Focal areas

1. Awareness on AFR in a One Health Context: Informing and Educating on AFR

• Importance: Increasing awareness among stakeholders is foundational for driving coordinated action. Misunderstandings about the sources and implications of AFR can hinder progress.
• Possible actions:
  • Conduct education campaigns targeting healthcare professionals, agricultural workers, policymakers, and the general public.
  • Develop training programs on AFR for different sectors, emphasizing its impact on human, animal, and environmental health.
  • Use case studies to highlight the real-world consequences of azole resistance and successful mitigation efforts.
  • Foster interdisciplinary dialogue to promote understanding of the interconnectedness of One Health.
• Expected Outcomes: Improved stakeholder knowledge, reduced misuse of antifungals, and stronger buy-in for AFR control measures.

2. Monitoring of AFR / Resistant Fungi in a Global One Health Context

• Importance: Reliable data is critical for understanding the scale and dynamics of AFR, identifying hotspots, and evaluating the effectiveness of interventions.
• Possible actions:
  • Establish and strengthen global surveillance systems to track the prevalence and spread of azole-resistant A. fumigatus and other resistant fungi.
  • Integrate data collection across human health, animal health, and environmental sectors.
  • Use molecular diagnostic tools to detect resistance mechanisms and identify transmission pathways.
  • Share surveillance data internationally to foster transparency and collaboration.
• Expected Outcomes: A comprehensive picture of AFR trends, enabling targeted interventions and policy formulation.

3. Surveillance of Controlled Use of Fungicides in a One Health Context

• Importance: The widespread use of fungicides in agriculture is a major driver of AFR. Surveillance can ensure their application is responsible and sustainable.
• Possible actions:
  • Monitor the types, quantities, and patterns of fungicide use in agriculture, horticulture, and industrial processes.
  • Identify misuse or overuse of fungicides and assess their contribution to AFR development.
  • Promote adherence to international guidelines on fungicide application.
  • Encourage the development of integrated pest management (IPM) practices that reduce reliance on fungicides.
• Expected Outcomes: More sustainable fungicide usage patterns, minimizing selection pressure for resistant fungi.

4. Research, Development, and Commercialization of Novel Fungicides (and Alternatives?) for Medical Use

• Importance: The medical sector urgently needs new antifungal agents to overcome resistance and provide effective treatment options.
• Possible actions:
  • Prioritize funding for research into new classes of antifungals with unique modes of action.
  • Explore non-azole alternatives or combination therapies to mitigate cross-resistance issues.
  • Accelerate the pipeline from research to commercialization, ensuring regulatory approvals are streamlined while maintaining safety standards.
  • Foster public-private partnerships to pool resources for antifungal innovation.
• Expected Outcomes: New therapeutic options for resistant fungal infections, reducing treatment failures and mortality.

5. Research, Development, and Commercialization of Novel Fungicides and Alternatives for Horticulture Use

• Importance: Agriculture is a key driver of AFR due to the extensive use of azole-based fungicides. Alternatives are needed to sustain agricultural productivity while mitigating resistance risks.
• Possible actions:
  • Invest in research on biocontrol agents, natural antifungals, and crop varieties resistant to fungal diseases.
  • Develop fungicides with minimal environmental impact and reduced potential for cross-resistance with medical antifungals.
  • Promote practices like crop rotation, companion planting, and organic farming to reduce dependency on chemical fungicides.
  • Support collaborative efforts between agricultural researchers, farmers, and the private sector.
• Expected Outcomes: Sustainable agricultural practices that balance productivity with reduced AFR risks.

6. Reduction of Fungicides (and Resistant Fungi) in the Environment

• Importance: Environmental contamination by fungicides contributes to the selection and spread of resistant fungi, which can impact ecosystems and human health.
• Possible actions:
  • Implement stricter regulations on fungicide discharge into the environment from agricultural and industrial processes.
  • Develop technologies to degrade or neutralize fungicides in soil, water, and plant waste.
  • Encourage the recycling or safe disposal of agricultural waste contaminated with fungicides.
  • Monitor environmental reservoirs of resistant fungi and develop strategies to mitigate their impact on ecosystems and public health.
• Expected Outcomes: Cleaner ecosystems, reduced selection pressure for resistance, and a safer environment for all sectors.

Synergies Across Focus Areas

While each focus area addresses specific aspects of AFR, their implementation is interdependent:

• Awareness campaigns can drive compliance with surveillance, stewardship, and research initiatives.
• Monitoring and surveillance data will inform targeted policies and research priorities.
• Innovations in fungicide development for medical and agricultural use must align with strategies to reduce environmental contamination.

By integrating efforts across these six areas, stakeholders can achieve meaningful progress in managing AFR while supporting sustainable practices in medicine, agriculture, and environmental health.