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 July - December 2020 The following newsletter provides access and overview of the communication content of the CGIAR AMR hub led by ILRI that has been developed with our scientific partners for this quarter The following blog posts have been developed:  Experts call for global One Health platform to consolidate evidence action to tackle antimicrobial resistance. - ILRI, World Fish CGIAR AMR Hub strengthens partnerships and research to reduce agriculture-associated antimicrobial resistance in low- and middle-income countries –  ILRI The British Poultry Council report reduction in antibiotic use.  - Europe News Global Agenda for Sustainable Livestock: Antimicrobials in livestock from scrutiny to action in low-income countries. - ILRI, SLU, World Bank Watch a video: Watch Online event discussing AMR:Moving from National Action Plans to National Action, featuring Arshnee Moodley (CGIAR AMR Hub), Ambassador Lone Wisborg(Danish Ambassador to the United States, Embassy of Denmark), Mirfin Mpundu (Director, ReAct Africa).    Something to share with your partners:  Share the brochure on Antimicrobial Susceptibility Testing Facility at the CGIAR AMR Hub Review research highlights under the five pillars: AM use Transmission dynamics Interventions Policy Capacity For more information contact me or amrhub@cgiar.org   

CGIAR AMR Hub launch event in Febraury 2019 (photo credit: ILRI/Paul Karaimu) Written by Ekta Patel The CGIAR Antimicrobial Resistance Hub, which is hosted and led by the International Livestock Research Institute (ILRI) is working the International Food Policy Research Institute (IFPRI), World Fish and the International Water Management Institute (IWMI) to address agricultural-associated antimicrobial resistance (AMR) in low- and middle-income countries (LMICs).  The research is largely supported by the CGIAR Research Program (CPR) on Agriculture for Nutrition and Health (A4NH) as well as Livestock and Fish CRPs.   AMR has been described as a silent pandemic that affects everyone. But its burden is disproportionately higher in LMICs due to the many challenges people face in these countries such as lack of access to healthcare, clean water, sanitation, and higher disease burden. Several LMICs have developed national action plans to address AMR but their implementation remains a challenge because of lack of resources and the absence of a comprehensive multisectoral approach, which is needed to reduce the burden of AMR in both humans and animals.   ‘The CGIAR AMR Hub is a unique platform as it works with various strategic partners who have expertise in many different areas,’ says Arshnee Moodley, team lead of the CGIAR AMR Hub. ‘For example, ILRI’s entry point in tackling AMR is through livestock and associated environmental systems, whereas World Fish’s focus is on aquaculture in LMICs. IWMI’s expertise is well suited to address AMR in irrigated and or wastewater systems.’ Moodley adds that a global collaborative effort is needed to address the multifaceted factors that contribute to the development of AMR.’ John McDermott, A4NH program director, notes that AMR is an urgent and complex issue  and its mitigation requires cross-sector cooperation. ‘Integrated agriculture and health actions are critical in addressing the problem and the CGIAR is well placed to contribute,’ he says. At ILRI, several AMR research activities are underway. These include investigating drivers for antimicrobial use among livestock farmers, assessing transmission of AMR at human-animal interfaces, and carrying out interventions to reduce antimicrobial by using non-antibiotic alternatives such as phage therapy to control bacterial populations in poultry farms in Kenya. Earlier this year, despite the disruptions caused by the COVID-19 pandemic, ILRI, under the CGIAR AMR Hub, was selected by the Fleming Fund to lead AMR projects across the globe. For example, in Zambia and Bangladesh, Fleming Fund fellows, who have been paired with scientists from ILRI and World Fish, are developing and improving their skills in AMR and antimicrobial use diagnostics and surveillance. While these projects are currently run virtually with online meetings and training sessions, the teams expect to commence robust activities in 2021. World Fish has been working on addressing AMR in Bangladesh’s aquaculture. In Asia and many other parts of the world, aquaculture is a major food producing industry with high levels of antimicrobials use, posing a risk for AMR selection and dissemination. Led by the University of Exeter, World Fish is supporting campaigns to raise awareness of AMR in rural aquaculture practices in Bangladesh through digital communications.   Elsewhere, the ReWater MENA project, which is led by IWMI, is expanding the safe reuse of water in the Middle East and North Africa (MENA) region with specific activities in Egypt, Jordan and Lebanon. In Jordan, supported by the Royal Scientific Society, the Ministry of Water and Irrigation is collecting baseline data and analysing the long-term risks of reusing treated wastewater in the north Jordan Valley with a specific emphasis on antibiotic resistance genes and antibiotic residues in agricultural chains.   Javier Mateo-Sagasta, senior scientist at IWMI and project leader of the ReWater MENA project anticipates ‘the data from this study will provide a platform to understand risks associated with reusing treated wastewater in other countries and potentially provide information on transmission of resistant genes in other LMICs with similar irrigated systems.’  He says IWMI is also working to understand better the sources, transport and fate of antibiotics, antibiotic-resistant bacteria and resistance genes in aquatic environments. ‘We want to identify research priorities for modelling and system analysis, with the longer-term goal of developing a modelling framework to assess risks (to human, aquaculture, livestock, agriculture and ecosystem health) and test “what if” scenarios to support decision-making.’ At IFPRI, Devesh Roy, a senior researcher at A4NH, is conducting a macro-level analysis in India to understand the availability of veterinary-specific antibiotics using trade and industrial data, in partnership with Food Safety and Standards Authority of India. Simultaneously, a sister project led by ILRI is assessing antibiotic use at the farm level in the country. The World Antimicrobial Awareness Week (WAAW), which is commemorated annually between 18-24 November 2020, aims to increase awareness of AMR and encourage best practices among all sectors including the general public to reduce irrational antimicrobial use and halt the further emergence of antimicrobial-resistant infections. Learn more about the CGIAR AMR Hub projects

The following newsletter provides access and overview of the communication content of the CGIAR AMR hub led by ILRI that has been developed with our scientific partners for this quarter The following blog posts have been developed:  Addressing antibiotic resistance in the Jordan Valley - IWMI The straw that might break the camel’s back: exploring the link between COVID-19 and antibiotic resistance in low- and middle-income countries - ILRI European Medicines Agency ranks animal antibiotics and appropriate ways to use them to protect public health - Europe News Increasing antimicrobial resistance awareness through community conversations - Ethiopia Digital communications used to raise awareness of AMR in Bangladesh’s aquaculture practices. - World Fish Quick Q&A with the newly appointed head of the CGIAR AMR Hub - ILRI Watch a video: Watch a five minute video made by Haiya TV as a series covering  Antibiotic Resistance: The next public health disaster featuring Arshnee Moodley (CGIAR AMR Hub), Dr. David Silverstein, Prof. Gunturu Revathi (Aga Khan University Hospital),Dr Victor Yamo (World Animal Protection) Media Highlights: The Petri Dish, Fleming Fund discusses the CGIAR AMR Hub, Issue 15 Something to share with your partners:  Share the brochure on Antimicrobial Susceptibility Testing Facility at the CGIAR AMR Hub Review research highlights under the five pillars: AM use Transmission dynamics Interventions Policy Capacity In other news With the support of the CGIAR AMR-Hub:  Mahesh Jampani has joined IWMI as a researcher on water quality modelling (AMR). He will be investigating the sources, loads, transport and fate of antimicrobial compounds, resistant bacteria, and antimicrobial resistant genes in water systems. AMR Hub communications looks forward to catching up with him on a Q&A on his project.  Lilian Wambua, FLAIR fellow joins ILRI where her project focuses on developing diagnostics from shortcomings caused by infections caused by AMR.  Dishon Muloi, Postdoctoral Fellow also joins ILRI to implement the Fleming Fund country grant for Kenya focusing on strengthening One Health surveillance for AMR. CGIAR AMR Hub supported activities with World Fish and University of Exeter to raise awareness of antimicrobial resistance in rural aquaculture practice in Bangladesh through digital communications: a pilot study. Read more here   For more information contact me or amrhub@cgiar.org                                                              

Written by Arshnee Moodley and Ekta Patel  Testing for antimicrobial resistance (photo credit: Will Crowne/ DFID). With over two million people infected with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and almost half of the world’s population under lockdown, the effects of the coronavirus disease (COVID-19), which is caused by  SARS-CoV-2, on our global community have been immediate and profound. Many countries are scrambling to source crucial medical supplies, hospitals are battling to cope with the high admissions of thousands of patients and critical healthcare systems are stretched beyond their capacities. This pandemic has called on all governments, international organizations, the private sector and the public to play a role in its containment. While the number of COVID-19 infections in Africa does not rival those seen in Europe or America, they are gradually increasing and so is the fear of the impact this infection may have on the continent’s low- and middle-income countries (LMICs). According to the World Bank, nearly 645 million people live in the rural areas in sub-Saharan Africa. Three quarters of this population lack the facilities at home to wash their hands with soap and water, which is one of the key measures of preventing infection and spread of SARS-CoV-2.  Moreover, many people in LMICs are already battling malnutrition and other endemic infectious diseases, which raises the question of how they will cope with the COVID-19 pandemic. The delayed arrival of COVID-19 on the African continent gave governments in these countries an opportunity to start implementing preventative measures to reduce community infections when just a few cases were detected. In Kenya, for example, after the first confirmed case of COVID-19 was reported on 13 March 2020, the government responded by implementing quick preventative measures to reduce transmission. People were advised to work from home, schools and universities were closed, international travel was prohibited, county borders were closed to restrict movement, public transport restrictions were implemented, and the government began advocating for frequent handwashing and physical distancing. In countries like Uganda and South Africa, strict lockdowns have been implemented with people instructed to stay at home, leaving to purchase only essential items or seek medical care. Nearly 33 of the 54 countries in Africa have some form of regional or national lockdown. Viral respiratory infections like those caused by SARS-CoV-2 can be complicated by secondary bacterial infections – an additional infection in individuals who already have another infection. These secondary infections are important and often fatal complication. The virus weakens the immune system making it easier for a bacterial superinfection. In the 1918 and 2009 influenza pandemics, more than 50% of deaths could be attributed to secondary bacterial pneumonia highlighting the risks associated with bacterial secondary infections. SARS-CoV-2 is no exception. A retrospective study published in The Lancet about the outbreak in Wuhan, China, noted that of the patients who died from COVID-19, approximately 50% had a secondary bacterial infection. While all patients were prophylactically treated with antibiotics, it remains unclear if death was attributed to ineffective antibiotic treatment due to antibiotic resistance or the poor condition of the patients too weak to fight the infections. Researchers globally are currently exploring the links between COVID-19 and AMR, but it is unlikely that the exact role of antibiotic resistance will ever be known for COVID-19. This is due to the overwhelming mortality rate per day; in some countries hundreds of people die daily and coupled with the lack of post-mortem examinations, the exact cause of death will not be known. Antibiotics play a pivotal role in a pandemic both as prophylaxis – to prevent bacterial infections – as well as pre-emptive treatment of secondary bacterial infections, which can be difficult to distinguish between viral pneumonia and bacterial pneumonia. This use of prophylactic or pre-emptive use of antibiotics in hospitalized patients will select for antibiotic resistance in the long-term negating any short-term benefits, moreover, underscoring the need for effective antimicrobial stewardship.  To determine which antibiotics would be effective as first line or empiric treatment choices in the absence of a laboratory diagnosis, requires country- or regional-specific knowledge on antibiotic resistance trends in key bacterial respiratory pathogens, which is achieved by annual collection of antibiotic resistance surveillance data. According to the World Health Organization (WHO) 2018/2019 survey on global monitoring of countries progress on addressing AMR, no country in sub-Saharan Africa noted having a functional national surveillance system for AMR in humans covering common bacterial infections in hospitalized and community patients, making it very difficult to develop effective treatment guidelines. WHO lists antibiotic resistance as one of the ten greatest human health threats and the review on antimicrobial resistance by Jim O’Neill indicates 700,000 people die annually as a result of an antibiotic resistant infections with the most affected in LMICs. This clear geographic distinction is also reflected in the distribution of antibiotic resistance genes identified through a surveillance of urban sewage systems. Countries in Asia, Africa, and South America having higher levels than countries in Europe and North America. Antibiotic resistant bacteria can be found in people, animals, food and the environment and know no boundaries. This public health and agricultural sector challenge also affects human development as it is intimately linked to inefficient disease control, poor animal husbandry, inadequate sanitation, inappropriate food handling and socio-economic growth. These factors inadvertently affect LMICs and their attainment of the UN Sustainable Development Goals. Launched in 2019, the CGIAR Antimicrobial Resistance Hub, which is led by the International Livestock Research Institute (ILRI), is focused on mitigating agricultural associated AMR risks using a One Health framework with transdisciplinary partnerships, to promote sustainable agriculture and improving human health in LMICs. The emergence and rapid spread of COVID-19 highlights the importance of diagnostic testing, which is also important for antibiotic resistance and successful treatment outcomes. The Antimicrobial Susceptibility Testing (AST) facility at the CGIAR AMR Hub, in partnership with the International Centre for Antimicrobial Resistance Solutions (ICARS) in Denmark and the European Committee on Antimicrobial Susceptibility Testing Development Lab (EUCAST EDL) in Sweden, is focused on providing robust AST testing and enhancing capacity development in LMICs. In addition, ILRI is leading the animal component of the Fleming Fund Kenya country grant and together with national partners has established a sustainable national AMR surveillance system. For more information on CGIAR AMR Hub visit the website follow us on twitter here