Novel Approaches to Characterizing and Tracking the Global Burden of Antimicrobial Resistance (Round 17)

The Opportunity

Increasingly, antimicrobial resistance (AMR) and drug resistant infections are being recognized as a crosscutting threat to global health. High rates of resistant infections have been documented in healthcare and community settings, in all WHO regions, and for a broad range of microorganisms. Despite the global focus, considerable gaps remain in our understanding of burden and resistance patterns, including the burden of drug-resistant infections on children in the highest mortality countries in Africa and Asia. A reliable evidence base that accurately describes and characterizes the aggregate burden of AMR in low- and middle-income settings will be essential to inform global and national priority setting and to drive public health actions.

These data gaps are directly relevant to the current debate surrounding the appropriate balance of access to antimicrobials for vulnerable populations vs. excessive use in many settings. For example, pediatric mortality primarily associated with drug-susceptible infections would benefit from interventions focused on broadly increasing access to antibiotics; conversely, if drug resistant infections are disproportionately contributing to mortality, the focus would shift to judicious and selective use of antibiotics to preserve their value and better target resistant infections.

The Challenge

Our goal is to identify approaches that provide more robust and reliable evidence regarding the global scale, impact, and/or transmission dynamics of AMR, specifically as applicable to low- and middle-income settings. We also seek solutions that will provide an assessment of various drivers and the health impact of interventions on rates of resistance.

Because AMR is a complex problem with multiple interconnected drivers and our focus is on high mortality and data-poor geographies, these approaches will likely require new data streams and approaches (e.g. modeling) applied in a sufficiently robust way to lead to strategic guidance for decision-makers.

What we are looking for:

We are soliciting innovative ideas for models, tools, analytics, surveillance platforms, technologies, and other high impact approaches to generating evidence about the burden and impact of antimicrobial resistance in low and middle income settings, and improving its translation into practice. We are particularly seeking transformative and innovative approaches which identify and fill knowledge and practice gaps currently limiting progress in AMR surveillance and epidemiology.

Proposed projects should have the scope and potential to transform public health practices for AMR on a global or regional scale.

Specifically, we seek proposals that support the following.

1. Evaluating and prioritizing the impact of drivers of antimicrobial resistance, including existing interventions, environmental factors, etc.
2. Accelerating the generation of robust, generalizable, evidence to characterize and track the global epidemiologic and economic burden of AMR.
3. Understanding and describing the epidemiology of molecular resistance and transmission of AMR

We will consider a wide variety of approaches, as outlined below, provided a case can be made for how the approach will facilitate and support the generation of generalizable evidence that will improve our ability to document and track the burden of AMR, and use the resulting data to inform policy making, prioritization, and action. Programs should show a clear path to scale widely across our priority geographies.

Proposals must i) have a testable hypothesis, ii) include an associated plan for how the idea will be tested or validated, and iii) yield interpretable and unambiguous data in Phase I in order to be considered for Phase II funding. Proposals and associated outputs must be directly relevant to developing contexts.

A few examples of work that would be considered for funding:

• Proposals that quantify the contribution of various drivers and/or interventions on the global emergence and spread of AMR.
• Novel metrics and analytic approaches (e.g. using previously unappreciated data/sources or new analytical methods) to provide a more complete picture of the scale, impact, or dynamics of global AMR.
• Integrated approaches to understanding and describing the association between resistance patterns, anti-microbial use, access, and health and economic burden.
• Proposals focused on creating novel high-level, scalable systems architecture (e.g. data sources and streams) and activities necessary to transform global AMR epidemiology.
• Proposals that provide a detailed analysis of the economic and health systems impacts of AMR.
• Non-incremental innovative technology and surveillance platforms capable of accelerating the generation of robust evidence to document and track the burden of AMR. To be relevant to this call, the proposal should be scalable to a large number of contexts and/or provide generalizable insights.
• Methods to improve surveillance capacity and reporting of AMR beyond enhanced routine surveillance and targeted surveys (e.g. the application of genomics and machine learning).

We will not consider funding for:

• Proposals without a clear application to surveillance or facilitating the development of new evidence describing the global burden of AMR.
• Proposals seeking to apply existing tools in ways that do not transform our understanding of the global emergence and/or spread of AMR.
• Incremental improvements to conventional solutions or typical disease surveillance. We will not consider local surveillance programs or projects or small improvements in surveillance, (e.g. use of mobile data collection, automation of traditional processes, improving access to existing tools or technologies).
• Proposals that simply expand the availability of primary data without a clear link to informing our understanding of global AMR epidemiology.
• Applications proposing basic research.
• Ideas not directly relevant to low and middle income contexts.
• Proposals focused on upstream development of new diagnostics, therapeutics, or interventions to treat or control resistant infections, unless these can be actively implemented in a way that informs AMR epidemiology.
• Genomic and other laboratory-based approaches that lack a clear application to AMR surveillance and/or epidemiology.
• Ideas focused on quantifying resistance in animal/livestock populations or in environmental samples without a direct linkage to how data would impact public health practice.
• Proposals involving clinical trials in human volunteers or patients (note: use of existing datasets or other outputs from clinical trials may be considered, so long as the proposed approach is feasible within the time and financial envelopes provided).