AMR Alert System for real-time surveillance of AMR (AMR ALS Thailand)

An advanced digitalized alert system designed to enhance AMR mapping at genetic level, facilitating awareness and informing policy decisions. It aims to provide comprehensive AMR tool for One Health approaches, serving as crucial reference for policymakers, researchers, and the public, ultimately fostering more informed and proactive response to AMR challenges.

Pimlapas Leekitcharoenphon, Senior Researcher, Research Group of Genomic Epidemiology, Technical University of Denmark

In Thailand, the AMR ALS initiative faces a pressing challenge: a severe lack of data to support and evaluate AMR management policies. The initiative specifically addresses the urgent need for comprehensive, AMR data to inform policy and action, especially in light of climate change, which exacerbates the complexity of bacterial AMR and disrupts antibiotic supply chains. 

Healthcare policymakers and practitioners face challenges in developing effective AMR strategies and assessing the effectiveness of existing interventions in the absence of a robust data infrastructure. The lack of precise data impedes the development of targeted solutions and stymies efforts to address the AMR crisis at its source. Furthermore, Thailand currently lacks dedicated monitoring tools capable of providing continuous surveillance to ensure that AMR management strategies are not only implemented, but also effective. This deficiency results in a reactive rather than proactive approach to AMR management, potentially escalating the threat to public health. 

The AMR ALS solution aims to close these critical gaps by creating real-time surveillance dashboards to track antimicrobial access, reducing the use of falsified antimicrobials in humans and the food chain, and facilitating point-of-care testing for AMR genes in agricultural effluents allowing policymakers to implement well-informed policies and assess impact.

The AMR ALS initiative in Thailand is dedicated to serving healthcare professionals, policymakers, and the public. The primary goal is to provide these stakeholders with accurate data and analytical tools to combat antimicrobial resistance (AMR), a critical public health issue. Real-time surveillance and point-of-care testing capabilities will benefit healthcare professionals by allowing for more precise treatment decisions and antibiotic stewardship. Policymakers will be given robust datasets and analysis to effectively inform and evaluate AMR management policies. The initiative aims to raise awareness and reduce the spread of AMR at the community level through education and monitoring tools. 

The initiative maintains ongoing dialogue with healthcare providers, policy forums, and community representatives to better understand the needs of these diverse groups. Surveys, focus groups, and pilot feedback are used to ensure that the solution is user-centric and tailored to the real-world challenges that each group faces. AMR ALS ensures that it remains relevant, practical, and effective in addressing the specific needs of those it serves in Thailand by developing this solution in collaboration with its end-users.

The AMR ALS initiative benefits the public by providing an open-source, real-time dashboard that serves as an important antimicrobial resistance (AMR) surveillance tool in Thailand. The solution significantly benefits public health by enabling a rapid response to AMR trends and outbreaks by providing immediate access to AMR data and analytics. This dashboard is intended to be freely available, ensuring fair and non-discriminatory use, in keeping with the global need for open data in combating public health crises. 

The initiative may also contribute to the global body of knowledge on AMR through white papers or peer-reviewed publications, in addition to the dashboard. Such contributions will be critical in guiding policy, informing public health strategies, and providing new data and insights on AMR to researchers. The AMR ALS initiative upholds the principle of serving the public good by providing these resources at no cost, ensuring that its benefits reach all segments of the population, from Thai communities to the global public health community.

The AMR ALS initiative is poised to make a real difference by providing Thailand's healthcare professionals, policymakers, and the public with a powerful tool for combating antimicrobial resistance (AMR). The real-time alert system, which is powered by advanced analytics, aims to transform the approach to AMR by providing immediate insights into resistance patterns, allowing for faster treatment and policy implementation decisions. 

This solution is especially beneficial for underserved populations, who may lack access to quality healthcare and are frequently the most vulnerable to AMR's effects. AMR ALS can significantly reduce antibiotic misuse, which is a major contributor to the development of resistance, by enabling more accurate diagnoses and targeted interventions. Pilot programs that demonstrate the system's ability to accurately track AMR trends and inform effective responses provide evidence for the expected impact. In addition, interviews with healthcare providers revealed a clear need for such a tool to help them manage infections daily. The logical progression from real-time data collection to analysis and dissemination via the dashboard leads directly to improved health outcomes by influencing clinical practices as well as health policy.

The AMR ALS initiative intends to significantly expand its impact over the next year and three years through strategic government-to-government (G to G) collaborations within ASEAN countries. This regional expansion strategy is based on intergovernmental collaboration to share knowledge, technology, and best practices in antimicrobial resistance management (AMR). 

The foundation for this scale is based on the Thai implementation's success and lessons learned, with adaptations to suit the specific health landscapes and AMR challenges faced by neighboring countries. The initiative aims to create a more comprehensive and unified response to AMR in the region by extending the real-time AMR monitoring and alert system across borders. This collaborative effort is expected to not only improve individual countries' AMR management capabilities, but also to strengthen regional health security against the threat of resistant infections.

The AMR ALS initiative employs several specific and measurable indicators to assess progress toward our impact goals. These indicators are critical for tracking progress and communicating the effectiveness of the solution. The following are key metrics: 

1.     Antibiotic Misuse Reduction: Measuring the reduction in inappropriate antibiotic prescriptions or use because of the intervention in both human and veterinary medicine. 

2.     AMR Incidence: Tracking changes in AMR infection incidence rates before and after the implementation of the AMR ALS system. 

3.     Statistics on Engagement and Usage: Tracking the frequency and intensity with which healthcare professionals and policymakers use the real-time dashboard to assess the tool's integration into daily practice. 

Where available, pilot performance data demonstrates the strength of these links. For example, a pilot could show a decrease in the use of a specific antibiotic associated with the implementation of the AMR alert system, indicating the system's effectiveness in guiding treatment decisions. Third-party research or impact evaluations that validate the chosen metrics may provide additional evidence of the solution's impact on the desired outcomes.

Financial constraints, technical infrastructure limitations, legal and regulatory hurdles, cultural differences, policy adaptation, and market acceptance challenges are the primary barriers to achieving AMR ALS initiative goals over the next one to three years. 

1.     Scaling the initiative requires significant financial investment. To address this, we intend to work with international donors, apply for grants, and form partnerships with both private and public entities interested in public health and innovation. 

2.     Technical challenges revolve around building strong infrastructure capable of handling large-scale data analytics. We will address this by collaborating with technology companies and academic institutions to leverage their expertise and resources. 

3.     To ensure compliance and support for our initiative, legal and regulatory barriers will be addressed through ongoing dialogue with local and international health authorities. To navigate these, we intend to collaborate closely with legal experts. 

4.     Cultural and policy barriers necessitate customized communication strategies as well as policy advocacy. To raise awareness of the importance of AMR management, we will conduct educational campaigns and collaborate with local communities. 

5.     Market barriers necessitate a demonstration of our solution's value proposition. We hope to build trust and encourage adoption by demonstrating the effectiveness and benefits of our pilot projects. 

As mentioned previously that one of the main barriers in Thailand is financial constraints. Most of the research grants in Thailand are heavily for human health and clinical related research. The area of antimicrobial resistance, animal health and environment are neglected in Thai’s research. This makes the solution to antimicrobial resistance in Thailand is unsuccessful because the reason and the cause of AMR in animal and environment are neglected. Another barrier is technical infrastructure limitations, this AMR ALS project will resolve this barrier and building an infrastructure capable to handle data analysis and integrate AMR results from all important source; human, animal and envionment. This system with one-health perspective can move forward to the successful AMR solution in Thailand. 

We are confident that The Trinity Challenge’s goal and vision can help us to overcome these barriers and successfully scale the impact of our AMR ALS initiative.

Animal: The AMR Alert System for Thailand, aimed at enhancing real-time surveillance of antimicrobial resistance (AMR), seeks collaboration with key organizations to initiate, accelerate, and scale its solution. Collaborating with the Department of Livestock Development (DLD) in Thailand, the Federation of Asian Veterinary Associations (FAVA), and all faculties of Veterinary Science within Thailand will be pivotal. These partnerships can provide vital expertise, infrastructure, and networks to support the system's development and implementation. Such collaborations will ensure a comprehensive One Health approach and bolster efforts to combat AMR effectively.

Food: Food and Drug Administration, Thailand, Provincial Public Health Environment, Thailand, Department of Fisheries, Ministry of Agriculture and Cooperatives, Thailand, Local government organization such as Municipality, Provincial Public Health

Human: Collaborating with hospitals and organizations in the Ministry of Public Health such as Department of Disease Control, Department of Medical Sciences, and Provincial Public Health etc.