The 4th One Health | Professor Yonghong Xiao: Advancing the One Health Approach to Address Cross-Sector Challenges in Antimicrobial Resistance Control in China
Editor's Note: Antimicrobial resistance (AMR) has become a major global public health problem. Resistant bacteria and resistance genes can spread across the human–animal–environment interface through the food chain and the water environment. Relying solely on antimicrobial stewardship within medical institutions makes it difficult to resolve this complex, systemic problem, which is why the integrated One Health prevention and control model is becoming increasingly essential. At the 4th One Health Conference of Antimicrobial Resistance Containment, experts from multiple fields — clinical medicine, animal husbandry, the environment and public health — gathered to discuss the practical dilemmas and development pathways of AMR prevention and control in China. Infectious Disease Frontier invited Professor Yonghong Xiao, Chair of the Conference and of the First Affiliated Hospital, Zhejiang University School of Medicine, for an in-depth conversation covering the value and positioning of the conference, the identification of high-risk resistant pathogens with cross-sector transmission potential, the difficulties of cross-departmental coordination, the building of an integrated surveillance system, and the raising of societal awareness.Infectious Disease Frontier: As Chair of the 4th One Health Conference of Antimicrobial Resistance Containment, could you share the objectives and key highlights of this year’s meeting? What progress do you hope to achieve in advancing One Health-based AMR prevention and control in China through this conference? Compared with other countries, what are the distinctive features of China’s approach?
Professor Yonghong Xiao: This is the fourth edition of the One Health Conference of Antimicrobial Resistance Containment, which has been held annually since its launch in 2023. Both its attendance and influence have grown steadily, while its reach has continued to expand. This year’s participants came from across China rather than being limited to a particular region. Representatives from Heilongjiang, Xinjiang, Yunnan, and many other regions attended, demonstrating the conference’s broad geographical coverage.
The conference also brought together professionals from a wide range of disciplines. In addition to clinical experts, participants included professionals working in animal health, environmental science, public health, and community health. This truly reflects the One Health philosophy and establishes a platform for multidisciplinary exchanges on AMR prevention and control.
At this stage, the platform primarily serves as a forum for academic exchange and collaboration, and many participants have used it to establish research partnerships. However, we believe that simply facilitating academic discussions is far from sufficient. Moving forward, we hope to leverage this academic platform to translate the One Health approach into concrete AMR prevention and control practices in China. This could include developing consensus-based strategies for One Health AMR control, establishing channels for information sharing, and undertaking more practical initiatives in talent development and academic exchange. These will be among our key priorities in the years ahead.
Globally, One Health-based AMR prevention and control is still at an early stage, and China is no exception. Although a preliminary framework has been established domestically, related initiatives have yet to be widely promoted at a broader level. Over the past two years, national authorities have increasingly recognized the importance of this area, with One Health-related research incorporated into several national science and technology programs. Our team, for example, is undertaking a National Major Science and Technology Project for Infectious Diseases that adopts the One Health approach to investigate cross-sector AMR prevention and control.
Overall, awareness of One Health-based AMR prevention and control has increased significantly across different sectors in China, accompanied by growing enthusiasm for participation. The steady increase in conference attendance, the expanding scope of research, and the increasingly in-depth discussions are all encouraging developments.
Progress in AMR prevention and control requires sustained, step-by-step efforts. We hope to use the One Health Conference on Antimicrobial Resistance Control as a platform to facilitate ongoing academic exchanges and collaboration, translate more initiatives into practice, and contribute to AMR control in China.
Infectious Disease Frontier: Resistance genes can spread across different ecological compartments through food chains and water systems. Which resistant bacteria or resistance genes warrant particular attention because of their potential for cross-sector transmission? Compared with antimicrobial stewardship conducted solely within hospitals, what are the greatest challenges in implementing an integrated human-animal-environment approach to AMR prevention and control?
Professor Yonghong Xiao: All types of microorganisms carry the potential for antimicrobial resistance transmission. However, from a One Health perspective, different pathogens have different levels of transmission risk and therefore warrant different priorities.
For example, as highlighted by Academician Hongning Wang in her presentation at this conference, foodborne pathogens carry a relatively high risk of AMR transmission. Salmonella and Escherichia coli found in poultry, eggs, meat, and other food products can be transmitted to humans through the food chain. During cross-host transmission, these pathogens may also carry and disseminate antimicrobial resistance gene elements.
In addition, as human lifestyles become increasingly diverse and urban pet ownership continues to grow, close contact between people and their pets creates opportunities for the cross-species transmission of resistant bacteria. A typical example is methicillin-resistant Staphylococcus aureus (MRSA), for which animal-to-human transmission has already been documented.
Beyond these relatively well-recognized pathogens, some less frequently discussed organisms also deserve considerable attention. For instance, Campylobacter jejuni and Yersinia enterocolitica can also spread through the food chain via partially processed and ready-to-eat foods, potentially facilitating the dissemination of both pathogens and antimicrobial resistance genes.
The most fundamental challenge in advancing integrated One Health prevention and control is intersectoral coordination. At present, work across different sectors remains fragmented. The agricultural, food safety, and animal health systems largely operate independently, and stable, effective coordination mechanisms have yet to be established. Only by breaking down institutional barriers and establishing coordinated mechanisms can we truly translate One Health strategies into practice.
Infectious Disease Frontier: AMR involves multiple sectors, including healthcare, animal husbandry, and ecology. However, surveillance systems and data standards vary across industries. From your perspective, what should be the first priority in establishing a truly integrated One Health AMR surveillance system?
Professor Yonghong Xiao: Several years ago, a commentary published in Nature proposed that a common “language” was needed for AMR prevention and control. At first glance, this might be interpreted as referring to linguistic differences. In fact, the “language” in this context refers to the standardization of systems for describing AMR-related information, including professional terminology, units of measurement, and the technical methods used for surveillance.
Without harmonizing these fundamental standards, it would be extremely difficult to establish an integrated AMR surveillance system. Although some basic testing technologies are shared across sectors, the ways in which data are presented and surveillance strategies are implemented differ considerably.
For example, healthcare institutions report patient-related data to national surveillance networks, as is the case with the bloodstream infection surveillance network we have established. Surveillance in the animal health sector, however, follows a completely different model. A single livestock farm may house tens of thousands or even hundreds of thousands of animals. Surveillance is generally conducted through periodic sampling, often involving animal excreta or environmental samples rather than direct sampling from individual animals. As a result, data from different sources are difficult to integrate.
Human population surveillance also has significant gaps. Current surveillance efforts are primarily concentrated in hospitals, while extending coverage to community populations remains a challenge. Community-based surveillance requires substantial investment in personnel and resources, and standardized protocols are still lacking. Different departments also use different denominators when reporting AMR data: the size of the human population, the number of microorganisms, or the volume of antimicrobial consumption.
For example, when monitoring antimicrobial consumption in livestock, European countries calculate consumption based on the total annual biomass of food-producing animals. China has not yet adopted this standard. For antimicrobial consumption in human populations, other countries commonly use consumption per 1,000 inhabitants as an indicator, whereas China’s existing surveillance data are largely derived from hospitalized patients. These two sets of data are therefore not directly comparable.
Consequently, I believe the first priority is to establish consensus on this common “scientific language” for AMR prevention and control. Only on this basis can we undertake coordinated action and achieve interoperability and integration of data across different sectors.
Infectious Disease Frontier: At present, both public awareness and industry standards for AMR prevention and control require further improvement. Looking ahead, how can we better raise awareness of AMR across society and build a concerted effort to advance AMR prevention and control under the One Health framework?
Professor Yonghong Xiao: We currently have favorable conditions for making progress in this area. Social development, particularly advances in information technology, has made public education on AMR more accessible. The internet, new media platforms, and artificial intelligence can all be used to raise public awareness of the dangers of antimicrobial resistance. The key is to strengthen public education and science communication on a broad scale.
At present, awareness of AMR remains largely confined to professional communities. Healthcare professionals, managers of large-scale livestock farms, and experts in disease control and prevention generally have a relatively good understanding of the issue. However, awareness among China’s general population of more than one billion people remains insufficient. Relevant surveys have shown that even among university students, many have limited knowledge of AMR. There are various ways to improve public awareness. Traditional approaches, such as putting up educational posters, are feasible but have limited reach and communication efficiency.
A more effective approach would be to leverage modern information technologies for online science communication. In addition, international experiences, including those promoted by the World Health Organization (WHO), are worth drawing on. Where conditions permit, schools could incorporate topics such as bacterial transmission and antimicrobial resistance into science curricula at the primary and secondary levels.
Young people are generally receptive to the principles of rational antimicrobial use and can also help influence their parents’ attitudes. This advantage is particularly relevant in China, where many parents are willing to listen to their children’s views. If children acquire basic knowledge about AMR, they can raise questions and offer thoughtful reminders when family members consider taking antimicrobials on their own initiative—commonly referred to as “anti-inflammatory drugs” in everyday language. This form of education and awareness-raising can sometimes be more effective than communicating directly with adults.
In summary, raising awareness across society is a prerequisite. Only when the public develops a shared understanding of AMR can subsequent efforts—including scientific research, interventions, interruption of transmission pathways, and cross-sector collaboration—be implemented more effectively.
