Most countries have a national action plan – but implementation is lagging. The next phase must focus on costing and budgeting these plans and establishing a clear monitoring and evaluation system.
Many countries have regulations on antimicrobial sales but – with the exception of a few countries – they are poorly implemented. We need to improve appropriate antibiotic use in all health care facilities, especially in primary care where most prescriptions happen. Sales of antibiotics need to be monitored systematically. This can be achieved through strengthening stewardship programmes, through education and training and by using digital tools for monitoring.
Progress in implementing national plans is being slowed by insufficient and unstable financing. While surveillance systems have expanded, data are not used consistently to guide prescribing, procurement or policy decisions. A fully integrated One Health approach is necessary, bringing together human, animal, food and environmental dimensions into a single functioning system with seamless exchange of data and information leading to tangible outcomes. Yet One Health remains fragmented, with environmental surveillance the weakest, and workforce capacity continues to fall short.
Closing these gaps will require political leadership and administrative and financial commitment at the highest level. Accountability must extend beyond ministries of health and be reflected in national priorities and budgets. At the minimum, domestic budgets need to cover the highest priority activities in national plans. Infection prevention and antimicrobial stewardship must be built into daily health system functioning, tied to financing, accreditation and performance.
Global investments in antimicrobial research and development cannot happen in isolation but must strengthen national systems by supporting regulatory capacity, local production and procurement mechanisms. The goal is to ensure that countries can independently access, regulate and use antimicrobials responsibly. Greater investment in diagnostics and preventive tools is also essential to reduce unnecessary use.
At a time when conflicts, fragile health systems and climate change accelerate AMR, it is our overriding duty to ensure antimicrobials work for future generations. This requires sustained political commitment, reliable financing, transparent reporting and accountability across all sectors.
Progress will depend on countries treating antibiotics not just as commodities, but as assets that need to be protected.
