Shining a light on the problem
What does AMR surveillance require? Data – more of it, and of a higher quality – and the ability to use it to plan effective strategies for fighting back against AMR.
The Fleming Fund is helping countries to develop their national surveillance networks, by supporting laboratories and experts to gather and analyse AMR samples, share data, and use the insights it provides to inform action. It is also working with health service providers, governments, multinational organisations, academia, veterinarians and animal health specialists, and the livestock industry.
Critical equipment has been installed at national reference laboratories in the 22 countries currently supported by the fund. In all 22 countries, the fund is also building core surveillance skills, such as bacteriology, antibiotic testing, and epidemiology. International professional networks are being strengthened.
Each country has its own AMR coordination committee, which collects and processes data from local labs, turning it into valuable information informing health policy and interventions for both humans and animals.
Data serves local, national and global purposes. For example, the fund has invested in equipment that can perform automated blood culture, drug sensitivity testing and species identification, trained staff to use it and organised long-term support and service contracts with the equipment providers. In Bhutan, this has increased national blood culturing capacity five-fold. When a doctor suspects a patient has a bacterial infection, they can now take a blood sample and send it off for laboratory analysis.
Culturing the blood sample enables lab-based experts to perform drug susceptibility tests. Information about which drug will be most effective against the infection is sent back to the doctor, improving the patient’s chances of a speedy recovery, and reducing the risk of the bacterial strain being further strengthened by contact with ineffective treatment and preventing onward transmission.
As well as helping doctors, data gathered from many samples reveals local, regional and national patterns in what is causing infections and drug resistance. This enables local healthcare providers and health departments to select the most effective drugs. Data is also fed into the Global Antimicrobial Resistance Surveillance System, which is run by the World Health Organization (WHO) to provide a global picture of how the AMR threat is developing.
AMR is an inter-species problem. The US National Institutes of Health attributes almost 16% of all deaths worldwide to infectious diseases. Historically, about 60% of those diseases have been spread from animals to humans (zoonoses). But currently, about 75% of emerging infectious diseases are zoonotic. This is why the fund has supported development of AMR surveillance plans in poultry, fish and other food-producing animals in most of the Fleming Fund priority countries. Antimicrobials are often used in raising chickens and other livestock because they are seen as helping improve food production efficiency - but AMR is a by-product of this practice.
Grants have helped complete poultry sampling in Ghana, Laos, Pakistan, Uganda, Vietnam, and Zambia with more planned in other countries. Data gathered is revealing trends in the use of antimicrobials and the incidence of AMR, which will be used to inform livestock rearing practices.
