Antimicrobial Resistance as a Public Health Systems Challenge

Antimicrobial resistance (AMR) has emerged as one of the most complex and urgent threats to global public health, undermining decades of medical progress in the treatment of infectious diseases. While traditionally framed as a microbiological or clinical issue, AMR is increasingly recognized as a systems-level challenge shaped by interconnected human, animal, environmental, and healthcare factors. This presentation explores AMR through a public health systems lens, emphasizing how structural determinants—such as antibiotic prescribing practices, healthcare infrastructure, infection prevention and control (IPC) capacity, pharmaceutical regulation, agricultural antibiotic use, and environmental contamination—collectively drive resistance dynamics at the population level. The persistence and spread of resistant organisms are further amplified by global mobility, urbanization, and inequities in healthcare access and quality. A key argument is that fragmented responses focusing solely on individual behavior or clinical stewardship are insufficient. Instead, effective AMR mitigation requires integrated governance across sectors, aligned with the One Health framework, and supported by coordinated surveillance systems capable of linking human health, veterinary data, and environmental monitoring. Strengthening laboratory capacity, improving diagnostic stewardship, and ensuring equitable access to effective antimicrobials are central pillars of this approach. The presentation also highlights the importance of health system resilience, including preparedness for outbreaks of resistant infections, workforce training, and the implementation of evidence-based antimicrobial stewardship programs. In addition, policy interventions at national and international levels are examined, with emphasis on regulatory mechanisms, economic incentives, and global coordination.

Key messages

• Antimicrobial resistance is not only a clinical problem but a systemic public health challenge driven by interconnected human, animal, environmental, and healthcare factors.

• Effective control of antimicrobial resistance requires integrated, cross-sectoral action—combining stewardship, surveillance, and health system strengthening within a One Health framework.