ACTION TRACK 5 Mitigating antimicrobial resistance – why One Health AMR data matters for public health in South Africa Antimicrobial resistance (AMR) is a major global health threat that compromises the prevention and treatment of infections in humans and animals, and undermines progress in modern medicine. In South Africa, AMR has been approached through a One Health lens, recognising the interdependence of human, animal and environmental health and the implications for patient outcomes, food security and ecosystem integrity. The South African AMR National Strategy Framework (One Health Approach, 2017 – 2024) provided the first coordinated platform for multisectoral surveillance, stewardship and governance, and although expired, many of its surveillance and stewardship initiatives continue in practice. Multisectoral commitment and engagement are essential for developing sustainable mitigation solutions. Against this backdrop, and to follow on from the One Health Framework Strategy meeting held in Pretoria from 9 to 11 February 2026, specialists from the human, animal and environmental sectors were invited to reflect on four key questions central to South Africa’s AMR response: what AMR trends are emerging in South Africa; what kind of surveillance systems exist and where are the gaps; where are stronger cross-sector links needed; and what change could strengthen South Africa’s ability to translate AMR data into public health action? By Vindana Chibabhai of the Centre for Healthcare Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, National Health Laboratory Service, South Africa Several issues were raised with regard to AMR trends in South Africa. In human health, a significant rise in gram-negative pathogens (Klebsiella pneumoniae and Acinetobacter baumannii) has been observed, with carbapenem resistance of great concern in hospitals as reflected in recent national AMR surveillance reports. Within communities, Escherichia coli predominates, with rising rates of fluoroquinolone resistance. In both hospital and community settings, rates of co-resistance are increasing. The Department of Agriculture highlighted the risk of AMR transmission through the food chain and through direct contact with animals, which also threatens the sustainability of food production. Colleagues from the South African National Biodiversity Institute (SANBI) have recognised wildlife as potential reservoirs of resistant pathogens in zoological collections, while the Wastewater Genomics Syndicate highlighted the role of wastewater in the spread of AMR across sectors. Interpreting these trends depends on robust, crosssector surveillance. In human health, there is wellestablished hospital-based laboratory AMR surveillance, although antimicrobial consumption data remains limited. In the animal sector, testing antibiotic residues from slaughter facilities is underway, alongside a recently introduced bacterial AMR surveillance programme in food-producing animals. Antimicrobial use monitoring initiatives are also being implemented, including reporting through the World Organisation for Animal Health’s ANIMUSE platform. Surveillance in the wildlife and zoological sectors remains nascent, with pilot projects examining the role of flies in AMR transmission. Wastewater sampling currently focuses on identifying carbapenem-resistant enterobacterales, with the analysed data expected in the coming months. 13
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