Donors making a difference: combating antimicrobial resistance

As the World Antimicrobial resistance (AMR) Awareness Week is underway, we present the progress to date with a summary of key developments since 2015, snapshots of country success stories that exemplify how critical the role of partners and donors is. We also look ahead to the way forward, based on the commitments agreed during 2024 - a monumental year for AMR.

Antimicrobial resistance is one of the most critical global health threats we face today. It affects humans, animals and plants, and occurs when bacteria, viruses, fungi and parasites no longer respond to antimicrobial medicines. In humans, AMR leads to infections that become difficult or even impossible to treat, increasing the risk of disease spread, severe illness, disability and death. Today, AMR is associated with about 5 million deaths per year, a figure projected to increase in the coming decades.

In 2015, a Global Action Plan (GAP) on AMR was adopted by the World Health Assembly (WHA) to ensure that infectious diseases could still be treated with quality-assured, safe and effective medicines. The GAP has driven subsequent progress, which has only been possible because of donor contributions to WHO's AMR initiatives.

By 2024, the foundations of the global response were laid as many countries are taking the lead: 170 have developed an AMR National Action Plan (NAP) spanning the health, environmental, animal and agrifood sectors. 67% are currently implementing their NAPs, according to the Tracking AMR Country Self-assessment Survey (TrACSS). Results from the Global AMR and Use Surveillance System (GLASS) also indicated that 92 and 74 countries are now submitting data on AMR and antimicrobial use, respectively.

Learn more about why 2024 is a milestone year for AMR and the way forward

WHO creates an enabling environment for countries to implement their NAPs. Activities include developing and rolling out: Bacterial and Fungal Priority Pathogen Lists, antimicrobial product pipeline analyses, guidance on antimicrobial stewardship and the WHO AWaRe (Access, Watch, Reserve) system to inform the use of antibiotics for common infections.

The Organization also runs a range of awareness-raising initiatives and campaigns to help sensitize policymakers, media, youth and the general public about AMR, including through the Task Force of AMR Survivors and World AMR Awareness Week (WAAW).

WHO's AMR work is entirely about partnerships: we host the Quadripartite Joint Secretariat for AMR, made up of the Food and Agriculture Organization of the UN (FAO), the UN Environment Programme (UNEP), WHO and the World Organisation for Animal Health (WOAH).

All this adds up to a comprehensive response in the human health sector, which takes place in the context of the One Health approach, aiming to sustainably balance and optimize the health of people, animals and ecosystems. As a result of these initiatives, strongly supported by partners and donors, WHO has been better able to support its Member States in addressing the challenges that AMR presents at global, regional and country level. The impact is enhancing health security, protecting populations and reducing ill health, disability and death.

Setting up countries for success.

Today, many Member States are better addressing AMR thanks to WHO's support, whether it be in the form of direct technical assistance in-country, or through the use of guidelines and tools to help develop, cost and streamline gender into AMR NAPs; improved stewardship; healthcare facility assessments; enhanced pandemic preparedness and response; or a strengthened people-centred approach in healthcare settings. A few examples of such initiatives - some in their early stages, some further on in their implementation - are provided below.

Nigeria launches action plan to combat AMR

^{Group photo at the launch of the AMR Global Action Plan in Abuja, Nigeria 2024. Photo credit: WHO/Nigeria}

In a bold step towards combating the growing threat of AMR, the Federal Government of Nigeria has launched its Second National Action Plan (NAP) on AMR. This aligned with the political declaration approved at the 2024 UNGA High-Level Meeting on AMR, President Bola Ahmed Tinubu's health sector renewal initiative, and Nigeria's commitment to global health security. WHO has been a key technical partner in developing this latest plan, providing guidance on global best practices and supporting the federal government in aligning its strategies with the Global Action Plan on AMR. Funding from the Kingdom of Saudi Arabia and the Fleming Fund of the United Kingdom Department of Health and Social Care using UK Aid, supported the development of the strategic document One Health AMR NAP-2.0.

Find out more about Nigeria's strategic approach to tackling AMR.

Addressing the challenge of AMR in Ethiopia

^{Pharmacist Tigist Shimeles at ALERT Comprehensive Specialized Hospital closely monitors the prescribed use of antimicrobial medicine for a client with a multidrug-resistant (MDR) infection, Addis Ababa, Ethiopia 2023. Photo Credit: WHO Ethiopia}

Recent disease surveillance findings from more than 4 000 health centres across Ethiopia point to an increasing AMR in the country. However, Ethiopian health authorities have been taking measures to tackle this rising threat. With support from WHO, and funding from the Kingdom of Saudi Arabia, the Ministry of Health developed policies and trained health workers to promote the appropriate use of antimicrobials, improve treatment, reduce AMR and decrease the spread of infections caused by drug-resistant germs. Ethiopia is one of the few countries in the African region that has a costed, multisectoral AMR national action plan, signed by the ministries overseeing the human, animal and environmental sectors. The Ethiopian Food and Drug Administration authority, with support from WHO, has started antimicrobial consumption surveillance at health facilities. More than 250 health professionals have been trained to implement antimicrobial stewardship and evidence-based therapy for infection management.

Find out more about Ethiopia's work to address the challenge of AMR.

WHO Costing and Budgeting Tool for Tanzania's AMR action

^{Costing coordinators during AMR training in the United Republic of Tanzania. Photo credit: WHO Tanzania}

The Government of Tanzania, recognizing the grave threat that AMR poses to humans, animals and the environment, developed its first National Action Plan on AMR for 2017-2022 (NAP 1.0) and made remarkable progress in implementing the interventions and activities. The second NAP on AMR 2023-2028 (NAP 2.0) was developed through consultation amongst relevant AMR stakeholders and sectors. Training in the use of the WHO costing and budgeting tool for NAPs on AMR brought together all the relevant ministries, beyond human health, animal health and agriculture. It underlined the importance of prioritizing and costing activities to ensure that NAP 2.0 was operationally feasible. The costing of NAP 2.0 for the United Republic of Tanzania was supported by the WHO Country Office, the WHO Regional Office for Africa and WHO headquarters. Financial contributions were made by the Federal Ministry of Health, Germany and the governments of Saudi Arabia and the Fleming Fund of the United Kingdom Department of Health and Social Care using UK Aid.

Find out more about WHO's costing and budgeting tool in Tanzania.

WHO costing and budgeting tool for National Action Plan on AMR in South Sudan

^{Stakeholders at a National Action Plan on AMR workshop, Juba 2023. Photo credit: WHO South Sudan}

South Sudan is in the early stages of its AMR response. One of its priorities has been to strengthen multistakeholder coordination and engagement in a One Health, country-led approach. In 2023, the National Action Plan (NAP) on AMR 1.0 provided a governance structure integrated into the country's One Health governance in the Office of the Cabinet Affairs Ministers to ensure high-level political commitment and alignment with national priorities. To cost the South Sudan NAP, consultations were held on the use of the WHO costing and budgeting tool for NAPs on AMR with the South Sudan national AMR secretariat and representatives of the three levels of WHO. Virtual and in-person training in the use of the tool was provided to build national capacity for applying the tool so that the team could cost the operational plan for NAP 1.0. The costing exercise offered an opportunity to identify activities that could readily be implemented jointly and ensured that the costs of the activities were realistic. Financial contributions were made by the African Centre for Disease Control, the Federal Ministry of Health, Germany, and the governments of Saudi Arabia and the Fleming Fund of the United Kingdom Department of Health and Social Care using UK Aid.

Find out more about South Sudan's efforts to tackle AMR through strategic planning and costing.

Supporting antimicrobial stewardship efforts in Bangladesh

^{Paran Sarimita Winarni listen to the doctor explaining the results of the X-ray at the Friendship Hospital. Diagnosis of TB is not only through X-rays but also must check sputum through laboratory tests. Photo credit: WHO Bangladesh}

In Bangladesh, concerted efforts are needed to strengthen regulatory enforcement, enhance public awareness campaigns, and promote antimicrobial stewardship practices across all sectors of society. With technical support from WHO and Staten's Serum Institute in Denmark, alongside financial backing from the Fleming Fund, the Directorate General of Drug Administration, operating under the UK Ministry of Health & Family Welfare, investigated escalating antibiotic use in the country. The collaborative effort identified the underlying causes and framed interventions to tackle the issue effectively. Subsequently, an initiative was launched to overhaul antibiotic packaging for all antibiotics manufactured and sold within Bangladesh.

Read more about Bangladesh's collaborative effort to change antibiotic packaging and improve antibiotic stewardship.

WHO and partners support Indonesia to develop path-breaking human health sector plan based on new WHO guidance

^{WHO, Indonesian Ministry of Health and key partners such as the Asia-Europe Foundation concluded a series of workshops to address AMR based on the WHO people-centred approach. Photo credit: Asia-Europe Foundation}

In February 2024, WHO, the Indonesian Ministry of Health and key partners including the Asia-Europe Foundation concluded a series of workshops aimed at developing the world's first human health sector-specific national action plan to address AMR based on the WHO people-centred approach. A workshop, held on 29-30 January and 26-29 February, aimed to translate WHO's new people-centred core package of 13 interventions for addressing AMR in human health into an Indonesia-specific national health sector action plan. After this launch, the plan will be integrated into Indonesia's national health transformation agenda, including efforts to strengthen primary health care and build health system resilience and emergency preparedness and response capacities. It will complement ongoing One Health action to address AMR at the human-animal-environment interface.

Read more about Indonesia's work to integrate WHO guidance into national AMR policy.

Combating AMR through healthcare facility and poultry farm assessments in Indonesia

^{Interview during IPC-WASH and AMS assessment in Puskesmas in Blitar District, East Java. Photo credit: IQVIA Indonesia}

In Indonesia, improper management of medical waste and limited implementation of infection prevention control measures in healthcare facilities contributed to the rise of AMR. These gaps call for infection prevention control and water, sanitation, and hygiene (IPC-WASH) and antimicrobial stewardship assessments (AMS). The AMR Multi-Partner Trust Fund (MPTF) in Indonesia, driven by WHO with the Food and Agriculture Organization, UN Environment Programme, and the World Organisation for Animal Health, selected four pilot districts in Central and East Java to assess IPC-WASH and AMS in 33 primary health centres, 18 hospitals and 160 poultry farms. The Indonesian AMR MPTF team held a high-level meeting involving national and local governments to share the study results, and the team advocated for the strengthening of IPC and WASH measures in pilot areas. This activity is generously supported by the Multi-Partner Trust Fund and the Kingdom of Saudi Arabia.

Read more about Indonesia's efforts to strengthen IPC and WASH to tackle AMR.

PAHO and World Bank launch PROTECT project to strengthen pandemic response in South America

In July 2024, the Pan American Health Organization (PAHO/WHO) and World Bank launched the PROTECT Project, an initiative to improve pandemic response in 7 South American countries. The initiative, funded by a grant from The Pandemic Fund of almost US$ 17 million, will focus on optimizing surveillance and laboratory systems in border regions of Bolivia, Brazil, Chile, Colombia, Ecuador, Paraguay and Uruguay. Engaging a diverse coalition, PROTECT brings together Ministries of Health and Agriculture, PAHO/WHO, the World Bank, and PAHO's Pan American Foot and Mouth Disease and Veterinary Public Health Centre. The project aims to improve the early detection, characterization and response to emerging zoonotic diseases that can trigger a pandemic and will focus on rural and remote communities in the Amazon Basin. Over the next 3 years, PROTECT is expected to benefit more than 2.4 million people, including indigenous and riverside communities.

Read more about the PROTECT Project and how it will strengthen responses to AMR across communities in 7 countries in the Americas.

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WHO's AMR work wouldn't be possible without the support of all Member States and partners. WHO thanks all donor countries, governments, organizations and individuals who are contributing to the Organization's work, with special appreciation for those who provide fully flexible contributions to maintain a strong, independent WHO.

Donors' direct funding for AMR initiatives enables WHO to support Member States in addressing AMR. WHO is grateful to the donors who have directly contributed to WHO's work on AMR over the past years, including: the AMR Multi-Partner Trust Fund, the Asia-Europe Foundation, Australia, Austria, Canada, Denmark, European Commission, Foundation for Innovative New Diagnostics (FIND), France, Germany, Global Antibiotic Research and Development Partnership (GARDP), Global Fund, International Centre for AMR Solutions (ICARS), Japan, Luxembourg, Netherlands (Kingdom of), Norway, Pandemic Fund, Republic of Korea, Saudi Arabia (Kingdom of), Susan Thompson Buffet Foundation, Sweden, the United Kingdom of Great Britain and Northern Ireland (UK Aid / Fleming Fund), United States of America, and Wellcome Trust.

WHO also recognizes the critical role its various technical partners play in addressing AMR, especially the 34 WHO Collaborating Centres for AMR it works with each day from all across the world.

Despite the progress made, much more needs to be done.

WHO, Member States and all AMR partners alike are now equipped with important roadmaps, commitments and targets. Key aims include ensuring global deaths associated with bacterial AMR are reduced by 10% annually by 2030, and establishing sustainable sources of financing to addresss AMR.

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