Towards Developing an International Environmental AMR Surveilance Strategy

There is an urgent and increasing need to fully understand the development and transmission of AMR both into and within the wider environment. However, at present research into environmental aspects of AMR has been largely confined to individual institutions or academic laboratories. National governments and international bodies (EU, UN, WHO) have recognised that we must establish effective environmental surveillance systems to identify and monitor AMR in our waters, soils air and wildlife in order to increase understanding of the natural environment's role in emergence and spread of AMR and how the introduction of antimicrobials / resistant microorganisms from human / animal sources into the environment contribute to AMR. A One Health approach promotes harmonised surveillance across human, veterinary and food sectors and the use of common outcome indicators to monitor AMR and antimicrobial use: several joint national reports publish AMR trends for key indicator bacteria and key antibiotics (for example UK One Health report, DANMAP and Scottish One Health Antimicrobial Usage and Antimicrobial Resistance Report (SONAAR). However, there is no clear consensus so far regarding which indicators to measure for the environmental sector. This network aims to identify robust, measurable surveillance indicators and methodologies for environmental AMR by: building on and transferring existing knowledge from clinical and animal AMR indicators and methodologies in the context of a multi-sectoral, One Health approach. We will bring together key researchers with policy makers and regulators across the environmental, human health and veterinary sectors and from countries with a wide range of economic settings. We aim to arrive at a standardised set of targets and reproducible, accessible methodologies allowing comparative data to be generated in a coordinated manner. We will then set out our findings in advice and briefings to governments and international bodies.

With growing awareness of the role of the natural and farmed environments in the evolution, landscape scale dissemination and transmission of AMR, coordinated efforts to undertake environmental surveillance are required. Microbial populations are highly complex with billions of bacteria present in 1 gram of soil, sediment or faeces. A considerable number of these bacteria carry mobile genetic elements (MGEs) which can be passed between even unrelated species, and these mobile elements may carry a wide range of different resistance mechanisms to widely used and even last line of defense drugs used to treat infection. Human and animal waste introduce AMR bacteria to the natural environment, where they mix with environmental bacteria in the presence of antimicrobial residues, leading to the possibility of new AMR bacteria emerging from these environments. Acute transmission risk also occurs through direct contact with the environment or indirectly through the food chain from exposed crops and livestock. Due to the complexity of microbial populations (billions of bacteria of thousands of species per gram) and the number of AMR genes (numbering in the thousands) determining appropriate endpoints for surveillance is challenging. There are also a variety of analytical methodologies with varying utility in terms of cost, complexity and data outputs. Currently many labs use different surveillance targets and methodologies making comparison over time and between sample sites extremely difficult. The aim of the network is to establish standardised targets and protocols for surveillance, bearing in mind varying analytical capability across the globe. We will liaise with other funded JPIAMR networks with overlapping remit, to ensure efficient use of resources, alignment across networks and to reduce duplication of effort.

The membership of this network has been carefully considered in terms of geographical coverage (EU, North America, Africa, South Asia and SE Asia), research expertise and policy / regulatory / government coverage including those involved in environment, animal and human health. Between network members we cover membership of a wide range of national and international regulatory and policy making bodies and we have a wide network of contacts within the global academic research environment and industry. We will use these networks to communicate network outputs in addition to the impact focused objectives which includes a series of expert recommendations on potential methods for environmental surveillance and monitoring of AMR.