During the height of the COVID-19 pandemic, I had the rare privilege of presenting genomic surveillance data and other laboratory insights at Pakistan’s National Command and Operation Center (NCOC). It was more than just a professional milestone—it was a front-row seat to one of the most remarkable crisis management operations in the country's history. The NCOC wasn’t just a command center; it was a game-changer, transforming fragmented efforts into a unified national strategy. Pakistan’s ability to tackle the pandemic—and now the Mpox threat—didn’t happen by chance. It was the result of a centralized, data-driven approach that many still don’t fully appreciate.

When COVID-19 first hit Pakistan in early 2020, the nation stood at a crossroads. With a fragmented healthcare system and governance challenges stemming from the 18^th Amendment, which devolved health responsibilities to the provinces, a coordinated response seemed nearly impossible. Yet, against all odds, Pakistan emerged as one of the few countries that managed to navigate the crisis with remarkable efficiency. The secret weapon? The National Command and Operation Center.

As the nerve center of Pakistan’s pandemic response, the NCOC became a beacon of centralized decision-making and data-driven governance. It transformed what could have been a chaotic, disjointed effort into a streamlined and effective national strategy. And now, as Pakistan grapples with a looming threat in the form of Mpox (formerly monkeypox), the NCOC’s legacy continues to shape the country's response.

A Blueprint for Crisis Management

When COVID-19 struck, developed nations with robust healthcare infrastructures faltered. Pakistan, despite its resource limitations, took a different approach: it established a unified command. Using constitutional provisions to bypass bureaucratic bottlenecks, the federal government created the NCOC in April 2020. This body did what few expected—it brought all provinces, health agencies, and security forces onto the same page.

Led by the Minister of Planning and Development, with military leadership providing operational expertise, the NCOC crafted policies that balanced public health and economic stability. Unlike blanket lockdowns that paralyzed many economies worldwide, Pakistan introduced smart lockdowns—a targeted strategy that restricted only high-risk areas. This approach not only curbed the virus’s spread but also kept businesses afloat, mitigating economic devastation.

The NCOC’s achievements were staggering. COVID-19 testing capacity skyrocketed from just four laboratories to over 170 nationwide. Daily testing rose from 500 to an impressive 65,000. The “Test, Trace, and Quarantine” strategy helped contain outbreaks, while aggressive vaccination campaigns, backed by real-time data analysis, ensured effective immunization coverage. One of the hallmarks of the NCOC during the COVID-19 pandemic was its ability to make quick

decisions. I remember advocating for genomic surveillance and the need to strengthen next- generation sequencing (NGS) facilities at NIH. Given the high costs of NGS technology, securing funding seemed unlikely. However, to my surprise, the proposal was swiftly approved by the Special Assistant to the Prime Minister (SAPM) on Health—who, being an infectious disease expert, recognized its critical importance. With these funds, NIH was able to report variants and their spread in real time to the NCOC, significantly aiding data-driven decision-making. Additionally, the NCOC played a key role in shaping public behavior through strategic communication. Initially, many citizens underestimated COVID-19’s severity, but by mid-2020, the NCOC’s multi-platform messaging—through media campaigns and mobile phone alerts— helped drive compliance with mask-wearing and social distancing. By the time the NCOC wound down operations in April 2022, it had successfully steered Pakistan through six waves of the pandemic.

NCOC 2.0: Taking on Mpox

While many saw the NCOC’s closure as the end of an era, its operational framework proved too valuable to retire completely. In 2024, as Mpox cases surfaced worldwide, Pakistan was quick to react. The NCOC was reactivated (this time led by National Institute of Health (NIH), leveraging its pandemic-tested model to preempt a full-blown crisis.

Despite initial WHO recommendations against screening travelers at entry points, Pakistan took a proactive stance. Border Health Services, under NCOC directives, implemented early screenings, leading to the timely detection of imported Mpox cases. Public health laboratories across the country, in collaboration with the NIH, ramped up diagnostic capacities, while the polio environmental surveillance network was repurposed to track Mpox outbreaks. These measures allowed Pakistan to detect and contain 14 cases as of March 2025—before the virus could spiral into an uncontrollable epidemic.

Genomic surveillance, another NCOC hallmark, has played a crucial role in tracking Mpox mutations. Scientists at NIH have successfully sequenced and identified imported viral strains, helping public health officials anticipate transmission patterns. Meanwhile, isolation protocols and containment strategies, similar to those deployed during COVID-19, are ensuring that Pakistan stays ahead of the curve.

Lessons for the World

Pakistan’s handling of COVID-19 and now Mpox underscores an invaluable lesson: centralized coordination works. The NCOC model—grounded in data, rapid decision-making, and inter- agency collaboration—has proven that even countries with limited resources can effectively manage global health crises.

While international recognition has poured in, with WHO commending Pakistan’s pandemic response, the real victory lies in the blueprint it offers for future public health emergencies. Whether it’s a resurgence of COVID-19, another viral outbreak, or an unforeseen health crisis, Pakistan now possesses a tested and scalable mechanism to respond.

As global health threats continue to evolve, perhaps it’s time for other nations to take a page from Pakistan’s playbook. The NCOC didn’t just help Pakistan survive a pandemic—it set a precedent for how nations can turn adversity into opportunity through strategic, science-backed governance.

Dr. Massab Umair Presenting Genomic Surveillance Data on SARS-CoV-2 at NCOC: Informing Pakistan’s Pandemic Response.

By ISID Emerging Leader, Dr. Massab Umair

The author is a virologist and public health expert with a focus on disease surveillance and health systems strengthening (massab.umair@yahoo.com).

The longstanding global crisis of childhood undernutrition

For years, global efforts to reduce childhood undernutrition have focused on the idea that “what you are is what you eat.” This approach has led to initiatives like promoting exclusive breastfeeding and improving sanitation and hygiene, backed by organizations like the World Health Organization (WHO). However, despite these efforts, the rates of childhood undernutrition worldwide have not dropped as expected^[1]. This shows that we need new, innovative ways to strengthen existing programs and better support children’s health.

One major reason why childhood undernutrition remains a problem is due to enteric infections—infections that affect the intestines. Diarrhoea is one of the most common consequences of enteric infections, and it often leads to a cycle where children lose nutrients, feel less hungry, and cannot absorb nutrients properly, resulting in malnutrition^[2]. In areas with poor sanitation and hygiene, children are also exposed to harmful microbes, which can cause a condition called environmental enteric dysfunction. This condition, which can be acquired as early as 12 weeks of age, damages the intestines, making it harder for children to digest and absorb nutrients^[3].

Gut Health: The key to prevention

To prevent both enteric infections and undernutrition, we need to keep the intestines healthy. Interestingly, scientists are now looking at how probiotics (beneficial bacteria) and prebiotics (compounds that feed beneficial bacteria) can play a role in improving gut health and preventing infections. Probiotics are live microorganisms, often bacteria, that, when consumed in adequate amounts, can have a positive effect on health. Prebiotics, usually types of fibre, act as food for these good bacteria. Synbiotics combine both probiotics and prebiotics to support gut health.

In high-income countries, probiotics have been used for years to treat and prevent various childhood conditions, like diarrhoea and premature birth complications^[4]. These beneficial bacteria work by improving the gut microbiota—the community of microbes living in our intestines. When we consume probiotics, they help increase the number of good bacteria, which compete with harmful pathogens for space in the gut. They also help digest food and produce acids that fight off bad bacteria, boost the growth of healthy intestinal cells, and support the immune system.

The future of gut health in fighting undernutrition

Most research so far on probiotics has focused on children who are already sick or older children. However, there is a growing interest in using probiotics from early childhood to help build a stronger, healthier gut from the start. Early studies, particularly in sub-Saharan Africa, are exploring whether giving probiotics to infants can improve their growth, development, and overall health. These studies suggest that the health of our intestines is just as important as the food we eat when it comes to fighting undernutrition^[5].

In short, for children to fully process and utilize the nutrients in the food they eat, their intestines must always be strong and healthy. By improving gut health through probiotics, we could help children grow stronger, fight infections more effectively, and ultimately reduce the rates of childhood undernutrition.

By ISID Emerging Leaders, Benjamin Kadia and Tintu Varghese

References

1. Scott N, Delport D, Hainsworth S, Pearson R, Morgan C, Huang S, et al. Ending malnutrition in all its forms requires scaling up proven nutrition interventions and much more: a 129-country analysis. BMC Med. 2020;18(1):356.
2. Rodriguez L, Cervantes E, Ortiz R. Malnutrition and gastrointestinal and respiratory infections in children: a public health problem. Int J Environ Res Public Health. 2011;8(4):1174-205.
3. Naylor C, Lu M, Haque R, Mondal D, Buonomo E, Nayak U, et al. Environmental Enteropathy, Oral Vaccine Failure and Growth Faltering in Infants in Bangladesh. EBioMedicine. 2015;2(11):1759-66.
4. Alcon-Giner C. Microbiota Supplementation with Bifidobacterium and Lactobacillus Modifies the Preterm Infant Gut Microbiota and Metabolome: An Observational Study. Cell Reports Medicine 2020.
5. Momo Kadia B, Otiti MI, Ramsteijn AS, Sow D, Faye B, Heffernan C, et al. Modulating the early-life gut microbiota using pro-, pre-, and synbiotics to improve gut health, child development, and growth. Nutr Rev. 2023.

The recent Ebola outbreak in Uganda has raised significant concerns regarding its potential spread, given the virus's history of rapid transmission and high mortality rates. On January 29, 2025, a 32-year-old nurse in Kampala succumbed to the Sudan strain of the Ebola virus, marking the country's first Ebola-related death in two years. This incident underscores the persistent threat of Ebola in the region and the challenges associated with containing its spread [1].

The Sudan strain of Ebola, responsible for the current outbreak, is particularly concerning due to the absence of an approved vaccine. Unlike the Zaire strain, for which vaccines exist, the Sudan strain necessitates alternative containment strategies. In response, Ugandan health authorities have initiated a clinical trial for a vaccine targeting this specific strain. Developed by the International AIDS Vaccine Initiative (IAVI), the trial is being conducted by the Makerere Lung Institute, which has received approximately 2,460 doses. The primary focus is on vaccinating contacts of confirmed cases to curb further transmission [2].

The risk of Ebola spreading in Uganda is exacerbated by several factors. Kampala, the capital city, is densely populated and serves as a major travel hub, increasing the likelihood of rapid virus transmission. The mobility of the city's 4 million residents poses significant challenges for contact tracing and containment efforts. Health officials have identified 44 contacts associated with the deceased nurse, including 30 health workers, highlighting the critical need for effective monitoring and intervention strategies [3].

Key Drivers of the Outbreak

• Delays in Seeking Medical Care – Fear, stigma, and lack of awareness led many infected individuals to avoid seeking timely medical attention, allowing the virus to spread within communities.
• Traditional Burial Practices – Cultural rituals involving direct contact with the deceased significantly contributed to the transmission of the virus.
• Mistrust in Health Authorities – Some community members were skeptical of government interventions, leading to reluctance in following containment measures such as quarantine and contact tracing.
• Mobility and Trade Routes – High population movement, particularly along trade corridors, facilitated the spread of the virus beyond the initial outbreak areas.
• Healthcare Worker Exposure – Inadequate personal protective equipment (PPE) and delayed case detection led to nosocomial transmission among healthcare workers, increasing the outbreak's severity.

These findings highlight the urgent need for community engagement, improved surveillance, and culturally sensitive public health interventions to mitigate the spread of Ebola and enhance outbreak response efforts.

Conclusion

The current Ebola outbreak in Uganda underscores the critical importance of swift and coordinated public health responses. While the initiation of vaccine trials offers hope, the absence of an approved vaccine for the Sudan strain necessitates reliance on traditional containment measures, including contact tracing, community engagement, and strict adherence to infection prevention protocols.

In your opinion, how can addressing the root causes of transmission, particularly delays in seeking care, traditional burial practices, and mistrust in health authorities be mitigated to prevent the spread of this current outbreak?

By ISID Scientific Manager, Aisha Abubakar

References

1. Associated Press. Uganda nurse dies of Ebola, first fatal case in two years [Internet]. 2025 [cited 2025 Feb 4]. Available from: https://apnews.com/article/762d73117fda1220f9907ad54295f1ef
2. Reuters. Ebola vaccination trial launched in Uganda, WHO says [Internet]. 2025 [cited 2025 Feb 4]. Available from: https://www.reuters.com/business/healthcare-pharmaceuticals/ebola-vaccination-trial-launched-uganda-who-says-2025-02-03/
3. Associated Press. Uganda health workers exposed to Ebola after nurse’s death [Internet]. 2025 [cited 2025 Feb 4]. Available from: https://apnews.com/article/fc33af48307c911c7771db825c159333
4. Ssali M, et al. Transmission dynamics of the 2022 Ebola outbreak in Uganda: a mathematical modeling approach. J Infect Dis [Internet]. 2023 [cited 2025 Feb 4];228(5):678–85. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11413514/
5. Chowell G, Hengartner NW, Castillo-Chavez C, Fenimore PW, Hyman JM. The basic reproductive number of Ebola and the effects of public health measures: the cases of Congo and Uganda. J Theor Biol [Internet]. 2005 [cited 2025 Feb 4];229(1):119-26. Available from: https://arxiv.org/abs/q-bio/0503006
6. Nanyonjo A, et al. Perceived drivers of Ebola outbreak in Uganda’s Mubende and Kassanda districts: insights from a qualitative study. BMJ Public Health [Internet]. 2023 [cited 2025 Feb 4];2(2):e001267. Available from: https://bmjpublichealth.bmj.com/content/2/2/e001267  
7. Kupferschmidt K. Uganda’s Ebola outbreak underscores need for Sudan strain vaccine. Nature [Internet]. 2022 [cited 2025 Feb 4]. Available from: https://www.nature.com/articles/d41586-022-03192-8
8. Gostin LO, Hodge JG. The global response to Ebola in Uganda: legal and ethical challenges. BMJ Glob Health [Internet]. 2022 [cited 2025 Feb 4];7(12):e010982. Available from: https://gh.bmj.com/content/7/12/e010982
9. Bell BP, Damon IK, Jernigan DB, Nichol ST. Overview, control strategies, and lessons learned in past Ebola outbreaks. N Engl J Med [Internet]. 2020 [cited 2025 Feb 4];382(4):393-403. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6831630/
10. Bausch DG, Towner JS, Dowell SF, Kaducu F, Lukwiya M, Nichol ST, et al. Assessment of the risk of human-to-human transmission of Ebola virus in healthcare settings. J Travel Med [Internet]. 2024 [cited 2025 Feb 4];31(5):taae079. Available from: https://academic.oup.com/jtm/article/31/5/taae079/7691187

On the 3rd of November 2024, the One Health Day was celebrated globally. This reminds us that the intersection of health, climate, and resistance demands cohesive, global action, a goal achievable only through a shared commitment to our interconnected world.

Climate overshoot is a reality, carrying significant ecological, health, and socioeconomic consequences. While “climate change” encompasses a range of long-term shifts in temperature, weather patterns, and atmospheric conditions largely driven by human activities, “climate overshoot” refers to temporary but severe breaches of temperature limits that may prompt irreversible environmental damage.

Countries agreed to pursue efforts to limit global warming to below 1.5 - 2°C at the 2015 Paris Climate Agreement. According to the Climate Overshoot Commission, “climate overshoot” refers to crossing the 1.5 °C threshold. One of the less discussed aspects of climate overshoot is its impact on health systems, particularly with respect to antimicrobial resistance. Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi, and parasites adapt and become resistant to medications that successfully treat these infections, is a global public health emergency. Climate change and AMR are linked through several mechanisms.

• Agricultural Pressures: Climate impacts on agriculture, such as altered rainfall patterns and drought, may drive a higher reliance on antibiotics to prevent infections in stressed animals, intensifying antibiotic use and resistance. In regions with weak regulatory oversight, this can lead to unchecked AMR spread, impacting local and global health.
• Changing Ecosystems and Disease Vectors: Rising temperatures can broaden the habitat of disease-causing organisms and their carriers, such as ticks and mosquitoes, leading to increased disease exposure. For example, warmer climates can expand the range of vector-borne diseases (such as malaria or dengue), increase respiratory illnesses due to pollution and wildfires, and lead to waterborne disease outbreaks after floods. This expansion of infectious diseases could increase antibiotic usage, consequently hastening the development of antibiotic resistance.
• Human Migration and Overcrowding: Climate overshoot may trigger human migration and displacement due to extreme weather events or sea-level rise, leading to overcrowded living conditions and increased risk of infection. A high population density often coincides with increased antimicrobial use and poor sanitation, both facilitating the spread of AMR.

It is clear that human health is intricately tied to the health of animals and the environment, and the links between climate change, AMR, and health outcomes are undeniable. Ongoing global health initiatives recognise the need for integrated solutions. The Paris Agreement focuses on reducing emissions to maintain global temperatures below critical thresholds. Although primarily aimed at climate mitigation, the agreement also supports climate adaptation strategies to help buffer health systems against the consequences of overshoot scenarios, including AMR. The WHO’s Global Action Plan on AMR highlights a One Health

approach, stressing collaboration across the human, animal, and environmental health sectors. This plan acknowledges that climatic factors play a role in the spread of AMR, particularly in agriculture and other ecosystems. The One Health High-Level Expert Panel (OHHLEP) emphasises the importance of integrated approaches in addressing AMR and climate health impacts. OHHLEP helps governments align climate and AMR strategies by advocating for the One Health approach, fostering health resilience across sectors.

The impact of climate overshoot on AMR highlights the need for unified action. It is important that we need to reinforce policies that bridge health, environment, and

Agriculture by:

• Reducing Antibiotic Pollution: Strengthening regulations regarding antibiotic use in agriculture and promoting clean water access can protect the environment from antibiotic residues, thus slowing the spread of AMR.
• Supporting Sustainable Agriculture: Climate-resilient crops and livestock practices help to reduce the need for antibiotics. Investing in climate-smart agriculture can mitigate climate impact and limit AMR.
• Investing in Climate-Resilient Health Systems: This refers to building health healthcare systems equipped to handle the increased disease burden and health challenges triggered by climate overshoot. Climate changes can lead to increased occurrence of outbreaks. There is a need to deploy improved health data monitoring systems, especially genomic epidemiology for infectious diseases, improve access to healthcare services and institute community-driven preventive strategies (vaccination, health promotion).

Climate change, health, resistant infections, and antimicrobial use are all entwined within our ecosystem. By investing in sustainable climate-smart healthcare practices, One Health policy, and eco-friendly practices in agriculture, we can truly state that we are committed to a future where the health of people, animals, and the planet is protected for generations to come.

Written by ISID Emerging Leader, Abiodun Egwuenu

References

1. IPCC. (2023). Climate Change 2023: Synthesis Report Summary for Policymakers.
2.  World Health Organization. (2015). Global Action Plan on Antimicrobial Resistance.
3. Murray, C. J., Ikuta, K. S., Sharara, F., Swetschinski, L., Aguilar, G. R., Gray, A., & Han, C. (2022). Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. The Lancet, 399(10325), 629-655.
4. United Nations. (2015). Paris Agreement.

This month, a high-level meeting on antimicrobial resistance (AMR) organized by The UN General Assembly will take place on the 26th of September in New York, USA ⁽¹⁾. Global leaders will come together and agree on actions needed to tackle the threat of AMR.

AMR is the ability of a pathogen to survive exposure to antimicrobial agents that previously were an effective treatment. Such pathogens usually acquire AMR through mutations in specific genes or through gene transfer; when a microorganism acquires multiple genetic changes making it resistant to multiple antimicrobials, this pathogen is then called a multi-drug resistant organisms (MDRO), more commonly known as a “superbug”. It has been estimated that 4.95 million deaths were associated with AMR in 2019 ⁽²⁾, with this number predicted to increase to 10 million per year by 2050 ⁽³⁾. As we all know too well, pathogens do not recognize borders and can spread between environments, which means that they are everyone’s problem, and global equitable solutions need to be sought out.

Whole genome sequencing (WGS) allows us to look at the full genetic makeup of the pathogen such as genetic features that allow us to characterize them based on genotype, virulence genes and genomic changes or acquired genes conferring resistance to antibiotics; as well as providing insights into evolutionary changes in pathogen populations when investigating genomes from longitudinal studies. Overall, genomics has great potential to assist outbreak investigation, pathogen surveillance and help to detect difficult to grow pathogens, identify novel types of pathogens and novel antimicrobial resistance determinants.

Genomics so far has been instrumental in helping to track pathogenicity of particular clinically-relevant pathogens ⁽⁴⁾, detect outbreaks and the source of the outbreak ^(5,6), track novel and emerging AMR trends ^(7,8) and understand better how AMR can spread through horizontal gene transfer in hospital settings ^(9,10). Additionally, genomics has put a higher importance on looking into AMR emergence and spread with ‘ONE Health’ view, with studies reporting on zoonotic exchange of bacterial pathogens and AMR genes between the environment, animals, and humans ^(11-13), understanding the drivers for exchange of AMR between different interfaces will allow to make informed actions for intervention.

How can we better utilise genomics and implement it as integral part of our fight against AMR?

A SECRIC Working Group on Genomics for AMR Surveillance (https://sedric.org.uk/working- groups/) has published 9 recommendations ⁽¹⁴⁾ on what needs to happen to help implement genomics into AMR surveillance whilst discussing current advantages and challenges faced for implementing genomics for AMR Surveillance in health laboratories, public health networks and One Health ^(15-19). WHO GLASS (Global Antimicrobial Resistance Surveillance system) has also published overview of benefits and limitations of implementing current WGS technologies into routine surveillance ⁽²⁰⁾. A number of very successful workshops aimed at building capacity for bioinformatics and genomic sequencing for AMR surveillance workshops aimed at building capacity has taken place and were funded by Wellcome Trust ⁽²¹⁾ and Fleming Fund ⁽²²⁾.

What can we do to help fight AMR?

You can help by getting involved and organising activities to engage your family, institution, public, policy members, and colleagues in learning more about AMR during World Antimicrobial Awareness Week (WAAW), which will take place from November 18 to 24, 2024.

References:

1. The UN Meeting on AMR: https://www.who.int/news-room/events/detail/2024/09/26/default- calendar/un-general-assembly-high-level-meeting-on-antimicrobial-resistance-2024
2. Murray et al, 2022: Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis; doi: https://doi.org/10.1016/S0140-6736(21)02724-0
3. O’Neil report May 2016: doi: https://amr- review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf
4. Heinz E, et al 2024: Longitudinal analysis within one hospital in sub-Saharan Africa over 20 years reveals repeated replacements of dominant clones of Klebsiella pneumoniae and stresses the importance to include temporal patterns for vaccine design considerations, doi: https://doi.org/10.1186/s13073-024-01342-3
5. Self JL et al, 2019: Multistate Outbreak of Listeriosis Associated with Packaged Leafy Green Salads, United States and Canada, 2015-2016, doi: https://doi.org/10.3201%2Feid2508.180761
6. Bottichio L, et al, 2020: Shiga Toxin-Producing Escherichia coli Infections Associated With Romaine Lettuce-United States, 2018, doi: https://doi.org/10.1093/cid/ciz1182
7. Alba P, et al, 2018: Molecular Epidemiology of mcr-Encoded Colistin Resistance in Enterobacteriaceae From Food-Producing Animals in Italy Revealed Through the EU
Harmonized Antimicrobial Resistance Monitoring, doi: https://doi.org/10.3389/fmicb.2018.01217
8. Forde BM, Zowawi HM, et al, 2018: Discovery of mcr-1-Mediated Colistin Resistance in a Highly Virulent Escherichia coli Lineage, doi: https://doi.org/10.1128%2FmSphere.00486-18
9. Evans DR, et al, 2020: Systematic detection of horizontal gene transfer across genera among multidrug-resistant bacteria in a single hospital, doi: https://doi.org/10.7554/eLife.53886
10. Wan Y, Myall AC, Boonyasiri A, 2024: Integrated Analysis of Patient Networks and Plasmid Genomes to Investigate a Regional, Multispecies Outbreak of Carbapenemase-Producing Enterobacterales Carrying Both blaIMP and mcr-9 Genes, doi: https://doi.org/10.1093/infdis/jiae019
11. Mwapasa T., et al, 2024: Key environmental exposure pathways to antimicrobial resistant bacteria in southern Malawi: A SaniPath approach, doi: https://doi.org/10.1016/j.scitotenv.2024.174142
12. Cocker D., et al 2023: Investigating One Health risks for human colonisation with extended spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Malawian households: a longitudinal cohort study, doi: https://doi.org/10.1016/s2666-5247(23)00062-9
13. Mourkas E., et al, 2024: Proximity to humans is associated with antimicrobial-resistant enteric pathogens in wild bird microbiomes, doi: https://doi.org/10.1016/j.cub.2024.07.059
14. Harnessing genomics for AMR surveillance Policy Brief: https://sedric.org.uk/wp- content/uploads/2022/06/SEDRIC_infographic_23-06-2022.pdf
15. Baker KS, Jauneikaite E., et al, 2023: Evidence review and recommendations for the implementation of genomics for antimicrobial resistance surveillance: reports from an international expert group; doi: https://doi.org/10.1016/s2666-5247(23)00281-1
16. Jauneikaite E. et al, 2023: Genomics for antimicrobial resistance surveillance to support infection prevention and control in health-care facilities, doi: https://doi.org/10.1016/s2666-5247(23)00282-3
17. Baker KS, et al, 2023: Genomics for public health and international surveillance of antimicrobial resistance, doi: https://doi.org/10.1016/s2666-5247(23)00283-5
18. Muloi DM, et al, 2023: Exploiting genomics for antimicrobial resistance surveillance at One Health interfaces, doi: https://doi.org/10.1016/s2666-5247(23)00284-7
19. Wheeler NE, et al, 2023: Innovations in genomic antimicrobial resistance surveillance, doi: https://doi.org/10.1016/s2666-5247(23)00285-9
20. GLASS WGS for surveillance of AMR: https://www.who.int/publications/i/item/9789240011007
21. https://coursesandconferences.wellcomeconnectingscience.org/news_item/uniting-against- antimicrobial-resistance-in-africa-a-collaborative-effort-to-build-capacity-in-genomic-surveillance-of-amr/
22. https://www.flemingfund.org/publications/going-into-battle-future-of-pathogen-genomics-and-bioinformatics-in-africa-amr/