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Inclusion of antimicrobial resistance in a pandemic agreement: why it matters and what comes next?
Jesic Beckham1, Rishabh Jain1, Delaram Haghgozar1
1Department of Global, Public and Population Health and Policy, School of Health and Medical Sciences, City St Georges, University of London, London EC1V 0HB, United Kingdom.
Background:
Antimicrobial resistance (AMR), referred to as the "constant pandemic," exceeds malaria and HIV as a cause of mortality across low- and middle-income countries. As AMR has been included in the recently adopted world's first pandemic agreement, we assessed the implications going forward for addressing AMR and meeting the UN General Assembly AMR targets.
Methods:
A rapid literature review was conducted to synthesize policy perspectives and empirical literature using 3 databases (PubMed, Embase, and CABI-Global Health) for studies published from December 2021 to May 2025.
Results:
Of the 56 included studies, only 2 were empirical research. Inductive and deductive analyses using the Organization for Economic Co-operation and Development framework with a force-field analysis were used to identify drivers and factors that may impede AMR reduction via the pandemic agreement. Challenges include inequity, inadequate governance, and financing. Factors that may impede implementation of the agreement currently outweigh driving forces.
Conclusion:
While AMR is included in the pandemic agreement, assessing the merits and risks associated with doing so is important to inform the detail and implementation strategy of the agreement itself. There is consensus that strengthening governance frameworks, fostering equity, and ensuring fair access to health resources are imperative.
Insights
Antimicrobial resistance (AMR) is a major global threat. Inclusion in the pandemic agreement is a step forward, but challenges like inequity and inadequate governance must be addressed for effective AMR reduction.
Area of Science:
- Global Health Security
- Infectious Disease Epidemiology
- Public Policy
Background:
- Antimicrobial resistance (AMR) poses a greater mortality risk than malaria and HIV in low- and middle-income countries.
- AMR is recognized as a "constant pandemic" and is now included in the global pandemic agreement.
- The UN General Assembly has established targets for addressing AMR.
Purpose of the Study:
- To assess the implications of including AMR in the pandemic agreement.
- To identify drivers and impediments to AMR reduction strategies within the agreement's framework.
- To inform the implementation strategy of the pandemic agreement concerning AMR.
Main Methods:
- A rapid literature review was conducted using PubMed, Embase, and CABI-Global Health databases.
- Studies published between December 2021 and May 2025 were included.
- Inductive and deductive analyses, including OECD framework and force-field analysis, were applied to 56 studies.
Main Results:
- Only 2 of the 56 reviewed studies were empirical research.
- Key challenges identified include inequity, inadequate governance, and financing issues.
- Factors impeding AMR reduction currently appear to outweigh driving forces for implementation.
Conclusions:
- Including AMR in the pandemic agreement requires careful assessment of merits and risks.
- Strengthening governance, fostering equity, and ensuring fair access to health resources are crucial.
- Consensus exists on the imperative need for these foundational elements in the agreement's strategy.
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