One Health and antimicrobial stewardship: a call to multi-sectoral collaboration to prevent the emerging epidemic of antimicrobial resistance.

A common misconception is that Antimicrobial resistance (AMR) stems solely from poor treatment management in hospitals and weak health systems. AMR is, however, driven by a multitude of factors, including environmental stressors such as contamination from industrial, agricultural, domestic, and healthcare waste, use of antibiotics in veterinary medicine and agriculture, inadequate water, sanitation, and poverty. This paper is a synthesis of stakeholder engagement to advocate for a multi-sectoral One Health approach to address the emerging global threat of AMR. The Africa One Health Network for Disease Prevention (ADAPT) led multi-sectoral stakeholder engagement at the 15th CUGH annual conference in San Francisco, USA. Up to 100 in-person attendees included medical clinicians, microbiologists, anthropologists, veterinarians, agriculturalists, crop scientists, data scientists, mathematical modellers, policy makers, and economists, among others. Stakeholders' views were audio recorded, transcribed, and analyzed manually according to pre-determined themes of (a) key achievements, (b) challenges, and (c) recommendations for multi-and inter-sectoral approaches towards antimicrobial stewardship (AMS) and AMR. Academic research institutions and governments are called to foster multi-sectoral and inter-sectoral collaborative education, research, policy, and community engagement innovations, together with the human and animal health, wildlife, agriculture, trade, tourism, urbanization, and immigration sectors, to prioritize efforts to promote AMS.