International Efforts to Control Antimicrobial Resistance May Be Insufficient

National efforts to control antimicrobial resistance (AMR) varied significantly in an analysis of 114 countries, suggesting international response to AMR may be insufficient.

Efforts to control antimicrobial resistance (AMR) were found to significantly vary between countries, according to study results published in The Lancet Infectious Disease.

Researchers systematically reviewed the national action plans of 114 countries on efforts to control AMR. The primary objective was to perform a comprehensive evaluation of each plan in regard to AMR governance. Three independent researchers performed a blinded review of each national action plan, assigning a score to each plan using a quantification system based on 54 indicators. Disagreements on assigned scores were resolved via consensus agreement. Scores were determined using a 100-point scale, with 0 and 100 defined as the worst and best scores, respectively.

Among 114 NAPs included in the final analysis, the overall mean (SD) AMR governance score was 51 (14). Analysis of individual countries showed significant variation between scores, with the highest score noted in Norway and lowest in the Federated States of Micronesia (85 vs 51, respectively).

Participation (83), infection control and prevention (73), and coordination (63) were the highest-scoring domains among all countries. Of note, scores related to AMR education were among the lowest overall (mean, 32), indicating most countries had not established basic and continuous education on AMR control among health care workers.

Countries should improve their methods for evaluating NAP objectives transparently and establish protocols for unmet commitments to improve accountability.

Of the 20 highest-scoring countries, 11 were in Europe, and 17 were high-income countries. Of the 20 lowest-scoring countries, 7 were islands, 8 were upper-middle-income countries, and 7 were lower-middle-income countries.

Austria was the only country to score positively on sustainability-related indictors, which evaluated whether a country considered budget requirements for activity related to AMR control.  

Limitations of this analysis include potential bias and the lack of a universally standardized method for reporting on measures related to AMR control.

According to the researchers “Countries should improve their methods for evaluating NAP [national action plan] objectives transparently and establish protocols for unmet commitments to improve accountability.”


Patel J, Harant A, Fernandes G, et al. Measuring the global response to antimicrobial resistance, 2020–21: A systematic governance analysis of 114 countries. Lancet Infect Dis. Published online January 16, 2023. doi:10.1016/s1473-3099(22)00796-4