian Savulescu
- Oxford Martin School, University of Oxford, Oxford, UK.,Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Steven J Hoffman
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, ON, M3J 1P3, Canada. .,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada. .,Oxford Martin School, University of Oxford, Oxford, UK. .,Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA. .,Department of Health Research Methods, Evidence, and Impact and McMaster Health Forum, McMaster University, Hamilton, Canada.
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9
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Laxminarayan R, Van Boeckel T, Frost I, Kariuki S, Khan EA, Limmathurotsakul D, Larsson DGJ, Levy-Hara G, Mendelson M, Outterson K, Peacock SJ, Zhu YG. The Lancet Infectious Diseases Commission on antimicrobial resistance: 6 years later. THE LANCET. INFECTIOUS DISEASES 2020; 20:e51-e60. [PMID: 32059790 DOI: 10.1016/s1473-3099(20)30003-7] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/02/2020] [Accepted: 01/06/2020] [Indexed: 12/21/2022]
Abstract
In 2013, a Lancet Infectious Diseases Commission described the state of antimicrobial resistance worldwide. Since then, greater awareness of the public health ramifications of antimicrobial resistance has led to national actions and global initiatives, including a resolution at the high-level meeting of the UN General Assembly in 2016. Progress in addressing this issue has ranged from a ban on irrational drug combinations in India to commitments to ban colistin as a growth promoter in animals, improve hospital infection control, and implement better antimicrobial stewardship. Funds have been mobilised, and regulatory barriers to new antibiotic development have been relaxed. These efforts have been episodic and uneven across countries, however. Sustained funding for antimicrobial resistance and globally harmonised targets to monitor progress are still urgently needed. Except for in a few leading countries, antimicrobial resistance has not captured the sustained focus of national leaders and country-level actors, including care providers.
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Affiliation(s)
- Ramanan Laxminarayan
- Centre for Disease Dynamics, Economics & Policy, New Delhi, India; Princeton Environmental Institute, Princeton University, Princeton, NJ, USA.
| | - Thomas Van Boeckel
- Institute for Environmental Decisions, Swiss Federal Institute of Technology in Zurich, Zurich, Switzerland
| | - Isabel Frost
- Centre for Disease Dynamics, Economics & Policy, New Delhi, India; Faculty of Medicine, Department of Infectious Disease, Imperial College, London, UK
| | | | - Ejaz Ahmed Khan
- Shifa International Hospital, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | | | - D G Joakim Larsson
- Institute for Biomedicine, Department of Infectious Diseases, Centre for Antibiotic Resistance Research, University of Gothenburg, Gothenburg, Sweden
| | - Gabriel Levy-Hara
- Infectious Disease Unit, Hospital Carlos G Durand, Buenos Aires, Argentina
| | - Marc Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | | | | | - Yong-Guan Zhu
- State Key Lab of Urban and Regional Ecology, Research Centre for Eco-environmental Sciences, Chinese Academy of Sciences, Beijing, China
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10
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Islam S, Aldstadt J, Aga D. Global antimicrobial resistance: a complex and dire threat with few definite answers. Trop Med Int Health 2019; 24:658-662. [DOI: 10.1111/tmi.13230] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Shamim Islam
- Pediatric Infectious Diseases University at Buffalo State University of New York Buffalo NY USA
| | - Jared Aldstadt
- Department of Geography University at Buffalo State University of New York Buffalo NY USA
| | - Diana Aga
- Department of Chemistry University at Buffalo State University of New York Buffalo NY USA
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11
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Hawkey PM. The 2017 Garrod Lecture: Genes, guts and globalization. J Antimicrob Chemother 2018; 73:2589-2600. [PMID: 30085107 DOI: 10.1093/jac/dky277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The widespread use of antibacterial drugs over the last 70 years has brought immense benefits to human health at the price of increasing drug inefficacy. Antibacterial agents have a strong selective effect in both favouring resistant strains and allowing particular species and families of bacteria to prosper, especially in the healthcare setting. Whilst important Gram-positive bacterial pathogens such as Staphylococcus aureus and Streptococcus pneumoniae caused concern over the last 20 years because of the spread of antibiotic-resistant strains, Enterobacteriaceae have become the biggest challenge. They have very efficient mechanisms for genetic exchange, as illustrated by the emergence and rapid spread of CTX-M β-lactamases and the carbapenemases. The unique epidemiology of Enterobacteriaceae, with substantial numbers colonizing the mammalian gut and subsequent release into and spread in the environment, presents a significant threat to human health because of the high levels of exposure for the whole community. The use of antimicrobials in agriculture combined with global movements of people, animals and food, arising from worldwide industrialization, generates a diversity and level of resistance not seen previously. Control will require globally coordinated interventions similar to those needed to ameliorate climate change.
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Affiliation(s)
- Peter M Hawkey
- Institute of Microbiology and Infection, School of Biosciences, University of Birmingham, Birmingham, UK.,Department of Microbiology, Queen Elizabeth Hospital, University Hospitals Birmingham Foundation Trust, Birmingham, UK
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12
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Larsson DGJ, Andremont A, Bengtsson-Palme J, Brandt KK, de Roda Husman AM, Fagerstedt P, Fick J, Flach CF, Gaze WH, Kuroda M, Kvint K, Laxminarayan R, Manaia CM, Nielsen KM, Plant L, Ploy MC, Segovia C, Simonet P, Smalla K, Snape J, Topp E, van Hengel AJ, Verner-Jeffreys DW, Virta MPJ, Wellington EM, Wernersson AS. Critical knowledge gaps and research needs related to the environmental dimensions of antibiotic resistance. ENVIRONMENT INTERNATIONAL 2018; 117:132-138. [PMID: 29747082 DOI: 10.1016/j.envint.2018.04.041] [Citation(s) in RCA: 210] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/30/2018] [Accepted: 04/21/2018] [Indexed: 05/24/2023]
Abstract
There is growing understanding that the environment plays an important role both in the transmission of antibiotic resistant pathogens and in their evolution. Accordingly, researchers and stakeholders world-wide seek to further explore the mechanisms and drivers involved, quantify risks and identify suitable interventions. There is a clear value in establishing research needs and coordinating efforts within and across nations in order to best tackle this global challenge. At an international workshop in late September 2017, scientists from 14 countries with expertise on the environmental dimensions of antibiotic resistance gathered to define critical knowledge gaps. Four key areas were identified where research is urgently needed: 1) the relative contributions of different sources of antibiotics and antibiotic resistant bacteria into the environment; 2) the role of the environment, and particularly anthropogenic inputs, in the evolution of resistance; 3) the overall human and animal health impacts caused by exposure to environmental resistant bacteria; and 4) the efficacy and feasibility of different technological, social, economic and behavioral interventions to mitigate environmental antibiotic resistance.1.
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Affiliation(s)
- D G Joakim Larsson
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Guldhedsgatan 10A, SE-413 46 Gothenburg, Sweden; Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Guldhedsdsgatan 10A, SE-413 46, Sweden.
| | - Antoine Andremont
- INSERM, IAME, UMR 1137, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France
| | - Johan Bengtsson-Palme
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Guldhedsgatan 10A, SE-413 46 Gothenburg, Sweden; Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Guldhedsdsgatan 10A, SE-413 46, Sweden.
| | - Kristian Koefoed Brandt
- Department of Plant and Environmental Sciences, Faculty of Science, University of Copenhagen, Thorvaldsensvej 40, 1871 Frederiksberg, Denmark.
| | - Ana Maria de Roda Husman
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, PO Box 80175, 3508 TD Utrecht, The Netherlands; Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, The Netherlands.
| | | | - Jerker Fick
- Department of Chemistry, Umeå University, Umeå, Sweden.
| | - Carl-Fredrik Flach
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Guldhedsgatan 10A, SE-413 46 Gothenburg, Sweden; Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Guldhedsdsgatan 10A, SE-413 46, Sweden.
| | - William H Gaze
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
| | - Makoto Kuroda
- National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama, Tokyo 208-0011, Japan.
| | - Kristian Kvint
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Guldhedsgatan 10A, SE-413 46 Gothenburg, Sweden; Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Guldhedsdsgatan 10A, SE-413 46, Sweden.
| | | | - Celia M Manaia
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Rua Arquiteto Lobão Vital, Apartado 2511, 4202-401 Porto, Portugal.
| | - Kaare Magne Nielsen
- Department of Life Sciences and Health, Oslo and Akershus University College of Applied Sciences, 0130 Oslo, Norway.
| | - Laura Plant
- Swedish Research Council, Box 1035, SE-101 38 Stockholm, Sweden.
| | | | - Carlos Segovia
- Unidad funcional de Acreditación de Institutos de Investigación Sanitaria, Instituto de Salud Carlos III, Spain.
| | - Pascal Simonet
- Environmental Microbial Genomics Group, Laboratory Ampère, UMR CNRS 5005, École Centrale de Lyon, Université de Lyon, 36 avenue Guy de Collongue, 69134 Écully Cedex, France.
| | - Kornelia Smalla
- Julius Kühn-Institut, Federal Research Centre for Cultivated Plants, Institute for Epidemiology and Pathogen Diagnostics, Messeweg 11-12, 38104 Braunschweig, Germany.
| | - Jason Snape
- Global Environment, AstraZeneca, Cheshire SK10 4TF, UK; School of Life Sciences, University of Warwick, Coventry CV4 7AL, UK.
| | - Edward Topp
- London Research and Development Center, Agriculture and Agri-Food Canada (AAFC), Department of Biology, University of Western Ontario, London, ON N5V 4T3, Canada.
| | - Arjon J van Hengel
- Directorate Health, Directorate-General for Research and Innovation, European Commission, Brussels, Belgium.
| | - David W Verner-Jeffreys
- Cefas Weymouth Laboratory, Centre for Environment, Fisheries and Aquaculture Science, Weymouth, Dorset DT4 8UB, UK.
| | - Marko P J Virta
- Department of Microbiology, University of Helsinki, Helsinki, Finland.
| | | | - Ann-Sofie Wernersson
- Swedish Agency for Marine and Water Management, Box 11 930, SE-404 39 Gothenburg, Sweden.
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13
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Hasan R, Shakoor S, Hanefeld J, Khan M. Integrating tuberculosis and antimicrobial resistance control programmes. Bull World Health Organ 2018. [PMID: 29531418 PMCID: PMC5840628 DOI: 10.2471/blt.17.198614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Many low- and middle-income countries facing high levels of antimicrobial resistance, and the associated morbidity from ineffective treatment, also have a high burden of tuberculosis. Over recent decades many countries have developed effective laboratory and information systems for tuberculosis control. In this paper we describe how existing tuberculosis laboratory systems can be expanded to accommodate antimicrobial resistance functions. We show how such expansion in services may benefit tuberculosis case-finding and laboratory capacity through integration of laboratory services. We further summarize the synergies between high-level strategies on tuberculosis and antimicrobial resistance control. These provide a potential platform for the integration of programmes and illustrate how integration at the health-service delivery level for diagnostic services could occur in practice in a low- and middle-income setting. Many potential mutual benefits of integration exist, in terms of accelerated scale-up of diagnostic testing towards rational use of antimicrobial drugs as well as optimal use of resources and sharing of experience. Integration of vertical disease programmes with separate funding streams is not without challenges, however, and we also discuss barriers to integration and identify opportunities and incentives to overcome these.
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Affiliation(s)
- Rumina Hasan
- Department of Pathology & Laboratory Medicine, Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, Pakistan
| | - Sadia Shakoor
- Department of Pathology & Laboratory Medicine, Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, Pakistan
| | - Johanna Hanefeld
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, England
| | - Mishal Khan
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, England
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