Partnership for AMR Surveillance Excellence

CORDS Project

Antibiotics have played a major role in the control of infectious diseases globally. The control of these diseases has helped improve the health and socio-economic status of people around the world. However, various strains of microbes, including bacteria, viruses, fungi, and parasites have developed resistance to existing antimicrobials. This resistance makes treatment progressively less effective and efficient, leading to higher mortality and morbidity and higher treatment cost. Antimicrobial resistance (AMR) affects humans, livestock, aquaculture, agriculture, and the environment. In 2016, it was estimated that 700,000 deaths occur per year due to AMR, and if appropriate actions are not taken to control it, this figure will reach 10,000,000 per year by 2050. Most AMR cases will occur in low- and middle-income countries (LMIC), where poverty is exacerbated by infectious diseases and weak health systems. Within these health systems, antimicrobials are often prescribed based on imprecise diagnostic techniques and patient request, leading to imprudent use, compounded by the widespread presence of counterfeit medication.

To tackle AMR at a global level, the World Health Organization (WHO), World Organization for Animal Health (OIE), and the Food and Agriculture Organization (FAO) formed a tripartite collaboration and developed the Global Action Plan on AMR (GAP). The GAP, ratified at the 68th World Health Assembly in 2015, listed five strategic objectives:

  1. Improve awareness and understanding of AMR through effective communication, education, and training.
  2. Strengthen the knowledge and evidence base through surveillance and research.
  3. Reduce the incidence of infection through effective sanitation, hygiene, and infection prevention measures.
  4. Optimize the use of antimicrobial medicines in human and animal health.
  5. Develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines, and other interventions.

The Fleming Fund is a £265 million UK Aid investment to tackle antimicrobial resistance in low- and middle-income countries around the world. The program is managed by the UK Department of Health and Social Care, in partnership with Mott MacDonald, the Fleming Fund Grants Management Agent.The Fleming Fund was established in response to the urgent need highlighted by the UK’s AMR Review, which called for funding to improve public AMR awareness, drug use and public health surveillance. Specifically, the Fleming Fund seeks to strengthen AMR surveillance systems in low- and middle-income countries through three focus areas:

Support the strengthening of national AMR surveillance systems and laboratories through a portfolio of Country, Regional and Fellowship Grants in 24 countries in Africa and Asia.

Develop global frameworks and support AMR governance by supporting national action plan development, global guidance, and data protocols.

▪ Improve public awareness and global data use through health economics, health policy and civil engagement.

The program focuses on low- and middle-income countries because they are expected to bear the heaviest consequences of the spread of AMR. The AMR Review estimated that, by 2050, up to 90% of all deaths related to AMR will come from Africa and Asia.

CORDS is the recipient of a Round 2 Fleming Fund Regional Grant. The aim of this grant is to strengthen AMR surveillance through the development and piloting of common surveillance protocols through the Partnership on AMR Surveillance Excellent (PARSE). Prior to protocol development and testing, it is key to conduct a situational analysis and identify gaps in existing antimicrobial surveillance systems in the four Fleming Fund priority regions: East Africa, West Africa, South Asia, and Southeast Asia. Following this mapping of existing gaps and challenges, partners will work together to develop evidence-based AMR surveillance protocols, pilot them across the regions, and share results with key stakeholders.

The Partnership for Antimicrobial Resistance Surveillance Excellence

Steering Committee
The Steering Committee of the PARSE project provides leadership, technical assistance and recommendations in all areas of the project implementation and oversees the work of the AMR Technical Working Groups.

Mark Rweyemamu (Chair) SACIDS
Silvia Bino, SECID
Vishnumurthy Mohan Chadag ,World Fish
Rumina Hasan, Aga Khan University
Amin Soebandrio,  APEIR
Eduardo Leano, Network of Aquaculture Centres in Asia-Pacific
Ronello Abila, OIE
Yewande Alimi, Africa CDC
Antonio Valcarce, FAO
Kamini Walia, Indian Council of Medical Research
Mark Smolinski, Ending Pandemics
Louise Gresham, Ending Pandemics

Protocol Development
Based on mapping and gap analysis results and review of existing guidelines PARSE will develop common protocols and SOPS and identify pilot locations. The One Health approach will be central to decision-making about which protocols and sectors to prioritize. Key AMR stakeholders will be engaged at the regional and national levels to ensure buy-in, acceptability, and sustainability.

Piloting will take place in each of the four regions, with PARSE partners working together to harmonize implementation, including data collection sites, techniques, tools, methods for analysis and interpretation, and minimum essential data. Countries will be selected during Year 1 of the project – after the completion of the Mapping and Gap Analysis.

Results Sharing
Once PARSE partners pilot common protocols and SOPs, they will share results with national, regional, and global stakeholders in the AMR sphere. Based on findings and discussions, the PARSE Partners will make recommendations about the adoption of the AMR surveillance protocols across project pilot countries and regions.

Recent Activities

The network members of CORDS (APEIR, EAIDSNet, MBDS, MECIDS, SACIDS, and SECID), along with trusted partners from POHA, BOHC, and EMPHNET, convened in Bangkok in December 2019 to strategize implementation of the Fleming Fund CORDS AMR Regional Grant. These networks are well positioned to successfully establish and sustain regional mechanisms for AMR surveillance in Asia and Africa, countries set to bear the highest burden of resistant infections.

Mapping and Gap Analysis
CORDS Networks and Partners are mapping current AMR surveillance practices and characterizing what is needed to be able detect and monitor AMR at the national and regional levels. This includes the review of current guidelines, protocols, and regional and country level situational analyses to determine the need for protocols and SOPs. Mapping existing AMR surveillance systems will identify i) different approaches for monitoring emergence and spread of AMR, including the range of baseline data, ii) models and mechanisms for AMR surveillance, capacity building in the different country or regional settings, iii) opportunities for common surveillance protocols.