Evaluating the Integration of One Health in Surveillance Systems for Antimicrobial Use and Resistance: A Conceptual Framework.

Cécile Aenishaenslin,André Ravel,Katharina D C Stärk,E Jane Parmley,Sarah Mediouni,Houda Bennani,David L Buckeridge,Barbara Häsler

doi:10.3389/fvets.2021.611931

Abstract

It is now widely acknowledged that surveillance of antimicrobial resistance (AMR) must adopt a “One Health” (OH) approach to successfully address the significant threats this global public health issue poses to humans, animals, and the environment. While many protocols exist for the evaluation of surveillance, the specific aspect of the integration of a OH approach into surveillance systems for AMR and antimicrobial Use (AMU), suffers from a lack of common and accepted guidelines and metrics for its monitoring and evaluation functions. This article presents a conceptual framework to evaluate the integration of OH in surveillance systems for AMR and AMU, named the Integrated Surveillance System Evaluation framework (ISSE framework). The ISSE framework aims to assist stakeholders and researchers who design an overall evaluation plan to select the relevant evaluation questions and tools. The framework was developed in partnership with the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS). It consists of five evaluation components, which consider the capacity of the system to: [1] integrate a OH approach, [2] produce OH information and expertise, [3] generate actionable knowledge, [4] influence decision-making, and [5] positively impact outcomes. For each component, a set of evaluation questions is defined, and links to other available evaluation tools are shown. The ISSE framework helps evaluators to systematically assess the different OH aspects of a surveillance system, to gain comprehensive information on the performance and value of these integrated efforts, and to use the evaluation results to refine and improve the surveillance of AMR and AMU globally.

Highlights

Antimicrobial resistance (AMR) is a major threat to public health (1)
There was a lack of consensus between and within the team members and end-users from Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS), on how to define the integrated surveillance for antimicrobial Use (AMU) and antimicrobial resistance (AMR)
Proposed explanations for this lack of consensus were that the essential components of an integrated surveillance system will differ depending on the objectives of the system, the targeted problem under surveillance (AMR in the food chain vs. AMR in general), and the expertise and background of the participants

Summary

Introduction

Antimicrobial resistance (AMR) is a major threat to public health (1). the development of resistant human pathogens is primarily driven by antimicrobial (AM) consumption in human populations, the use of AMs in animals selects for resistant microorganisms, which can be transmitted to human through direct contact or through the food chain (2, 3). The spread of the existing resistant microorganisms and resistance genes, and the emergence of the new ones are major global concerns in the human and animal health sectors (7). Surveillance systems for AMR should integrate the surveillance of AMU and resistance in microorganisms circulating in humans, in animals, and in the environment (8, 9). This approach, in line with the concept of “One Health” (OH), is central to the global action plan of the WHO on AMR (10) and to the Food and Agriculture Organization (FAO)/Organization for Animal Health (OIE)/WHO tripartite collaboration on AMR (11). Despite years of experience with integrated surveillance in different countries, evidence of the added value of applying a OH approach is still lacking (13, 14)

Methods

Results

Discussion

Conclusion