Reflections for the Future of AMR Surveillance and AMR Action

This paper builds on the other papers in this series to present high-level lessons learnt and considerations for the future of antimicrobial resistance (AMR) surveillance and its contribution to action on AMR in low- and middle-income countries.

Participatory synthesis involved engagement with individuals who had worked within and alongside the Fleming Fund from a range of organizations and geographies, to scope and solidify lessons learnt and future considerations relevant to a wide range of donors, partners, and policy makers or implementors. Contributors were invited to join a Writing Group, which included individuals from academia, clinical sciences, applied public, animal, environment, and food sciences health, as well as senior scientists and administrators from 14 organizations. The synthesis was informed by contributions to 4 virtual workshops and 3 drafts of the manuscript. Authors read and commented on the drafts, several wrote and referenced sections, and all gave substantive feedback with their reactions to the draft conclusions as consensus was built.

Over nearly 10 years, the Fleming Fund achieved significant improvements in AMR surveillance. Analysis of the barriers and enablers across settings and systems highlights key lessons for how surveillance is positioned, funded, used, and innovated upon. The success of future AMR surveillance and its sustainability relies on planning within resource constraints for a sharpened system that focuses the scope, frequency, and depth of data to inform action, technical, and architectural developments directions to streamline investment and financing that supports country-led sustainable approaches.

Investment in AMR surveillance and broader AMR actions has yielded substantial progress. Expanded domestic public financing, large-scale private sector engagement, or enhanced multilateral support will be needed to ensure recent gains are sustained. Progress will require well-designed, targeted, and cost-effective investments to maintain current capacity while enabling further system strengthening.