ONE ARMOR

We propose integrated surveillance with actionable indicators derived from multisectorial data to proactively identify antimicrobial resistance threats under a One Health (Armor) perspective. This approach aims to facilitate community engagement, early intervention, risk assessment and mitigation  associated with antimicrobial resistance ensuring comprehensive surveillance and enabling timely action within countries.

The lead team is Valeria Torres.

Globally, it is estimated that AMR contributes to at least 700,000 deaths annually, with projections indicating a potential rise to 10 million deaths per year by 2050 if left unsolved.

The causes of AMR are multifactorial, our solution addresses these causes by focusing on three key areas:

a) Implementation of real-time surveillance dashboards to monitor antimicrobial access and quality, enabling timely intervention, money and prescription allocation (supply chain) and the main variables of the established Antimicrobial Surveillance program GLASS.

b) Integration of community-level health data making an emphasis in people in rural areas and country people as well as indigenous minorities; including human mobility through borders, we aim to understand the perspective of AMR within the community, event based surveillance, access to antibiotics and the spread of bacterial resistance.

c) Innovation utilizing non-traditional data sources to track antibiotic resistance, use, access, and indicator based surveillance, including genomic surveillance and highly virulent strains.

Through these approaches, we aim to center systems through the lens of people affected by AMR empowering communities with actionable insights, fostering collaboration across sectors, and promoting innovative solutions to combat AMR on a local scale with a projection of national, regional level.

"One Armor" serves a diverse range of stakeholders, including rural communities, academic and research institutions, healthcare providers, farmers, policymakers, and environmental agencies. We aim to support these groups by addressing their specific needs related to AMR and promoting an intercultural, multisectoral approach.

Our solution intends to standardize variables collected in both community-based surveillance and indicator-based surveillance. By doing so, the information collected from humans, animals, and the environment within the community can be correlated, enabling analysis of dissemination patterns and integration with surveillance indicators and genome data from the surveillance system and academia. Ultimately, these sources can be visualized through a dashboard, making information more understandable and providing different policymakers with a clearer view of which actions to prioritize.

To understand the needs of our target audience, we will conduct stakeholder consultations, community surveys, and participatory workshops. Through these engagements, we gather insights into local challenges and co-design solutions that are contextually appropriate and responsive to community needs. As we develop the solution, we will maintain ongoing communication and collaboration with stakeholders, seeking their input and feedback to ensure that "One Armor" effectively meets their needs.

Our solution offers a sophisticated surveillance system designed to address the interconnections of human and environmental health within the framework of One Health within countries and between countries. 

In addition to establishing robust surveillance mechanisms, our proposal will deliver standardized documentation encompassing variables derived from community, scientist and policy makers across human-animal and environment sectors. These variables will turn into systematic surveillance efforts spanning human cases, wildlife, domestic and production animals, crops, water sources, soil, and plants. The surveillance will cover a wide range of antimicrobials used in various settings (AWARE, restricted, insecticides, pesticides, parasitic, fungal, viral antimicrobials) and affected by mobile elements transmitting antimicrobial resistance or selective pressure resistance.

Furthermore, our proposal extends beyond conventional surveillance to deliver additional public goods. These include capacity-building initiatives aimed at enhancing surveillance, a space for multisectorial communication and engagement and collaboration between stakeholders from different sectors, promoting knowledge-sharing and interdisciplinary approaches to combat antimicrobial resistance effectively. 

By addressing the multifaceted nature of antimicrobial resistance, our solution offers comprehensive support for mitigating the spread of resistant pathogens- either from mobile elements as plasmids or from selective pressure mechanisms- and safeguarding public health.

Our solution holds particular significance for underserved or vulnerable populations, including countryside farmers in the Highlands, primarily represented by women, indigenous communities in the Amazonian regions, and montubios along the coast. These communities, deeply intertwined with nature and animals in their way of life, serve as vital links between resistance patterns in water, soil, plants, and produce.

Through robust community engagement and the integration of citizen-scientist collectives, we ensure the inclusion of their perspectives in the data gathering process. This inclusive approach not only bolsters the accuracy and relevance of our analytics but also champions equity in addressing AMR challenges.

Past assessments have underscored the efficacy of integrating event-based surveillance data with indicator-based systems, as evidenced by initiatives spearheaded by reputable institutions such as the CDC and the University of Florida. These endeavors, focused on respiratory diseases like COVID and highly pathogenic avian influenza, provide a solid foundation for our approach and its potential impact.

Over the next three years, One Armor will embark on a comprehensive development plan aimed at further enhancing our proposal's efficacy and scope. We will leverage artificial intelligence to predict AMR patterns and detect outbreaks by guiding the use of antimicrobials in the human-animal-environment interface. 

This will involve refining our existing data analytics algorithms to incorporate machine learning models capable of identifying subtle trends and anomalies indicative of emerging AMR threats.

Furthermore, we will expand our platform's reach and impact by forging strategic partnerships with leading research institutions and public health agencies, and expanding our solution to our neighbouring countries and at a regional level.

Additionally, we will invest in capacity-building initiatives to empower local stakeholders with the knowledge and skills needed to effectively utilize our platform. Through targeted training programs and knowledge-sharing initiatives, we will ensure that our solution remains accessible and actionable for communities across diverse geographical and socio-economic contexts.

Ultimately, our goal is to position One Armor as the premier tool for AMR surveillance and mitigation, driving tangible improvements in public health outcomes and fostering global collaboration in the fight against antimicrobial resistance while involving communities through out prevention, preparedness and response to AMR.

To effectively monitor and evaluate the impact of our proposal we will implement a comprehensive plan that includes both quantitative and qualitative indicators: 

• Community engagement in the validation of signals 
• Adaptability to the reporting system 
• Costumers' questions and queries resolved
• Assessing improvements in awareness and knowledge of AMR
• Evaluating the strengthening of surveillance and response capacities
• Monitoring reductions in healthcare-associated infections in human, domestic and farm animals

By regularly collecting and analyzing data on these indicators, we will assess the effectiveness of our system, thus tailoring solutions to the communities, academia and local stakeholders.

We will also have an annual review by stakeholders implementing the CDC guideline for evaluating Public Health Surveillance Systems available at: https://www.cdc.gov/mmwr/previ...

One Armor constraints are: 

a) Financial: the primary hurdle, as the development and implementation of the proposed technologies require investment on the team, logistics and venues for phase 1 were communities engage and the standardization of variables takes part.

b) Cultural and educational gaps:  overcoming these barriers requires targeted educational initiatives and community engagement efforts to foster awareness and build capacity at the grassroots level.

c) Acceptance: even though it is a supported and proved concept in other areas, Ministries of Health might not be interested or willing to partake into this innovative approach. 

However we will address the issues by: 

1. Securing additional funding through grants and strategic collaborations to invest in technology development and infrastructure upgrades. 

2. Associating the project with relevant NGOs such as REACT Latin America and multicultural NGOs working locally like RIOS. 

3. Ensuring compliance with legal and regulatory requirements set by international standards and interoperability such as HL7. 

Through proactive planning and collaborative action, we are confident in our ability to overcome these barriers and realize our vision of advancing One Armor on a national and then regional scale.

We are applying to The Trinity Challenge mainly given the financial possibility it provides. We are aware that many innovative and well produced ideas cannot thrive given this constraint, thus the Trinity challenge gives us a unique opportunity to showcase innovation and solutions that are tailored and adaptable to multicultural settings and necessities. Most importantly, we recognize that many other solutions are born from the "Global North" to address issues from the "Global South" and One Armor is a solution born from a group of experienced public health officials working in Ecuador at the moment and that have a clear view of an integral solution to AMR. 

However, Trinity Challenge's network facilitates stakeholder engagement and access to expertise that can help address technical challenges, including data integration and AI implementation; as well as deepening our views hand in hand with experts worldwide. 

Guidance and support by The Trinity Challenge itself and its valuable members, will assist in navigating regulatory and policy hurdles, further financial support ensuring alignment with global initiatives. 

By leveraging The Trinity Challenge's resources, we aim to accelerate the development and deployment of our solution, effectively combating AMR and advancing global health security.

We would like to start with the International Federation of Red Cross and Red Crescent Societies and the African CDC, given that they are pioneers in community based surveillance and in variable standardization and interoperability.

We would then like to follow with the ECDC for its EWRS system to understand the process of unifying surveillance under one single system while respecting political and structural differences. Finally we think that Chile with their HL7 initiative will be pivotal towards achieving interoperability through out the region.

Finally, we would like to receive support from the network in the Trinity challenge and other experts that have submitted solutions to learn about AI and novel IT process that will help the development of our project.

AMR Community of Practice from WHO