Antimicrobial Resistance in 2025: A Deepening Structural Crisis in Global Health Governance
Antimicrobial resistance (AMR) has moved from being a predicted global health risk tobecoming clear proof of system-wide failure. The Lancet reported 1.27 million deaths directly caused by bacterial AMR and nearly five million linked to resistant infections.¹ Updated GRAM projections show that without structural action, annual deaths could reach 1.9 million by 2050.² These numbers highlight a key reality: AMR cannot be solved by science alone. It is a challenge of governance, financing, and system design.
What defines 2025 is not scientific uncertainty but the clearer view of structural weaknesses: gaps in surveillance, poor incentives, stalled National Action Plans, ongoing agricultural misuse, and weak economic models for innovation. As the data improves, governance gaps become impossible to ignore.
Global Snapshot: AMR in 2025
2025 AMR Snapshot
- 40% rise in resistant infections globally since 2018³
- 1.27M AMR-attributable deaths (Lancet)¹
- Fewer than 15 novel antimicrobial candidates worldwide (WHO pipeline)⁴
- Surveillance incomplete in >70 countries (GLASS)⁵
- Agricultural antimicrobial use remains >2× human use (OECD)
1.Surveillance: The Foundation That Remains Uneven
GLASS participation now includes more than 100 countries, but surveillance capacity varies widely. Many low-resource health systems still lack basic bacteriology labs, electronic reporting tools, or reliable tracking of antimicrobial consumption.⁵ These gaps distort the national picture of AMR and undermine planning, resource allocation, and procurement.
Effective AMR control requires real-time visibility. Without reliable diagnostics and national surveillance dashboards, countries operate with incomplete epidemiological information.
2.Innovation: A Pipeline Too Thin to Sustain the Future
The WHO’s 2024 pipeline review lists around 90 antibacterial agents in development, butonly a small share represent truly novel mechanisms.⁴ Many are reformulations or slight variations of existing classes, leaving major gaps against carbapenem-resistant Gram-negative pathogens. This fragile innovation ecosystemis driven mostly by small biotech companies with limited capital and high riskof failure.
Key structural constraints include:
- High R&D costs and technical risk
- Low utilization due to stewardship requirements
- Weak pricing power for new agents
- Fragmented procurement that weakens demand signals
- Lack of global pull incentives to ensure sustainable returns
This creates a fundamental paradox: antibiotics with the greatest societal value often have the lowest commercial value.
3.Governance Gaps: Ambition Does Not Equal Execution
More than 140 countries have National AMR Action Plans, but fewer than one-fifth are fully costed, and fewer than one in ten show measurable progress.⁶ Many plans lack clear indicators, funding, cross-ministerial accountability, or enforceable rules for agriculture and wastewater management.
While One Health is widely used as a guiding framework, its real-world application is inconsistent. Without measurable, sector-specific indicators—particularly for agriculture and the environment—One Health risks becoming rhetoric instead of agovernance tool.
4.Pharma’s Strategic Role: Shaping Incentives, Procurement and Market Architecture
Pharmaceutical companies have a strategic role in shaping a functional AMR ecosystem. The goal is not to increase sales volumes, but to keep the innovation pipeline alive while supporting stewardship and ensuring equitable access.
Key policy priorities include:
- Expanding multi-country subscription (“pull”) incentives that reward availability, not volume
- Developing reimbursement models linked to diagnostics for appropriate use
- Supporting societal-value frameworks (e.g., reduced transmission, prevented mortality)
- Strengthening regional procurement alliances to stabilise demand
- Co-building measurable One Health indicators with agriculture, wastewater, and food-system ministries
5.Strategic Imperatives for 2026–2027
2026–2027 Priority Actions
- Expand subscription payment models beyond pilot countries
- Require agricultural antimicrobial consumption reporting
- Introduce national diagnostic bundles in primary care
- Establish global value frameworks for new antimicrobials
- Enforce wastewater and environmental AMR discharge standards
References
1. Murray,C.J.L. et al. (2022). Global burden of bacterial antimicrobial resistance in2019. The Lancet.
2. GRAMProject (2025). Global AMR Mortality Forecasts.
3.FightBack/BU (2025). Global Antibiotic Resistance Trend Report.
4. WHO(2024). 2024 Antibacterial Pipeline Review.
5. WHOGLASS (2024). Global AMR and Use Surveillance Report.
6. WHO(2023). AMR Global Action Plan Implementation Progress.
Conclusion
AMR is nolonger just a biological challenge; it is a test of global coordination,health-system maturity, and the ability to align economic incentives withpublic-health needs. The evidence is strong, scientific tools are available,and policy recommendations are well-established. What is missing is coherence:unified surveillance, aligned financing, responsible use, and enforceablecross-sector regulation.
There isstill a narrow window for meaningful action. With better surveillance, smarterincentives, and coordinated procurement, AMR can remain a manageable threatrather than a defining crisis. The next two years will show whethergovernments, multilaterals, and industry can move from planning to disciplinedimplementation. Future progress depends on aligning systems so that responsibleuse, innovation, and access reinforce each other rather than compete.
