The challenge of reducing antimicrobial resistance (AMR) across the one health landscape: Diverse perspectives on AMR risks and their mitigation in sinks, drains, and wastewater

Multisectoral control of antimicrobial resistance (AMR) from water/wastewater is critical to meet United Nations targets of 10 % reduced AMR deaths by 2030. The complexity of policy and practice adaptations underpinning public health protection against AMR, requires coordinated One Health approaches. To inform harmonized solution implementation, we explored AMR mitigation practices, motivations, and opportunities among One Health stakeholders across healthcare, agricultural and environmental sectors, using mixed methods. Quantitative and qualitative responses were collected via online survey (n = 55), followed by semi-structured interviews (n = 26). Respondents were subdivided into; healthcare, facilities/estates, agriculture/veterinary. Thematic analysis was carried out using NVivo. Among 21 survey respondents interfacing with wastewater, antimicrobials, AMR bacteria and persistent pathogens were high priority for all human and animal healthcare respondents (60 % and 80 % respectively) compared to estates/facilities workers (37.5 % and 44 % respectively). Among respondents, 62 % reported wastewater monitoring deficits and containment challenges, including outdated infrastructure (73 %), resourcing (68 %) and persistent colonization of AMR reservoirs (77 %). Technology interventions were important to most stakeholders (92 %) but regulatory needs (28 %), proof-of-concept (22 %), cost and energy use (12 %) and maintenance (10 %) were drivers or considerations for technology adoption. Divergent perspectives emerged between sectors, including; feasible technology, source control, screening/surveillance. Consensus was clearer regarding sink/wastewater risks and comprehensive AMR policy needs. One Health oriented, AMR mitigation requires enhanced practices and implementable policies. This research highlights competing and complementary drivers for change across One Health settings. As new technologies emerge, their performance and integration to meet healthcare, societal and economics needs must be considered.