A one health roadmap towards understanding and mitigating emerging Fungal Antimicrobial Resistance: fAMR

The worldwide emergence of fungal antimicrobial resistance (FAMR) across a broad range of pathogenic fungi is having a significant and growing impact on food security, human and animal health. Plant-infecting fungi cause substantial losses in genetically uniform monocultures necessitating the widespread usage of fungicides. However the use of fungicides targeting single fungal cellular processes has led to the emergence of FAMR, lessening yields and compromising global food security. Agricultural fungicides have a dual impact by selecting FAMR in the environment for major opportunistic human fungal pathogens, potentially reducing the efficacy of frontline clinical antifungal drugs. This impact is compounded by the limited choice, and availability, of licensed antifungal drugs that can lead to long-term use as monotherapies in chronic infections, with consequential evolution of clinical FAMR in vivo and ultimately treatment failure. Furthermore, we are heavily reliant on antifungals as preservatives in the food supply chain and built environments, and they are widely available as over-the-counter medications. The 2022 World Health Organisation Fungal Priority Pathogens List recognised the risk to public health of emerging resistance amongst human fungal pathogens and highlights the need for wider collaboration across economic and policy sectors to better address one health aspects of FAMR. Moreover, there is a critical need for effective advocacy for robust food protection against rising FAMR. Global warming is expected to increase the need for sustainable crop production in the face of the expansion of the disease range of many phytopathogenic fungi; this may exacerbate FAMR and lead to new and emerging species of pathogenic fungi. Accordingly, as humanity’s reliance on antifungal chemicals escalates, our understanding of the wider one-health consequences of their use needs to scale accordingly if we are to protect our future ability to manage the global spectrum of fungal disease effectively and sustainably