GOVERNANCE of national action plans (NAPs) on antimicrobial resistance (AMR) remains highly variable worldwide, with weaker plans associated with higher burdens of drug-resistant infections, according to a systematic analysis of 161 countries and territories.
Researchers conducted a comprehensive governance review of publicly available NAPs for 2021–22, including 47 more countries than in previous analyses. Using machine learning and artificial intelligence to translate non-English plans, three investigators assessed 22,057 data points across 54 indicators in 18 domains within three governance areas. Country scores were generated on a 0–100 scale, and correlations were examined with AMR-related disability-adjusted life-years (DALYs) and deaths using data from the IHME GRAM project.
Scores ranged widely, from Norway at 100 to Djibouti at 0, with higher scores generally observed in high-income countries such as France, the USA, the UK, Sweden, and Denmark. Lower-income countries, including Libya, the Central African Republic, South Sudan, and Seychelles, consistently scored poorly. Stronger governance correlated with a lower burden of AMR-associated DALYs (r = –0.469, p<0.001) and deaths (r = –0.477, p<0.001). Among governance domains, infection prevention and control (r = –0.532), surveillance (r = –0.482), and stewardship programmes (r = –0.459) showed the strongest associations with reduced AMR burden.
The study highlights stark global disparities in AMR governance, linked closely to national income and systemic infrastructure, such as public health funding and access to clean water and sanitation. The authors emphasise that implementation tools, particularly those strengthening infection prevention, surveillance of antimicrobial use, and stewardship programmes, should be prioritised in NAP design and execution. Strengthening these areas in low- and middle-income countries could reduce the global burden of drug-resistant infections and improve population health outcomes.
Reference
Patel J et al. Global policy responses to antimicrobial resistance, 2021-22: a systematic governance analysis of 161 countries and territories. Lancet Infect Dis. 2025; DOI:10.1016/S1473-3099(25)00406-2.
