Antimicrobial resistance (AMR) is driven by inter-related dynamics in the human, animal, and environmental health sectors and is one of the most significant and complex current public health issues of our time. Without effective antimicrobials even common infections may become life-threatening and many treatments such as surgical procedures and chemotherapy will not be possible. Today, drug-resistant pathogens are a challenge for all healthcare-systems; modelling of the health impact of AMR using 2019 data indicates that an estimated 4.95 million people died with a drug-resistant bacterial infection, and that more than 1.27 million of those deaths are directly attributable to AMR. Within the World Health Organisation (WHO) EURO region, an estimated 541,000 people died with a drug-resistant bacterial infection, with 133,000 of those deaths directly attributable to AMR. If not addressed, AMR is projected to cost the global economy up to EUR 90 trillion by 2050, due to losses in international trade or livestock production and increased healthcare expenditure.
International and national efforts to combat AMR have grown steadily over the last two decades. Two major landmark developments include the launch of the WHO Global Action Plan on AMR in 2015, which asks all countries to develop national action plans by 2017, and the United Nations (UN) General Assembly agreeing a political declaration on AMR in 2016 where countries committed to work at national, regional, and global levels to develop and implement multisectoral national action plans in accordance with the ‘One Health’ approach. Within the WHO Regional Office for Europe (WHO EURO), the AMR Roadmap has been developed to support countries to identify, prioritize, implement and monitor high-impact interventions to tackle AMR. The roadmap is organized around an AMR Compass that identifies five action areas and six enablers based on a combination of the best available evidence and expert opinion, for countries to adapt to their own national contexts. It has received widespread support with health ministers and delegates from 53 Member States endorsing the new European Roadmap on AMR during the Seventy-third Regional Committee for Europe in October 2023, and the endorsement includes support for WHO EURO to develop a monitoring and evaluation framework to oversee implementation of the AMR Roadmap and Compass, providing a mandate for WHO EURO to monitor the performance of member states in this regard.
From this policy context, this project will develop an AMR Accountability Index to benchmark the performance of countries in development and implementation of evidence-based interventions to combat AMR. It will highlight examples of best practices and policy areas that require improvement across member states, facilitate knowledge transfer between countries, and improve transparency and awareness regarding AMR policy action. Crucially, countries that perform poorly in rankings may be motivated to adopt best practices and strengthen AMR policy action to improve their ranking when compared to other countries.Similar to the inclusive process through which the AMR roadmap was developed, extensive country and sub-regional level consultations will take place from February to June 2025 to ensure applicability and acceptance of the AMR Accountability Index. After incorporating country feedback and input obtained through the official Member State consultation process leading up to the 75th Regional Committee in 2025, the AMR Accountability Index will be submitted for adoption.
The project will be rolled out over 24 months in several phases, and will be overseen by a steering committee with representatives from relevant funders and stakeholders to monitor progress against described deliverables and timelines:
- Phase 1, ‘Literature review and synthesis of potential AMR Accountability indicators’, will include reviewing and consolidating pre-existing literature to identify potential quantitative and qualitative indicators for the AMR accountability index.
- In Phase 2, a multi-stage Delphi process will further develop and refine the AMR accountability index.
- Phase 3, will examine the feasibility and comprehensiveness of the proposed AMR Accountability index. Tt will be piloted using 2-3 countries to identify any practical issues experienced during application and potential concepts or areas of policy not fully covered within the draft index.
- In Phase 4, an independent WHO EURO AMR Commission will be established to validate the final AMR Accountability Index and oversee the application to all 53 member states within the WHO EURO region and produce policy recommendations.
The project has the potential to later be expanded to apply the index to other WHO regions globally. The prioritisation and weighting of AMR accountability indicators (Phase 2) will draw upon an international group of experts to ensure the final AMR Accountability index has global relevance.