Towards controlling antimicrobial resistance in global aquatic animal food systems by enhancing collective resilience (AMFORA)

Lead Research Organisation: Royal Veterinary College
Department Name: Pathobiology and Population Sciences

Abstract

Aquatic animals such as fish and shellfish are an increasingly important source of protein for the growing world population. In 2014 the contribution of aquaculture to supply food for human consumption overtook that for wild-caught fish for the first time. Fish diseases are still considered to be a major constraint to aquaculture globally and it has been estimated that 10% of all farmed aquatic animals are lost because of infectious diseases alone, amounting to >10 billion USD in losses annually on a global scale. Farmed fish are often kept in intensive systems where antibiotics are heavily used. Effective vaccines exist for use in Atlantic salmon aquaculture and the use of antibiotics has been reduced by over 99%. In comparison, although many other species (e.g. carp and tilapia) are well established cultured species, there are few vaccines available, and antibiotics are still heavily used. Aquatic animals are increasingly traded worldwide, partly due to growing awareness for balanced diets and healthy eating in high-income countries and as a vital source of quality animal protein in low and middle income countries (LMIC). This creates opportunities and supports livelihoods in countries such as Bangladesh, Egypt and Vietnam, that together contribute to 9% of the global aquaculture production.
Despite the importance of antibiotic use in aquaculture and the size of the global trade, the contribution of aquaculture to the burden of consumer exposure to antibiotic resistance genes is currently not being addressed. Reasons why this issue is currently not been tackled include; i) the complexity of global food systems that involve different actors (producers, suppliers, intermediaries) spanning different countries across the world, ii) the lack of knowledge of the so called "drivers" of resistance in aquatic systems (i.e. the influences, e.g. through animal husbandry and farm management, that result in the emergence of resistance in bacteria) and, iii) the fragmented responsibilities in global food systems. However, it is important that antibiotic resistance in aquaculture is addressed as a global issue, because hazards emerging in producer countries will have public impact on consumers elsewhere through global trade and travel. Also, opportunities to learn from progress made in European fish farming remain underexploited. To address this complex challenge we need innovative research strategies that combine different disciplines and approach the system as a whole rather than its individual components in isolation. Our plan for the full proposal stage is to apply research methods that allow us to integrate societal, legal, governance and economic drivers in addition to biological risk, creating new approaches to better describe, analyse and assess the resilience of a global food system. In the first phase of the project, two workshops will be conducted to develop the model framework and plan the activities for the second phase. These workshops together with a review of published studies, reports and interviews with key stakeholders will allow us to map the different components of the system, the drivers, responsibilities and governance and to identify knowledge gaps for the main project. Our focus will be on selected fish species farmed in Bangladesh, Vietnam and Egypt, all of which are traded internationally. In the full-stage proposal, intervention strategies to reduce antibiotic use will be developed and implemented and their impact assessed using novel approaches. Our aspiration is that this project increases risk awareness for consumers, enhances surveillance and develops a novel set of indicators of system resilience in the context of antibiotic resistance.

Technical Summary

Aquaculture is an important protein source for the growing world population but its development is constrained by infectious diseases, which are responsible for the annual loss of 10% of all farmed aquatic animals, amounting to >10 billion USD. Fish are often intensively farmed with heavy antibiotic (AB) use, but there are alternatives as shown by the drastic reduction of AB use in Atlantic salmon production in UK and Norway through vaccination. Aquatic animals are traded worldwide, but their contribution to the burden of consumer exposure to AB resistance genes is not being addressed because of the complexity of global food systems, the lack of knowledge of the drivers of resistance in aquatic systems and the fragmented responsibilities in global food systems. Our vision for the full proposal is to apply innovative systems-based research to implement and evaluate strategies that have the potential of reducing vulnerability of fish farming to the threat of AB resistance. In the development phase we will establish robust foundations for these activities working with strategic partners (World Fish, FAO, ILRI) in 3 LMIC that contribute to 9% of global aquaculture production: Bangladesh, Egypt and Vietnam. Through a combination of desk research (literature review, data synthesis), two workshops (Vietnam and Egypt) and stakeholder interviews we will identify i) drivers of AB usage in fish farming systems and ways in which they impact on resistance development and global public health, ii) knowledge gaps that currently preclude assessment of the consequences of AB usage in fish farming and iii) candidate interventions with the potential of enhancing resilience of the fish farming system to the threat of AB resistance. Building on the consortium's expertise we will expand classical risk assessment to develop a framework (to be used in the full proposal) suitable to assess resilience of of the fish farming system and the consequences of AB usage and resistance development.

Planned Impact

Building on previous and on-going research collaborations with Bangladesh (ZELS BALZAC (RVC/LSHTM/CVASU/FAO), Egypt (KafrElSheikh University and Government Veterinary Services) and Vietnam (Can Tho University, Vietnam National University of Agriculture and Research Institute for Aquaculture) and the global partnerships with the aquaculture sector of WorldFish and UStirling, AMFORA represents an ideal vehicle for to conduct high impact research and build awareness and capacity around the challenge of ABR emergence in aquaculture in the focus countries and beyond. The project seeks to establish these countries as case-studies for future research on aquaculture in LMICs, and furthermore, assess and develop resilience of the aquaculture production systems and surveillance of ABR in farmed fish. With this in mind, beneficiaries of the research would include the governmental veterinary but also public health services of participating LMICs responsible for overseeing the surveillance of ABR, food industry stakeholders and final consumers. In-depth interviews with key stakeholders, together with evidence collated through literature reviews and map risk factors and drivers for AB use and ABR and develop a framework tool to assess resilience of fish production and surveillance systems in the context of ABR. Our findings will help inform the development of effective, sustainable interventions for the prevention and mitigation of ABR in aquaculture systems, promote research and training opportunities and raise stakeholders and public awareness for ABR whilst protecting the livelihoods of farmers taking into account the socio-economic context of these countries.
The main impact of this research will be to safeguard food security and stability of participating LMICs but also of the global fish production systems. ABR represents an important biological threat to these countries, could threaten to destabilise animal and public health infrastructures and also impact global food systems via trade and travel. Bangladesh, Egypt and Vietnam contribute to 9% of the global aquaculture production. It is of paramount strategic importance to the fragile stability that still remains in Egypt and Bangladesh that resilience is built in food systems and surveillance of ABR in order to protect public and animal health. In contrast, Vietnam is politically stable but ABR could have a negative impact in its exporting market and consumer's confidence. Therefore, effective monitoring and control of ABR in LMICs is in the national interest of both the UK and the wider global community. It will help set priorities among intervention strategies which is essential in a limited-resource setting as interventions currently implemented in high income countries are unlikely to be effective due to the lack of infrastructures and resources in LMIC that are often overlooked. Such evidence is a prerequisite for the implementation of national action plans for tackling of AMR as well as to achieve the global goals set out in the strategies and programmes promoted by the International Animal Health Organisation (OIE), the United Nation's Food and Agriculture Organisation (FAO) and the World Health Organisation (WHO)*. With this is mind the impact of this research will also be its significant contribution to the current worldwide research effort directed at the control of ABR following a "One Health" approach.

*Antimicrobial Resistance. A Manual for Developing National Action Plans. February 2016. World Health Organization (WHO), Food and Agriculture Organization of the United Nations (FAO) and World Organisation for Animal Health (OIE), 2016. 32 pages. http://apps.who.int/iris/bitstream/10665/204470/1/9789241549530_eng.pdf?ua=1
 
Title Survey data on alternatives to antibiotics to promote aquatic health in Egypt 
Description Following the workshop in Kafr El Sheikh, Egypt in May we contacted participants and their networks to collect further information about potential alternatives to using antibiotics in tilapia farming using a questionnaire. In the questionnaire we proposed a number of measures based on the suggestions at the workshop, and asked respondents to consider the feasibility of implementing the measures, and the benefits and drawbacks of each. The proposed measures were grouped under eight headings: improved management, improved genetics/breeds, alternative therapies/products, diagnostic tools, monitoring and surveillance, biosecurity, initiatives and incentives, and education and training. The questionnaire was written in English, then translated in to Arabic by an Egyptian member of the project team. The questionnaire was made available online through Survey Monkey, and as a paper copy for those without access to a computer. Paper responses were collected and input in to the online questionnaire by an Egyptian member of the project team, before being translated back in to English. 
Type Of Material Database/Collection of data 
Year Produced 2019 
Provided To Others? No  
Impact We are currently analysing the data, but initial indications are that it has revealed some very interesting and useful insights in to the feasibility of certain interventions to reduce antibiotic usage in Egyptian aquaculture. 
 
Description Applying a One Health systems modelling approach to formulate strategies for mitigating the risk to human health of AMR in Aquaculture (AMFORA) 
Organisation Chittagong Veterinary and Animal Sciences University
Country Bangladesh 
Sector Academic/University 
PI Contribution We led the development of a large consortium research proposal to build on this existing research grant. The vision of the consortium was to identify effective, long-term, economically viable and culturally acceptable solutions to the challenge of ABR in aquaculture in LMICs by adopting a systems perspective.
Collaborator Contribution All partners played a key role in the development of the research proposal, and each took the lead on at least one specific work objectives and activities within the consortium.
Impact Proposal submitted to the MRC: MR/S004750/1. This was a large multidisciplinary consortium proposal comprising expertise in veterinary epidemiology, economics, anthropology, aquaculture, aquatic science, public health and microbiology.
Start Year 2018
 
Description Applying a One Health systems modelling approach to formulate strategies for mitigating the risk to human health of AMR in Aquaculture (AMFORA) 
Organisation International Livestock Research Institute (ILRI)
Country Kenya 
Sector Charity/Non Profit 
PI Contribution We led the development of a large consortium research proposal to build on this existing research grant. The vision of the consortium was to identify effective, long-term, economically viable and culturally acceptable solutions to the challenge of ABR in aquaculture in LMICs by adopting a systems perspective.
Collaborator Contribution All partners played a key role in the development of the research proposal, and each took the lead on at least one specific work objectives and activities within the consortium.
Impact Proposal submitted to the MRC: MR/S004750/1. This was a large multidisciplinary consortium proposal comprising expertise in veterinary epidemiology, economics, anthropology, aquaculture, aquatic science, public health and microbiology.
Start Year 2018
 
Description Applying a One Health systems modelling approach to formulate strategies for mitigating the risk to human health of AMR in Aquaculture (AMFORA) 
Organisation Kafrelsheikh University
PI Contribution We led the development of a large consortium research proposal to build on this existing research grant. The vision of the consortium was to identify effective, long-term, economically viable and culturally acceptable solutions to the challenge of ABR in aquaculture in LMICs by adopting a systems perspective.
Collaborator Contribution All partners played a key role in the development of the research proposal, and each took the lead on at least one specific work objectives and activities within the consortium.
Impact Proposal submitted to the MRC: MR/S004750/1. This was a large multidisciplinary consortium proposal comprising expertise in veterinary epidemiology, economics, anthropology, aquaculture, aquatic science, public health and microbiology.
Start Year 2018
 
Description Applying a One Health systems modelling approach to formulate strategies for mitigating the risk to human health of AMR in Aquaculture (AMFORA) 
Organisation London School of Hygiene and Tropical Medicine (LSHTM)
Country United Kingdom 
Sector Academic/University 
PI Contribution We led the development of a large consortium research proposal to build on this existing research grant. The vision of the consortium was to identify effective, long-term, economically viable and culturally acceptable solutions to the challenge of ABR in aquaculture in LMICs by adopting a systems perspective.
Collaborator Contribution All partners played a key role in the development of the research proposal, and each took the lead on at least one specific work objectives and activities within the consortium.
Impact Proposal submitted to the MRC: MR/S004750/1. This was a large multidisciplinary consortium proposal comprising expertise in veterinary epidemiology, economics, anthropology, aquaculture, aquatic science, public health and microbiology.
Start Year 2018
 
Description Applying a One Health systems modelling approach to formulate strategies for mitigating the risk to human health of AMR in Aquaculture (AMFORA) 
Organisation University of Stirling
Department Institute of Aquaculture
Country United Kingdom 
Sector Academic/University 
PI Contribution We led the development of a large consortium research proposal to build on this existing research grant. The vision of the consortium was to identify effective, long-term, economically viable and culturally acceptable solutions to the challenge of ABR in aquaculture in LMICs by adopting a systems perspective.
Collaborator Contribution All partners played a key role in the development of the research proposal, and each took the lead on at least one specific work objectives and activities within the consortium.
Impact Proposal submitted to the MRC: MR/S004750/1. This was a large multidisciplinary consortium proposal comprising expertise in veterinary epidemiology, economics, anthropology, aquaculture, aquatic science, public health and microbiology.
Start Year 2018
 
Description Applying a One Health systems modelling approach to formulate strategies for mitigating the risk to human health of AMR in Aquaculture (AMFORA) 
Organisation Worldfish
Country Malaysia 
Sector Charity/Non Profit 
PI Contribution We led the development of a large consortium research proposal to build on this existing research grant. The vision of the consortium was to identify effective, long-term, economically viable and culturally acceptable solutions to the challenge of ABR in aquaculture in LMICs by adopting a systems perspective.
Collaborator Contribution All partners played a key role in the development of the research proposal, and each took the lead on at least one specific work objectives and activities within the consortium.
Impact Proposal submitted to the MRC: MR/S004750/1. This was a large multidisciplinary consortium proposal comprising expertise in veterinary epidemiology, economics, anthropology, aquaculture, aquatic science, public health and microbiology.
Start Year 2018
 
Description CGIAR Antimicrobial Resistance hub 
Organisation International Livestock Research Institute (ILRI)
Country Kenya 
Sector Charity/Non Profit 
PI Contribution We have been invited to participate in the new CGIAR Antimicrobial Resistance hub being hosted by ILRI. This has involved to date: - Participation in a workshop on the 11th December 2019 to consider the proposed activities of the hub, prioritise activities for 2019 and discuss the focus for the next 3 years. - Attendance at the partner's workshop in Nairobi on 21-22 February 2019 to present outputs from this award.
Collaborator Contribution CGIAR partners at ILRI and WorldFish have provided intellectual input to the following activities: - Development of a research aggreement between RVC and ILRI to explore interventions for reducing antimicrobial use in aquaculture in LMICs - A proposal for a PhD studentship building on the research conducted under this award.
Impact - Poster presented at CGIAR AMR hub partner's workshop 21-22 February 2019: "AMFORA: Applying a One Health systems modelling approach to formulate strategies for mitigating the risk to human health of ABR in aquaculture" - Summary of workshops conducted under this award published on CGIAR website: https://amr.cgiar.org/sites/default/files/AMFORA_Lucy_Brunton.pdf - PhD studentship advertised by RVC, co-supervised and part funded by ILRI - Contractual research agreement between RVC and ILRI to explore interventions for reducing antimicrobial use in aquaculture in LMICs
Start Year 2018
 
Description Egypt stakeholder mapping workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Study participants or study members
Results and Impact An interdisciplinary workshop was held in Kafr El Sheikh, Egypt in May 2018. The aim of the workshop was to use a 'systems-thinking' approach to map aquaculture systems and identify potential hotspots for the emergence and selection of resistance and human exposure to antibiotics and antibiotic-resistant organisms. Additionaly, the workshop was designed to develop systems thinking and experience in mapping systems, to build collaborations and understanding of different expertise. The workshop identified potential interventions as well as key knowledge gaps, and provide a template for more detailed characterisation of the tilapia systems. The next step will be to build on the information captured at this workshop using system dynamics modelling to deepen understanding of how a complex system, such as intensive aquaculture in LMICs, behaves.
Year(s) Of Engagement Activity 2018
URL https://amr.cgiar.org/case-study/amfora-applying-one-health-systems-modelling-approach-formulate-str...
 
Description Vietnam stakeholder mapping workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Study participants or study members
Results and Impact An interdisciplinary workshop was held in Vietnam in January 2018. The aim of the workshop was to use a 'systems-thinking' approach to map aquaculture systems and identify potential hotspots for the emergence and selection of resistance and human exposure to antibiotics and antibiotic-resistant organisms. Additionaly, the workshop was designed to develop systems thinking and experience in mapping systems, to build collaborations and understanding of different expertise. The workshops identified potential interventions as well as key knowledge gaps, and has provided a template for more detailed characterisation of the striped catfish and white-leg shrimp systems in Vietnam. The next step will be to build on the information captured at this workshop using system dynamics modelling to deepen understanding of how a complex system, such as intensive aquaculture in LMICs, behaves.
Year(s) Of Engagement Activity 2018
URL https://amr.cgiar.org/case-study/amfora-applying-one-health-systems-modelling-approach-formulate-str...