A One Health framework for global and local stewardship across the antimicrobial lifecycle

Antimicrobial resistance (AMR) is a One Health challenge, affecting human and animal health, plants and the environment. It has significant impacts on population health, food security and economies of all countries. AMR is a complex problem that requires broad One Health stewardship from local to global levels, encompassing infection prevention together with stewardship across the six stages of the antimicrobial lifecycle, i.e., (1) research and development, (2) production, (3) registration evaluation and market authorization, (4) selection, procurement and supply, (5) appropriate and prudent use and (6) disposal, as outlined by the World Health Organization (WHO), the Food and Agriculture Organization (FAO), and the World Organization for Animal Health (WOAH). This requires the stewardship of innovation, access, use and disposal. Such end-to-end stewardship will individually and collectively help to maintain the efficacy of existing and new antimicrobials for the optimal management and prevention of infections in humans, animals, and plants while protecting the environment. This Perspective proposes a comprehensive One Health stewardship framework that spans the entire antimicrobial lifecycle-from innovation to disposal-across humans, animals, plants, and the environment as One Health sectors. By embedding stewardship principles at all levels, the framework aims to preserve antimicrobial efficacy, mitigate resistance, and safeguard global health, animal health food security, and ecosystems.