Hello, my name is Danny de Vries. I am an Associate Professor of Anthropology of Health at University of Amsterdam and also work as a fellow at the Amsterdam Institute for Global Health and Development and it's my honor to welcome you to this massive open online course or MOOC on the social dimensions of antimicrobial resistance. The MOOC was developed as part of the European Union funded sonar global project. The MOOC that you're looking at is an independent course for professionals, non social scientists or social scientists who want to know more about the social dimensions of AMR. You want to introduce the social science-based perspective on issue that is of great societal concern, which is typically still seen as a medical issue. In addition to an independent introduction, this MOOC can also be used as a basis for the sonar global upward suck AMR curriculum. That's a curriculum developed for trainers who want to provide interdisciplinary training on the social dimensions of AMR. In this video, I will review the following: First of all, a little bit of introduction. What is antimicrobial resistance? Secondly, what are some of the training aims of the MOOC? Then review a little bit about the MOOC content and then we'll look a little bit about little introduction to sonar global, as well as the SPECIAL-SOC and OPERATE-SOC curricula that we've developed. To start with, what is AMR anyway? And I guess it starts with thinking about what is antibiotics? While working at St. Mary's Hospital in London, this Scottish physician Alexander Fleming was the first to experimentally discover that a penicillium mold secreted an antibacterial substance and he was the first to concentrate the active substance that was involved, which he named penicillin in 1928. Penicillin has further developed for mass production with a release of the compound in about 1944, with the support of a number of pharmaceutical partners in the United States particularly and also very much in the contents of World War II. Because this new wonder drug from molds, as you can see in these images was a game changer in the battlefield and provided the expectations about a new future beyond this context. In 1949, the aspiration surrounding antibiotics in medicine were to live in a world without medicine microbes to have all disease producing microbes rendered harmless and domesticated. To see infectious diseases vanish from the earth or at least be easily controlled and to make the planet free from the dangers of death from infectious disease. In fact, by 1976, it looks so promising that the United States surgeon general confidently declares, "It's time to close the book on infectious diseases." What is an antibiotic anyway? It works in four ways. I'm not going to really dive deep into this because that's not our field and not the point of this course. But as you can see, antibiotics affect the functioning of bacterial cells in four ways, first of all by innovating RNA synthesis, secondly, by disrupting cell wall synthesis, then inhibiting protein synthesis, and finally inhibiting DNA replication. Now an antibiotic is strictly speaking, the compound which combats bacterial infections inside the body. And these typically are used as medicine for humans and animals and even for plants and other trees against bacteria. The term antimicrobial, actually is a more general term, also including antibiotics. This term applies to the inhibition of all microorganisms in or outside the body. Next to antibiotics or antibacterials, antimicrobials also include antivirals, which obviously work against viruses. It's a structural herpes or HIV, anti-parasitic agents which work against parasites, such as a drug for malaria and antifungals, which work against fungi, such as drugs for yeast infections. Now Fleming warned early on the problem of antimicrobial resistance. Shortly after the discovery of penicillin, there were reports of resistance in many bacteria. In 1942 already strains of Streptococcus aureus had been documented to have a strong resistance to penicillin. The problem with resistance is that use of antimicrobials in animals and humans leads to what we call selective pressure where resistance naturally develops. It's a natural process. As you can see in this little graph here, antibiotic resistance may happen in four stages. First, there are a lot of germs inside our bodies, only a few are drug resistant. The drug resistant germs cannot easily proliferate as the microbial ecology keeps it in check. They went into the other chart plate. As you can see in stage 2, antibiotics kill all the bacteria causing the illness, including also, by the way, the good bacteria protecting the body from infection. However, the drug resistant bacteria are now allowed to grow and take over as shown in stage 3. In addition, in stage 4, we see that through what is called horizontal gene transfer, some bacteria give their drug resistance over to other types of bacteria causing more problems. One thing you may wonder is how does this drug resistant bacteria occur in the first place in stage 1. How did it get there? Overall, there are three pathways for this. I just already mentioned horizontal gene transfer between organisms. This is really a movement of genetic material between unicellular or multicellular organisms, which is different, of course, from the vertical transmission that parents have to their offspring. Another explanation is that there may be intrinsic barriers within bacteria, for example, because it modifies drug target sites or produces enzymes that inactivate the drug. But most known, I think, most understandable is now particularly after we've learned a lot from COVID-19 is the issue of mutation. As a result of mutations, changes in the bacteria are passed vertically to descendants. By 1960, most of the Staphylococcus aureus strains were resistant to penicillin. This of course did not remain unnoticed. In popular culture, interests surged by the mid 1990s when articles and books with titles like the ones you see on this picture here like the Coming Plague: Newly Emerging Diseases in a World Out of Balance by Laura Garrett, 1994, or Superbug: Nature's Revenge by Geoffrey Cannon in 1995. These books start to come out. Today, while researchers are sounding the alarm bell, the general public still has a little awareness of antimicrobial resistance. One of the reasons is that due to the medical application of antibiotics, awareness of the problem has remained limited still to the medical sector. What we don't see is the linkages to veterinarian practices due to agriculture and food production, to environmental hygiene and issues with sanitation. Often we also don't see the link to our own behavior. Really liked this next citation. It's from a UK reports from the Economic and Social Research Council in 2014 made by Professor Dame Sally McIntyre from University of Glasgow. The report is called antimicrobial resistance sets into social science agenda. She writes, "The mechanisms which leads to antimicrobial resistance are biological. However, the conditions promoting or militating against these biological mechanisms are profoundly social. How our farmers and regulatory systems manage livestock production for human consumption; how regulatory and fiscal frameworks incentivize or deter antimicrobial development, production and use; how the public and healthcare professionals understand, value, and use antimicrobials; the context in which animals and humans interact; the ways in which particular groups of humans are exposed to particular microbial infections; all these are shaped by social, cultural, political, and economic forces." The MOOC that we have here has a number of training objectives which relate to what was just said in a sentence. First of all, it's to provide an introduction to the social dimensions of AMR. Then is to learn about the relevance of social science perspective and approaches in the study of AMR. It's also to get introduced to the need for interdisciplinary collaboration with social scientists as well when working on AMR. Finally, to serve as a basis for the Sonar-Global-Operate-SOC curriculum. In this slide, here you see an overview of all the lectures and topics that are in the MOOC. We've brought together, I think, a fantastic group of lecturers from different social science disciplines who have been conducting research on the social dimensions of AMR. Through this MOOC, you will learn, for example, about perspectives from science and technology studies. There's a talk by Dr. Iona Walker about how language shapes the way we imagined the AMR problem, to the global governance of AMR, as talked over by Professor Olivier Rubin, who deals with the history of AMR regulations, the current global governance regime, and the alignment between national and global governance of AMR. In-between, there's a lot more , relationships to epidemics, stigmatization, perception, and use of antibiotics, healthcare-seeking behaviors, over-the-counter use, AMR networks, stewardship in hospitals, and to build a history, the role of preventive veterinary medicine, community engagements, general public explanatory systems about what AMR may be, the economics of AMR, etc. A few words about Sonar-Global. This MOOC was developed in the context of the Sonar-Global project. Since 2019, this project has been a collaborative project that has been working to mobilize the social scientists against infectious threats. Sonar-Global acts as an international network that aims to strengthen the active participation of the social sciences in the prevention and response to infectious threats, including those posed by AMR and vaccine hesitancy. To achieve these objectives Sonar-Global pursues social science activities in four different areas that are shown here. First of all, by developing a platform for collaboration. Secondly, by creating regional hubs including one hub in Bangkok, Thailand, where AMR is central. Thirdly, adapting, testing, and evaluation tools and models. We're just specifically focused on vulnerability assessments and engagement models. This has been, of course, a plight to COVID-19 and last but not least, strengthening of capacity. As part of that latter agenda, we here have the MOOCs and we have the AMR training curricula. The project has been developing four training curricula on epidemic threats, including two on epidemic outbreaks and two on AMR. These curricula are meant for trainers to support them in the development of relevant training modules. Because you can see here there are two AMR curricula available on the Sonar-Global website. They're for free under an open common license. They're connected through the Coursera MOOC, which is hosted by the University of Amsterdam. On the left, you can see what we call Special-SOC AMR curriculum, which is a specialized curriculum for social scientists on the social dimensions of AMR, hence, the SOC. SOC stands for social sciences. Information from this curricula has been summarized then in this MOOC in a condensed format through the lectures, readings, and quizzes. An extra summary of Special-SOC, the Coursera MOOC also is the basis for the Operate-SOC AMR training curriculum. This curriculum has the goal to operationalize the social dimensions of AMR in the field, paying attention to interdisciplinary needs, and forming an introduction also to non-social scientists, including professionals. In addition to these curricula, there's also two additional curricula developed by our team in Senegal on epidemics. More information about any of these you can find on the website. I want to make a few notes about how these curricula came about, how they were developed. At least for the AMR curricula, it started with a four-day expert consultation at the Amsterdam Institute for Global Health and Development in 2019. After this, there was a two-day regional hub meeting in Thailand hosted by the MORU Tropical Health Network for more input. Then we piloted the special curriculum and form of four-day training, again supported by the MORU Tropical Health Network, which is also part of the University of Oxford. To develop the opera SOC curriculum, we first conducted a needs assessment among a target audience. Then after that, we again organized another expert consultation on the opera SOC developments in 2020 to finalize the curriculum. Now one common element to both curricula, as well as this MOOC, is the framework of the social dimensions of AMR, which was developed during the first expert meeting in 2019, and which also has been published in Toro-Alzate and colleagues in 2021. What you can see in this image is that this is a multi-scalar setup starting with the microbe and then expanding in concentric layers of analysis and understanding around that. The scale of daily lived experience which we call people in publics, we see studies that are about experience, about vulnerability, about knowledge access and usage, about social networks and relationships, the media, and also infrastructures. The latter, infrastructures actually is also a bit of a connective issue linking to systems analysis which includes attention to healthcare, pharmaceutical, and food systems, including the enabling and liberating influence of economics, and further broadened by geographic attention to the landscape, land-use, to mobility, migration, and human movement. Surrounding all of this, we find crosscutting influence of, of course, regulations and policies at various levels from global action plans to local stewardship programs at hospitals and all analysis of how these are framed. Then finally, at all levels, social science in science we think are necessary if you want to achieve any real transformation in addressing this really big challenge. At multiple levels, through supported by social science studies, evaluations and implementation sciences and above all into this spherical liberation, we believe challenge of AMR can be addressed. One point that I want to make here is that this graph does not suggest that the social scientists are only irrelevant beyond the microbiome scale. The great graph we developed also pay attention to science and technology studies, including attention to the way that the natural sciences like microbiology, who studied the bio may also have cultural elements and influences in the way they practice. Furthermore, microbiomes are also co-produced through human behavior and culture. Just think about your food intake. What we eat influences the way I got biome develops, behaves, etc. A special SOC curriculum is designed for trainers who wants to teach social science students. This reflects this scalar framework that I just reviewed. As you can see in the list of modules, these different scales are reappearing. Furthermore, on the left you can see what a chapter in the curriculum looks like, including several elements, like the summary, the length, the objectives, content, course, and then pedagogical considerations of some suggestions for teaching, references. Then a very nice set of case studies that can be used as teaching tools, and these case studies are really fantastic. The AMR operate SOC list of modules resembles some of the elements of special SOC, but has a more integrated focus on one health, interdisciplinarity, and fieldwork. The idea is that through this MOOC, the basic elements of social dimensions can be learned through self study. A trainer can then design live lectures in which students and teachers reflect on the elements in this MOOC, or additional elements as well. But really the novelty of the operate SOC curriculum is also in the applications of lessons learned and interest in small, specially designed fieldwork case studies. These fieldwork applications can be various length depending on what the teacher wants to do, and it's basically giving students an opportunity to apply what they've learned in their own environment. That's the idea of the operate SOC curriculum. Of course, these curricula are all available on our website. Finally, I want to briefly point at the help that's many people have provided us in developing the curriculum as well as MOOC. In terms of special SOC, 29 contributors support us in our expert workshops and by developing case studies. We really appreciate that they're listed here. For the upper top curriculum, 37 people helped us, and that's fantastic and we are so appreciative. With that said, we really hope that this MOOC will be useful for you, and then it will give you the introduction on the structural dimensions that you may need. Enjoy and thank you for your interest.
