Antimicrobial Resistance in 2025: A Deepening Structural Crisis in Global Health Governance

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

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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.

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