Enhancing One Health surveillance in Asia

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The AMROH-SEA project is a Fleming Fund Regional Grant led by the Asia-Pacific Centre for Animal Health, based at the University of Melbourne in Australia. This is part of the new AMROH (AMR One Health) series of four grants initiated in phase 2 of the Fleming Fund to support the development of national surveillance systems across the regions the programme operates in.

The AMROH grants promote a One Health approach to AMR and AMU surveillance in human and animal health, food safety, and the environment to improve each sector’s participation and engagement in integrated AMR surveillance. This involves collaborating with clinicians and professionals to improve the use of laboratory services and data to support antimicrobial stewardship (AMS) and the rational use of antibiotics in the veterinary workforce and agriculture and aquaculture sectors.

AMROH-SEA

Partnering with Fleming Fund Country Grantees in Indonesia, Timor-Leste, Papua New Guinea, Vietnam, and Laos, the AMROH-SEA grant provides technical assistance in AMR and antimicrobial use (AMU) surveillance for animals, aquaculture, and the environment. It also covers AMS and practitioner engagement in animal health and supports using surveillance data to influence policy and practice from a One Health perspective.

For example, in addition to providing training, the regional and country grant teams and relevant stakeholders in Timor-Leste and Indonesia co-develop AMR treatment guidelines and protocols and conduct AMR surveillance. Similarly, in Vietnam, they support an active AMR surveillance plan on pigs and chickens on a national and regional level. These collaborations involve the relevant stakeholders of the respective countries.

Hosted by the Asia-Pacific Centre for Animal Health, the AMROH-SEA project recently held a regional workshop in Bali, Indonesia, to address the critical need for enhanced AMU and AMR surveillance in Southeast Asia - focused on data integration from the human, animal, and environmental health sectors.

With over thirty participants from the Fleming Fund-supported country grant teams and respective government agencies in Vietnam, Laos, Indonesia, Timor-Leste, and Papua New Guinea, the workshop targeted One Health sectors.

They took part in training for AMR and AMU surveillance design, evaluation and reporting, genomic data use in decision-making, and spatial epidemiology which uses data mapping to describe and understand the geographical variation in AMR. The workshop highlighted the importance of supporting clinical veterinary microbiology to improve animal health capacity and enable appropriate AMU in the region, providing significant opportunities for strengthening cross-sectoral and international networking.

Results from pre- and post-workshop participant surveys marked a significant increase in their confidence in designing a surveillance programme fit for purpose:

It was also emphasised the need for more training opportunities like this in their countries.

AMROH-SEA is planning a second regional workshop in 2025, to support the development of antimicrobial treatment guidelines and antimicrobial stewardship strategies and will create a One Health Community of Practice around AMU in the region.

AMROH-SA

The Fleming Fund AMROH grant in South Asia (AMROH-SA), led by [Massey University[(https://www.massey.ac.nz/) in New Zealand, is increasing One Health collaboration between the human, animal, and environment sectors. Providing technical assistance to Bhutan, Nepal, and Bangladesh to develop a strategy and protocol for initiating AMR surveillance in the environment, this is the first time such activities have been undertaken in these countries as an expansion of the Fleming Fund programme in phase 2.

For example, AMR surveillance in Bhutan is led by the Royal Centre for Disease Control at the Ministry of Health, which is working on a nationwide drinking water quality surveillance system, incorporating monitoring of Extended-spectrum-beta-lactamases (ESBL)-producing E coli. In Bangladesh, a laboratory at the Institute of Public Health is being improved with microbiology facilities to carry out testing for environmental AMR surveillance - analysing bacteria, E coli, Salmonella (non-typhoidal), and vibrio in river water, hospital, and communal wastewater, with the opportunity to utilise wastewater samples collected for polio surveillance.

In Nepal, AMR environment surveillance is led by the Nepalese government, conducting microbiological testing of river water to establish an environmental AMR system, with a new laboratory to build this capability. The lead microbiologists’ expertise will be strengthened through the Fleming Fund Fellowship Scheme, with Host Institution, Melbourne University – focusing on ESBL-E coli in river water and sewage samples as a part of the integrated surveillance Tricycle programme.