 My name is Vipin, I'm based at Mahidol Hospital Tropical Medicine Research Unit at Bangkok, currently I'm in Nepal. Today I'll be talking about one health approaches to AMR. Basically in this talks I would like to cover what do we understand by one health approach in the MR and why is it important and share some studies from Nepal and then potential approaches to tackle the MR including some of the frameworks that we studied about. AMR burden, I think previous speakers have already talked about the the buttons of AMR, one of them discussed by Ben. The only report, the projected deaths if appropriate actions are not taken is alarming and WHO has already warned that we could step into post antibiotic error if no actions are taken. So in these regards it looks like MR is a big problem. And then stepping into MR and discussing about MR. We cannot extricate human health from animal and environmental health. One health has been defined heterogeneously in different literature and different resources from different sources. But to me one health is an intersection between animal, human and environmental health. So it allows us to remind us that we cannot look at human health in isolation or with isolation lens. The major question is why should you be concerned about animal health environmental health. Why can't we focus on human health, because antimicrobials are widely used in sectors other than human health. That include animal health and husbandry, agriculture and generally food production and as you know, increasingly over the years we've seen air water and environmental pollution, the infection and reservoir as it acts to you know, post resistant organisms is a major problem that can come back to human as well. And from these reports, you could see 60% of pathogens that have human that has human diseases comes from animal and wildlife. 75% of emerging human pathogens are of animal origin, and 80% of pathogens that are concerned for by tourism are from animals. So with this, it leads to some more concerns around, why should we, why should we adopt one health approach, or why should we concern about animal and environmental health. You might have read this book by David Kwamen, the spillover. This is a fantastic book where David has shared his experience of visiting various forest areas in Africa and elsewhere. He has walked thousands of miles alongside other scientists in exploring how spillover must have happened. There he also adds lots of descriptions and discussions amongst different scientists from different sectors. One of them was Professor Donald Burke. His lecture in 1997 already predicted that coronaviruses could be a potential can lead to potential pandemic upon asking him, how could he predict that he sarcastically ironically said that that was just a guess but in fact, the the evolved viability and the predictability by Donald Burke did come true in 2003 first with SARS outbreak, and then Mars outbreak in 2014. And the current COVID-19 is an alarming example of how much we should be concerned about all the genetic disease in general. Just to show you pictorially how much connected we are with animal and environmental health as antimicrobials are used substantially by humans and animals as well. And for animals, especially for food production, it can, it can go in multiple different ways to humans through manures that can contaminate environment, and then through sewage and water system that can come to humans. Moving on, just to give you another glimpse of how these tiny compounds if they, if they behave abnormally that can topple the whole programs, for example, 1950s 60s historical malaria eradication program or the ambitious plan by WSO to adopt malaria eradication was toppled by DDT resistance. So just trying to show here how much these tiny compounds for the resistance to this tiny compounds can topple the whole programs. So just showing how much inextricably linked we are with agriculture and animal health. Here I'm trying to show our experience of the over the counter use of antibiotics use in Nepal. We did, we did interviews with various stakeholders. Obviously, this relates to human health only, but we interviewed patients, clinicians and dispensers various parts of Nepal. And obviously, you could guess, we found out that these were rooted to various different things like policies, ambiguous policies, although we did, we did predict and we did guess but it was not in that clarity that we could. We could guess so we found out that it illuminated it gave us massive insights how those ambitious policies, ambiguous policies might have led to use of over the counter use of antibiotics, including other issues such as accessibility costs and demand for antibiotics. So to to our surprise when we discussed this findings with different departments in Nepal, we found similar this this eco with other sectors as well other sectors meaning animal and agriculture sectors that use of antimicrobials was widespread and knowledge about antimicrobial resistance was very low. So in this nationwide survey, we found out that the use of antimicrobials especially in poultry chickens and animals was used, although not much sector, we, we then did a tiny review a commentary how antimicrobial are using food animals and agriculture. So this eco with our findings that antimicrobials using food animals are extensive compared to the literature around agricultural products, although we, we are not sure how much of this is being reported or underreported. So this led us to think about. So how should we tackle amr then this is a, of course million dollar question. The answer to this question offers a lot of promises but unfortunately we don't have strict for the answer assassin others described it is a complex problem. So we need obviously multi sectoral collaboration that requires experts in a vast number of fields and from us numbers discipline. This editorial on the right hand side we tried to have this ambitious topic to, you know, get into a bottom up how could we resolve tackle antimicrobial resistance. But then we ended up concluding that we need broader we need to broaden the gaze that is best selling framework and existing framework that includes broader broader disciplines of broader. These sectors that should come together or that could offer insights to insights and solutions to fight antimicrobial resistance rather than focusing on only human health. Obviously, this board stands to why one help them. As previous speakers have already described implementation science seem to offer insights and obviously I agree with them. Because when we, when I looked into this topic and I found very little literature about one health that is being implemented or conducted in the countries. And one of these study in Kenya on the right hand side, they showed that drift value bias, morbidity and mortality is before applying one hand approach and after applying one hand approach was significantly different. That is, it reduced the number of quantities and mortality and this took very promising to me, although this study, this programatic implementation was supported by CDC US lab supported by Cambridge technical supported by various other organizations, including it was a collaboration between three different ministries, which is a health agriculture, and then animal health departments so this obviously sounded very ambitious project. So and then I came down to ponder about myself, why is it not working in Nepal then or is there any animal health one health project in Nepal. Yes, there is there is animal one health task force. I discussed with some of the authorities in Ministry of Health, and all they shared with me was there was lack of political commitment and lack of policy formulation and sustainable financing was lacking. And this led us to understand that there were lots of gaps that the foremost thing and the proximal and the most important thing was the commitment from political side, and then the policy and then the financing, and then the rest of the others such as capacity enhancement, which all the way around down to engaging communities because some of our speakers also talked about how do we engage community members or behavior change that some of the questions were there. So this led me to think that it needs a broader approach from top to the bottom and then from and then and then to engage community. It doesn't sound easy, but although it's complex. It might offer us some insights that we need broader implementation science approach for future to implement one health in future. So with this I would like to acknowledge contributors to some of these studies that are presented here, and the collaborators here. Thank you.