OpenAMR: A Global Community for Antimicrobial Resistance

We propose the development of a global community and data repository to support antimicrobial resistance surveillance, stewardship, policy, and innovation, powered by a suite of advanced tools. With this global community, we will aim to drive public awareness, enhance surveillance, support clinical care, and inform public health and policy.

John Brownstein

Senior Vice President & Chief Innovation Officer, Boston Children’s Hospital, Professor, Harvard Medical School

John.Brownstein@childrens.harvard.edu

We aim to address gaps in information, public awareness, and resources regarding antimicrobial resistance (AMR). AMR is recognized as a massive public health threat, contributing to 4.95 million deaths globally in 2019. Increases in the use and misuse of antibiotics across One Health contributed to AMR globally, disproportionately affecting low- and middle-income countries (LMICs). 

Simple and accessible tools shown to improve AMU in humans and animals have been absent and public engagement in AMR has been lacking; highlighting a need for mechanisms to drive both political will and innovation. Moreover, developing standardized mechanisms to increase accountability from national governments is key to driving global progress. 

Currently there is no centralized access for AMR information or tools; our solution addresses this need for a single repository. OpenAMR will be a freely available online community for AMR data, decision-making support, news, and feedback. OpenAMR aims to address the One Health challenge through reimagining and expanding existing platforms, including ResistanceOpen and OPEN Stewardship, to be an innovative, publicly available hub combining novel AMR surveillance data sources, human and animal antibiotic prescription practices, and national and international policies. Further, by centralizing and democratizing this data it will increase accessibility, especially for LMICs.

By combining multiple technology tools including ResistanceOpen and Open Stewardship to create OpenAMR, each component of the new platform addresses different audiences to support. ResistanceOpen provides global resistance and susceptibility surveillance data from healthcare facilities and regional laboratories, catering to researchers and decision-makers. Open Stewardship is designed for prescribers of antimicrobials, in both human and veterinary medicine. The Georgetown Center for Global Health Science and Security’s Analysis and Mapping of Policies for Emerging Infectious Diseases (AMP for EID) is publicly available policy data that can also be used by researchers and decision-makers. Combined, OpenAMR will create a dynamic and collaborative resource that can be used for a variety of audiences within AMR spaces. OpenAMR will provide a centralized repository for AMR researchers, antimicrobial prescribers, AMR steward, decision-makers, and policy advocates. Initial collaborators within the United States, Canada, Israel, South Africa, and Sweden will be engaged in the planning, scoping, and development of OpenAMR. These collaborators will then engage their networks to gain additional utility in low resource settings. OpenAMR addresses the need for a single repository for a variety of data, resources, and community-building that is easily accessible and designed to be useful in low, middle, and high income countries. 

We seek to develop OpenAMR as a low-resource tool to support AMR surveillance, antimicrobial stewardship, and AMR policy standardization for both human and animal medicine. Our online tool will be free to access and will be developed with an emphasis on accessibility to ensure usability for all individuals with internet access. AMR surveillance data will allow snapshots by location of actual antimicrobial susceptibility and resistance. Prescriber feedback will empower antimicrobial stewards to adapt their own prescribing habits based on guidelines for both human and veterinary medicine. The policy assessments and scorecard will provide nations an accurate benchmark of where their AMR policy stands in regard to their national action.

We seek to develop a low-resource, One Health tool to support AMR surveillance, antimicrobial stewardship, and AMR policy standardization for both human and animal medicine. OpenAMR will be a resource repository for AMR surveillance, antimicrobial stewardship, and AMR policy standardization for human and veterinary medicine. Additionally, the tool will establish a shared community for users of all backgrounds and origins to communicate and interact around AMR and AMU to support engagement, innovation, and social and policy change. We expect OpenAMR to be impactful by streamlining efforts to understand AMR holistically, and how different facets of the problem interplay. Not only will it be easier to see data in one place, it will encourage innovative approaches and considerations of AMR by compiling data and resources from a variety of relevant sources and contexts. For example, OPEN Stewardship has been evaluated in two multinational prospective cohort studies of outpatient physicians and veterinarians. Initial analyses of these interventions suggest that the platform is both well accepted and valued by prescribers, and indicates that it can have beneficial impacts on antibiotic prescribing including potential reductions in rates and durations of prescriptions.

In the first year we will develop OpenAMR as described in this proposal. This includes integration of ResistanceOpen and Open Stewardship. We will also conduct literature reviews to identify and systematically capture policies pertaining to human prescription of antimicrobials for AMP for EID WASH. This category of policies will then be integrated into the broader dataset, ensuring that ensuing analyses evaluate the policy landscape from a one-health perspective. The first year will also include the guidance and input of our established partners, and cultivating relationships with LMIC partners. In year two, we will scale from proof of concept to a pilot phase. The pilot will include iterative testing of the platform and feedback from both LMIC and HIC partners outlined in this proposal. Furthermore, we will holistically assess the policy literature review into a landscape review to inform the development of a standardized scorecard rubric. In the third year we will recruit through our network to expand the community and diversify the data and resources being included. The National Action Plans of each country included in AMP for EID will be assessed against the benchmarks identified for the standardized scorecard to elucidate each nations’ progress towards fulfilling their AMR policies. 

To monitor and evaluate the impact of OpenAMR: A Global Community for Antimicrobial Resistance Surveillance, Stewardship, Policy and Innovation, we will have a usable site to pilot, test, and receive feedback. Furthermore, we will expand and grow upon the indicators already in place for the ResistanceOpen and Open Stewardship tools. User engagement will be measured on Open AMR through utilizing Google Analytics to monitor click rates and success metrics on the website. We will also manually track users who sign up to the site to participate. 

Furthermore, the team will consistently track user engagement and recruitment, with particular emphasis on outreach and recruitment of LMIC partners. To meet our diversity goals, we will monitor the data and resources added to the repository and ensure a diversified collection of data and resources is included. Additionally, we commit to recruiting users from all over the globe to participate and use OpenAMR, with particular interest in recruiting LMIC and underrepresented users. Lastly, we will publish a scientific publication in the later years of the proposed work discussing OpenAMR as a tool, its utility, uptake, and any insights gleaned from the data to that point. 

With over fifteen years of experience in conceptualizing, building, and maintaining online tools for public health, we know there are barriers that are important to consider. In the first year of the proposed work, we anticipate there may be barriers surrounding access to similar technology, competing priorities across collaborating groups in different resource settings, and delays in development timelines due to unforeseen bugs. In years two and three, sustainability of growing our community consistently and in a representative manner may present challenges. Maintaining the technology behind OpenAMR to run efficiently and as expected may present some barriers across various settings and nations. Beyond the timeline of the work outlined in this response, sustainability of resources to support OpenAMR is a concern. Furthermore, keeping the underlying technology up-to-date with gold standards is a barrier when projects move from being actively developed and funded to more maintenance phases.  

We are applying to the Trinity Challenge to support our goal in developing a sustainable, free online tool and repository, combining AMR surveillance, antimicrobial stewardship, and AMR policy standardization for human and veterinary medicine, to address the One Health crisis of antimicrobial resistance. OpenAMR will establish a global community where users can share and interact around AMR and AMU to support engagement, innovation, and policy change. Furthermore, we aim to continuously iterate upon OpenAMR to maintain resilience as the technical landscape evolves.

We have initiated and planned outreach to the Thailand and Argentina arms  of the WHO Collaborating Centre for Antimicrobial Resistance (AMR) Prevention and Containment. Outreach has also been initiated to Siriraj Hospital, and Mahidol University in Bangkok, Thailand and National Institute of Infectious Diseases, Ministry of Health of Buenos Aires, Argentina.