Antimicrobial use in animals: a journey towards integrated surveillance

directly at the farm level, strengthen interoperability and integrated analysis with cross-sectoral databases, facilitate institutionalisation of data collection, and systematic use in monitoring, evaluation, lesson learning reporting and eventually, surveillance of AMU/AMR when implementing and updating NAPs. This paper describes how all these different challenges were overcome and how those foreseen in the future will be addressed.


Introduction
The World Organisation for Animal Health (WOAH, founded as OIE) provides, amongst others, standards to ensure availability and utilisation of high quality veterinary products including antimicrobial agents. In 2016 the Organisation published its strategy on antimicrobial resistance and the prudent use of antimicrobials [1]. Monitoring antimicrobial use (AMU) in animals, in conjunction with surveillance of antimicrobial resistance (AMR), provides essential information to empower veterinary services in their assessment and management of risks related to AMR in animal health and beyond. Based on developed standards in this area [2,3,4,5], and within the framework of the Global Action Plan on AMR [6], the creation of a global database on antimicrobial agents intended for use in animals was initiated in 2014.
Launched the following year as a Microsoft Excel spreadsheet, it offered a harmonised tool for data collection available in the three official languages of the Organisation (English, French and Spanish).
Several evolutions have been made since.
The first one concerned the introduction of an updated methodology to report quantitative data for relevant animal populations, including an analysis of antimicrobial quantities adjusted for animal biomass on a global and regional level [7]. Other upgraded features were added over time, such as a specific Calculation Tool, facilitating data entry and

Flying at cruising altitude -consolidation of the system
Since 2016, a series of evolutions were considered and implemented to maintain Member's participation and increase accuracy of collected data.
The development of an analysis denominator (WOAH Animal Biomass methodology) was set to compare quantitative data reported on antimicrobial agents intended for use in animals across regions and over time. The need to evaluate these data in the context of relevant animal populations, which vary in size and composition, is already highlighted in WOAH Standards [3,4] and within the methodology developed by the AMR ad hoc Group [12]. The overall objective of the methodology is to obtain the biomass of animals present during the year of analysis, in a specific country, using internationally and publicly available data [13]. The strength of the methodology comes from the uniformity of animal population data sources used and the high standardisation of 41_2_21_Yugueros-Marcos_preprint 6/19 calculations, allowing a significant comparability of indicators globally [14]. surveillance programmes [16].
As the data collection cycles succeeded, the number of participating overcome. This is a human interaction based exercise which is key in getting a larger perspective and quality contextual information about the AMU situation at the local level. Noteworthy, these exchanges are also key in building trust, and improving the knowledge of the country respondent on their own AMU data.
Last, but not at all least, is the AMU Annual Report WOAH publishes every year, and releases data and analyses. The Annual Report is one of a kind, as it provides a situational analysis on the use of antimicrobials in animals worldwide, with regional and global analysis perspectives, enabling to better understand the current situation, for a given year, as well as over time. It highlights the increased capacity for country monitoring and accurate collection of data, establishing baselines for countries to monitor the implementation of their National Action Plans (NAPs) against AMR in the animal sector. Developed since the first edition and adapted through the years, the report is also a communication tool. It contributes to spread awareness and to educate on the responsible and prudent use of antimicrobials, highlighting progress and areas for further effort, being also a surrogate indicator for the implementation of WOAH standards on AMU. As such, it is planned that some features will also be incorporated in the Observatory.

Flying higher, flying with others -heading towards integrated surveillance
ANIMUSE is expected to be launched when kicking off the eighth data collection round, by September 2022. During this round, hybrid data submissions will be allowed. Members will be able to either fill data directly online or to send their classical Excel template, which will be automatically integrated into the ANIMUSE Global Database. WOAH is ready, as it was done in 2015, to interact with and assist Members.
Evolutions and adaptations will be likely needed till a new era of AMU data collection, analysis and reporting is consolidated. In line with its vision of greater transparency, ANIMUSE will provide the Members the opportunity to choose the level of confidentiality for their validated data: confidential, semi-public, or public. In parallel to this, the way the AMU Annual Report is structured and disseminated is planned to evolve. While keeping the level of confidentiality that Members will choose, design of infographics and interactive visualisations will be developed in parallel to better show global and regional situational analysis. A summarised report consolidating and analysing essential results, important trends, progresses and areas to focus further efforts will be edited, in addition to a full comprehensive and thorough report for those who wish to dive into details. Enabling Focal Points for Veterinary Products and WOAH Delegates to use their AMU monitoring data in surveillance programmes, within the further implementation of NAPs, and influence relevant policy makers, must remain our principal goal. Inspired by the past, consultation of Members will be organised to redefine the AMU Annual Report and other associated communication tools.
Since the beginning, WOAH has been tackling AMR with a One Health approach. Integrated surveillance of AMR/AMU across sectors will be key in helping us to understand the global situation and define joint action plans to control AMR more effectively. The re-development of WOAH's WAHIS, has provided the opportunity for systems compatibility, so that the annual data collection process can potentially be streamlined into one global data system ensuring compatibility with data platforms from other Quadripartite members. ANIMUSE will 41_2_21_Yugueros-Marcos_preprint 12/19 therefore be part of the integrated system for monitoring on AMR/AMU platform, which intends to make available in a user-friendly manner on a global and regional basis validated and official data provided by countries to Quadripartite partners on patterns and trends in AMU and AMR in humans, animals, food, plants, and eventually in the environment. A first step in the journey to integrated analyses and surveillance across sectors.

Conclusions
Since 2015 WOAH has been collecting, analysing and reporting global AMU data is a crucial asset that creates value on various possible aspects at global, regional and country level. It is not solely about monitoring data, but it is about building the knowledge to collect them, understand them, analyse them and act on them. In order to do so, developing the adequate tools and answering to the needs expressed by the end-user is critical. ANIMUSE is integrated with a powerful business intelligence tool that helps countries create deeper and more helpful insights from their data. These insights can inform decisions and turn them into actions. The evolution of this tools responds to the objectives of WOAH Standards [3,5]. Authors would also like to thank all our colleagues from Regional and Sub-Regional Representations. They are an essential part of this success, being at the front end in the interaction with Focal Points.
Authors would also like to thank colleagues from other Departments