The Fleming Fund’s efforts to support countries with AMR challenges have contributed to more effective responses to the COVID-19 pandemic. Dr Toby Leslie, Health Specialist and Global Technical Lead for the Fleming Fund, asks whether the crisis has awoken governments to long-term threats to global health security.
As the global COVID-19 emergency escalated in March last year, the question for the Fleming Fund – the UK aid-funded programme that supports generating and sharing antimicrobial resistance (AMR) data across Sub-Saharan Africa and South-East Asia – was: how to respond?
For many countries, the COVID-19 response centred on scaling up diagnostic testing, an area where the Fleming Fund has helped to raise the standard of laboratories and training in recent years. However, while Fleming is fully focused on bacterial threats, the agent that causes COVID-19 is a virus, which demands different technology, processes, skills and supply chains.
Fleming supports transferable skills which any laboratory needs in order to operate safely, such as biosafety and biosecurity, good laboratory practice, and the development of standard operating procedures. These are relevant to the three main branches of microbiology: parasitology, virology and bacteriology, including those used for COVID-19 surveillance. As a result, the training that we provided meant that laboratories in low and middle income countries were better prepared to respond to COVID-19.
Stick to your guns
When the pandemic intensified, the programme remained focused on its core objective: surveillance of AMR in bacteria. Retooling the programme and reconfiguring supply chains to support the COVID-19 response was not feasible, especially in such a short timeframe. Besides, the care of severely ill COVID-19 patients requires good quality bacteriology, such as analysis of secondary pneumonia or bloodstream infections. And for that, you need a bacteriology lab.
While COVID-19 is the immediate threat, AMR is a longer, more insidious global health emergency that will rival or even dwarf the impact of the current pandemic. Indeed, there is emerging evidence from the World Health Organization that the need for AMR prevention has intensified during the pandemic. COVID-19 patients are often treated with antibiotics in hospital, even where no bacterial infection has been confirmed, which can increase the likelihood of drug resistance developing and spreading.
With this in mind, the Fleming Fund decided to respond to the emergency where possible while remaining focused on the long-term threat of AMR. We duly provided COVID-19 support in Zambia, Nepal and other countries where assistance was specifically requested by governments.
One area where we are contributing is supporting sequencing of DNA and RNA that can help detect disease mutations and track outbreaks. This technique is used in AMR surveillance, and we’ve supported its use in COVID-19 surveillance. In South Africa, through Fleming Fund grantees in Denmark, whole genome sequencing for the virus has made an immediate contribution to surveillance on the continent of Africa. Fleming is now supporting scientists to monitor COVID-19 viruses, helping to bolster the response across multiple countries.
One Health approach
The COVID-19 crisis has also reinforced the importance of a One Health approach, which is a central pillar of the Fleming Fund’s work. It’s vital that a multi-sectoral response – one that includes human health, animal health and environment – is used to prevent, detect and respond to emerging and epidemic diseases. The Fleming Fund uses a One Health approach for AMR, which brings partners together from agriculture, wildlife, the environment, public health and epidemiology.
Moving forward, governments need to progress One Health research and practices to avoid similar outbreaks, whether viral or bacterial.
With hindsight, it was really important for the Fleming Fund to keep its focus on AMR prevention because we’re playing the long game against AMR and pivoting to COVID-19 would have risked taking our eye off the ball. The response to the pandemic within our countries of operation suggests that COVID-19 may act as a catalyst for continued action on laboratory strengthening, infectious disease surveillance and AMR, and help governments to recognise the importance of surveillance. Despite its devastating effects, COVID-19 may help avert an even more serious global health crisis in the future.