Zambia's Integrated Antimicrobial Resistance Surveillance Framework, January 2020



Antimicrobial resistance (AMR), particularly antibiotic resistance, is recognized as a global public health threat, causing grave health problems and putting a severe economic burden on people and nations. AMR can also negatively impact food safety, nutrition security, livelihood and the attainment of Sustainable Development Goals (SDGs). Antibiotic use and misuse in humans, animals—particularly in the foodanimal sector—and crops are known causes of rising AMR. Now, the environment is also recognized to play a key role in the emergence and spread of AMR. A growing concern is the waste from factories, healthcare settings, farms and community settings, which could contain antibiotics, resistant bacteria or genes that confer resistance to antibiotics. AMR is a ‘One Health’ issue that needs to be addressed through improved policy and practice across diverse sectors including human-health, animal and crop production, and environment.
The tripartite of the World Health Organization (WHO), Food and Agriculture Organization of the United Nations (FAO) and World Organisation for Animal Health (OIE) has been working towards AMR containment.1,2&3 Recently, the United Nations Environment Programme (UNEP) has also been roped in to address the environmental aspects of AMR.

Integrated and multi-sectoral surveillance of AMR is vital to gather evidence for necessary action.4 But there is limited laboratory capacity and understanding to integrate surveillance in different sectors. Globally, many reports provide insight into different aspects of surveillance—WHO’s Global Antimicrobial Resistance Surveillance System (GLASS), Guidance on Integrated Surveillance of Antimicrobial Resistance in Food-borne Bacteria5 and Report on Surveillance of Antibiotic Consumption;6 OIE’s survey on use of antimicrobial agents in animals in 2018,7 and Chapters in the Terrestrial Animal Health Code on AMR.8 However, there is limited reflection through one guiding report on surveillance across all relevant sectors, which includes environmental AMR surveillance in particular.

Over the last few years, many countries have also developed plans for multi-sectoral AMR surveillance in their National Action Plans (NAPs). So far, the focus has been on surveillance in human-health sector while some countries are planning to conduct routine AMR surveillance in animal sectors. A few countries are also focusing on environmental AMR. Developed countries such as Canada, Denmark, England, Japan, Netherlands, Sweden and the United States already have surveillance programmes in the food-animal sector. AMR data in the environment sector relies heavily on research studies. The implementation of surveillance programmes in lowand middle-income countries (LMICs) is particularly challenging due to constraints in resources and capacities, competing priorities, and limited focus on waste and environment. Such countries would, therefore, need more assistance. On the positive side, global understanding on the need for enhanced AMR surveillance is evolving and opportunities of cross learning between nations are increasing.

The Zambia National Public Health Institute (ZNPHI) and the Centre for Science and Environment (CSE), as part of an existing collaboration to support implementation of Zambia’s NAP-AMR9, jointly organized a three-day workshop on Integrated Surveillance Framework for Antimicrobial Resistance in March 2019 in Lusaka, Zambia. Experts referred to the existing Zambia National Integrated Antimicrobial Resistance Surveillance Strategy (NIAMRSS) developed by the Zambian Antimicrobial Resistance Coordinating Committee (AMRCC), and deliberated on the development of an integrated AMR surveillance framework for the country. The surveillance of AMR for food-animal sector was further finalized at the Expert Meeting on Implementation of Zambia’s Multi-sectoral National Action Plan on AMR, which was organized jointly by ZNPHI and CSE in August 2019.

This report provides a framework to conduct AMR surveillance in an integrated manner, keeping in mind the capacities in Zambia. The framework aims to support the implementation of the surveillance component of Zambia’s multi-sectoral NAP on AMR in the short- and long-term.

Other countries will also be able to draw from this framework and design their respective integrated surveillance frameworks for effective monitoring of AMR and implementation of their NAPs.