Building bridges to operationalise one health – A Sino-Swedish collaboration to tackle antibiotic resistance

Antibiotic resistance is a complex global health challenge. The recent Global Action Plan on antimicrobial resistance highlights the importance of adopting One Health approaches that can cross traditional disciplinary boundaries. We report on the early experiences of a multisectoral Sino-Swedish research project that aims to address gaps in our current knowledge and seeks to improve the situation through system-wide interventions. Our research project is investigating antibiotic use and resistance in a rural area of China through a combination of epidemiological, health systems and laboratory investigations. We reflect here on the challenges inherent in conducting long distance cross-disciplinary collaborations, having now completed data and sample collection for a baseline situation analysis. In particular, we recognise the importance of investing in aspects such as effective communication, shared conceptual frameworks and leadership. We suggest that our experiences will be instructive to others planning to develop similar international One Health collaborations.

[1]  Petra Wächter Thinking in systems – a primer , 2011 .

[2]  B. Cookson,et al.  Working across the veterinary and human health sectors. , 2012, The Journal of antimicrobial chemotherapy.

[3]  Göran Tomson,et al.  Antibiotic resistance in China—a major future challenge , 2009, The Lancet.

[4]  S. Davies,et al.  The World Health Assembly resolution on antimicrobial resistance. , 2014, The Journal of antimicrobial chemotherapy.

[5]  S. McOrist,et al.  Modern pig farming in the People's Republic of China: growth and veterinary challenges. , 2011, Revue scientifique et technique.

[6]  Kevin J. Dooley,et al.  A Complex Adaptive Systems Model of Organization Change , 1997 .

[7]  S. Kennedy,et al.  One Medicine One Science: a framework for exploring challenges at the intersection of animals, humans, and the environment , 2014, Annals of the New York Academy of Sciences.

[8]  S L Pestotnik,et al.  Antibiotic resistance-systems thinking, chaos and complexity theory. , 1999, Current opinion in infectious diseases.

[9]  M. Petzold,et al.  The impact of China’s national essential medicine system on improving rational drug use in primary health care facilities: an empirical study in four provinces , 2014, BMC Health Services Research.

[11]  Yonghong Xiao,et al.  Legislation of clinical antibiotic use in China. , 2013, The Lancet. Infectious diseases.

[12]  B. Buntain,et al.  Transdisciplinary research for complex One Health issues: a scoping review of key concepts. , 2013, Preventive veterinary medicine.

[13]  B. Eriksson,et al.  Unnecessary antibiotic use for mild acute respiratory infections during 28-day follow-up of 823 children under five in rural Vietnam. , 2011, Transactions of the Royal Society of Tropical Medicine and Hygiene.

[14]  N. V. Trung,et al.  High prevalence of antibiotic resistance in commensal Escherichia coli among children in rural Vietnam , 2012, BMC Infectious Diseases.

[15]  B. Antonisamy,et al.  Patterns of antibiotic use in the community and challenges of antibiotic surveillance in a lower-middle-income country setting: a repeated cross-sectional study in Vellore, South India. , 2013, The Journal of antimicrobial chemotherapy.

[16]  M. Tanner,et al.  From “one medicine” to “one health” and systemic approaches to health and well-being , 2011, Preventive veterinary medicine.

[17]  A. So,et al.  Meeting the challenge of antibiotic resistance , 2008, BMJ : British Medical Journal.

[18]  S. Yezli,et al.  Antibiotic resistance amongst healthcare-associated pathogens in China , 2012, International Journal of Antimicrobial Agents.

[19]  O. Cars,et al.  Sustained reduction of antibiotic use and low bacterial resistance: 10-year follow-up of the Swedish Strama programme. , 2008, The Lancet. Infectious diseases.

[20]  N. Sewankambo,et al.  Enabling Dynamic Partnerships through Joint Degrees between Low- and High-Income Countries for Capacity Development in Global Health Research: Experience from the Karolinska Institutet/Makerere University Partnership , 2015, PLoS medicine.

[21]  O. Dyar,et al.  Overuse of antibiotics for the common cold – attitudes and behaviors among doctors in rural areas of Shandong Province, China , 2015, BMC Pharmacology and Toxicology.

[22]  Mindi Schneider,et al.  China's Pork Miracle? : Agribusiness and Development in China's Pork Industry , 2014 .

[23]  S. Bakken,et al.  Perspectives on antimicrobial resistance: establishing an interdisciplinary research approach. , 2005, American journal of infection control.

[24]  Diana Wright,et al.  Thinking in systems: a primer , 2012 .

[25]  Yonghong Xiao,et al.  Changes in Chinese Policies to Promote the Rational Use of Antibiotics , 2013, PLoS medicine.

[26]  Qijing Zhang,et al.  Identification of New Delhi Metallo-β-lactamase 1 in Acinetobacter lwoffii of Food Animal Origin , 2012, PloS one.

[27]  Göran Tomson,et al.  The need to look at antibiotic resistance from a health systems perspective , 2014, Upsala journal of medical sciences.

[28]  P. Promburom,et al.  A framework to promote collective action within the One Health community of practice: Using participatory modelling to enable interdisciplinary, cross-sectoral and multi-level integration , 2015, One health.

[29]  Timothy A. Johnson,et al.  Diverse and abundant antibiotic resistance genes in Chinese swine farms , 2013, Proceedings of the National Academy of Sciences.

[30]  Lei Dai,et al.  Prevalence and antimicrobial resistance of Campylobacter isolates in broilers from China. , 2010, Veterinary microbiology.

[31]  Ping Shen,et al.  Epidemiology and characteristics of antimicrobial resistance in China. , 2011, Drug resistance updates : reviews and commentaries in antimicrobial and anticancer chemotherapy.

[32]  H. Goossens,et al.  Antibiotic resistance—the need for global solutions , 2013, BDJ.

[33]  O. Cars,et al.  Changes in patterns of antibiotic use in Chinese public hospitals (2005-2012) and a benchmark comparison with Sweden in 2012. , 2015, Journal of global antimicrobial resistance.

[34]  M. Knapp,et al.  Nonverbal communication in human interaction , 1972 .

[35]  W. Trochim,et al.  Systems thinking to improve the public's health. , 2008, American journal of preventive medicine.

[36]  K. Liu,et al.  Prevalence and antimicrobial resistance of Enterococcus species of food animal origin from Beijing and Shandong Province, China , 2013, Journal of applied microbiology.

[37]  G. Tomson,et al.  Varying High Levels of Faecal Carriage of Extended-Spectrum Beta-Lactamase Producing Enterobacteriaceae in Rural Villages in Shandong, China: Implications for Global Health , 2014, PloS one.

[38]  R. K. Khandal,et al.  Antibiotics and antibiotic-resistant bacteria in waters associated with a hospital in Ujjain, India , 2010, BMC public health.

[39]  G. Ying,et al.  Comprehensive evaluation of antibiotics emission and fate in the river basins of China: source analysis, multimedia modeling, and linkage to bacterial resistance. , 2015, Environmental science & technology.

[40]  C. Lundborg,et al.  Geographical Variation in Antibiotic-Resistant Escherichia coli Isolates from Stool, Cow-Dung and Drinking Water , 2012, International journal of environmental research and public health.