Roadmap for Integrated One Health AMR Surveillance
This roadmap outlines the path toward integrated AMR and AMU surveillance across the Nordic countries, following One Health principles.
Citation
Abramova, A., Baral, A., Osińska, A. D., Metsä-Simola, N., Räisänen, K., Duarte, A. S. R., Helgason, K. O., Halldórsdóttir, A. M., Pärnänen, K., Simonsen, G. S., Sariola, S., Lahti, L., Bengtsson-Palme, J., Wasteson, Y., Munk, P., & Pettersen, V. K. (2026). Roadmap for integrated One Health AMR surveillance in Nordic countries. Public Health, 255, 106285. https://doi.org/10.1016/j.puhe.2026.106285
Current State
The Nordic countries - Denmark, Finland, Iceland, Norway, and Sweden - have well-established surveillance systems monitoring AMR and AMU. However, each country currently operates within its own framework with limited connections to neighbouring countries’ surveillance structures.
Data sharing is primarily through international/EU systems (EARS-Net, GLASS, EFSA), which often have limited resolution compared to national datasets.
Why Integration Matters
A better integration of AMR and AMU surveillance in the Nordic region would:
- Enhance preparedness by enabling early data sharing and warnings about emerging threats
- Support evidence-based policy and antimicrobial stewardship
- Foster cross-sector and cross-border collaboration
- Remove barriers to data-sharing contracts and promote improved research
- Serve as a model inspiring other countries worldwide
Proposed Model
Decentralised data collection, centralised insight.
The proposed system:
- Builds on existing national systems - no need to replace what works
- Collects and shares data via an integrated platform - enabling unified regional surveillance
- Could leverage federated machine learning for joint analyses on data that cannot be directly shared
Challenges and Proposed Solutions
We identify five current obstacles to integrated regional AMR surveillance and propose solutions for each.
1. Data Granularity
Start with nationally aggregated, standardised, de-identified datasets submitted by each country’s national coordinating bodies. This avoids GDPR complications and builds on existing reporting structures. In parallel, develop a regulatory framework that enables access to both aggregated summaries and raw anonymised data, removing the need for various institutional clearance applications. See Reporting of Aggregated Data.
2. EUCAST Breakpoints
EUCAST breakpoints are updated regularly, making historical data no longer directly comparable with current data. Raw data (MIC values, disk zone diameters) is not always saved — only the S/I/R interpretation. Implement a policy for the storage of raw MIC and disk zone data in national databases to allow retrospective analysis and ensure consistent trend monitoring even with evolving breakpoints. See AST Reporting.
3. Missing Link Between Clinical Isolates and Diagnosis
Bacterial isolates are typically reported with resistance profiles but are not always linked to clinical context (diagnosis, type of infection, outcome). Develop national systems that securely connect laboratory results with clinical information by leveraging national electronic medical record platforms and existing health data registries. Adopt standardised data formats (e.g., WHO GLASS-compatible frameworks) and unique patient identifiers that enable linkage across datasets without compromising privacy. See Clinical Isolate-Diagnosis Link.
4. Delayed Reporting
Reliance on EU structures for AMR surveillance has drawbacks, including challenges with real-time data sharing due to reporting delays. Timely data is crucial for detecting emerging resistance trends, outbreaks, and cross-border transmission events. Build on existing national notification systems for selected resistant phenotypes to enable near real-time sharing for high-priority resistance phenotypes. See Real-Time Data Sharing.
5. Secondary Data Use
A vast amount of data is produced that can be utilised for both surveillance and research, including genomic and metagenomic datasets, socio-economic and environmental variables, and pharmaceutical industry data. However, legal restrictions are often associated with secondary use of data, and cross-border data sharing is hindered by national regulations. Address the need for secure computing environments that comply with data protection regulations, and develop novel computational analysis strategies for sensitive data environments. See Legal and Ethical Considerations.
Vision
See Vision for Integrated Surveillance for the long-term vision of what an integrated Nordic AMR/AMU surveillance system could achieve.