Integrating Environmental Surveillance into One Health Responses to AMR: Challenges, Solutions and Global Perspectives

Abstract

Antimicrobial resistance (AMR) poses a critical global health threat exacerbated by the complex interplay between humans, animals, and environmental reservoirs. Despite progress in clinical and agricultural surveillance, environmental AMR monitoring remains underdeveloped and fragmented, undermining comprehensive control efforts. This review synthesizes current knowledge on environmental compartments such as surface waters, wastewater systems, soils, and sediments as pivotal reservoirs and transmission pathways for resistance genes. It highlights the challenges in environmental AMR surveillance, including sampling heterogeneity, lack of standardized protocols, technical and financial constraints, and integration gaps within One Health frameworks. Global case studies from the Middle East, Africa, India and the European Union illustrate varied progress and persistent implementation barriers, especially regarding environmental data integration, laboratory capacity, and multisectoral coordination. The review underscores ethical considerations surrounding data sharing and privacy in the era of high-throughput technologies. Finally, it advocates for strategic investments in environmental surveillance infrastructure, harmonized methodologies, and inclusive governance models to strengthen One Health responses and curb the spread of antimicrobial resistance.