High global ambitions, limited resources: Why sustainable impact from AMR solutions matters now more than ever

Dr Sujith J. Chandy,  ICARS’ Executive Director, argues why, in a time of shrinking global resources and rising challenges, efforts to address AMR must do more with less, implementing tailored and affordable solutions that deliver sustainable impact where it matters most.

The last few years have posed extraordinary challenges for the global development and health landscape. Competing domestic and international priorities have constricted aid funding, deepening the pressure on low- and middle-income countries (LMICs) and vulnerable populations. Last year, global official development assistance (ODA) dropped for the first time in five years by 7%, and this year an even bigger decline is projected – up to 17%. On top of this, there are cuts to multilateral organisations, further impacting the ability of LMICs to sustain essential health and development programmes. Meanwhile, the world is facing a growing global debt crisis with public debt projected to exceed 100% of GDP by 2029 – its highest level since 1948 – heavily affecting LMICs, just as conflict, migration, inequality and health vulnerability are on the rise. We are witnessing what could be a generational shift in how the world supports global priorities.

Amid all this are issues of access, affordability and availability of medicines. Unfortunately, our life-saving medicines for infectious diseases – antibiotics – have become one of the prominent victims, becoming less effective due to bacterial resistance, compounded by the depleted pipeline of new antibiotics. The vagaries of global financing and funding, therefore, could not have come at a worse time for addressing the growing threat of antimicrobial resistance (AMR).

Forecasts show that if we do not act now, cumulatively between 2025 and 2050, AMR will cause 39.1 million deaths, with an additional 169 million people dying from illnesses associated with AMR. AMR has the potential to negatively impact economies worldwide, halt development and drive-up poverty levels. It is a true One Health issue spanning human, animal and plant health, and the environment, affecting countries in all regions and people at varying income levels. Furthermore, AMR has for a long time suffered from chronic underfunding. Despite widespread development of National Action Plans (NAPs) on AMR, only 29% of 186 countries have costed or budgeted their NAPs and are monitoring their implementation.

Last year marked a turning point in building global momentum against AMR. The UN General Assembly’s high-level meeting produced a bold political declaration, yet as attention shifted from pledges to practice, global funding lagged behind. Against this backdrop of uncertainty, Denmark’s commitment to fund ICARS through 2030 delivers a glimmer of hope and is a testament to what is possible when governments set their mind to critical priorities such as AMR. With this support, ICARS can continue partnering with LMICs to implement practical, scalable solutions towards AMR mitigation, proving that even when global momentum falters, targeted investment can drive real, sustainable impact.

Given the challenging global scenario, it is evident that all interventions to mitigate AMR really need to be tailored, cost-effective and deliver lasting impact. Since the available funds both globally and within countries are limited, we need to act wisely and imbibe an approach attempting to do more but with less. Also, we have to integrate AMR interventions with other global priorities. Above all, we need to continue to invest in AMR mitigation, but invest in a way that is sustainable – our solutions need to pay-off.

The critical questions therefore are… How do we ensure sustainable impact from the implementation of solutions for AMR mitigation? What kind of implementation measures should we focus on, how should we tailor these, and how do we ensure their longevity?

For solutions to be sustained, interventions should be based on the needs of countries, sectors and settings, and tailored to the context. This is why at ICARS we take a top-down and bottom-up approach – securing government commitment while engaging with researchers and stakeholders on the ground. Project activities are guided by specific AMR challenges that countries are committed to addressing, rather than following a one-size-fits-all approach. Interventions are implemented by multidisciplinary teams of local stakeholders who have invested in the project’s success from the outset. Co-developing evidence-based, context-specific solutions, however, is only the preliminary step – ensuring sound implementation of interventions is key.

Implementation of interventions towards AMR mitigation must be done in a smart, affordable and collaborative manner, ensuring that the impact from investments goes a long way. ICARS is committed to demonstrating that cost-effective AMR solutions do exist. For example, preliminary results from an ICARS-supported project conducted across multiple pig farms in Colombia showed that sow vaccination and piglets’ colostrum intake led to more than 50% decrease in piglet diarrhoea, with a 91% reduction in the use of antibiotic feed. Furthermore, the piglets receiving colostrum gained more weight and showed stronger immunity.

Such cost-effective interventions cannot stop there. We must maximise the impact of solutions, ensuring that their positive effects go beyond the project cycle. For this to come true, capacity strengthening and policy translation are key. While capacity strengthening lays a solid foundation for effective implementation and sustained programme delivery, engaging policy makers in the uptake of evidence-based solutions to embed this into national systems is crucial. Both elements are needed in the recipe for sustainable impact.

With project results such as those in Colombia, stakeholders can translate the project’s success into nationwide adoption. The benefits then could be far-reaching, including optimising animal health, boosting farm profitability, and advancing sustainable livestock management. Engaging local stakeholders and policymakers from project inception creates the foundations for such meaningful country-ownership that enables the usability and uptake of results. Without this policy bridge, interventions risk being standalone projects doing “a bit of something” rather than driving systemic change.

The message is clear: we must invest our limited resources into AMR solutions that are context-specific, cost-effective and scalable.  Solutions need to be implemented in ways that enable sustainable impact by strengthening local capacity and translating the evidence into lasting policy change. Imbibing these key elements can ensure that we keep seeing the impact from this kind of work many years from now and preserve the precious resource of antibiotics.

Together, we must develop sustainable solutions to mitigate AMR and ensure that effective antibiotics remain available for those who need them most. This is exactly why ICARS will dedicate a full session to discussing sustainable impact at this year’s Annual Partners Meeting. As we discuss these critical approaches, let us continue to challenge ourselves towards action, thinking ahead for our children and children’s children. Lastly, let us continue to ask ourselves that critical question… “How can we save the antibiotics for the future that have saved us in the past?”