News Release

Global response to antimicrobial resistance ‘insufficient’

Peer-Reviewed Publication

University of Leeds

University of Leeds news 

For immediate release 

Global response to antimicrobial resistance ‘insufficient’ 

Governments around the world must do more to tackle the growing threat of drug-resistant infections, new research suggests. 

National action plans to tackle the threat from antimicrobial resistance (AMR), which occurs when bacteria, viruses, fungi and parasites stop responding to medicines designed to treat them, were developed by more than 100 countries.   

The plans focus on designing policies to curb AMR and devising tools to implement the policies - but they do not adequately factor in monitoring and evaluation.    

The new research, carried out by experts at the universities of Leeds, Edinburgh and Hamburg, is the first large-scale analysis of these plans. They were designed after encouragement from the World Health Organisation, which has declared AMR one of the top 10 public health threats facing humanity. 

Lead author Jay Patel, undergraduate dental student in the University of Leeds’ School of Dentistry, said: “Our analysis showed that countries were highly focused on designing AMR policies, and thinking about what tools would be required to implement those, but they generally did not consider how they would monitor and evaluate the impact of those efforts.  

“This suggests that the international response may be inadequate to meet the scale and severity of AMR. This is particularly concerning in low and middle-income countries, where action plan activities often lack sustainable funding – relying instead on funds from foreign donors and philanthropies.  

“The available evidence also suggests that simply developing a national action plan may not necessarily mean a country is more prepared to respond to the threat of AMR.  

“Our study shows that the global response to AMR, and preparedness for the predicted challenges of AMR, require improvement in all locations around the world.” 

The research team says governments across the world must strengthen their responses to AMR. 

What is antimicrobial resistance? 

AMR refers to changes in microbes, particularly bacteria, that cause the drugs used to treat infections to become less effective. AMR has emerged as a defining challenge for global public health in the 21st century. In 2019 alone, AMR was a factor in 4.95 million deaths worldwide – more than half of deaths due to bacterial infections.  

Without action, AMR could render many routine antibiotics ineffective, claiming tens of millions of lives annually. 

In 2017, the World Health Organization encouraged member states to develop national action plans stipulating how countries would tackle AMR. More than 100 countries have produced action plans, with several being implemented - but there had been no global analysis of the contents of these plans. 

Published in The Lancet Infectious Diseases, this new research is the first to comprehensively assess international AMR efforts and national action plans and generate comparable quantitative results across countries and regions. 

The 114 action plans, which were created in 2020-21, were evaluated against 54 elements, such as education, stewardship, and accountability, and each awarded a score out of 100. A mean score out of 100 for each country’s plan was then taken from these results. 

Countries and action plan scores are shown in the table below 

Norway 

85 

Croatia 

60 

Indonesia 

53 

Rwanda 

45 

Paraguay 

36 

USA  

84 

Tanzania  

59 

Timor-Leste  

52 

Cyprus  

44 

Afghanistan 

35 

UK 

83 

Zimbabwe 

59 

Ethiopia 

51 

Egypt  

44 

Uruguay  

34 

Sweden  

78 

Canada  

58 

North Korea  

51 

South Africa  

43 

Costa Rica 

34 

Denmark  

76 

Ghana  

57 

India  

51 

Sudan  

43 

Mauritius 

33 

Germany  

76 

Portugal  

57 

Sri Lanka  

51 

Ecuador  

43 

Maldives 

33 

Japan  

75 

Saudi Arabia 

57 

Kenya 

51 

Nepal 

43 

Fiji 

32 

Australia  

75 

Slovenia 

57 

Laos 

50 

Turkey 

43 

Mongolia 

31 

Switzerland  

75 

Mozambique 

57 

Colombia 

49 

UAE 

43 

Libya 

31 

France 

74 

Iran 

57 

Slovakia 

49 

Bhutan 

42 

Turkmenistan 

31 

Malaysia 

73 

Finland 

56 

Madagascar 

49 

Papua NG 

42 

Ukraine 

29 

South Korea 

73 

Iceland 

56 

Serbia 

48 

Pakistan 

41 

Sierra Leone 

29 

Thailand 

72 

Uganda 

56 

Iraq 

48 

Argentina 

40 

Barbados 

28 

Netherlands 

71 

Estonia 

56 

Cuba 

48 

Eritrea 

40 

Micronesia 

28 

Philippines 

71 

Liberia 

56 

Lithuania 

47 

Cambodia 

39 

 

 

Spain 

71 

Bahrain 

55 

Eswatini 

47 

Tunisia 

39 

 

 

Austria 

70 

Mexico 

55 

Czech Republic 

47 

Bangladesh 

39 

 

 

Ireland 

69 

Malawi 

55 

Luxembourg 

47 

Oman 

39 

 

 

Singapore 

66 

Russia 

55 

North Macedonia 

46 

Malta 

38 

 

 

Greece 

65 

Nigeria 

55 

Chile 

46 

Cameroon 

38 

 

 

Italy 

65 

Morocco 

54 

Georgia 

45 

Montenegro 

38 

 

 

China 

64 

Burkina Faso 

54 

Brazil 

45 

Tajikistan 

38 

 

 

Belgium 

63 

Zambia 

54 

Namibia 

45 

Nicaragua 

38 

 

 

Latvia 

63 

Myanmar 

53 

Poland 

45 

Brunei 

37 

 

 

Peru 

61 

Jordan 

53 

Lebanon 

45 

Vietnam 

36 

 

 

 

The findings 

The study found that across all plans, there was a greater focus on policy design and implementation tools, but efforts to monitor and evaluate activities are generally poorly-considered.  

Of all areas evaluated, accountability and feedback mechanisms were the joint-lowest scoring, followed by education.  

Training and professional education across human health, veterinary, and agricultural sectors were insufficient in many countries, with several lacking a sustainable workforce strategy to deliver antimicrobial stewardship policies. 

Countries scored well on participation, demonstrating a shared awareness that AMR can only be successfully addressed through engagement with multiple sectors spanning human, animal and environmental health. Infection prevention and control was frequently recognised as a critical objective. 

Norway’s response was the highest scoring with 85, followed by the USA with 84 and the UK with 83. The lowest scoring countries were Ukraine and Sierra Leone with 29 points each, and Barbados and Micronesia with 28 points. 

Further information 

Contact University of Leeds press officer Lauren Ballinger via l.ballinger@leeds.ac.uk with media enquiries. 

Measuring the global response to antimicrobial resistance, 2020–21: a systematic governance analysis of 114 countries" is published in The Lancet Infectious Diseases. 

The research was funded by the Wellcome Trust and the Leibniz Association. JP, GF and DS are funded by the Wellcome Trust (106635/Z/14/Z). AH, WH and DD are funded by the Leibniz Association (SAS-2021-1-FZB). AJM provides consultancy services to the WHO Regional Office for Africa. 

University of Leeds  

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