International efforts to address antimicrobial resistance (AMR) vary considerably between countries, with notable weakness in monitoring and evaluation, according to an analysis of AMR National Action Plans (NAPs) published yesterday in The Lancet Infectious Diseases.
For the analysis, a team of researchers from Scotland and Germany used a governance framework to assess all publicly available NAPs developed and implemented since 2017, when 194 World Health Organization (WHO) member states made a commitment to develop multisectoral NAPs using a One Health approach.
The framework consisted of 54 indicators pertaining to 18 domains that focus on three main areas relevant to global health governance: policy design, implementation tools, and monitoring and evaluation. The researchers used national data from five sources to generate composite scores for each country, then ranked the countries by their mean score on a scale of 0 to 100.
Of the 306 NAPs identified through a literature search, 114 were eligible for content analysis. Country governance scores ranged from 85 in Norway to 28 in Micronesia, with a mean overall score of 51. When ranked by WHO region, the European Region had the highest governance score (57) and the Eastern Mediterranean Region had the lowest score (46). Of the 20 countries with the highest scores, 17 were high-income countries; of the 20 lowest-scoring countries, 8 were upper-middle-income countries, and 7 were lower-middle-income countries.
The international response ... might not be commensurate with the scale and severity of antimicrobial resistance.
The highest-scoring domain across all countries was participation (83), followed by infection prevention and control (73) and coordination (63). The lowest-scoring domains were accountability (30) and feedback mechanism (30). Domains relating to policy design (55) and implementation tools (54) scored similarly, whereas monitoring and evaluation efforts (38) were lower.
"Our results show substantial variability in the strategic responses to antimicrobial resistance of 114 countries and highlight the need to improve relevant governance and policy responses in all locations," they wrote. "These data suggest that the international response, including efforts to monitor and evaluate interventions, might not be commensurate with the scale and severity of antimicrobial resistance."