Global AMR Governance & Outcomes: A 2000–2021 Longitudinal Study

A new global evaluation of antimicrobial resistance (AMR) governance across 193 countries offers a detailed assessment of national strategies to combat drug-resistant infections, informing updates to the 2026 Global Action Plan. The study, published in January 2026 in Global Health, reveals a complex picture of progress, with some regions demonstrating stronger governance systems than others, and highlights the critical need for sustained investment and coordinated action.

Antimicrobial resistance occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines, making infections harder to treat and increasing the risk of disease spread, severe illness, and death. The World Health Organization (WHO) identifies AMR as one of the top 10 global public health threats facing humanity.

A Longitudinal Assessment of National Approaches

Researchers used a longitudinal, country-level design, analyzing data from 2000 to 2021, including 190 United Nations Member States, the Cook Islands, the State of Palestine, and Bermuda. The study constructed an indicator-based index to characterize national AMR governance across multiple domains, examining changes over time and assessing how governance trajectories relate to AMR-related outcomes. Data sources included national AMR policy documents, the Tracking AMR Country Self-Assessment Survey (TrACSS), and databases maintained by UNICEF, the Global AMR R&D Hub (https://dashboard.globalamrhub.org/), and the WHO’s Global Antimicrobial Resistance and Utilize Surveillance System (GLASS).

The evaluation framework comprises three primary governance domains: policy design, implementation, and monitoring, divided into 14 subdomains and 46 indicators. AMR-related outcomes were measured through AMR prevalence, antimicrobial use (AMU), and disease burden. The study period (2017–2022) was determined by the availability of TrACSS survey data, with data collection completed in November 2024.

Regional Variations and the Role of South-East Asia

The WHO regional characterization was used to capture heterogeneity across regions, distinguishing the Eastern Mediterranean, South-East Asia, and Western Pacific regions within Asia. This approach reflects critical differences in AMR governance trajectories. Notably, the research suggests that South-East Asia is playing a key role in driving momentum in AMR governance, challenging established perceptions of European leadership. This finding, detailed in a related publication on Research Square, disrupts conventional understandings of regional progress.

Data Handling and Weighting Strategies

Researchers addressed challenges related to missing data, particularly concerning animal antimicrobial use and agricultural crop-production antimicrobial use. Countries with structurally missing data in these areas were excluded from composite AMU score construction to avoid bias. For the remaining 172 countries, missing AMU data were handled using component-specific imputation strategies designed to preserve within-country temporal structure and cross-country heterogeneity. Human AMU values were projected using country-specific autoregressive integrated moving average (ARIMA) models, while animal AMU time series were constructed using backcasting and forecasting based on each country’s sociodemographic index (SDI) trajectory.

To derive indicator weights for the AMR governance index, a combined subjective–objective weighting strategy was used, balancing expert-judged relevance with data-driven variability. Subjective weights were obtained through a Delphi-based Analytical Hierarchy Process (AHP), while objective weights were computed using the entropy method. These were then integrated using a deviation-maximization method.

What the Findings Mean for Global Action

The study’s findings underscore the importance of robust governance systems in addressing AMR. Effective governance is not simply about having policies in place, but as well about their consistent implementation and ongoing monitoring. The research highlights the need for a multi-sectoral approach, encompassing human health, animal health, and environmental factors. The inclusion of agricultural crop-production AMU data, normalized by arable land area, demonstrates the importance of considering agricultural practices in AMR governance.

The evaluation of 269 national policy documents revealed a range of approaches to AMR governance. Four researchers independently reviewed these documents, rating governance indicators based on Cochrane Systematic Review standards, with discrepancies resolved through group discussion or third-party arbitration. Native-language NAPs were translated using Google Translate, a step acknowledged as potentially introducing some limitations, though the rigorous review process aimed to mitigate this.

Looking Ahead: The 2026 Global Action Plan Update

The findings from this comprehensive evaluation will directly inform the update of the 2026 Global Action Plan on Antimicrobial Resistance. The study provides a detailed baseline assessment of national governance systems, identifying areas of strength and weakness. This information will be crucial for setting realistic targets and prioritizing interventions.

The research team emphasizes the need for continued surveillance and data collection to track progress and identify emerging challenges. The use of the Global Burden of Disease (GBD) 2021 AMR study and data from the Institute for Health Metrics and Evaluation HealthData VizHub (https://vizhub.healthdata.org/microbe/) demonstrates the value of leveraging existing data sources to monitor AMR trends. Further research is needed to understand the specific governance components that are most effective in driving improvements in AMR-related outcomes.

The next steps involve ongoing monitoring of national action plans, refinement of the governance evaluation framework, and continued collaboration between researchers, policymakers, and stakeholders across all sectors. The WHO will likely use these findings to provide targeted support to countries in strengthening their AMR governance systems, ultimately contributing to a more effective global response to this critical public health threat.