Structural inequalities in global antimicrobial resistance governance

Area of Science:

• Global Health
• Infectious Disease Epidemiology
• Health Policy and Management

Background:

• Antimicrobial resistance (AMR) poses a significant global health threat.
• Existing AMR governance structures often perpetuate inequalities, disproportionately affecting low- and middle-income countries (LMICs).
• Short-term funding and high-income country-centric research priorities limit sustainable AMR surveillance and scientific independence in LMICs.

Purpose of the Study:

• To analyze the structural inequalities in current antimicrobial resistance (AMR) governance.
• To highlight the constraints faced by low- and middle-income countries (LMICs) in addressing AMR.
• To advocate for a transformative approach prioritizing LMIC institutional development and leadership in AMR response.

Main Methods:

• Drawing on data from the BALANCE study, which enrolled approximately 67,000 patients.
• Analysis of patient data across diverse economic settings to understand AMR governance challenges.
• Qualitative and quantitative assessment of funding, research frameworks, and leadership in AMR.

Main Results:

• Substantial global investment in AMR has not translated into equitable capacity building, particularly in LMICs.
• High-income country-centric research frameworks and short-term funding models undermine sustainable AMR surveillance and scientific independence in LMICs.
• Structural inequalities within AMR governance limit the effectiveness of global response efforts.

Conclusions:

• An equitable AMR response necessitates a fundamental transformation of current governance models.
• Prioritizing institutional development and leadership within LMICs is crucial for sustainable and effective AMR control.
• Empowering LMICs is essential to overcome structural inequalities and strengthen global AMR efforts.