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

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.

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.

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