• Full recording of the webinar is available here

Policy Webinar 2.

AMR Surveillance: Past, Present and Future

Dr Pascal Ondoa, African Society of Laboratory Medicine (ASLM), introduced Dr John Stelling, Co-director of the WHO Collaborating Center for Surveillance of AMR, based at the Brigham and Women’s Hospital in Boston. The focus of Dr Stelling’s work has been to support public health infrastructure for laboratory services, including enhancing routine surveillance. He provided a history of the use of computer science/IT in data collection for surveillance, including the development of the WHONET software: currently used to support over 120 countries, and 2,300 hospitals, public health, food and veterinarian laboratories.

Dr Stelling described how resistance surveillance had started largely as an academic exercise among researchers and microbiologists, without the connections needed for full policy on antimicrobial use on hygiene, and also on awareness, to get the broader perspectives. Major improvements have taken place over time:

“One of the good things in the last 20 years is the growing recognition and involvement of national health authorities in data collection and in data analysis and in data use…. there’s a much more holistic sense of bringing together all of the different sectors on the data collection side, but also on the data use side: the media, educators, researchers, industry, patient advocacy groups.”

Dr Ondoa introduced the second speaker, Dr David Aanensen of Big Data Institute at University of Oxford. Dr Aanensen is the Director of the Centre for Genomic Pathogen Surveillance.

Dr Aanensen’s described his work on data flow and use of genome sequencing for surveillance of microbial pathogens. The approach is to translate the use of genome sequencing and the rapid and large-scale analysis of data into information that can be used for public health decision-making at a local, national, international level. Currently BDI are partnering in AMR strategies in the Philippines, Columbia, Nigeria, and India to implement genomic surveillance.

“I think our major focus should be on enabling local data generators to have access to the tools and own those tools and interpretation to be able to then leverage feeding into these bigger broader initiatives. It has to be bottom-up and top-down.”

Policy Webinar 3.

Linking the ‘technical’ and the ‘social’

Dr Will Parks, UNICEF, introduced the first presenter, Professor Olivier Ruben, Professor of Global Studies at Roskilde University, Denmark. Prof. Ruben is a disaster researcher from a social science perspective. His presentation was entitled ‘Why should we care about the social stuff?’ He provided a perspective of the health sciences and social sciences and the tension between the two paradigms. He stressed the importance of synergies and interdisciplinary interaction in relation to addressing AMR. He also highlighted the disparity in research in these sciences, arguing that more social science research is needed:

“It is not very comforting for social sciences trying to work in the field of AMR because…. it’s very, very miniscule what has been produced of social sciences with regards to the AMR threat. And it’s a bigger problem because AMR is so obviously a problem that needs social science inputs, both on the global level, and the meso level and the local level.”

Dr Parks introduced the second speaker, Professor Claire Chandler, a medical anthropologist and Co-Director of the Antimicrobial Resistance Centre at the London School of Hygiene and Tropical Medicine. Professor Chandler described her work social research on antibiotic use, and the importance of social research for AMR, bringing together the different ways of working and thinking. She highlighted an important dilemma concerning antibiotic use or overuse: in some LMICs particularly, it is more difficult to get essential medicines to people, whilst in some settings antibiotics have previously been promoted in marketing campaigns. But in fighting AMR:

“One thing that I would say, that from our analysis, it promotes this question of are we wanting to protect people or to protect medicines….a warning I would put out is that let’s be careful not to shift our entire kind of effort towards just saving the medicines. The reasons we’re saving medicines is still for the same end, which is to protect people and to provide the best quality care.”

Policy Webinar 4.

The Public and the Private sectors:

Points of intersection, points of departure

Dr Gemma Buckland-Merrett, Research lead for drug resistant infections at the Wellcome Trust, introduced the first presenter, Dr Catrin Moore. Dr Moore is Research Group Leader of the Oxford Global Burden of Disease Project, working on the Global Research on Antimicrobial Resistance project (GRAM), funded by the Fleming Fund and Wellcome Trust. She described the background of AMR and need for such a project as GRAM, which produces health metrics and geospatial maps relating to the global disease burden of antimicrobial resistance.

“Our main goals were to build a comprehensive up-to-date, global synthesis of the data available, to really understand what was causing AMR, the selected bacteria and the resistance that we saw: to then use that data to understand the prevalence of resistance over time and space, so to perform the geospatial mapping”.

Dr Buckland-Merrett introduced the second presenter, Dr Bruce Altevogt, Vice President and Head of External Medical Engagement in Pfizer’s hospital business unit. Dr Altevogt described Pfizer’s commitment to addressing AMR, and the role of public-private partnerships. Dr Altevogt highlighted the importance of research and development – for both new antibiotics, and also for new vaccines, which could reduce the need for some antibiotics – and of stewardship.

Dr Altevogt described Pfizer’s ATLAS surveillance platform, which collects data on nine out of thirteen WHO priority pathogens, and looks at how bacteria are resistant. The data is provided free to users, through a web portal, and allowing understanding of the emergence of resistance patterns. ATLAS has a global reach of 241 centres in over 50 countries. He also introduced the SPIDAAR project, a surveillance partnership to improve data for action in sub-Saharan Africa:

“…a scalable surveillance platform that’s supported by a robust public private partnership, and this is absolutely critical to expand AMR resistance data, strengthen public health capacity and and, most importantly, improve patient outcomes in low- and middle-income countries.”

Policy Webinar 5.

One Health and AMR Surveillance:

Approaches and Options

Professor Sabiha Essack, Senior Implementation Research Advisor to the International Centre for Antimicrobial Resistance Solution (ICARS), introduced the first presenter Professor Frank Møller Aarestrup. Professor Aarestrup is a professor at the Technical University of Denmark and Head of Division at the National Food Institute. His research primarily targets the association between the use of antimicrobial agents to farm animals and the emergence and spread of AMR in humans, including on how next generation sequencing can contribute to the global surveillance of AMR and other pathogens.

““When it comes to AMR, there’s also very often a case of resistant genes and resistant bacteria in all kinds of reservoirs in healthy humans that’s not become recognized by this narrow-minded focus on clinical infections at hospitals. There is all the evolution that has taken place in wildlife, in livestock transmissions, into healthy populations, and we have very limited understanding of what’s actually happening there. And all of these things are important if we really want to tackle and control the problem of AMR.”

Dr Essack introduced the second presenter Professor Thomas Van Boeckel, a spatial epidemiologist at ETH Zurich. Professor Van Boeckel’s research includes developing maps of AMR and explores economic incentives to reduce AMU in animals. The work aims to inform policy makers to address the rise of drug resistant pathogens in animals, and is pioneering the development of a platform to centralize epidemiological data on AMR.

““The first question, perhaps, is why animals….it’s worth reminding that most antibiotics on this planet are actually used in the animals that we raise for food.”

Policy Webinar 6.

Disruptive methodologies: Artificial Intelligence,

Machine Learning, and AMR

Dr John Stelling, WHONet, introduced the first presenter, Dr Jon Stokes, Assistant Professor in the Department of Biochemistry and Biomedical Sciences at McMaster University, Canada, where he established the research laboratory. His work focuses on understanding the relationships between antibiotic structure, bacterial cell physiology, and the extracellular environment. The work has the potential to improve patient outcomes from the antibiotic therapy, while simultaneously decreasing the global dissemination of resistance determinants. He is lead author of ‘A deep learning approach to antibiotic discovery’.

Dr Stokes described a timeline of antibiotic discovery, highlighting the ‘Golden era’ of antibiotic discovery during the 1940s to the 1960s. After this period the approach became more difficult, due to de-replication, i.e. discovering the same antibiotics over and over again. In an attempt to overcome these difficulties, high throughput screening of synthetic chemical libraries has been utilised, but without finding new antibiotics. This has coincided with the global dissemination of resistance.

“What we need are new methods to discover novel antibiotics more rapidly and ideally less expensively than we have been, in order to outrun the global dissemination of resistance, and that’s what I hope ML [machine learning] has the capacity to help us with.”

Dr Stelling introduced the second presenter, Dr Brian Hie, Stanford Science Fellow at Stanford University School of Medicine. Dr Hie develops algorithms and machine learning methods, with a focus on biological application. He is the first author of ‘Learning the language of viral evolution and escape’.

Dr Hie highlighted the line of research predicting the evolution of pathogens, leveraging algorithms called neuro-language models that were originally developed in the context of natural language, to instead start to learn about the rules or the language of protein evolution. The basic question is: How predictable is evolution?

“There’s really a lot of predictability within evolution, and so this research is trying to push the boundaries of evolutionary predictability and, in particular, motivated by the problem of escape from immunity or from drugs.”