Global policy responses to antimicrobial resistance, 2021–22: a systematic governance analysis of 161 countries and territories

This study systematically analysed 161 national action plans (NAPs) on antimicrobial resistance (AMR) published between 2021–22, expanding on earlier work. Using a governance framework with 54 indicators across 18 domains, researchers scored countries from 0–100 and correlated results with the burden of drug-resistant infections.

Key Findings

• Governance scores ranged from 0 (Djibouti) to 100 (Norway).

• High-income countries (e.g., France, USA, UK, Sweden, Denmark) generally had stronger AMR governance, while low-income countries scored lowest.

• Higher governance scores correlated with a lower burden of AMR-related deaths and disability-adjusted life years (DALYs).

• The domains most strongly linked to reduced AMR burden were infection prevention and control, surveillance, and stewardship.

Interpretation
The strength of national AMR governance is highly income-dependent, reflecting disparities in public health resources and infrastructure (e.g., water, sanitation). To make NAPs effective, implementation should prioritise practical tools for infection prevention, surveillance of antimicrobial use, and stewardship programmes, particularly in low-resource settings.