IPM Take
AMR has reached the stage where political commitment is no longer the scarce commodity. Implementation money is.
Asia-Pacific countries are producing stronger national action plans, setting measurable targets and building monitoring frameworks. That is real progress. But a plan that has not been costed, financed or connected to functioning laboratories and infection-control systems is still closer to an aspiration than a public-health intervention.
Executive Summary
New data from 28 Asia-Pacific countries show significant improvements in national planning against antimicrobial resistance following the 2024 UN General Assembly political declaration on AMR.
Twenty-seven countries had endorsed at least one multisectoral national action plan. Compared with first-generation plans, second-generation plans were substantially more likely to be costed, include monitoring and evaluation frameworks and contain measurable targets.
Financing remains the central weakness. Forty-nine percent of the 27 countries with AMR plans had plans that were not costed at all, while 44% were fully costed and 7% partially costed. Only eight countries reported financing their AMR activities entirely through domestic sources, and 15 countries received less than 30% of their AMR funding domestically.
Why it matters
- Policymakers: AMR targets for 2030 will remain rhetorical unless national plans are linked to explicit budgets and domestic financing.
- Hospitals and clinicians: Weak infection prevention, diagnostics and stewardship infrastructure accelerates both antimicrobial use and resistant infection.
- Public authorities: Monitoring plans needs to move beyond whether documents exist towards whether funded interventions are actually being delivered.
Governments rarely suffer from a shortage of antimicrobial-resistance strategies anymore. The language is established, the One Health principle is widely accepted, international targets exist and almost every country in the latest Asia-Pacific analysis has produced a multisectoral national action plan. On paper, AMR has become one of global health’s most thoroughly planned crises.
The problem begins when the paper ends.
The new regional assessment is important because it separates improvement in policy design from improvement in implementation. Second-generation AMR plans are clearly becoming more sophisticated. They are twice as likely to be costed as first-generation plans, almost three times as likely to include monitoring and evaluation frameworks, and far more likely to contain measurable targets. Governments have learned how a credible AMR strategy should look.
Yet nearly half of the national plans assessed are still not costed at all. Only eight countries say their AMR activities are fully financed domestically, while more than half of countries reporting financing data obtain less than 30% of their AMR funding from domestic sources. That dependency matters because antimicrobial resistance is not an emergency that can be sustainably managed through episodic grants. Surveillance laboratories, infection-control programmes, wastewater systems, pharmacy stewardship and trained workforces require recurring expenditure year after year.
The infrastructure gaps make the financing problem visible. Only 16 of the 28 countries reported that more than three quarters of their healthcare facilities had basic water, sanitation and hygiene services. This is not a peripheral development indicator. A hospital that cannot reliably prevent infection will generate more infections, require more antibiotics and create more opportunities for resistant organisms to spread.
Antibiotic use tells a similar story. WHO encourages countries to achieve a high proportion of antibiotic consumption from the Access group: generally narrower-spectrum medicines recommended as first-line treatment for many common infections. Yet only nine countries reported that more than 70% of antibiotic use came from this group. Stewardship therefore remains uneven even while national strategies increasingly describe it correctly.
The political risk is obvious. International AMR diplomacy can create the impression that agreement itself represents progress. Governments endorse declarations, announce targets and present national plans at global meetings, but resistant infections respond only to what happens inside clinics, laboratories, farms, pharmacies and communities.
There is also a sovereignty argument for domestic financing. External support will remain important, particularly in lower-resource health systems, but national AMR programmes cannot depend indefinitely on donors deciding that resistance remains fashionable enough to finance. If governments regard AMR as a threat to health security, essential medicines and economic resilience, the budget should begin to reflect that status.
The next generation of accountability therefore needs to ask harder questions. How much does the plan cost? How much has actually been allocated? Which ministries are paying? Are laboratories producing usable resistance data? Are hospitals implementing infection prevention? Are antibiotic-use indicators changing?
Asia-Pacific governments are getting better at answering what should be done.
The uncomfortable question is now who will pay to do it.
