Opinion: We need to improve AMR surveillance systems, now more than ever

The systematic collection and analysis of health data during the patient care pathway provides vital public health information, helping guide care and data-based decision-making. For antimicrobial resistance, or AMR, and other drug-resistant infections, this surveillance process underpins the availability of data on the prevalence of drug-resistant infections and corresponding patterns of antimicrobial use, as well as data for guidance on infection prevention and control.

In 2015, the World Health Organization launched the Global Antimicrobial Resistance Surveillance System, or GLASS — a platform for global data-sharing worldwide that aimed to support countries in establishing national AMR surveillance systems as part of national action plans, or NAPs, to enable collection, analysis, and sharing of data.

But to date, just 82 countries — less than half of WHO member states — have enrolled in GLASS, and 66 have submitted AMR data. Technically, this means that national AMR data is either unavailable in a shareable format or not readily accessible — thus hindering the comparison of local or global trends in AMR.

As low- and middle-income countries continue to work toward developing and implementing the NAPs, the need for efficient data capture and management systems to support AMR surveillance cannot be underestimated.

The COVID-19 impact

This is more pertinent with COVID-19. Besides driving an increase in the use of antibiotics and potentially AMR, the pandemic has highlighted failings in health care systems globally, the need for better data on health system capacities, and crucial gaps in real-time disease surveillance data.

Countries with well-developed, comprehensive health information systems have been able somewhat to rapidly track the evolution of cases, connect clinical information with laboratory information, and actively track patient outcomes, as well as the impact of the pandemic on other essential medical services.

Yet this is far from the situation in many LMICs where patient data is not electronic and not readily retrievable, leading to an acute lack of reliable data that can inform patient care.

Often, records are available for inpatients with a higher likelihood of getting laboratory testing requested. Outpatient treatment is often based on empirical treatment, creating a potential bias in AMR data as most samples tested are from severely ill patients with treatment failure and a higher probability of infection with resistant pathogens. Empirical treatment is also driven by a lack of clinician trust in laboratory services and the absence of well-equipped microbiology laboratory facilities.

Streamlining data collection and surveillance

There is an urgent need for patient and laboratory information management systems, or LIMS, that will streamline and strengthen the collection, management, and sharing of microbiology data in LMICs and support the surveillance of AMR and diseases of public health importance. This will enable the use of data to guide patient care, support data availability and use for decision-making, and allow for the comparison of trends, both regionally and globally.

It is important to note that the health care sector is not short of LIMS, especially in high-income countries; a basic Google search returns at least 50 different commercially available LIMS whose functionalities vary from inventory and materials management to billing processes, subject tracking, and data-sharing, among others. Financial and human resources constraints impede the availability of similar systems in LMICs where policymakers need actionable data to improve health care delivery.

How to build national plans

A descriptive analysis of health information systems in 46 of the African Union’s member states concluded that country goals should include the development of comprehensive national plans for health information and surveillance systems that address the full range of data needs and sources and include provision for building national capacities for data generation, analysis, dissemination, and use.

So what needs to be done?

First, the infrastructure around how AMR data is currently captured does not fully support this goal of achieving effective surveillance as a key component of NAPs. The development of a user-friendly data-capture system and a LIMS — with the capabilities of integrating with existing systems, leading to the unification of such systems across countries — is urgently needed.

Second, functionally streamlined surveillance systems at national and subnational levels — providing important data sources for outbreak detection, understanding transmission dynamics, informing clinical practice, and the development of treatment guidelines — will reduce or eliminate methodological barriers of data integration and enhance country capacity to submit more reliable data to GLASS.

Third, at the global level, comparing data across countries and health systems is important for enabling global burden estimates, maximizing resources, and a unified response to AMR.

One of the key areas of focus for the Global Health Security Agenda — launched in 2014 to help build capacity within countries and create a world safe from infectious disease threats — is surveillance, and the emergence of new pandemics since then are reminders of why such planning matters. Systems, infrastructure, and initiatives to prevent the spread of emerging and reemerging diseases will be critical components for continued global health security.

An urgent need

Significant funding has been allocated to AMR surveillance, including the Wellcome Trust’s program on drug-resistant infections.

An analysis by the UK Collaborative on Development Research shows that for the 2016-2022 period, U.K. funders have committed £464.4 million ($608 million) toward international development research to tackle AMR globally through over 25 strategic initiatives, including Fleming Fund country grants with activities around AMR research, surveillance, laboratory infrastructure, equipment, and capacity strengthening. An overview of the thematic areas covered by the current funding shows only one AMR funding partnership with a specific focus on LIMS to support AMR surveillance data systems.

While ongoing activities will support the generation of AMR data, there is an urgent need for a universal LIMS that is open-source, is adaptable across different national health systems, and will be interoperable with existing systems, especially in LMICs, where the need is greatest.

Coinfections with COVID-19 and drug-resistant pathogens in the ongoing pandemic suggest that investments in surveillance systems designed to capture patient data and clinical information linked to microbiology and other laboratory test results and patient outcomes are key to managing patient care, both now and beyond.