Stakeholder engagement in One Health antimicrobial resistance approaches

EFSA's assistance for the 2015 Codex Committee on Residues of Veterinary Drugs in Food (CCRVDF) in relation to rBST

Interconnections between the food system and antimicrobial resistance: A systems-informed umbrella review from a One Health perspective.

Political attention to antimicrobial resistance (AMR) has never been greater. Governments worldwide are concerned that AMR threatens to undo modern medical achievements with the spectre of a post antibiotic era in which commonplace infections, once eminently treatable, become nontreatable causes of serious morbidity and mortality 1. With suggestions that AMR and multi-drug resistant organisms are as important as climate change and could cast the world back into the dark ages of medicine, ranking alongside terrorism as matters of national risk 2, 3, the political landscape on this subject has been clearly set. Concerns about AMR and its health impact are, of course, not new and began at almost the same time as the introduction of antimicrobials. In 1945, just after the introduction of penicillin as a therapeutic agent in humans and animals, Fleming warned in his Nobel Prize acceptance speech that misuse of antimicrobials could result in bacterial resistance. This prediction rapidly became true with the discovery of each new class of antimicrobial quickly followed by the appearance of resistance to it. By the 1960s there was widespread realisation, and acceptance in the scientific community and lay press, that antimicrobial use (and misuse) resulted in rapid selection for resistance against all classes of antimicrobials. What is new, and has changed the political and regulatory landscape for AMR completely, is the realisation that science is not able to out-pace the microbes. There have been no completely new classes of antimicrobials discovered and brought to market since the 1980s, perhaps not surprising given the relatively small range of bacterial targets and the rapid rate of antimicrobial discovery during the ‘golden age’ from the mid 1940s onwards 4. Although there are some rays of hope, for example the recently reported new compound ‘teixobactin’ 5, the pipeline for new antimicrobials is practically dry. In other words, the solutions to AMR must come from within the medical, veterinary and animal industry sectors by addressing the underlying causes of, and changing the therapeutic approaches to, infectious disease. The political and scientific view that antimicrobials can no longer be regarded as the panacea or ‘magic bullet’ capable of eradicating infectious disease is widely accepted, and it is now clear that the human and animal health care sectors need to respond accordingly. A major challenge for the politicians is that there are still significant gaps in the surveillance data required to fully understand the drivers of AMR in both humans and animals 6, 7 and, critically, to measure the effects of interventional measures to reduce AMR. It is therefore not surprising that scientific opinion continues to be divided on practically every key question about AMR except that it is now a serious global problem causing significant economic loss with welfare, morbidity and mortality impacts in humans and animals. Antimicrobial resistance is a natural phenomenon: bacteria produce antimicrobial substances as part of their repertoire to compete in the struggle for colonisation, space and nutrients. Resistance therefore existed long before the introduction of antimicrobial drugs: the effect of using antimicrobials has been to accelerate AMR through classical selective pressure. That this has happened in both veterinary and human populations of bacteria is not disputed; the evidence for interconnection of AMR in these two populations is, however, inconclusive and is the subject of continuing political and scientific debate with contradictory evidence produced by both sides 8-10. It does appear that antimicrobial use in animals increases AMR in animal bacteria and that treating people with antimicrobials increases AMR in human bacteria. However, current scientific evidence does not allow definitive assessment of whether reducing antimicrobial use in animals has reduced AMR in medical pathogens. The extent to which AMR in populations of animal bacteria threatens public health therefore remains uncertain. The evidence for resistance in animal bacteria acting as genetic reservoirs of resistance for transfer to bacteria of public health importance is also inconclusive. Even for zoonotic bacteria such as Salmonella typhimurium DT104, the links between animal and human bacterial populations have become less clear with the application of sophisticated molecular typing bacterial methods and population genetics adding new complexity to the AMR debate 11. However, the lack of conclusive evidence notwithstanding, the prevailing political and regulatory opinion continues to be that antimicrobial use, and associated AMR, in animals is a driver of AMR in medical pathogens and that controlling veterinary prescription of antimicrobials will help safeguard public health. The ongoing political and public health scrutiny of veterinary use of antimicrobials is not surprising and the assumption that veterinary antimicrobial use contributes to, or is perhaps even directly the cause of, AMR in human medicine is understandable. The fact that the classes of antimicrobials used in veterinary and human medicine are the same 12; that food-borne and other zoonotic infections provide an opportunity for transfer of resistant bacteria from animals to humans; that populations of pathogenic and nonpathogenic animal bacteria may act as genetic reservoirs of resistance for important medical pathogens, with close contact between people and companion animals, in addition to food products, providing opportunity for genetic exchange; and, perhaps most importantly from a political perspective, that in many countries around the world the total quantity (gross weight) of antimicrobials used in veterinary medicine is greater than in human medicine 13, 14, has put antimicrobial use in animals at the centre of the public health AMR debate. When combined with the use of antimicrobials for disease prevention at herd or flock level and, in around half of the world's countries, for growth promotion, it is little wonder that antimicrobial use in animals has resulted in sustained political concern over the contribution that veterinarians and the animal sector in general may be making to the growing crisis of antimicrobial resistance in humans, with frequent calls for restriction or even banning of veterinary use of antimicrobials. Despite numerous political recommendations that coordinated, overarching surveillance of AMR is implemented at national and international level 15, 16 there are still relatively few examples of harmonised and integrated surveillance in humans and animals that allow comparison of data. Examples include The National Antimicrobial Resistance Monitoring System (NARMS) in the USA, Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) in Canada, Japanese Veterinary Antimicrobial Resistance Monitoring System (JVARM) in Japan and several European schemes including Danish Integrated Antimicrobial Resistance Monitoring and Research Programme (DANMAP) (Denmark), NORM-VET (Norway), Swedish Veterinary Antimicrobial Resistance Monitoring (SVARM) (Sweden) and NethMap/Monitoring of Antimicrobial Resistance and Antibiotic usage in Animals in the Netherlands (MARAN) (the Netherlands). At EU level, the European Food Safety Authority (EFSA) and the European Centre for Disease Prevention and Control (ECDC) monitor AMR in the food chain and food-borne zoonotic pathogens, but not in companion animals. In the absence of sufficient scientific evidence about AMR, in particular the key question of the impact of veterinary antimicrobial use on public health, politicians around the world have faced difficult decisions. In the absence of scientific certainty politicians have adopted the ‘precautionary principle’, allowing preventive action to be taken when there is a possibility of harm but where the scientific evidence is not sufficiently complete to allow full assessment. The result in Europe is a continuing European political focus on banning or restricting veterinary antimicrobial use, especially in the agricultural sector, and reducing the total quantities of antimicrobials used in animals. In the political and regulatory environment in the USA, the precautionary principle has been applied somewhat differently with less political appetite for banning or restricting antimicrobials 9. The first active political engagement with antimicrobial resistance occurred in 1968 in response to growing concerns over multidrug resistant Salmonella in humans and animals, with the establishment of an independent advisory committee by the UK Government chaired by Professor Michael Swann. The Swann Report 17, published in 1969, recommended restriction of the use of antimicrobials as growth promoters, which took 45 years to fully implement in Europe, and establishment of overarching monitoring of AMR in humans and animals, which has still not been implemented globally. Almost 50 years on, this report continues to set the political stage in relation to veterinary antimicrobial use and possible impacts on human health. We would do well not to lose sight of the lessons learned in the decades following its publication, specifically that sensible recommendations based on competent assessment of the available, even if incomplete, scientific evidence should not be sidelined pending collection of conclusive evidence; instead the two should progress in parallel with continuous monitoring and refinement as evidence is gathered. The global political thrust in relation to AMR in the human and animal health sectors continues to be that overuse of antimicrobials is the cause of the problem and that reducing their use is the solution. In Europe, most political effort since 1969 has been directed at the food animal sector through reducing the use of antimicrobials as growth promoters and, more recently, reducing total antimicrobial use. It was not until 2006 that a EU-wide ban on antimicrobial growth promoters was eventually implemented, completing a political process that had started four decades previously with the banning of tetracycline, penicillin and streptomycin for growth promotion in 1974, followed by complete bans of antimicrobial growth promoters in Sweden and Denmark in 1988 and 1994. Denmark also implemented restrictions on veterinary dispensing of antimicrobials; decoupling veterinary prescription of antimicrobials from supply remains on the European political agenda and, if implemented, would have significant impact on veterinary practice business models in many countries. Monitoring, and reducing, antimicrobial use has become a key global political driver. The European Medicines Agency monitors the sales of antimicrobial agents for food producing animals and horses across Europe 18 providing benchmarks against which political targets for reduction are set. In some countries governmental targets for reduction in the sales of veterinary antimicrobials have been agreed with stakeholders. For example, the Netherlands decreased sales of antimicrobials by 49% between 2010 and 2012 with further reduction targets agreed; antimicrobial sales in Scandinavia have been progressively reduced through a series of government–stakeholder agreed targets 18. Nevertheless, the estimated consumption of antimicrobials (corrected for estimated biomass) in animals continues to be greater than in humans across Europe as a whole 6. It is becoming increasingly clear, however, that the concept of overuse as the key driver of AMR may be overly simplistic 19. Antimicrobial resistance is a complex public and animal health issue and there is recognition that integrated strategies across all sectors, backed by political will, stakeholder buy-in and sufficient economic support, are required to control it 1. Although overprescribing of antimicrobials is undoubtedly an important factor, reducing their use in human medicine has not consistently resulted in reduction of resistance for key pathogen–antimicrobial combinations with examples of resistance remaining apparently stable or even increasing despite reduced antimicrobial use. The question of whether phasing out antimicrobials as growth promoters across Europe and the restrictions placed on therapeutic use of antimicrobials in Scandinavia, with associated reductions in quantities used, has resulted in a positive impact on human health continues to be the subject of scientific and political disagreement. Responsible, or ‘prudent’, use of antimicrobials has emerged as a parallel precautionary approach to the control of AMR. Initially, the political focus was on restricting veterinary use of antimicrobials used to treat multidrug resistant human pathogens presenting significant risk to public health. Since 2005 the World Health Organization has published lists of ‘critically important antimicrobials for human medicine’, ranked according their importance with the goal that their use should be restricted in all sectors to preserve their effectiveness 20. This approach has been extended by the World Organisation for Animal Health (OIE) with the publication of a list of antimicrobials of veterinary importance which contains recommendations for restricting the use in food animals of antimicrobials that are critically important for both human and animal health 21. This list includes fluoroquinolones and third- and fourth-generation cephalosporins and forms a rational basis for responsible guidelines worldwide. There are several examples of stakeholder groups at national and international level that have responded to the AMR challenge and shown leadership in producing responsible use guidelines. In the late 1990s the UK veterinary and farming sectors established the RUMA (responsible use of medicines in agriculture) alliance and in 2005 EPRUMA (European platform for responsible use of medicines in animals) was established. Stakeholder groups have now produced a variety of responsible use guidelines for antimicrobials in veterinary practice. Examples include general guidance to veterinary practitioners from the British Veterinary Association (BVA) and the Federation of Veterinarians in Europe (FVE), guidelines on antimicrobial use in companion animal practice from the Federation of European Companion Animal Veterinary Associations (FECAVA), the British Small Animal Veterinary Association (BSAVA), the American Veterinary Medical Association (AVMA) and in equine practice from the British Equine Veterinary Association (BEVA). Widespread adoption of responsible use guidelines in equine practice is an important goal, coupled with accurate recording of use (as, for example, already happens in Scandinavia), that will go some way to addressing political concerns about the prescription of critically important antimicrobials and cascade prescribing by veterinarians, including equine practitioners 22, 23. It is understandable, given the importance of food-borne zoonotic bacteria, that the political lens has thus far been focused mainly on the food animal sector. It is only recently that antimicrobial use in companion animals and horses has received political attention 7, 24 probably because comparatively small quantities (<10% of total quantities sold each year) of antimicrobials are used in these species 18 and because of a public health focus on food-borne pathogens. There are now recommendations that systematic international surveillance of AMR is established for companion animals and horses and a recognition that the close relationship between people and companion animals may provide new opportunities for transfer of resistance to human pathogens 7, 24. Antimicrobial resistance is now a highly important One Health issue with political impact squarely on companion animal and equine veterinary medicine; it is no longer a subject confined to the food animal sector. Antimicrobial resistance is, of course, also important for companion animal and equine health with multidrug resistant pathogens such as meticillin-resistant Staphylococcus aureus (MRSA) causing clinical disease in horses and with evidence of transfer of MRSA between humans and horses 25 and of carriage in horses 26. As would be expected, therapeutic treatment of horses with antimicrobials temporarily increases the prevalence of resistant sentinel Escherichia coli, including multidrug resistance and production of extended spectrum β-lactamases 27, acting as a reminder of the impact of ‘routine’ veterinary therapy on microbial populations. The message is clear that it is time to apply common sense and sound scientific principles to address AMR in equine practice. As a minimum, further surveillance in horses is required, along with universal adoption of responsible use guidelines 28. Irrespective of the scientific uncertainties, AMR is a true One Health issue that is relevant to the equine industry. Whatever the political dimensions of this debate it is essential that the equine veterinary profession and equine industry continue to engage actively with the AMR agenda, promote public and political confidence by demonstrating leadership through responsible use of antimicrobials and monitoring of AMR, and participate in evidence-based practice.

Antimicrobials play a vital role in treating infectious diseases in humans, animals, and plants, thereby supporting health, food safety, and food security. However, inappropriate use and overuse of antimicrobials across sectors contribute to the development and spread of antimicrobial resistance (AMR), particularly antibiotic resistance, which poses a growing threat to global public health. Resistant microorganisms can be transmitted between humans, animals, plants, food, and the environment, with significant implications for both human and animal health, food production, biodiversity, and economic stability. AMR causes around 35,000 deaths annually in the EU/EEA and significantly increases healthcare costs and productivity loss. While the EU promotes a One Health approach through the 2017 Action Plan and the 2023 Council Recommendation, surveillance remains largely sector-specific and fragmented. Strengthening integrated, cross-sectoral AMR surveillance holds significant potential. It enables timely evidence-based interventions that reflect the full scope of AMR's impact across human, animal, plant, and environmental health, thus effectively contributing to sustainable health and well-being. This workshop will explore the opportunities and challenges of developing integrated AMR surveillance across EU/EEA member countries. Based on a recent EU-commissioned feasibility study, it aims to support the countries in designing effective One Health surveillance systems for AMR and AMC by outlining key components, identifying barriers and enablers, and proposing practical solutions across sectors.Objectives1. Describe the key characteristics and objectives of an integrated AMR surveillance system; 2. Present core components for designing and implementing effective integrated surveillance systems for AMR and AMC at national level; 3. Explore barriers and enablers for cross-sectoral surveillance across human, animal, plant, food, wastewater, and environmental sectors; 4. Based on concrete examples, examine potential synergies and trade-offs in implementing integrated systems at national and EU levels; 5. Discuss and propose practical solutions to overcome challenges for implementing integrated One Health surveillance systems.Key messages• Supports EU/EEA countries in building integrated AMR/AMC surveillance to enable timely, One Health-informed interventions across human, animal, plant, and environmental sectors.• Advances cross-sector collaboration by identifying key components and solutions for sustainable, evidence-based AMR surveillance, improving public health and food system resilience.Speakers/PanellistsIvo ClaassenEuropean Medicines Agency, Amsterdam, NetherlandsMarie-Cécile PloyUniversité de Limoges et CHU de Limoges, Limoges, FranceAnn-Sofie HintzmannDanish Veterinary and Food Administration, Glostrup, DenmarkGunilla EklundEuropean Comission, Brussels, Belgium

The development of antimicrobial resistance (AMR) is linked to the imprudent use of antimicrobials and is fuelled by industrial farming, accounting for 70% of antimicrobial use. Tackling AMR requires a One Health approach that addresses the root causes of high antimicrobials use in intensive farming and generates co-benefits for human, animal and environmental health. On intensive farms animals are mostly of high-yield breeds and are exposed to stressors, which leads to immunosuppression, increasing susceptibility to infections that need antimicrobial therapy. To combat AMR the EU Commission adopted legislation prohibiting the use of antimicrobials to compensate for poor husbandry and management. However, there is a gap in policy regarding animal welfare improvements necessary to reduce the need for antimicrobials. We assess how the EU animal welfare legislation, under revision, can contribute to filling this gap by providing the regulatory framework for improvements needed to reduce antimicrobial use. Methods include literature review and expert interviews in an approach that integrates knowledge across the human-animal-environmental sectors. Improvements in husbandry and management (lower stocking density, outdoor access, genetic diversity, etc.) positively impact animal health and welfare, consequently reducing susceptibility to infections and antimicrobial use. By prescribing these improvements the revised animal welfare legislation can have a synergistic effect with the Veterinary Products Regulation, in line with the Farm to Fork strategy, and provide the regulatory framework for higher animal welfare standards that reduce antimicrobial use. The positive correlation between higher animal welfare and the reduced need for antimicrobials demonstrates the urgency of improving welfare in farming as a key strategy to limit AMR. It builds the case for an ambitious revision of the EU animal welfare legislation to protect animal and human health in line with One Health. Key messages • The revised EU animal welfare legislation can become a relevant policy in tackling AMR by providing the regulatory framework for high animal welfare standards neded to reduce antimicrobials in farming. • Tackling AMR requires a One Health approach addressing the root causes of high antimicrobial use in intensive farming: the poor welfare of animals, which increases their susceptibility to infections.

Antimicrobial resistance (AMR) and zoonotic diseases are global public health threats with serious implications for human, animal, and environmental health. In South Africa, AMR and zoonotic disease outbreaks pose significant threats to public health and food security. Despite a robust AMR surveillance system for human health, the absence of a national routine surveillance program for livestock hinders a comprehensive One Health (OH) approach. The 2024 UK-South Africa workshop in Cape Town convened key stakeholders from human and animal health, environmental sciences, and food production to address these challenges. Discussions focused on integrating OH surveillance, leveraging Next-Generation Sequencing (NGS) for early outbreak detection, and improving food and water safety. Workshop outcomes emphasized the necessity of cross-sector collaboration to enhance AMR monitoring and outbreak preparedness. Stakeholder engagement, particularly within agricultural communities, was identified as critical for OH implementation. Participants highlighted the need for culturally sensitive engagement strategies, qualitative research methods, and policy reforms to drive adoption. Lessons from tuberculosis (TB) and HIV programs informed strategies for fostering compliance and integrating OH principles into veterinary education, particularly in antimicrobial stewardship. Challenges such as resource limitations, bioinformatics capacity gaps, and resistance to new technologies were addressed through recommendations for joint consortia, leveraging existing infrastructure, and targeted training. Aligning OH initiatives with consumer-driven concerns, such as water quality monitoring, was also identified as a key opportunity. Moving forward, translating research into action will require sustained collaboration, policy alignment, and community engagement. Strengthening OH surveillance can enhance South Africa's ability to prevent and control infectious diseases, ensuring long-term public health resilience and food security.

Antimicrobial resistance (AMR) is one of the greatest threats to public health, and it is spreading across the human health, animal health, and environmental sectors. Sole reliance on desk reviews and national-level stakeholder engagement carries a risk of overestimating the country’s health security and AMR capacity. For a genuine evaluation, engaging frontline and last-mile implementers such as health care facilities and workers, farmers, and district local governments ensures a more accurate assessment of existing capabilities and implementation progress. Uganda utilized a bottom-up approach to assess the implementation status of the National Action Plan on AMR (NAP-AMR) to ensure the engagement of key stakeholders at the subnational level, who are often overlooked in NAP-AMR evaluation initiatives. This review revealed poor engagement of subnational stakeholders in the development, validation, dissemination, and implementation of the NAP-AMR as well as various issues at the national level—including gaps in government One Health policy, insufficient funding, and ineffective coordination—that resulted in the inadequate implementation of the NAP-AMR. Addressing these challenges should involve establishing a One Health policy and identifying sustainable funding sources for AMR activities. We recommend the legislation of dedicated policy to formally incorporate the National One Health Platform into government structures at the national and subnational levels. In our experience, a bottom-up approach to evaluating NAP-AMR implementation enhances the effectiveness of the review process and could be utilized by the WHO during the joint external evaluation of health security capacity.

&lt;p&gt;This paper describes the overall achievements of the Animal Health and Welfare (AHAW) Panel of EFSA and its support unit since 2003. The AHAW Panel deals with animal health and animal welfare issues, primarily related to food-producing animals, at the human–animal–environment interface. Scientific opinions adopted by the AHAW Panel are comprehensive scientific reviews and risk assessments and provide the scientific grounds for the identification of control options, most of them being reflected in European Union legislation on animal health and welfare. Between 2004 and 2012, the AHAW Panel delivered 47 scientific opinions related to animal health and 38 scientific opinions on animal welfare on a wide variety of issues. The welfare of animals is a matter of much public concern and has an overall impact on the condition of the animals, with consequences for productivity, disease and food safety. A major achievement of the AHAW Panel has been to establish a unique multidisciplinary capacity, combining expertise in addressing animal health and welfare issues. The AHAW Panel has also demonstrated its capacity to respond rapidly to urgent requests, thus becoming a prominent partner of risk managers in response to crises. Over time, the AHAW Panel has become internationally recognised as a leader in risk assessment in the field of animal health and welfare, based on EFSA core values of scientific excellence, independence and transparency. The development of robust methodological frameworks for the assessment of risks related to animal health and welfare is a continuing process for the AHAW Panel. Over the past ten years, EFSA has achieved greater participation from the scientific community, stakeholders and interested parties, and fostered cooperation with relevant organisations in the EU Member States in the area of animal health and welfare. The AHAW Panel has demonstrated that evaluating health and welfare and assessing risk in animal populations serves to protect public health, the environment and the economic benefit we derive from animals.&lt;/p&gt;

This article calls into question how different the parallel ontologies of meat are in terms of the realities they enact. It argues that while biofabricated animal material is expected to transform the production and consumption of meat, the material’s ontologies reinforce existing interrelationships between the dominant meat culture and the law. Additionally, the expectations surrounding biofabricated animal material vests the material with transformative power, even though it does not challenge the structural factors, namely law and culture, which underlie the exploitation and commodification of animals. I begin by delineating the co-constituting relationship between law, the realities of meat production and consumption, and meat culture. I then unpack the interface between different ontologies of meat and consider why the contest has taken place in legal terrains. From here, I consider the key expectations that have assigned transformative power to biofabricated animal material. I suggest that these expectations work to reinforce existing meat culture, and the configurations of power that benefit from it, as supported via legal instruments.

The world’s large and growing appetite for meat and other animal products has profound implications for One Health, given its impacts on human health, the environment and animal health and welfare. Accordingly, there is robust evidence that a reduction of animal product consumption is urgently needed in regions where these consumption levels are currently high. A shift away from industrial animal production should be prioritized, given the high levels of animal product consumption this kind of system enables, its relatively high environmental toll, linkages to increasing risks of antimicrobial resistance and zoonoses emergence and harm to animal welfare. Until recently, however, few governments addressed the issue. On the contrary, many governments actively support industrial animal agriculture through subsidies and other measures. Now, motivated by both environmental and public health concerns, policy makers in several countries are adopting regulatory and financial measures to address the overconsumption of animal products. Although these changes are clearly necessary and long overdue, it is crucial that they are planned carefully and inclusively to ensure a just transition. In lower-resourced and food-insecure settings, meat and other animal products can be a vital source of nutrients – particularly during infancy and childhood. In addition, meat supply chains support many livelihoods, and meat is an important part of many people’s social and cultural traditions. This means that policies that curtail common production practices, reduce meat output and raise meat prices could have significant impacts across society. A just transition approach can help ensure that the costs and benefits of the transition are more equitably distributed and protect the most vulnerable stakeholders. By doing so, it can also help increase public support for the transition. The concept of just transitions is well established in the energy sector but is only starting to be recognized in the context of the food system. Governments in the Global North should take the lead in this area, given these countries have very high levels of animal product consumption and more resources available to support a transition. In this Policy Forum, we lay out the case for a just transition in animal agriculture and identify five principles to guide policy makers in promoting a just transition away from systems of industrial meat production and overconsumption. One Health impact statement Drawing on expertise from health, climate, biodiversity and animal welfare policy and science across several regions, this Policy Forum demonstrates how current levels of animal product production and consumption threaten One Health. Although a transition to a healthier, more sustainable and more compassionate food system is clearly needed, such a transition will necessarily involve both costs and benefits for affected stakeholders. Identifying lessons from international and national climate policy, and energy policy in particular, the authors highlight the value of an approach that is holistic and centred on just transition principles to support a transition away from large-scale animal product production and consumption that is in line with the One Health approach, with an emphasis on transitioning away from the consumption and production of industrially-produced meat. This Policy Forum is relevant to policy makers, companies and civil society seeking to promote a shift towards food systems that emphasize public and planetary health.

Antimicrobial resistance (AMR) is a major threat to global public health, affecting human and animal health, agriculture, food safety, and the environment. The control of AMR is often challenging, particularly when data are scanty or siloed in individual sectors. To develop evidence-based control policies for AMR, an electronic information system that integrates AMR data from various sectors, in a One Health approach, is critical. Acknowledging the interconnectedness of AMR in humans, animals, and the environment and the need to assess the AMR burden using a One Health approach, Kenya's National Antimicrobial Stewardship Interagency Committee (NASIC), with support from FIND, integrated human and animal health AMR data at the national AMR data repository and developed the One Health AMR Surveillance System (OHAMRS). The OHAMRS comprises two core digital components: interoperability middleware for integrating data from various sources and a DHIS2 web portal for the analysis and visualization of AMR surveillance data from the human and animal health sectors. These components are scalable for future inclusion of data from other One Health sectors, e.g., the environment, food/feed, and aquaculture sectors. The OHAMRS has 42 dashboards that facilitate the presentation, interpretation, and dissemination of actionable information relating to AMR, including 17 dashboards for human and animal health priority pathogens and 8 for drug-resistance indicators. The priority pathogen dashboards provide visualization of antimicrobial susceptibility patterns, resistance and susceptibility trends, resistance tables, and geospatial susceptibility maps. Other dashboards include surveillance sites and specimen reports, data completeness, data reconciliation, sample testing workload, a One Health intersectoral dashboard, and other reporting tools for diverse stakeholders. Digitalizing AMR surveillance through a One Health lens is pivotal to understand AMR prevalence and patterns across various sectors. The OHAMRS provides comprehensive data analysis and presentation, informing policymaking on AMR control. Digital tools such as the OHAMRS are vital in facilitating the availability of data and actionable information on AMR required to address the AMR crisis in Kenya.

Simple SummaryFood safety and quality are the main demands of consumers. Moreover, clear, truthful, and direct information about food, based on science, is essential to build trust among consumers and advance food safety. Traditionally, the role of the slaughterhouse is guaranteeing the safety of meat from the perspective of animal pathology and disease. However, it can be used for monitoring other aspects that influence not only the animal health (One Health), but also the food safety and public health. The present review discusses the role of the slaughterhouse to guarantee the food safety and monitor aspects, such as animal welfare, antimicrobial resistance, or prevalence of foodborne and zoonotic diseases.From the point of public health, the objective of the slaughterhouse is to guarantee the safety of meat in which meat inspection represent an essential tool to control animal diseases and guarantee the public health. The slaughterhouse can be used as surveillance center for livestock diseases. However, other aspects related with animal and human health, such as epidemiology and disease control in primary production, control of animal welfare on the farm, surveillance of zoonotic agents responsible for food poisoning, as well as surveillance and control of antimicrobial resistance, can be monitored. These controls should not be seen as a last defensive barrier but rather as a complement to the controls carried out on the farm. Regarding the control of diseases in livestock, scientific research is scarce and outdated, not taking advantage of the potential for disease control. Animal welfare in primary production and during transport can be monitored throughout ante-mortem and post-mortem inspection at the slaughterhouse, providing valuable individual data on animal welfare. Surveillance and research regarding antimicrobial resistance (AMR) at slaughterhouses is scarce, mainly in cattle, sheep, and goats. However, most of the zoonotic pathogens are sensitive to the antibiotics studied. Moreover, the prevalence at the slaughterhouse of zoonotic and foodborne agents seems to be low, but a lack of harmonization in terms of control and communication may lead to underestimate its real prevalence.

Global resistance to antimicrobials and their sustainable use in agriculture

Rising levels of antimicrobial resistance (AMR) in both humans and animals have reached alarming levels and are being recognized as a serious incremental threat to global food security, animal health and public health. The One Health approach recognizes the interconnectedness of human, animal and environmental health, and that AMR can be spread between different species and environments. The Fleming Fund, a UK Overseas Development Aid program managed by the UK’s Department of Health and Social Care, aims to improve AMR and antimicrobial use (AMU) surveillance data in Africa and Asia by generating, sharing, and using data to improve antimicrobial use and encourage investment in AMR research and development. The Fund awarded grants to several countries, including Kenya, to support national efforts in strengthening their capacity to collect, manage and use data on antimicrobial use and resistance. Six institutions, including the International Livestock Research Institute, University of Nairobi, the Aga Khan University, the Kenya Medical Research Institute, PATH and Washington State University, formed the Fleming Fund consortium in Kenya. Across animal and human health sectors, this consortium supported activities that address the gaps in the surveillance of AMR and its causes including antimicrobial stewardship training, development and dissemination of standard operating procedures for both active and passive AMR surveillance, capacity building of field and laboratory personnel and infrastructure work among other activities. The wide range of data acquired through this program will impact evidence-based policies and programs, enabling consumers and stakeholders to make informed decisions that preserve the effectiveness of antibiotics. Information © The Authors 2024

The application of a One Health approach recognizes that human health, animal health, plant health and ecosystem health are intrinsically connected. Tackling complex challenges associated with foodborne zoonoses, antimicrobial resistance, and emerging threats is imperative. Therefore, the One Health European Joint Programme was established within the European Union research programme Horizon 2020. The One Health European Joint Programme activities were based on the development and harmonization of a One Health science-based framework in the European Union (EU) and involved public health, animal health and food safety institutes from almost all EU Member States, the UK and Norway, thus strengthening the cooperation between public, medical and veterinary organizations in Europe. Activities including 24 joint research projects, 6 joint integrative projects and 17 PhD projects, and a multicountry simulation exercise facilitated harmonization of laboratory methods and surveillance, and improved tools for risk assessment. The provision of sustainable solutions is integral to a One Health approach. To ensure the legacy of the work of the One Health European Joint Programme, focus was on strategic communication and dissemination of the outputs and engagement of stakeholders at the national, European and international levels.