Fungal One Health and Antimicrobial Resistance Network Launch, 24th April 2025
- jstacey19
- Jun 10
- 11 min read
Updated: 6 days ago
A hybrid fungal community meeting held at the Imperial College London South Kensington Campus, 9.30am-5pm on April 24th 2025 - Programme
The Fungal One Health and Antimicrobial Resistance (F1AMR) Network launch event, which took place at Imperial College London, sought to enable community-led development of transdisciplinary research priorities around Fungal AMR. The day was divided into three parts: scene-setting keynote talks on Fungal AMR in research and policy in the morning; prioritisation workshops in the afternoon; and a closing segment focused on supporting early career researchers.
Scene-setting
The One Health approach, presented by Debbie Harding of UKRI, emphasises the interconnectedness between human health, wild, companion and livestock animals, and crops and plant life within both human-made and natural environments. Antifungal resistance in major animal and human fungal pathogens emerges as a side effect of agricultural fungicide usage. Meanwhile, climate change opens up both new vulnerabilities in human populations, and new sites for pathogens. As Professor Lord Darzi of Denham (Executive Chair of the Fleming Initiative) reminded the attendees in his pre-recorded address, the headline figures on fungal disease are stark. 30% of global crop loss is attributed to fungal pathogens[1] – enough to feed 600 million people and costing an estimated $2 billion annually – and over 2.5 million people are estimated to die every year from treatment-resistant fungal infections.[2] Innovation alone, Lord Darzi emphasised, is not enough. Scientists and policy makers must be brought together to answer vital questions: how can behavioural change optimise the use of existing antifungals, on the farm and in the pharmacy? What improvements to diagnostics can close the data gap which keeps us operating in the dark? What evidence is missing? How can the gaps be filled? What is needed to build a case for policy makers to act on? Networks like this aim to bring together the people who can, together, address these issues.
Keynote talks from Dr Hatim Sati (World Health Organization), Professor Paul Verweij (Radboud University), the UK Chief Plant Health Officer Professor Nicola Spence, and Professor Richard Quilliam (University of Stirling) set out the current policy landscape and gave a flavour of emerging research in fungal AMR.
Fungicides are widespread in modern agricultural practices, and likely to remain so.[3] DEFRA policy, presented by Nicolas Spence, calls for greater understanding of how fungicide use can be both optimised and rotated to mitigate, as far as possible, the build-up of resistance in the environment. The UK government is actively seeking to support bio-surveillance and develop networks across all sectors, to try to improve national and international monitoring of disease and link up the diverse groups currently monitoring microbes for distinct purposes. When “Azole” fungicides do build up in agricultural waste – where aspergillosis-causing aspergillus species like to grow – this produces a reservoir of antifungal resistant strains. Patients, as Paul Verweij reminded the group, can acquire azole-resistant disease without ever having taken the drugs before: understanding and addressing this “dual-use” problem is at the heart of the One Health approach. Different environments present different challenges, and global collaboration is indispensable if we are to understand how and why. At sites in Vietnam, over 85% of Aspergillus flavus isolates were resistant to at least one Azole.[4] In the Netherlands, resistance in Aspergillus flavus is negligible, but is extensive in A. fumigatus.[5] Meanwhile Candida spp., which can form very strong biofilms on plastics in hospitals and can cause disease by colonising medical implants, have been found by Richard Quilliam’s research team in the “plastisphere”: the ecosystem that forms around concentrations of plastic waste in the environment. Almost all plastics collected in the four Scottish catchment areas he presented were found to be colonised by Candida spp., and all the isolates tested were resistant to at least one azole antifungal.[6]
In response to these threats, WHO and other bodies have taken steps to encourage policy efforts to mitigate fungal AMR. WHO has recently published a Landscape analysis of commercially available and pipeline in vitro diagnostics for fungal priority pathogens and an overview of Antifungal agents in clinical and preclinical development; an Implementation Blueprint is also in production for the 2022 WHO fungal priority pathogens list. The Blueprint, a prioritised implementation framework to tackle fungal diseases, will focus on unmet needs of patients and on scalability across four domains: public health interventions; existing and emerging therapies and technologies; capacity building for laboratories, surveillance and outbreak monitoring; and social determinants of health. Updates to the priority pathogens list itself will begin next year. Fungal AMR is included in the Global research agenda for antimicrobial resistance in human health, published last year, and the Global Antimicrobial Resistance and Use Surveillance System (GLASS) includes Candida bloodstream infections. However, Hatim Sati of WHO emphasised – as did participants across the day – that there remains much to do in raising awareness of Fungal AMR among policy makers. One recommendation for the update to the Global action plan on antimicrobial resistance is to explicitly include antifungal resistance in the language and strategic objectives. Last year also saw a report by the five EU agencies into a. fumigatus resistance, with recommendations – a report which identified a long list of knowledge gaps.
Priority-setting
The Network leads presented rapid reviews of the work undertaken so far by four different working groups.
Rapid Reviews
Working Group 1: Understanding drivers for FAMR across One Health
Leads: Mike Bromley (University of Manchester) and Sarah Gurr (Exeter University)
The members of this group seek, across their different specialisms, to address four uncertainties: what is the threshold at which concentrations of fungicides in the environment start to drive antifungal resistance? Do combination therapies in medicine and agriculture induce or mitigate resistance? What are the current and future impacts of climate change on FAMR, in terms of pathogen thermotolerance, changing fungicide usage, and changes in the crops we grow? And finally, is it possible to build a mathematical model that would enable forecasting of dual-use FAMR? These uncertainties in turn raise a wide variety of potential research questions, such as: are there microenvironments which are particularly high risk for the development of antifungal resistance? How might resistance spread from such niches? Does antifungal resistance entail any fitness cost for the organism? What is the infectious dose of any given human or animal fungal pathogen – crucial to understanding when exposure becomes risk? Strategies for mitigation might include the development of new drugs (and the overhaul of incentives for new drug development); better targeting of treatments in both medicine and agriculture (not only which treatments should be used, but also when they will be most effective); combination therapies; and better management of agricultural waste.
Working Group 2: Surveillance of antifungal resistance
Leads: Darius Armstrong-James (Imperial College London) and Robin May (Food Standards Agency)
The Surveillance group is made up of members endeavouring to understand how to track resistant fungal pathogens across One Health. Two priorities early identified by this working group were the need for a wider and more transnationally integrated fungal surveillance framework, and for shared and standardised detection, diagnostic and genomic techniques. Current key foci include: the development and validation of integrated genomic protocols for identifying resistant fungi and analysing outbreaks; extending the Food Standards Agency’s Pathogen Surveillance in Agriculture, Food and Environment (PATH-SAFE) Programme to investigate spatial and temporal trends in the molecular epidemiology of antifungal resistance; facilitating and streamlining data sharing between organisations which hold or need information on antifungal resistance, including the NHS, NIHR Health Informatic Collaborative, the UK Clinical Mycology Network and the National Mycology Reference Laboratory; developing citizen science surveillance; and, inspired by the Cystic Fibrosis Trust's Antimicrobial Resistance Syndicate, establishing a biorepository and metadata for fungal AMR, to support faster and more efficient collaboration between academia and industry.
Working Group 3: Waste Streams
Lead: Helen West (Nottingham)
Waste is suspected to play a critical role in driving antifungal resistance. 11bn litres of wastewater is processed every day in the UK, and the removal of fungicides is inefficient – often at rates of less than 50%. The resultant water goes into rivers, while sludge goes to agricultural usage. Abattoir run-off can also contain fungicides; resistant fungi can multiply at sites where plastic accumulates; and flooding can help them disperse. In a recent analysis of river samples collected over 5 years at least one fungicide was detected in 91% of samples, and at times as many as 9 were found.[7] Humans can then be exposed to resistant fungi through bioaerosols – while ploughing a field, turning a compost heap, and so on. Focusing on waste, some research needs already mentioned recur, and some new ones arise: the need for surveillance of waste streams within the environment, the need to understand what levels of exposure constitute clinical risk, the need to integrate environmental sampling with clinical surveillance data, and the need to identify mitigation strategies for specific sites, including wastewater treatment and composting facilities.
Working Group 4: Interventions and Stewardship
Leads: Clare Chandler (London School of Hygiene and Tropical Medicine) and Tarek Soliman (Scotland’s Rural University)
This working group focuses directly on the use of antifungals in human and animal medicine, and of fungicides in agriculture, bringing together members seeking to establish how extensively such treatments are being used, and what rational stewardship interventions can limit the development of resistance. The lack of integrated data pipelines has once again emerged as a key block to such work and the group members seek to address this, as well as to develop toolkits and agri-economic models to support local antifungal stewardship programs for both medical practitioners/patients and farmers. The group also advocates for a subscription-based model for the development of antifungals to incentivise development, as put in place by UK NICE for antimicrobials.
Critical objectives in FAMR
Attendees divided into breakout sessions focussing on the different working group themes, and were given the following discussion questions:
What research is needed in this area?
How much progress could be made in the next 3-4 years?
Can this research readily be translated into impact?
What stakeholders need to be involved in driving the whole process?
From among the many important research priorities discussed, each group identified and presented 3 critical ones to the whole group:
Working Group 1: Mechanisms
a. Identification of risk factors in the environment, measuring fungicide levels and concentrations of resistant fungi with the aim of understanding thresholds for the development of resistance and hot spots for different species.
b. Steps towards understanding the impact of climate change on FAMR. For instance, approaching this very complex area by looking at how fungi adapt to gradual temperature rises, and investigating whether they “remember” and acclimate to extreme shifts in temperature.
c. Reduction of fungicides in the environment: investigating both how to spray less, and remove more.
Working Group 2: Surveillance
a. Standardisation of diagnostic and data accumulation approaches, integrating knowledge banks and biorepositories.
b. Development of new diagnostic tools for detection of resistant organisms.
c. Development predictive modelling for fungal antimicrobial resistance.
It was noted that these objectives build on each other, which already entails a specific order of feasibility – a is needed for b which is needed for c.
Working Group 3: Waste
a. Environmental surveying to assess risk and routes to exposure. Establish, across One Health sites (hospitals, farms etc.), where wastes are produced, through what processes, whether they contain fungicides which cause resistance, and identify the no-effect concentration.
b. A systems analysis approach to social behaviours pertaining to “unmanaged wastes” – all the untreated plastic that ends up in the environment, possibly including antifungal-containing agricultural and medical wastes.
c. Identification of strategies to mitigate the risks caused by waste, informed by the environmental surveying mentioned above.
Working Group 4: Stewardship
a. Map current interventions and identify what evidence would be adequate to develop a framework for FAMR mitigation.
b. Develop a public conversation about FAMR, in order to at once learn from different people in different domains, and educate the public about the risks of FAMR (for which the language we use needs to be improved).
c. Identify the impact we wish to achieve in the domain of mitigating Azole resistance, thence to establish what the minimum combination of interventions needed to achieve that impact would be. Model combinations, coordinate and test.
Rankings
All of the research objectives above were considered critical. The whole group of attendees was given the difficult task of identifying the most impactful and most feasible from among these critical objectives, with the following results:
Conclusions from prioritisation exercise
Some very similar objectives, when taken together, ranked extremely highly – for instance 1a, identifying risk factors and 3a, environmental surveying for risk and exposure came near the top in terms of both impact and feasibility. 1c, methods to reduce fungicides and 3c, waste mitigation were jointly high on impact, and around the middle on feasibility. 2b, the development of new diagnostic tools, performed strongly on both rankings (3rd for impact and 4th for feasibility), with 2a, standardisation and resources, just behind (6th for impact and 5th for feasibility). 4b, a national conversation about FAMR, scored notably highly on feasibility, coming in second. This item sparked an extended discussion, with suggestions to link in to UK 5-year action plan for antimicrobial resistance 2024 to 2029 - GOV.UK, and to World AMR Awareness Week (Nov 18-24). A meeting involving the relevant UK agencies, facilitated by Defra’s antimicrobial resistance coordination group (DARC), could be a first step towards this kind of conversation.
The outputs from this part of the day will be be, in the first instance, a published meeting report of research recommendations to be referenced in grant applications for the second phase of UKRI's Transdisciplinary research to tackle antimicrobial resistance call all and beyond, as well as further events to foster collaboration around the research goals identified.
Early career researcher forum
Tarek Soliman, the network’s Early Career Researcher lead, presented future plans for 6-monthly training workshops, including sessions on technical skills and grant-writing. Areas suggested were: Principles of Epidemiology and Evolution in Fungal AMR; Bioinformatic Resources for Fungal AMR Research; Economics of Agronomy and Health; Impacts of Fungal Diseases in Humans, Plants and Animals; Consequences of our changing environment on Fungal AMR. Further suggestions from the group included training on knowledge exchange, how to connect with stakeholders (especially in the farming community), training on specific aspects of diagnostics, and on cost-benefit analyses for antifungal interventions. The network committed to helping facilitate student/early career researcher-led events, and to keeping training open to more senior researchers while prioritising places for ECRs and students. The possibility was raised of using the “flexible funding” from the network grant for industry and policy placements. Debbie Harding further encouraged ECRs to explore unfunded placement weeks at DEFRA.
The projected output of this section of the day will be a series of training workshops, with a preparatory action to survey early career members of the network on what they would like to be captured under each of the training headings, plus any wish-list topics that fall outside of the areas currently suggested.
[1] Fisher MC, Hawkins NJ, Sanglard D, Gurr SJ. Worldwide emergence of resistance to antifungal drugs challenges human health and food security. Science. 2018;360(6390):739-42.
[2] Denning, David W. ‘Global Incidence and Mortality of Severe Fungal Disease’. The Lancet Infectious Diseases 24, no. 7 (1 July 2024): e428–38. https://doi.org/10.1016/S1473-3099(23)00692-8.
[4] Duong TMN, Nguyen PT, Le TV, Nguyen HLP, Nguyen BNT, Nguyen BPT, Nguyen TA, Chen SC, Barrs VR, Halliday CL, Sorrell TC, Day JN, Beardsley J. Drug-Resistant Aspergillus flavus Is Highly Prevalent in the Environment of Vietnam: A New Challenge for the Management of Aspergillosis? J Fungi (Basel). 2020 Nov 18;6(4):296. doi: 10.3390/jof6040296. PMID: 33217930; PMCID: PMC7711995.
[5] Verweij, Paul E., Yinggai Song, Jochem B. Buil, Jianhua Zhang, and Willem J. G. Melchers. ‘Antifungal Resistance in Pulmonary Aspergillosis’. Seminars in Respiratory and Critical Care Medicine 45 (9 January 2024): 032–040. https://doi.org/10.1055/s-0043-1776997.
[6] Metcalf, Rebecca, Ayorinde Akinbobola, Luke Woodford, and Richard S. Quilliam. ‘Thermotolerance, Virulence, and Drug Resistance of Human Pathogenic Candida Species Colonising Plastic Pollution in Aquatic Ecosystems’. Environmental Science and Pollution Research, 4 June 2025. https://doi.org/10.1007/s11356-025-36558-2.
[7] Porter, Nick, and Rob Collins. ‘Fungicides in English Rivers: Widening the Understanding of the Presence, Co-Occurrence and Implications for Risk Assessment’. Environments 12, no. 2 (February 2025): 45. https://doi.org/10.3390/environments12020045.
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