The following op-ed was published in The EastAfrican ahead of the UN General Assembly high-level meeting on pandemic prevention, preparedness and response. In the piece ICARS Executive Director Helle Engslund Krarup and Head of ICARS Africa Dr Titha Dzowela argue that action on AMR should be integrated into pandemic preparedness. They call for aligned plans and budgets, clear accountability, and investment in locally led solutions that strengthen the systems countries rely on every day.
This week, world leaders and experts will gather at the UN General Assembly in New York to reflect on and set targets for the world’s preparedness for the next pandemic. While the COVID-19 pandemic may seem far behind us, the systems meant to protect us from the next pandemic are already being tested every day – not by a new pathogen, but by familiar infections that no longer respond to treatment.
Over the past century, antimicrobials have transformed modern medicine, saving countless lives by making previously life-threatening infections treatable and enabling highly specialised procedures such as surgery, cancer treatment and organ transplantation to be performed safely. However, that positive development is now at risk, especially in Africa.
In 2023, one in five laboratory-confirmed bacterial infections reported in the WHO African Region was resistant to antibiotic treatment[1]. Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi, or parasites change over time and become less responsive to the medicines used to treat the infections they cause, turning previously treatable infections into longer and more dangerous illnesses. It keeps patients in hospital, increases the need for costly second-line medicines and intensive care, and raises the risk of disability and death. For already stretched health systems, this is not a distant treat, it is a daily emergency [2].
On 25 September, world leaders will meet at the United Nations General Assembly to review progress since the 2023 Political Declaration on Pandemic Prevention, Preparedness and Response and are expected to adopt a new declaration[3]. The 2023 text rightly recognised tackling AMR as “a crucial aspect” of pandemic preparedness, but set no AMR-specific targets, deadlines, or reporting requirements.
A draft for this year’s declaration circulated to Member States in late July again recognises action on AMR and includes antimicrobial stewardship among its prevention measures[4]. Recognition matters, but recognition without timelines, accountability and finance will not close the gap between plans and delivery. In 2024 the same Member States committed to scale up action to reduce the global deaths associated with bacterial antimicrobial resistance by 10 per cent by 2030. To reach that goal we need to act now!
That gap is stark in Africa. On the positive side, a recent WHO assessment found that 45 of the region’s 47 member states have developed National Action Plans on AMR. On the other hand, only 22 have costed and budgeted operational plans with monitoring mechanisms, and none reported dedicated national financial provision for implementing those plans[5]. Plans without predictable resources cannot strengthen laboratories, retain skilled staff, or make infection prevention and antimicrobial stewardship routine.
To move forward, we need to connect political ambition to funded and measurable action. National preparedness frameworks should explain how countries will prevent, detect and manage resistant infections, identify who is accountable for delivery, and specify the resources and indicators needed to track progress.
Invest once in systems that serve every day
AMR and pandemic preparedness are too often treated as separate agendas. In practice, they rely on many of the same capabilities: infection prevention and control, clean water and sanitation, vaccination, strong laboratories, surveillance, trained health workers, and trusted supply chains.
These are not investments that sit idle while countries wait for the next emergency. They protect patients every day and can be rapidly mobilised when an outbreak occurs.
Infection prevention and control reduces the spread of pathogens and the number of infections requiring antimicrobial treatment. Hand hygiene, environmental cleaning, equipment sterilisation, access to safe water, and the rapid identification and isolation of infections are as central to routine patient safety as they are to outbreak control.
A 2024 modelling study estimated that stronger infection prevention and control in health facilities, universal access to high-quality water, sanitation and hygiene, and wider coverage of priority childhood vaccines could avert more than 750,000 deaths associated with AMR each year in low- and middle-income countries, approximately 18 per cent of the current burden in those countries.
Vaccines offer the same double dividend. They protect against outbreaks while preventing infections that would otherwise lead to antibiotic use. WHO estimates that vaccines against 24 pathogens could reduce global antibiotic use by 22 per cent, equivalent to 2.5 billion defined daily doses each year. Some of these vaccines already exist; others still need to be developed. The case for investing in both access and innovation is clear.
Africa’s outbreak-surveillance systems show what sustained investment can achieve. In 2025, 71 per cent of public health events in the WHO African Region were detected within seven days. The 2024 TrACSS results indicate that substantial gaps remain in national AMR surveillance capacity across Africa. In particular, few countries have fully integrated AMR surveillance with antimicrobial-use data in the human health sector.
Surveillance investments should not be designed for emergencies alone. The same networks, laboratories and data systems should help countries identify resistant pathogens, monitor antimicrobial use, and respond before small signals become larger crises. There are several examples of countries, for instance Denmark, where strong systems for AMR and broader infectious-disease surveillance were used as a basis for effectively handling the COVID-19 pandemic. This can serve as inspiration.
Bring AMR and health security plans together
African governments have already identified many of these priorities through two related processes. National Action Plans on AMR set out how countries will address resistance across human, animal, and environmental health. National Action Plans for Health Security cover the wider capacities needed to prevent, detect, and respond to health emergencies. Both depend on laboratories, surveillance, infection prevention, effective governance, and a capable workforce.
Yet where these plans operate through separate committees, budgets and review cycles, their shared priorities compete for attention and scarce resources. As we face the realities of resources under pressure, Africa cannot afford parallel architectures for problems that depend on the same foundations.
Alignment does not mean merging every plan or weakening the One Health scope of AMR. It means identifying shared priorities, assigning clear responsibility, connecting budget and review cycles, and using compatible indicators. It also means ensuring that investments reach animal health, food systems and the environment, where surveillance and laboratory capacity often remain weakest.
Done well, preparedness finance can advance existing AMR priorities while building services that are ready for health emergencies. This is a better use of limited resources—and a more sustainable model than creating temporary systems during each crisis.
Back African institutions to deliver
Africa does not lack plans, expertise or promising solutions. The central challenge is moving what works from a project into policy, budgets, and routine services.
Across Africa, the One Health Drive AMS-IPC Africa programme, supported by the International Centre for Antimicrobial Resistance Solutions (ICARS), is developing a One Health training programme in antimicrobial stewardship, infection prevention and control, and biosecurity. The project team is currently reviewing and adapting the training curriculum to strengthen the One Health approach. From 2027, the programme is expected to train 40 professionals, who will subsequently mentor a further 80 participants from English- and French-speaking African countries. Participants will apply their learning through locally relevant projects in healthcare or agri-food settings, helping to build a regional pool of expertise for practical AMR action.
Regional institutions can extend such capacity across borders. At the International Livestock Research Institute in Nairobi, an ICARS-supported reference centre for antimicrobial susceptibility testing has tested around 4,000 bacterial isolates from Kenya, Ethiopia, Benin, Uganda, and Burkina Faso. It now supports laboratories across human health, livestock and aquaculture through training, quality assurance, and standardised testing.
These examples matter because they begin with African priorities and are led by African institutions. ICARS works with country teams to test locally appropriate solutions, assess their feasibility, costs, and results, and support the integration of effective approaches into policy and routine systems. The emphasis on local ownership is the reason why ICARS this spring established a regional hub for Africa, ICARS Africa, hosted at Amref Health Africa in Nairobi. Because local leadership is not simply a principle; it is what makes uptake and sustainability possible.
Actions to deliver on the global ambitions for both pandemic preparedness and AMR should reinforce this model. Governments and financing partners should fund clearly defined AMR priorities through pandemic-preparedness plans; align governance, budgets and reporting; and invest in scaling approaches shown to work in local settings. Progress should be judged not by how many plans have been written, but by whether laboratories function, data guides decision-making, health workers can prevent infections, and patients receive the right treatment at the right time.
Preparedness cannot begin when the next pandemic is declared. It is built through the systems countries use every day. If those systems cannot contain the resistant infections already confronting Africa, they will not be ready for the next global health emergency.
References
[1] World Health Organization, Global antibiotic resistance surveillance report 2025 (2025).
[2] World Health Organization, “Antimicrobial resistance”, 16 July 2026.
[3] World Health Organization, “Second United Nations General Assembly High-Level Meeting on Pandemic Prevention, Preparedness and Response”; United Nations General Assembly, Political declaration of the General Assembly high-level meeting on pandemic prevention, preparedness and response, A/RES/78/3 (2023).
[4] ReAct, “Beyond diplomatic aspirations: Bridging the implementation gap in Pandemic Preparedness and AMR”, 27 August 2026; Health Policy Watch, “Here is the ‘Final Text’ of UN Political Declaration on Pandemics”, 6 August 2026.
[5] World Health Organization Regional Office for Africa, Tracking implementation progress of AMR national action plans in the WHO African Region: Insights from the 2024 survey on human health (2026).
