A layered strategy for tackling antimicrobial resistance: the Swiss cheese model for policy, prevention, and engagement

Despite robust evidence on the health and economic burdens of AMR, policymakers, governments, and international organisations face persistent challenges in implementing and financing comprehensive strategies. Low political will, competing health priorities, weak health systems, and economic constraints hinder meaningful action. Although few countries have made progress, the meagre number of effective policies only highlights the broader global inertia.

This Comment from The Lancet Microbe introduces the Swiss cheese model of AMR, showing how successive imperfect layers of defence, when aligned effectively, can reduce risk and prevent system failure. The model visualises 15 codependent layers across:

• One Health contexts (human, animal, plant and environmental health),
• Targeted interventions (WASH, IPC, stewardship, diagnostics, awareness)
• Resource allocation (investment, workforce, innovation).

The authors make clear that without sustained investment, strategic communication, and coordinated action, AMR will continue to threaten public health, undermine modern medicine, and impose substantial economic costs.