14 Antimicrobial resistance (AMR) is a major global health threat that undermines progress in modern medicine. Participants also emphasised the interconnected pathways through which AMR spreads. Shared bacterial pathogens between animals and humans may be transmitted through food or direct contact. Antimicrobial use in livestock, particularly for growth promotion, contributes to selection pressure for resistant bacteria. Environmental contamination through manure, farm runoff and wastewater systems further facilitates the movement of resistance genes across animals, humans and ecosystems. All contributors acknowledged the need to strengthen links across sectors. Policy and legislative shifts were noted as important drivers of change in the AMR landscape. There is increasing recognition that each sector may act both as a recipient and a reservoir for resistant genes and organisms, which travel fluidly across ecosystems through the movement of humans and animals and through environmental exposure. Turning surveillance insights into public health action, therefore, requires coordinated change across multiple systems. Several changes were proposed to strengthen South Africa’s ability to translate AMR data into meaningful public health action. First, the renewal of the AMR National Strategy Framework, which expired in 2024, is essential, together with governance structures that formalise accountability across all sectors. Establishing integrated One Health AMR surveillance and data-use systems that link wildlife, livestock, environmental, plant and human health data into a coherent, actionable framework is also critical. Faster translation of surveillance data and science-based evidence into policies across sectors, alongside stronger collaboration with academia, NGOs and industry, will further support progress. Expanding wastewater surveillance could help address important AMR surveillance blind spots, particularly if it provides population-level data. Genomics can also strengthen AMR surveillance to identify emerging resistance genes, track transmission of high-risk clones, detect outbreaks earlier and link genomic insights across sectors. Ultimately, the goal is to move from collecting AMR data to using it in real time to guide decisions, protect effective antibiotics and improve patient outcomes. Efforts to advance these priorities are underway through the National Action Plan for Health Security under the AMR technical working group (P4) and South Africa’s One Health Implementation Framework. However, the absence of a formally costed programme, limited funding and constraints related to other resources (diagnostic and IT infrastructure) continue to restrict progress. AMR can shift from being a “silent pandemic” to becoming a key indicator of the strength of a resilient One Health system. Addressing the gaps outlined here would allow South Africa to move from siloed data collection towards coordinated, multisectoral public health action. Read more about the author: Vindana Chibabhai This article was reviewed by Sabiha Yusuf Essack, Ruth Lancaster, Kristan Mojapelo, Olga Perovic, Veronica Phetla, Nompumelelo Themba, Natalie Schellack and Mukhlid Yousif
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