Focal areas

I. 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:

1. 1. Conduct education campaigns targeting healthcare professionals, agricultural workers, policymakers, waste stream workers and the general public
   2. Develop training programs on AFR for different sectors, emphasizing its impact on human, animal, and environmental health
   3. Use case studies to highlight the real-world consequences of azole resistance and successful mitigation efforts
   4. Foster interdisciplinary dialogue to promote understanding of the interconnectedness of One Health

Expected Outcomes: Improved stakeholder knowledge, reduced misuse of fungicides, and stronger buy-in for AFR control measures.

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

Importance: Reliable data is critical for understanding AFR dynamics, identifying hotspots, and evaluating intervention effectiveness.
Possible actions:

1. Develop and implement standardized methodologies for sampling, testing, and reporting to improve data consistency and comparability
2. Strengthen global surveillance systems by integrating human, animal, and environmental health data, collaborating with mycology reference centers and public health institutions
3. Utilize molecular diagnostic tools to detect resistance mechanisms and track transmission pathways
4. Facilitate international data sharing to enhance transparency, collaboration, and coordinated response efforts

Expected Outcomes: A comprehensive picture of AFR trends, enabling targeted interventions and evidence-based policy formulation.

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

Importance: Fungicides are used widely in agriculture: “dual use” of the azole mode of action (which is also used in the clinic) has been shown to be a driver of azole-resistance in the environmental population of Aspergillus fumigatus.
Possible actions:

1. Monitor fungicide use across agriculture, horticulture, and industrial processes to track types, quantities, and patterns
2. Identify waste management practices contributing to AFR
3. Monitor fungicide residues in soil, water, and air to evaluate unintended exposure and resistance development
4. Promote adherence to product authorizations and support integrated management (IPM) to avoid overuse of fungicides  

Expected Outcomes: More sustainable fungicide usage patterns, minimizing selection pressure for resistant fungi.

IV. Research, Development, and Commercialization of Novel Antifungals and Alternatives for Medical Use

Importance: The medical sector urgently needs new antifungal agents to overcome resistance and provide effective treatment options.
Possible actions:

1. Prioritize funding and research into new antifungal classes with unique modes of action
2. Develop non-azole alternatives and combination therapies to reduce cross-resistance risks
3. Streamline regulatory approvals to accelerate research-to-commercialization pathways while ensuring safety
4. Strengthen public-private partnerships to drive antifungal innovation and resource pooling

Expected Outcomes: New therapeutic options for resistant fungal infections, reducing treatment failures and mortality.

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

Importance: Use of azole fungicides in certain agricultural settings is a key driver of AFR in the human pathogen Aspergillus fumigatus. Alternatives are needed to sustain agricultural productivity while mitigating the risk of resistance development in both crop and human pathogens.

Possible actions:

1. 1. Invest in sustainable solutions by funding research on biocontrol agents, natural fungicides, resistant crops, and eco-friendly fungicides with minimal cross-resistance to medical antifungals.
   2. Ensure responsible fungicide development by prioritizing novel targets unrelated to human medicine and preventing approval of fungicides with shared mechanisms.
   3. Promote practices like crop rotation, companion planting, adoption of varieties developed using new genetic techniques and other approaches to reducing dependency on chemical fungicides
   4. Foster collaboration between researchers, farmers, and industry to advance sustainable fungal disease management.

Expected Outcomes: Sustainable agricultural practices that balance productivity with reduced AFR risks

VI. 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:

1. 1. Risk assessment and, where appropriate, implementation of stricter regulations on fungicide discharge into the environment from agricultural processes
   2. Develop technologies to degrade or neutralize fungicides in soil, water, and plant waste
   3. Encourage the recycling or safe disposal of agricultural waste contaminated with fungicides
   4. 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.