The One Health concept recognizes that animal health, human health and environmental health are all inextricably linked. It also promotes a collaborative effort of multiple disciplines working locally, nationally and globally to attain optimal health for people, animals and the environment. The feedback from workshop participants reinforced that the One Health concept is the best lens from which to assess AMU and AMR, and the best concept to anchor collaborative, effective approaches.

Input from participants also reflected a consensus that Alberta’s approach should align with the major approaches adopted nationally, internationally and, where possible, with other provinces. This is based on the recognition that AMR is a global issue that recognizes no boundaries and requires the building of a cooperative, consistent effort among many jurisdictions under a One Health approach.

At the same time, input from participants reflected a consensus view that Alberta should not be afraid to lead — in fact, it should embrace the opportunity to lead. One Health is a framework that allows innovation and continual improvement. The opportunity to do both presents itself whenever the development and implementation of a new strategic approach is undertaken. The mindset of driving progress reflected at the workshop is one that needs to be sustained to continually improve approaches to AMU and AMR mitigation.

Overall feedback also reflected the recognition that one of the key hurdles to advancement is the potential for misinformation, misunderstandings and misconceptions to enter the discussion of AMU and AMR. A top priority must always be clear information and communication based on a foundation of science and fact, to guide education and awareness efforts as well as to provide the basis of shared understanding essential to multi-sectoral, multi-disciplinary progress.

Consensus was also evident around the concept of breaking down barriers so that all stakeholders in AMR can function as a cohesive team in addressing shared goals and interests. This includes reaching out to help other sectors in recognition that ultimately One Health approaches to address AMU/AMR can only be as strong as the weakest link. Teamwork, sharing, empathy, cooperation and collaboration are essential to sustained progress.

Discussion and input at the workshop reinforced a view that AMU and AMR touches everyone and that solutions require a level of understanding and support among everyone. Included in this, a well-informed public actively engaged in efforts to preserve the effectiveness of antimicrobial medicines is critical.

A key concept raised related to the principle of working together and helping one another was the suggestion that “industry health” be added as a prominent consideration within a One Health framework. The core approach of addressing One Health through the interconnected lens of “animal health,” “human health” and “environmental health” should remain the primary focus, but emphasis should also be placed on consideration of “industry health” with a mindset of designing action plans and other key initiatives in ways that work with industry and minimize the potential for added burden/challenges for industry.

Another key principle raised and reinforced throughout the workshop discussion was the need for action plans to be designed with processes/mechanisms for continual improvement. The issues, challenges and opportunities surrounding AMU/AMR are continually evolving and so too must the efforts to keep pace with and address these developments. Such plans should include ongoing efforts to identify new activities to help improve AMU and combat the spread and impacts of AMR.

There was general support for this analogy that speaks to the responsibility everyone involved has not only to themselves and their stakeholders, but to each other. It harkens to traditional, community-based values, reinforcing that “we are all in this together” and that positive and respectful interactions among everyone are critical to foster a healthy, progressive community. The objectives related to antimicrobial stewardship are about supporting a “community hall” and not “my hall” or “your hall” — One World, One Health is about the recognition that everyone’s interests are tied together.

Barriers such as lack of funding and a cohesive plan will take time, but all participants should not hold back in thinking what can they do right now to make things better, to improve the AMU/AMR situation in Alberta. Progress cannot wait.

Changes to Canada’s approach and response, toward greater integration and connection among sectors, are needed at a fundamental level, including in the university education system. Programs require updating to better support students to succeed in a complex and interconnected world, where various disciplines and sectors must work together to meet the most pressing challenges.

The input provided generally aligned with numerous specific objectives and directional priorities established by the major Canadian (Public Health Agency of Canada) and global (WHO) action plans on AMU and AMR. For example, the input reflected support for:

• Measures to promote and protect human, animal and environmental health through leadership, partnership, innovation and action.
• Ongoing cooperation among all jurisdictions and stakeholders, including a key emphasis on ongoing engagement and cooperation among human and veterinary medicine and among human health sectors and animal health sectors (predominantly animal agriculture).
• Efforts to improve awareness and understanding of AMR through effective communication, education and training.
• Efforts to strengthen the knowledge and evidence base through surveillance and research.
• Efforts to reduce the incidence of infection through effective sanitation and hygiene, and through infection prevention and control measures.
• Efforts to optimize the use of antimicrobial medicines in human and animal health.
• Efforts to support the development and use of new medicines, diagnostic tools, vaccines and other interventions.
• The goal to ensure that as much as possible and for as long as possible, the world benefits from continuity of successful treatment and prevention of infectious diseases with effective and safe medicines that are used responsibly and kept accessible to all who need them.

The discussion and input at the workshop reflected the need to move forward as quickly as possible in making improvements to address AMU/AMR. The viewpoints delivered reflected the WHO statement that “[AMR] is a crisis that must be managed with the utmost urgency. As the world enters the ambitious new era of sustainable development, we cannot allow hard-won gains for health to be eroded by the failure of our mainstay medicines.”