Enhancing Antimicrobial Resistance Mitigation: A Comprehensive One Hea

Establish a genomics hub equipped with cutting-edge sequencing platforms, including short-(Illumina) and long-read sequencing (Nanopore) systems, complemented by robust computational infrastructure and storage capabilities, fostering the integration of genomics and bioinformatics for AMR detection and prevention while equipping citizens and healthcare professionals with the knowledge and skills to address AMR. 

Sima Tokajian

Antimicrobial resistance (AMR) is an increasingly global public and animal health concern. The WHO Advisory Group on Integrated Surveillance of Antimicrobial Resistance (AGISAR) updated 2018 its list of critically important antimicrobials (CIA) for human medicine and classified third and higher-generation cephalosporins and carbapenems as CIAs. The notable increase in extended-spectrum β-lactamase producing and carbapenem-resistant Enterobacteriaceae in Lebanon and other countries poses a serious threat. Whole-genome sequencing (WGS) and genomics can support surveillance and stewardship by uncovering resistance mechanisms and transmission patterns. Implementing WGS within the existing national surveillance systems can enhance prevention measures to control the spread of resistant determinants and help overcome some of the significant challenges LMIC faces in combating and preventing the spread of resistance.  

Another significant issue is data availability. There is a need to develop a reporting system tailored to meet local clinical needs, ensuring data security and interpretability by healthcare professionals while facilitating integration into public surveillance networks to establish targeted and effective intervention strategies. 

Enhancing public understanding regarding AMR and its impact is another crucial challenge that should be addressed to combat the emergence and spread of resistance. We will approach this vital pillar through awareness campaigns and capacity building.

The target audience is the local community, healthcare workers, farmers, and school children. We will first address the lack of knowledge and awareness regarding antimicrobial resistance and its significant impact on humans, animals, and the environment. To do that, we will organize campaigns for schoolchildren using gamification as our primary method to instill knowledge and awareness regarding AMR. We will also engage children in activities about the importance of the responsible use of antibiotics and how this could impact the emergence and spread of difficult-to-treat infectious diseases. 

Increasing public awareness and empowering citizens are other essential elements to combat resistance. We plan to achieve this through outreach activities and social media platforms to spread accessible and easy-to-understand information regarding AMR, responsible use of antibiotics, and alternative approaches such as vaccination and proper diagnosis to manage animal diseases.

We also aim to target capacity building by organizing training sessions targeting public healthcare workers to strengthen and increase their understanding, knowledge, and skills in using and integrating genomics to combat antimicrobial resistance and using online data-sharing platforms. 

Our solution has a two-fold contribution. First, it prioritizes capacity building and public awareness, equipping citizens and healthcare professionals with the knowledge and skills to address AMR and the spread of infectious diseases. This, in the long term, will help reduce the burden of the use of antimicrobial agents. Secondly, our initiative envisions the use of the available genomics infrastructure at the Lebanese American University and complement with the needed computational resources in an attempt to establish a data collection center that facilitates creating a network between all stakeholders, tracking and predicting emerging resistance patterns and altogether be used to guide better planning and resource allocation.

Additionally, integrating life skills education into AMR prevention strategies presents an innovative approach to enhancing public understanding and actions toward antimicrobial resistance. Teaching critical thinking, decision-making, and effective communication can empower individuals to make informed decisions regarding antibiotic use. This educational framework will improve awareness of AMR's implications and promote responsible behaviors, significantly contributing to the mitigation of antimicrobial resistance across communities. 

One of the main pillars of our suggested solution is to have training and capacity-building programs that aim at introducing genomics in healthcare systems. The main expected tangible impacts are better patient outcomes through enhancing AMR surveillance efforts and having an almost real-time profile of the typical resistance patterns. Also, our solution encompasses a One Health approach, which will help raise awareness and reduce the spread of resistance in animals while monitoring the emergence of new resistance patterns through developing experimental and analysis pipelines to detect resistance patterns and infectious agents in sewage. Taken together, we hope to help health authorities respond faster, and healthcare systems make more informed decisions. Community health workers will also be empowered to generate data on AMR in humans and animals through targeted training programs, such as those offered by the European Health Management Association (EHMA). Community health workers can acquire the necessary skills for effective data collection and reporting by participating in such programs and incorporating digital tools for real-time surveillance. Strengthening collaborations with veterinary services will also ensure a One Health approach and will help integrate human and animal health data for comprehensive AMR surveillance and control strategies.

The impact will be scaled by working in phases. Phase I will establish a system that can gradually introduce next-generation sequencing (NGS)-based platforms in healthcare systems and, in parallel, develop data-sharing hubs using information technology. Phase II will involve doing a pilot trial on data sharing, creating an electronic health information system, using metagenomics to track antimicrobial resistance patterns, and implementing capacity building and training programs and awareness campaigns. Phase III will involve stakeholders from the public and private sectors, the health authorities, and policymakers towards integrating genomics and sharing data, and building partnerships between the government, non-governmental organizations, tech companies, and the healthcare sector to improve disease surveillance and AMR tracking, and public health awareness campaigns. Finally, the last phase will involve developing predictive models to help in the early detection and AMR mitigation.

We will scale success by measuring the cost-effectiveness, assessing skill development and implementation, determining and monitoring the willingness of all stakeholders to participate in data sharing through tracking the growth and validity of the shared data, the impact of the awareness campaigns on over-the-counter use of antibiotics and that of the farmers by limiting the use of antibiotics for disease prevention, lastly, by assessing the accuracy of the developed predictive model and its effectiveness and impact on early preparedness in mitigating emerging resistance patterns and patient outcomes.

Lebanon faces unique challenges, including a complex political layer, economic instability, and strained public health infrastructure, which may impact the development and adoption of such technology. However, there's potential for leveraging existing digital infrastructure and the high access rate of smartphones in the country to implement crowdsourced health initiatives.

Another significant challenge is to convince stakeholders to participate and commit to data sharing actively. To overcome this challenge, we plan to emphasize the critical role of data sharing in combating AMR, collaborating with the World Health Organization (WHO), and engaging public health authorities. We will also highlight the significant impact data sharing can have on public health through targeted awareness campaigns using different social media platforms and by developing a user-friendly, standardized, confidential, and secure platform.

Lastly, one of the barriers we are aware of is the lack of computational power since this project will involve significant amounts of data and machine learning. Thus, a partnership with tech companies such as Microsoft and Google can help overcome such an obstacle.

Due to resource constraints, the need to upgrade healthcare infrastructure, and the absence of data-sharing platforms, we face significant challenges in fighting and limiting the emergence and spread of AMR. Trinity Challenge will provide the proper framework for using a data-driven One Health approach to combat and mitigate AMR. It will also help bridge the gap between research, health care, and information technology, introducing innovative, transformative, and sustainable changes to mitigate AMR.

Microsoft, Google.