AMR policy report
Accelerating national and global responses — reaching for superbug-free societies.
Illustrative operational scenarios; historical laboratory evidence is identified separately. No live surveillance, integrations or AI models are connected.
Antimicrobial Resistance: Accelerating National & Global Responses
Reaching for Superbug-Free Societies
Mohammed A. Alaqil, Kingdom of Saudi Arabia
Geneva, Switzerland — 29 October to 1 November 2024
Built on extensive research and outreach, including consultations with global experts and a review of more than 235 documents.
Alaqil, Mohammed. Antimicrobial resistance: accelerating national and global responses. WHO and WFUNA, 1st ed., Geneva, Global Model World Health Organization, 1 Nov 2024.
Executive summary
Antimicrobial resistance is a growing global health threat: an estimated 700,000 lives are lost every year, projected to be tenfold by 2050.
This trajectory undoes recent achievements in infectious disease control and threatens critical healthcare outcomes — routine procedures such as caesarean section or knee and hip replacement can escalate into high-risk undertakings.
The economic burden of resistant pathogens falls hardest on low- and middle-income countries, impeding progress on the Sustainable Development Goals.
A multi-stakeholder consortium spanning government, intergovernmental organisations, civil society and the private sector is addressing the challenge, but sustaining progress depends on strategic interventions within pandemic preparedness.
Eighteen priority areas
Quality research and development
Advancing innovation in research to combat AMR.
Data sharing and access
Enhancing surveillance systems for better data utilisation.
Public health intelligence
Leveraging data for informed decision-making.
Centralised plans, decentralised actions
Balancing efforts to maximise efficiency.
Conflict and displacement
Addressing AMR in vulnerable populations.
Prioritisation of resistant pathogens
Focusing resources on the most critical threats.
Civic engagement and awareness
Increasing public knowledge and involvement.
Animal health and welfare
Ensuring responsible antimicrobial use in animals.
Food safety compliance
Strengthening programmes to prevent AMR spread through the food chain.
Risk assessment of AMR
Evaluating and mitigating AMR risks.
Clinical decision support
Implementing systems to guide appropriate antibiotic use.
AMR and the climate crisis
Understanding the interplay between climate change and AMR.
Economic cost and burden
Quantifying the financial impact of AMR.
Outbreak investigation
Improving processes for AMR-related outbreak responses.
Vaccination and immunisation
Enhancing coverage to prevent infections.
Alternative therapeutics
Exploring non-traditional treatments.
Occupational health
Reducing AMR risks for healthcare workers.
Oral health
Addressing AMR challenges in dental care.
Policy recommendations and actions
Augmenting AMR surveillance with AI-driven predictive analytics
- Establish a robust, coordinated international health informatics programme integrating AI and big data for evidence-based predictive analytics.
- Use data mining to reveal correlations that traditional antibiograms cannot, standardising practice within a centralised medical data warehouse integrated into hospitals and primary healthcare centres.
- Respect the unique epidemiology of each region — solutions from one country may not be universally applicable; incorporate climatic and meteorological data with regional spread patterns to forecast outbreaks.
- Use active and passive tracking dashboards, clustering and mapping so policymakers understand AMR dynamics proactively.
- Encourage member states to join TISSA, with protocols aligned to country metrics and cross-reporting guided by WHO AGISAR; GLASS, WOAH ANIMUSE and FAO InFARM should embolden civil society, researchers and public sectors to join.
Fuelling the engine of innovation: research as the catalyst
- Award incentives and grants to those bolstering international healthcare systems, with much of the creative response resting on deep learning.
- Turing tests and knowledge engineering exemplify neural network development in this context; genome editing and peptide synthesis offer hope against superbugs.
- Epigenomics is particularly promising: studying heritable changes in gene expression reveals how pathogens adapt and survive under antimicrobial pressure.
- Target the epigenetic machinery regulating resistance genes to re-sensitise pathogens and restore the efficacy of previously ineffective drugs.
- The G7 mobilises resources and drives policy; the Global AMR R&D Hub incubates AMR projects and features in G7 ministerial meetings.
The nexus of science and governance: crafting effective policies
- Robust policymaking incentivises judicious antimicrobial use and establishes regulatory frameworks across human healthcare, agriculture and animal husbandry.
- Strengthen National Action Plans and encourage countries to refine strategic programmes so local challenges are addressed effectively.
- Legislate infection prevention and control standards for biosecurity; follow Codex Alimentarius and FAO standards to secure the food chain and ensure fair trade practice.
- WOAH should incorporate local policies into its resolutions; NGOs and international efforts need open access to surveillance data, shared best practice and joint research.
- Support AMR under the One Health initiative in parallel with resolutions 14, 26, 36 and 38, alongside TrACSS monitoring and the GARDP–WHO SECURE initiative expanding access to essential antibiotics.
A global chorus against AMR: orchestrating cooperation
- Harmonising government, public, private and third-sector efforts is critical; success hinges on communication, knowledge exchange and resource mobilisation.
- Resolution A/RES/71/3 mandates the Interagency Coordination Group on AMR to work collaboratively across nations and stakeholders.
- Global governance acts as a catalyst for change within the Global Action Plan and the Quadripartite Joint Secretariat on AMR.
- The AMR Multi-Partner Trust Fund safeguards public health and economic stability through WHO, FAO, WOAH and UNEP collaboration while maximising investment impact.
- UNDP and UNFPA can serve as interim principal recipients, promoting whole-of-government and whole-of-society AMR responses.
A continuum model within the UN Sustainable Development Goals
Only one target for resistant infections exists — SDG target 3.d.2 for bloodstream infections due to selected AMR organisms, measured by the proportion of bloodstream infection due to MRSA and to third-generation-cephalosporin-resistant E. coli. Explicit AMR indicators make up 0.80% of all indicators and 0.59% of all targets, while a 2018 McKinsey report found 40% of indicators are indirectly pertinent to AMR.
Zero hunger
- Implement sustainable food production systems with less reliance on antimicrobials, phasing out antibiotic use for growth promotion in livestock.
- Develop food and nutrition compliance programmes that harness technology.
- Promote local food products and support farming families.
- Provide tax relief for farmers using organic materials, non-GE food and antibiotic-free meats with strong adherence to guidelines.
Good health and well-being
- Advance financial and social protection for access to good-quality services, especially for vulnerable individuals.
- Enhance universal healthcare access and prioritise systems for resistant infections including pneumonia, TB, malaria and HIV.
- Promote cautious access to medications within WHO's One Health approach.
- Promote regulation across the public health authority and the FDA.
- Invest in preventive care and health promotion.
- Implement sexual and reproductive health clinics and family planning strategies.
Quality education
- Promote awareness across all levels of sectors.
- Include the AMR crisis within public curricula.
- Provide effective training for healthcare providers.
- Engage children through entertaining education developed to mitigate AMR.
- Encourage capacity building through civil society and non-governmental organisations.
Gender equality
- Promote health equity strategies to the best standards.
- Promote equal pay including minimum wage across sectors, raising productivity and GDP.
- Encourage value-based care addressing gender gaps, as women and pregnant patients are more vulnerable, especially in LMICs.
Clean water and sanitation
- Ensure best practice for antimicrobial waste and disposal management locally, regionally and globally.
- Regulate strict policies for clean water and sanitation covering institutions and individuals.
- Advance antibiotic wastewater treatment technology.
- Implement solutions for floods, droughts and hurricanes that drive AMR.
Affordable and clean energy
- Harness solar and hydroelectric energy in facing AMR.
- Ensure affordable electricity in low-income countries reliant on laboratory equipment and information technology.
- Use solar power for running diagnostics where applicable.
Decent work and economic growth
- Support small and medium enterprises related to AMR mitigation to aid job creation and economic growth.
- Promote fair wages and working conditions to reduce turnover and raise productivity.
- Reduce out-of-pocket payments for antimicrobials, especially in the private sector, by redesigning health coverage.
Industry, innovation and infrastructure
- Promote innovation in research development and patents.
- Encourage start-ups led by angel investors in the pharmaceutical and AMR field.
- Incorporate corporate social responsibility to build better antimicrobial infrastructure.
- Ensure government and green public procurement of antimicrobials is compatible with the WTO agreement.
Sustainable cities and communities
- Treat target 11.7 on public green and open spaces as a vital environmental component for sustainable and healthy communities.
Responsible consumption and production
- Implement best-practice guidelines and legislation to ensure responsible antimicrobial consumption and production.
Climate action
- Address the relationship of climate change and AMR in educational curricula.
- Incentivise projects linking AMR and climate change.
- Continue Paris Agreement and UNFCCC COP efforts on both issues regionally and globally.
- Promote youth initiatives on the climate crisis and AMR.
Life below water and life on land
- Guide scientists towards discovering novel antibiotics and AMR patterns across wildlife habitats.
- Invest in studies of wildlife and migratory birds to understand fauna and flora in AMR transmission.
- Eliminate sources of anthropic pollution through innovative measures.
Peace, justice, strong institutions and partnerships
- Ensure equitable access to primary healthcare.
- Improve global AMR surveillance using robust AI techniques.
- Promote development and use of vaccines and alternative therapeutics.
- Orchestrate local, regional and global collaboration across government, public, private and civil society sectors.
- Promote research and incentivise grants and scholarships.
- Support youth-led AMR initiatives and involve young people in decision-making.
Glossary
Active pharmaceutical ingredients
The biologically active ingredients in a pharmaceutical drug.
Alternative products
Strategies or products other than antimicrobials used for prevention or therapy — vaccines, phage therapy, lysines, antibodies, probiotics, immune stimulation and peptides, plus improved biosecurity and sanitation. In agriculture this also covers better management, housing, production systems and husbandry.
Antibiogram
A laboratory resource determining the sensitivity of a bacterial strain to different antibiotics. A cumulative antibiogram profiles susceptibilities within an institution over a period, to monitor trends and guide empirical therapy selection.
Antibiotic
A drug that kills or stops the growth of bacteria; a type of antimicrobial. Penicillin and ciprofloxacin are examples.
Antibiotic resistance
Antimicrobial resistance of bacteria.
Antibiotic resistance testing
Laboratory testing performed on bacteria to find out whether they are resistant to one or more antibiotics; also known as antimicrobial susceptibility testing.
Antimicrobial agent
A substance, such as an antibiotic, that kills or stops the growth of microbes including bacteria, fungi or viruses. Grouped by the microbes they act against: antibiotics, antifungals and antivirals.
Antimicrobial residue
Parent compounds, metabolites and impurities of veterinary drugs persisting in edible animal products and the environment. Non-metabolised residues excreted in animal waste facilitate the selection and transfer of resistance genes; fluoroquinolone and sulphonamide residues are frequently detected.
Antimicrobial resistance
The ability of a microbe to resist the effects of a drug. Resistant germs are not killed by the drugs typically used against them and may continue to multiply. It includes antibacterial, antifungal and antiviral resistance.
Antimicrobial stewardship
Coordinated interventions designed to promote, improve, monitor and evaluate the judicious use of antimicrobials to preserve their future effectiveness. It encompasses the 5Rs of antimicrobial use: responsibility, reduction, refinement, replacement and review.
Antimicrobial susceptibility testing (AST)
Laboratory testing showing whether microbes are susceptible, intermediate (treatable but possibly requiring adjusted dosage) or resistant to one or more drugs.
Bacteria
Single-celled organisms with a structure distinct from other microbes. They can be helpful but also cause illnesses such as strep throat, ear infections and pneumonia.
Drug class
Antibiotics are categorised into classes, each defined by the way it kills or stops the growth of bacteria.
Genes
Made up of DNA, the basic units defining an organism's characteristics — including resistance to antibiotics in bacteria.
Genome
An organism's complete set of genes carrying the genetic instructions for building and maintaining it.
Isolates
Bacteria isolated from a specimen such as stool, blood or food.
Microbes
Living organisms such as bacteria, fungi or viruses that can cause infection or disease; also called germs.
Multidrug-resistant (MDR) isolate
An isolate resistant to at least one antibiotic in three or more drug classes.
Non-susceptible isolate
An isolate that is either resistant or not completely susceptible to one or more antibiotics.
Nosocomial infection
An infection acquired in hospital, excluding infections incubating at the time of admission.
One Health approach
A method of determining policies that bridge human, animal and environmental health, accounting for factors relevant to each sector.
Organism
Any living thing, including humans, animals, plants and microbes.
Predicted resistance pattern
The antimicrobial resistance expected based on analysis of an organism's genome, identifying resistance genes and mutations.
Priority microbes
Micro-organisms considered most important in the spread of AMR, by clinical disease impact, spectrum of resistance, appearance in novel environments or regions, and economic consequence.
Prophylaxis
Administration of an antimicrobial to exposed healthy individuals or animals at risk of disease, before symptom onset and before an etiologic agent is confirmed.
Resistance pattern
The characteristics of a single isolate, as distinct from a cumulative antibiogram.
Source document
Alaqil, Mohammed. Antimicrobial resistance: accelerating national and global responses. WHO and WFUNA, 1st ed., Geneva, Global Model World Health Organization, 1 Nov 2024.
Operational values are simulated. Historical records and source-listed forecasts retain their original attribution; they are not measured GermQ outcomes.