Antimicrobial resistance (AMR) poses a severe threat to our health care system as infections like whooping cough persevere, even in immunized individuals. The World Health Organization (WHO) projects the terrifying prospect of 10 million AMR-related deaths per year globally by 2050, reinforcing the global community’s responsibility to implement actionable approaches toward accelerating healthcare facilities’ prevention, detection and response capacities.

The dramatic increase in macrolide-resistant Bordetella pertussis (or whooping cough) has become a global concern in the past several years. Even countries with high immunization rates in early childhood have experienced rises in pertussis cases. Reasons for the resurgence of reported pertussis may include molecular changes in the organism, increased awareness, diagnostic capabilities, lessened vaccine efficacy and waning immunity. There is a pressing need for stronger diagnostic, treatment and surveillance systems to tackle the resistance of this organism to specific antibiotics for improved public health outcomes.

With active, capacity-building programs in more than 20 countries, ASM is a leader in the fight against AMR and other infectious disease threats. ASM’s Global Public Health Programs (GPHP) work with funders, local stakeholders and ASM’s extended network of subject matter experts (SMEs) to increase laboratory capacity in resource-limited areas. Most recently, ASM received funding from the Centers for Disease Control and Prevention (CDC) to support the first year of a 5-year program to improve infectious disease surveillance and prevention work for B. pertussis in Mexico and Brazil.

Maritza Urrego, a GPHP senior program officer overseeing ASM’s efforts in Brazil and Mexico, is eager to use her 15 years of experience in public and private sector project portfolio management, her background in international development and her multilingual skills to grow ASM’s expanding program in Latin America. Here she shares the background of the project and her hopes for the future, fueled by her desire to eradicate poverty and poor health conditions worldwide.

What Is the Focus for the Project?

ASM entered into the first year of a 5-year-long cooperative agreement with CDC’s newly established Global Antimicrobial Resistance Lab & Response Network in September 2021. The goal of this initiative is to improve the detection of emerging threats and identify risk factors that drive the emergence and spread of AMR across the community and the environment. ASM’s global consultants will specifically focus on Mexico and Brazil to monitor the emerging AMR of macrolide-resistant B. pertussis.

B. pertussis is a re-emerging pathogen that causes a highly contagious respiratory infection known as whooping cough, which predominately affects young children and infants. At least 90% of infections occur in resource-limited countries due to lack of diagnosis. B. pertussis diagnosis is based on clinical symptoms and a variety of laboratory tests—the most preferable of which is culture of nasopharyngeal samples—but obtaining reliable samples is challenging. Researchers also continue to uncover how novel aspects of the pathogenesis of B. pertussis lead to its continued ability to cause outbreaks. The lack of standardization of susceptibility tests requires urgent measures to improve the diagnosis and surveillance of this important pathogen for public health.

What Will ASM Consultants and Partners Specifically Be Working on?

ASM is collaborating with the Pan American Health Organization (PAHO) and Brigham and Women’s Hospital (BWH). ASM’s role will be in 2 main areas: training in-country laboratory staff and data collection. The team will engage the national and regional laboratory networks to optimize molecular testing and external quality assessment procedures for B. pertussis. ASM will train local staff in AMR-specific procedures and technologies, including isolation and sensitivity tests.

The team will also evaluate ways to improve each country’s technical capacity to screen for AMR. Using this information, partners will formulate a workplan and collaborate with the health ministries in Brazil and Mexico to address shortcomings and help inform clinicians on this pressing issue.

ASM will utilize the vast expertise of its global membership to manage and implement the technical activities proposed in the project. ASM has SMEs with the appropriate language skills and cultural sensitivity to support the expansion of training and mentoring activities. PAHO will leverage its experience in the field, vast network of experts and continued partnership with local governments to help ensure that technical cooperation is adapted to local priorities and needs. Meanwhile, the BWH Division of Infectious Disease will contribute its extensive experience in clinical and epidemiologic research. Their WHONET software, which is used to support global surveillance of AMR activities in over 140 countries, will be a valuable new tool for Mexico and Brazil.

How Will ASM's Prior AMR Work Inform This New Program?

This is the first time that ASM will be implementing projects in Mexico or Brazil. However, with over 15 years of work in more than 20 countries in Africa, Asia and the Middle East regions, ASM has a deep understanding of resource-limited health systems. The team tailors its scientific expertise in microbiology to develop and hone context-appropriate interventions to improve the function and performance of all aspects of the laboratory system. The emphasis of ASM's work is building capacity of both laboratorians and laboratory systems. Laboratory capacity building expands the availability of high-quality diagnostic services and data in order to avert outbreaks and enable high-quality medical care. 

“It is my hope that in year 2, we can introduce a mentorship plan, similar to one we have implemented in Ethiopia,” said Urrego. ASM has worked closely with a number of stakeholders in Ethiopia for more than 10 years to strengthen microbiology laboratory technical capacity in an effort to improve health outcomes—with some great successes—including the recent establishment of a completely virtual surveillance training program for laboratorians: Project ECHO (Extension for Community Healthcare Outcomes). In 2017, as part of the Global Health Security Agenda, ASM worked with CDC and the National Microbiology Reference Laboratory in Ethiopia to adapt the ECHO AMR curriculum for the Ethiopian local context and priorities. Through their virtual connections to ASM’s SMEs in the U.S., the trainees from resource constrained “spoke” sites improved their understanding of the identification of priority pathogens, as well as antibiotic susceptibility testing, proper reporting protocol and laboratory quality control.

What Is the Most Important Goal of the Project?

The ultimate goal of the project is to reduce morbidity in children, who are most affected by this disease in Mexico and Brazil, and even expand to other countries. We envision utilizing this project’s achievements as a model to continue improving diagnosis and surveillance of B. pertussis in the rest of Latin America and the Caribbean. 

Why Is It Important for Governments and Organizations to Work Together to Address AMR on a Global Scale?

Collaboration increases credibility and scope beyond what each organization has to offer and extends the reach of each partner’s messages and programs. Government partners like the CDC can provide valuable evidence-based tools and guidance benefiting both the partnership and the community's health. The federal government knows that no single stakeholder can solve a problem, so it encourages partnerships to speed up response and efficiency of efforts. Organizations with unique areas of expertise can adapt and execute programs in ways that amplify and fill in the gaps of the federal government’s efforts.

GPHP activities empower microbiologists around the world to help their facilities meet international standards and promote healthy patient outcomes. By safeguarding global health systems and supporting sustainable infection prevention control awareness, countries and facilities will have more success combatting AMR, leading to healthier lives for those at risk of drug-resistant infections.