November 17, 2025
World AMR Awareness Week – 2025
To commemorate World AMR Awareness Week (November 18-24, 2025), we have brought together One Health Trust articles, reports, podcasts, and infographics that cover the growing threat of antimicrobial resistance (AMR) and delve into the complexities of this global phenomenon.
Articles
Explore AMR research we’ve led and contributed to since last year’s World AMR Awareness Week, spanning a wide range of topics, from surveillance and social and economic inequities to control strategies, public policy, costing studies, and more.
October 2025
Limited access to antibiotics and inadequate drug diversity was found across 14 African countries.
A retrospective Africa CDC analysis supported by OHT researchers used pharmacy and medical supply data to examine antibiotic consumption in 14 sub-Saharan African countries between 2016 and 2019. The study found that overall consumption averaged just 8.4 daily doses per 1,000 inhabitants—far below global estimates—and was concentrated in a narrow range of common medicines such as amoxicillin and cotrimoxazole. The findings suggest that low antibiotic use and diversity in the region stem largely from limited access, underscoring the need to expand equitable access to appropriate treatments alongside ongoing efforts to promote the judicious use of antimicrobials. [PLOS One]
Knowledge gaps on AMR among pharmacy workers in Africa
A survey supported by OHT researchers assessed knowledge, attitudes, and practices regarding AMR among 908 pharmacy healthcare workers across 28 African countries. While 71 percent demonstrated good AMR knowledge, only 42 percent displayed good stewardship practices. Licensed pharmacists and pharmacists working in public facilities showed better practices than pharmacy technicians and those working in private pharmacies. Patient demands and pharmaceutical company influence were identified as key factors affecting antibiotic dispensing. The findings highlight the need to strengthen AMR and stewardship training in pharmacy education and workplaces to promote responsible antibiotic use, particularly for less experienced professionals and those in private pharmacies. [BMJ Global Health]
September 2025
The revised global action plan on AMR should address gender-based inequities.
OHT’s Dr. Deepshikha Batheja and Srishti Goel co-authored an article outlining recommendations for the revised global action plan (GAP) on AMR for 2025-2026. Since its introduction in 2015, the GAP, along with several national action plans on AMR, have not addressed the social and structural factors contributing to AMR. The authors recommend that the upcoming revision of the plan integrate considerations of gender and other social determinants of health that contribute to inequities in AMR prevention and treatment. This integration is essential to achieving the Sustainable Development Goals’ commitment to “leave no one behind.” [The Lancet]
The estimation of pharmaceutical use through wastewater surveillance
Researchers, including OHT’s Gilbert Osena analyzed 15 years of data to understand how accurately wastewater surveillance can estimate community-level pharmaceutical use. They studied the discharge of three wastewater treatment plants for active pharmaceutical ingredients (API) compared with pharmaceutical sales data. To evaluate consistency across time, treatment plants, and pharmacological characteristics, researchers calculated conversion factors (CFs), which are ratios of recovered API mass to projected consumption. CFs demonstrated that wastewater data can accurately indicate patterns of medication intake. Drug characteristics and treatment removal efficiency had little influence, while analytical precision strongly affected reliability. Although it was less sensitive to minute shifts in usage patterns, the technique successfully caught large usage trends. The results show that wastewater surveillance is a reliable, extendable, and economical method of tracking drug usage, especially in areas without extensive prescription or sales data systems. [Environment International]
August 2025
The impact of gender inequality on AMR
Social factors, including gender norms, play a key role in who is most affected by AMR. A collaborative study including OHT’s Dr. Deepshika Batheja explores how gender inequalities influence exposure to infections; vulnerability to AMR; and access to prevention, diagnosis, and treatment. Analyzing 141 studies published between 2000 and 2025, the research highlights how restrictive gender norms and societal expectations create disparities. For instance, caregiving responsibilities often increase women’s risk of infection, while structural barriers limit their access to healthcare, medicines, and timely treatment. In some communities, children of one gender (most often boys) may receive preferential access to healthcare, further shaping inequities in AMR outcomes. The study highlights the importance of policies that address these systemic gender barriers to ensure equitable access to AMR prevention, diagnosis, and treatment. The findings align with the WHO’s people-centered approach to tackling AMR. [Global Public Health]
July 2025
Tracking global antibiotic spending between 2013 to 2023
To better understand trends in antibiotic consumption, in a collaborative One Health Trust study researchers analyzed global antibiotic market data from IQVIA MIDAS across 62 countries between 2013 and 2023. They found that total spending on antibiotics fell from US$49.61 billion in 2013 to US$30.68 billion in 2023, while per-person spending dropped from US$12.08 to US$7.92. The cost per antibiotic unit also fell from US$0.85 to US$0.45. Spending declined across all income groups, with high-income countries seeing the sharpest reductions, bringing global levels closer together. The study also revealed that higher national income, health spending, older populations, and better access to clean water were linked to higher antibiotic spending, while higher education levels, more doctors, and stronger government institutions correlated with lower per-capita spending. These findings suggest progress in rational antibiotic use but highlight the ongoing need for targeted investment to reduce unnecessary use and develop new, effective antibiotics. [The Journal of Infectious Diseases]
June 2024
Optimizing wastewater surveillance to detect outbreaks in resource-limited settings
One Health Trust researchers and collaborators explored how wastewater and environmental surveillance (WES) can be optimized to detect infectious disease outbreaks, especially in low-resource settings. Using a mathematical model of two connected communities, they examined trade-offs in sampling frequency, location, and test accuracy. They found that when communities are closely linked and testing is effective, focusing on one site more frequently can outperform testing multiple sites less often. Increased movement between areas can help detect outbreaks faster, but also accelerates disease spread, highlighting the importance of timely interventions. These findings provide a framework for public health leaders to design cost-effective WES strategies tailored to specific diseases and resource constraints. [PLOS Computational Biology]
Insufficient infrastructure and testing capacities and drastic variations in AMR prevalence across Africa
The Mapping AMR and Antimicrobial Use Partnership, a UK government-funded project that includes the One Health Trust, Africa CDC, and other collaborators, analyzed retrospective AMR data collected from 14 African countries between 2016 and 2019. High geographical heterogeneity in AMR prevalence rates, largely due to disparities in data availability and quality, underscores the ongoing issue of gaps in AMR surveillance in the region. For example, Escherichia coli resistance to third-generation cephalosporins ranged from 19.3 percent in Eswatini to 68.4 percent in Ghana. For existing AMR records, only 12.1 percent could be linked to clinical patient data, such as the specimen source and inpatient/outpatient status. These findings underscore the urgent need for investment in strengthening antimicrobial susceptibility testing capacity, improving AMR databases and data collection tools, and establishing clear guidelines to assess AMR data quality. [PLOS Medicine]
Estimating the need for antibiotics for COPD and pneumonia
One Health Trust researchers and collaborators estimated that 2,276,046 mg of penicillin and 676,098 mg of cephalosporin were required to treat pneumonia and chronic obstructive pulmonary disease (COPD) across 20 countries in 2019. India and China accounted for the largest shares of penicillin use, at 37 and 21 percent, respectively, of the total use among the studied countries. According to their model, which incorporated the World Health Organization with antibiotic usage guidelines, antibiotic needs were primarily driven by community-acquired pneumonia, followed by hospital-acquired pneumonia and COPD exacerbations. These findings provide a basis for a framework that can be used to estimate national antibiotic needs given a country’s disease incidence data and make recommendations for future prescribing practices. [International Journal of Infectious Diseases]
May 2025
Challenges in quantifying global trends in inappropriate antibiotic use
OHT researchers and colleagues conducted a scoping review, which found that the prevalence of inappropriate antibiotic use is, on average, six percent higher in low- and middle-income countries than in high-income countries. However, this disparity disappeared after adjusting for physicians per capita, which serves as a proxy indicator for healthcare access. The estimated proportions of inappropriate antibiotic use globally based on clinical audits, patient interviews, and a lack of prescription were 29.5 percent, 36.5 percent, and 30.8 percent, respectively, suggesting substantial heterogeneity across sampling techniques and underscoring the need for international guidelines to quantify inappropriate antibiotic use. [BMJ Public Health]
April 2025
Exploring the connection between gender equality indicators and antibiotic consumption
One Health Trust researchers and colleagues estimated that a 1 percentage-point increase in the proportion of females with secondary or higher schooling attainment was associated with 0.12 defined daily doses (DDDs) lower antibiotic consumption after controlling for income group, demographics, healthcare access, and health spending. The study also found that a 0.1-unit increase in the female-to-male labor participation ratio was associated with 2.16 DDD lower antibiotic consumption. These findings suggest that as women’s workforce participation and educational attainment improve over time, their antibiotic consumption declines, underscoring the need for gender inclusion in antibiotic stewardship programs. [SSRN]
Higher national action rates to control AMR improve health outcomes for all income levels.
Governments worldwide have affirmed their commitment to controlling AMR. To investigate how national action levels affect AMR outcomes, a group of researchers led by OHT’s Dr. Eili Klein used data from the Global Database for Tracking AMR to analyze trends of antibiotic use and resistance across 73 countries from 2000 to 2016. Higher national action levels in 2016 were consistently linked with improved trends in antibiotic use, resistance rates, and the Drug Resistance Index. These links remained strong even when accounting for socioeconomic and environmental factors. Despite data limitations and varied implementation timelines, the results underscore the importance of sustained, high-level national efforts in reducing antibiotic resistance and improving health outcomes across all income levels. [PLOS Global Public Health]
High prevalence of AMR in global riverine environments
The One Health Trust’s Dr. Eili Klein co-authored a modeling study estimating that nearly 30 percent of the total mass of annual human consumption of the 40 most commonly used antibiotics (8,500 out of 29,200 tons) is released into the global river system. Global modeling estimates indicate that the greatest burden of river contamination is in Southeast Asia, a region already heavily impacted by the consequences of AMR. These findings underscore the need for improved wastewater treatment infrastructure and localized monitoring to protect surface water quality and reduce the prevalence of environmental AMR in high-burden regions.[PNAS Nexus]
Global livestock antibiotic use is predicted to rise by nearly 30 percent by 2040.
OHT’s Dr. Thomas P. Van Boeckel co-authored a study projecting that, without significant policy changes, global livestock antibiotic use could increase by almost 30 percent between 2019 and 2040. While the model predicts that Asia will remain the largest contributor to global livestock antibiotic use quantity (AMUQ) in 2040, Africa is expected to experience the highest relative growth in AMUQ, approaching nearly 42 percent between 2019 and 2040. An integrated approach to mitigating livestock antibiotic use and optimizing livestock biomass is essential as global demand for animal-source proteins rises, particularly in low- and middle-income countries, where economies and livelihoods heavily depend on livestock systems. [Nature Communications]
January 2025
A call for gender-transformative AMR mitigation strategies
The One Health Trust’s Dr. Deepshikha Batheja and Srishti Goel co-authored an article outlining the role that gender disparities and norms play in antibiotic overuse and AMR. Biological, sociocultural, and behavioral factors that lead to differences in susceptibility to antimicrobial-resistant infections among men and women – such as the risk of infection associated with pregnancy and childbirth – underscore the importance of integrating these considerations into AMR mitigation policies and strategies to avoid inadvertently augmenting gender disparity. [BMJ Global Health]
Reports
The GARP-Uganda policy brief explores the role of vaccines in mitigating AMR.
AMR is a growing threat in Uganda, undermining the effectiveness of essential treatments and intensifying the country’s already high burden of infectious diseases. In 2021 alone, more than 21,000 deaths were linked to six major drug-resistant pathogens, with thousands directly attributable to AMR. As new antimicrobials lag behind rising resistance, vaccines offer a powerful tool to prevent infections, reduce antibiotic use, and curb the spread of resistant strains. The Global Antibiotic Resistance Partnership (GARP)-Uganda Policy Brief, titled “The Role of Vaccines in Mitigating Antimicrobial Resistance in Uganda,” provides policymakers with evidence and concrete steps and interventions that leverage vaccines in the fight against AMR in Uganda. GARP – an initiative led by the One Health Trust and partner institutions in Africa and Asia – aims to support the evidence-to-policy transition, for vaccine use to fight infectious disease and slow AMR in country-specific contexts. [One Health Trust]
The value of vaccines to mitigate AMR in South Africa
AMR poses a severe and growing threat in South Africa, contributing to more than 35,000 deaths in 2021. High infectious disease rates, widespread antimicrobial misuse, and socioeconomic challenges are driving the rise of drug-resistant infections. The GARP–South Africa policy brief highlights vaccines as an underused but powerful tool to curb AMR by preventing infections and reducing the need for antibiotics. Strengthening vaccine delivery systems, expanding the national immunization schedule, demonstrating the economic value of vaccination, and rebuilding public trust through education are key steps to mitigate AMR. The brief underscores that investing in vaccines is essential for protecting health and reducing South Africa’s AMR burden. [One Health Trust]
GARP-Nepal reviews recommendations for vaccination initiatives against AMR
GARP-Nepal published a policy brief with key recommendations on how immunization programs can be leveraged in the fight against AMR in Nepal. The brief outlined how the National Immunization Programme, which includes vaccines such as the typhoid and pneumococcal conjugate vaccines, has helped to reduce cases of typhoid fever, pneumonia, and meningitis, and how it could be leveraged to target additional vaccine-preventable diseases. To improve AMR control in Nepal, there needs to be equitable access to vaccines, accompanied by clear messaging and effective communication of their value among policymakers, decision-makers, and communities. [One Health Trust]
The Global Antibiotic Resistance Surveillance Report 2025
The World Health Organization’s Global Antimicrobial Resistance and Use Surveillance System (GLASS) was launched in 2015 to strengthen evidence on the threat of AMR. OHT’s Dr. Erta Kalanxhi served as an external reviewer for the 2025 GLASS report, which analyzed over 23 million confirmed infections from both hospitals and communities across 104 countries. It found that resistance to key antibiotics is widespread, rising, and unevenly distributed across regions. One in three urinary tract infections and one in six bloodstream infections were resistant to first-line treatments. Resistance levels were highest in low- and middle-income countries with limited AMR surveillance and less robust health infrastructure. [World Health Organization]
One World, One Health – Podcasts on AMR
Listen to our podcasts with host Maggie Fox as she discusses the many facets and effects of AMR with experts on the devastating repercussions of this global crisis.
Fighting Killer Bugs in Babies
Dr. Heather Finlayson tells us about her struggles fighting drug-resistant infections in newborns.
From Young Adult Romance to the World’s Deadliest Infectious Disease – Writer John Green takes on TB
Best-selling author John Green tells us about his book, Everything is Tuberculosis, which weaves narrative around the history of the world’s deadliest infectious disease and the rising threat of drug-resistant tuberculosis.
Can Microplastics Spread Killer Bacteria?
Neila Gross of Boston University sheds light on how microplastics can spread drug-resistant bacteria & why that’s bad.
The Invisible Second Threat to Cancer Patients – Drug-Resistant Infections
Dr. Yehoda Martei tells us about the dangers of antimicrobial-resistant infections for cancer patients.
An Unknown Burden – Drug resistance and lab capacity in Africa
Dr. Sabiha Essack discusses the problem of insufficient lab capacities and testing for drug resistance in Africa.
Visualizing AMR
Explore OHT infographics published over the last year, which distill and highlight critical insights and messages on AMR.
Women and Antibiotic Consumption
Vaccines to Control Antimicrobial Resistance in Uganda
The impact of Antimicrobial Resistance in Uganda
The impact of Antimicrobial Resistance in Nepal
Vaccines to control antimicrobial resistance in Nepal
The impact of Antimicrobial Resistance in South Africa
