Convergence in evaluation frameworks for integrated surveillance of AMR (CoEval-AMR)

Antimicrobial resistance (AMR) is the ability of a microorganism (e.g. bacteria, parasites, viruses) to stop responding to an antimicrobial drug (e.g. antibiotics, antiparasitic or antiviral drugs) that previously treated them effectively. As a result, standard treatments become ineffective in people and animals with serious welfare and economic consequences. Resistant microorganisms and genes can be found in humans, animals and the environment. To understand better the evolution, emergence and behaviour of AMR and help informing decision-making for national, regional, and global solutions, it is important to have cost-effective surveillance systems. Surveillance in this context is the continuous, systematic collection, analysis and interpretation of health-related data for health decision-making.
Because of the complexity of the problem, various international organisations have called for collaboration across human, animal, and environmental sectors and adoption of a "One Health" approach. Several integrated surveillance strategies exist globally but their effectiveness and economic efficiency remain to be evaluated. Therefore, the aim of the Network "Convergence in evaluation frameworks for integrated surveillance of AMR" is to develop guidance for a harmonised evaluation framework that will address the specific needs of integrated surveillance systems for AMR. The use of this evaluation framework will help to understand what works and does not work in AMR surveillance and thereby help to set up improved, cost-effective surveillance for AMR. To elaborate this evaluation framework, we will bring together international experts in the field who have long-standing experience in surveillance, AMR and/or evaluation. We will organise two main scientific workshops to review and discuss existing evaluation frameworks and approaches. In the process, we will identify gaps and areas for improvements and we will work towards an agreed evaluation framework. In a next step, protocols and written guidance will be developed and made publicly available through an existing online website used for surveillance evaluation (SurvTools: https://survtools.org). Results will allow understanding the value of cross-sectoral, integrated surveillance for AMR, and help policy makers make decisions on how to invest resources for surveillance.

Antimicrobial resistance (AMR) constitutes a serious risk to health worldwide and has major economic impacts. Resistance genes are present in humans, animals and the environment and bacteria carrying resistance genes can spread between them. This needs to be considered when designing integrated AMR surveillance strategies to identify emerging resistance, understand the AMR epidemiology, and plan and evaluate policies for AMR mitigation.
An integrated approach to surveillance spanning different sectors has been promoted by international organisations for more than a decade and constitutes a central recommendation of the WHO action plan on AMR. The aim of the Network "Convergence in evaluation frameworks for integrated surveillance of AMR" is to develop guidance for a harmonised evaluation framework that will address the specific needs of integrated, One Health surveillance systems for AMR. Two main scientific workshops will be used to build on researchers' experience and expertise with learning, exchange and protocol development in small working groups between workshops. Strengths, gaps, and opportunities of existing evaluation approaches will be identified with the view to work towards harmonisation and standardisation. In the first workshop, agreement will be sought on the elements to include in an evaluation framework for AMR. Protocols and written guidance will be developed and made publicly available through an existing online website used for surveillance evaluation (SurvTools: https://survtools.org). Future application of the evaluation framework to AMR surveillance systems will result in information that will allow understanding the potential value of integrated surveillance for AMR, and comparing integrated surveillance strategies across countries in order to identify the most cost-effective approaches for surveillance policy.

One of the key elements for a better understanding and management of AMR is to develop efficient and effective integrated AMR surveillance systems that take into account the complex epidemiology of AMR and consider the impacts on humans, animals and the environment. While several (partly) integrated surveillance systems for resistance in microorganisms and/or use of antimicrobials have been developed in several countries, the effectiveness of these integrated systems and their socio-economic value have not yet been formally evaluated. Consequently, there is a risk that resources are not used efficiently and that opportunities are missed to create better information for the targeted and effective management of AMR. By bringing together multiple existing frameworks and approaches and assessing their usefulness and validity, the Network will produce a set of harmonised protocols and supporting guidance to evaluate the performance and value of AMR integrated surveillance systems. This topic is of growing importance globally, and our results will contribute to this new and dynamic field of research on OH evaluation and metrics.
The application of the novel, harmonised guidance for evaluation of integrated AMR surveillance systems nationally and internationally in the mid-term will allow working towards a database/compilation of case studies that demonstrates what works and does not work in AMR surveillance. Consequently, in the mid to long term, such work will allow identifying areas for improvement and offer an opportunity for changes that may increase the effectiveness and efficiency of integrated AMR surveillance.
The knowledge produced in the long-term is expected to lead to improved health of populations by allowing the identification and prioritisation of effective and efficient integrated surveillance strategies for AMR. The need for better evidence on the value of OH surveillance has been underlined by public health decision-makers and their technical advisors.