'One Health' collaboration to combat antimicrobial resistance: surveillance and regulation

摘要

Antimicrobial resistance (AMR) is a global threat to human health. It challenges the effective control of infectious diseases, jeopardises progress on health outcomes by increasing morbidity, hospitalisation and mortality and imposes huge costs on societies. Antimicrobial resistance also has a strong impact on animal health and welfare. Addressing the rising threat of AMR requires a holistic and multisectoral 'One Health' approach as promoted by FAO, the OIE and WHO under the Tripartite' agreement. Both FAO and the OIE have actively participated in the development by WHO of a Global Action Plan for AMR. The Global Action Plan (GAP) recognised that the main impact of antimicrobial resistance is on human health; however, the contributing factors and consequences, including economic and others, go beyond the health sector. The GAP emphasised the need for a coherent, comprehensive and integrated approach, using a 'One Health and beyond' perspective to involve different actors and sectors such as humanand veterinary medicine, agriculture, finance, environment and consumers. Further, a resolution adopted by the 68th World Health Assembly in 2015 requested the Director General of WHO to strengthen the collaboration between FAO, the OIE and WHO for combating AMR in the spirit of this 'One Health' approach. The Tripartite provides an important platform for collaborative activities on AMR at the global level across the human health, animal health and agriculture sectors. A Tripartite AMR work plan defining short-, medium- and long-term actions has been agreed on by the three organisations. The following issues and challenges should be addressed for containment of AMR using the 'One Health' approach:- need for the implementation of harmonised protocols and methodologies to monitor AMR and antimicrobial use according to international standards;- limited AMR surveillance data and data regarding the use of antimicrobial agents in both human and animal sectors, to support AMR risk analysis and to determine the effectiveness of AMR mitigation strategies;- lack of technical capacity, in particular in developing countries, to undertake monitoring and surveillance of AMR and antimicrobial use, and to conduct AMR risk analysis;- lack of new drugs and the need to support research and development; lack of legislation to ensure access to quality drugs and appropriately restrict their use;- need for good governance and good regulatory frameworks in all sectors regarding the authorisation and use of antimicrobials in both animal and human sectors; and- in conclusion, the 'One Health' approach is the most efficient and effective way to understand AMR threats and mitigate AMR risks at key intervention points at the human-animal-ecosystem interface and along the food chain. The WHO, in collaboration with FAO and the OIE, initiated programmes to strengthen WHO Member States' capacity for the containment of AMR through integrated surveillance, using a multisectoral approach aligned with the 'One Health' concept.