Advancing one health surveillance in South Africa.

Antimicrobial resistance (AMR) and zoonotic diseases are global public health threats with serious implications for human, animal, and environmental health. In South Africa, AMR and zoonotic disease outbreaks pose significant threats to public health and food security. Despite a robust AMR surveillance system for human health, the absence of a national routine surveillance program for livestock hinders a comprehensive One Health (OH) approach. The 2024 UK-South Africa workshop in Cape Town convened key stakeholders from human and animal health, environmental sciences, and food production to address these challenges. Discussions focused on integrating OH surveillance, leveraging Next-Generation Sequencing (NGS) for early outbreak detection, and improving food and water safety. Workshop outcomes emphasized the necessity of cross-sector collaboration to enhance AMR monitoring and outbreak preparedness. Stakeholder engagement, particularly within agricultural communities, was identified as critical for OH implementation. Participants highlighted the need for culturally sensitive engagement strategies, qualitative research methods, and policy reforms to drive adoption. Lessons from tuberculosis (TB) and HIV programs informed strategies for fostering compliance and integrating OH principles into veterinary education, particularly in antimicrobial stewardship. Challenges such as resource limitations, bioinformatics capacity gaps, and resistance to new technologies were addressed through recommendations for joint consortia, leveraging existing infrastructure, and targeted training. Aligning OH initiatives with consumer-driven concerns, such as water quality monitoring, was also identified as a key opportunity. Moving forward, translating research into action will require sustained collaboration, policy alignment, and community engagement. Strengthening OH surveillance can enhance South Africa's ability to prevent and control infectious diseases, ensuring long-term public health resilience and food security.