Table 8.

Costs to the environment, necessary in a “One-Health” cost model

Data element	Category of costs	Individual costs
Direct costs	Cost of removing/decontaminating/cleaning/stemming flow	− Drug production effluent − Irrigation systems, farm run-off that contains resistant pathogens − Relevant waste in waste management systems − Relevant waste in drinking water storage and distributions systems
	Costs of surveillance and control programmes	− Costs of enhanced surveillance − Cost of any screening that is triggered − Cost of having to shift activities to non-contaminated areas − Cost to authorities of enforcing penalties on industries
	Training of food chain professionals (Environment)	− Costs of pre-service, in-service and continuous professional education per relevant cadre of environmental health professional
	Legal and insurance costs	− Cost to authorities of enforcing any penalties on industries − Cost to industry to comply with AMR-related regulations surrounding treatment, disposal, etc. − Costs of implementing or regulating and enforcing national environmental surveillance programmes on water, soil and air in different components of the One Health triad as appropriate
Indirect costs	Loss of productivity	− Overall economic loss in having unusable land while decontamination takes place (t.b.c.). Note this will be of greater significance in countries that are densely populated, densely apportioned economically (where the land is used to the maximum extent for economic purposes), rely on agriculture, and where water provision or flow is important economic asset.
	Loss to medical or non-medical trade and tourism from reduced trade/tourism (e.g. exclusion of a place as a tourist destination explicitly due to AMR-related concerns)	− Loss in income from local tourism due to resistance in swimming water, drinking water, any other contamination (reputational costs). − Loss to medical or non-medical trade and tourism from reduced trade/tourism (e.g. exclusion of a place as a tourist destination explicitly due to AMR-related concerns) − Loss to the travel industry due to cancellations or to longer, sustained reductions in travel

^aAll types of productivity loss to the farm should be put together (again, individual from societal cost should not be separated to avoid double counting. Rather the model will ultimately scale the effects of individual resistance up to where the more generalized societal costs come into play