WHO Member States approved a new 10-year global action plan to combat antimicrobial resistance (AMR) on Friday after a months-long fight over how the world should share AMR-related medical technologies.

The plan, which runs through 2036, maps out strategies for countries to implementing the ambitious targets set at a UN High Level Meeting, including reducing deaths from AMR by 10% by 2030. It’s also the first overhaul of the WHO’s circa-2015 AMR strategy, adopted in an era when the public health threat of drug resistance was less, as was awareness.  

Today, the AMR crisis is associated with nearly five million annual deaths, with 1.14 million directly attributable to drug-resistant bacterial infections, a more than six-fold increase over the last decade. And pathogen resistance to many lifesaving drugs, particularly antibiotics but also antiviral and parasitic treatments, is growing rapidly.

Left unchecked, AMR could shave 1.8 years off global life expectancy within the decade, cause up to 39 million deaths by 2050, and generate total GDP losses of $575 billion, WHO reports.

“Do we realize enough that [AMR] also affects all of us already today?” the Dutch delegate asked the assembly. “Often framed as a long-term health threat with negative consequences expected by 2050, the reality is different.”

“This crisis is already unfolding today. Framing it solely as impacting us in the future is not only outdated but also dangerous.”

The investment case is equally staggering: action on infection prevention, water and sanitation, vaccination and responsible drug prescribing could avert 110 million AMR associated deaths and yield nearly $1 trillion in economic gains by 2050, WHO says.

Low- and middle-income countries bear the heaviest burden. People in LMICs are 1.5 times more likely to die from AMR than those in high-income countries, and 99.65% of children under five who die from drug-resistant infections live in poorer nations, according to research from the Global Research on Antimicrobial Resistance (GRAM) Project published in The Lancet.

In Zambia, “resistance to some commonly used antibiotics exceeds 80% in tertiary hospitals,” its delegation said. “More than 50% of prescriptions fall within the WHO Watch category,” referring to antibiotics flagged by the WHO due to their higher potential to drive resistance.

“This type of resistance is a global threat comparable in magnitude to other major challenges for humanity, including climate change,” Colombia’s delegate said.

Despite the threat, only 10% of countries reported dedicated domestic funding for their national AMR action plans in 2024, and just 29% have costed and budgeted plans, according to WHO.

“The magnitude of the threat means that we need to translate global strategies into real capacities at national level,” Colombia added. “The effects require us to act urgently.”

What’s the plan?

The plan pins itself to the goals adopted by member states in the 2024 UN political declaration on AMR. Along with the headline target of a 10% reduction in bacterial AMR-associated deaths by 2030. The declaration outlined a four-part strategy to combat AMR. It calls for more careful use of antimicrobial agents in healthcare, farming, and animal sectors, alongside improved management of untreated sewage and hospital emissions.  

The significant departure from the architecture of the 2015 strategy is a turn towards prevention as the key to the crisis, as compared to a prior focus overwhelmingly on new drug innovation. The plan elevates infection prevention and control, water and sanitation, vaccination, biosecurity, husbandry practices and pollution prevention as the primary tools, with new drug development framed as complementary.

The logic underpinning the plan is that the antibiotics the world already has can be made to last far longer if the drivers of resistance, such as overuse, poor sanitation and low vaccination coverage, are addressed.

“Preventing infections is central to minimizing the spread of resistant pathogens, thereby decreasing the need for antimicrobials, lowering morbidity and mortality and reducing the discharges into the environment,” the plan states.

New drug development for AMR remains slow and commercially unattractive, with pharmaceutical companies reluctant to invest the years and billions of dollars required to bring a new antibiotic to market for a drug that, if used responsibly, will be held in reserve and rarely prescribed. New “push” incentives have begun to address the R&D pipeline. And “pull” incentives like the United Kingdom’s ‘subscription model’ to ensure that drug innovation is rewarded even if new antibiotics are used sparingly, have begun to address those issues. But innovation, in the absence of a more holistic “One Health” approach that rations drug use and reduces opportunities for pathogens to mutate into resistant viruses and bacteria in agriculture and ecosystems, cannot solve the problem alone, policymakers now realize.  

Setting standards

Environmental dimensions of AMR are also written into the strategy as obligations for the first time, covering pharmaceutical manufacturing discharges, wastewater from healthcare facilities and agricultural run-off.

The plan also calls upon the World Organisation for Animal Health (WOAH) to develop a veterinary equivalent of WHO’s AWaRe (Access, Watch, Reserve) classification of antibiotics to fill the surveillance gap resulting from livestock and aquaculture accounting for the majority of global antimicrobial use. WOAH, a non-UN agency, has faced stiff resistance from agrobusiness as well as from veterinarians to more transparent reporting of drug consumption trends and stricter guidance on use.  

While the WHO strategy is not legally binding, it sets a global standard that can outlast changes in national governments and shifting domestic priorities. Thailand’s delegate noted that effective AMR governance at the national level often fluctuates with changing policy priorities and transitions in leadership.

“Strong global mechanisms can help maintain political commitment, accountability, multi-sectoral coordination, and sustainable financing, particularly during periods when national policy attention or institutional support may weaken,” the delegate said.

WHO’s director-general will report on implementation progress to the World Health Assembly in 2027, 2029, and 2031.

The tech transfer fight

The plan’s adoption this year was initially postponed at WHO’s Executive Board in February after Brazil, Colombia and Indonesia objected to language in the action plan stating that transfers of patents, manufacturing know-how and data from pharmaceutical companies to producers in developing countries for AMR innovations should happen on “voluntary and mutually agreed” terms.

The fight is, at its core, about whether developing countries can override drug patents during national health emergencies to produce generic versions of a drug. That is as per a core pillar of the World Trade Organization’s  TRIPPS agreement. The 1995 agreement set out the conditions under which countries can exercise a sovereign right to override a patent. 

Access advocates argued that voluntary-only language effectively set an unwanted precedent, ignoring the TRIPPS precedent that established countries’ rights to issue “compulsory licenses” for new, still patented drugs, in an emergency.

“This type of threat can’t be dealt with only with mechanisms that are voluntary in nature”, Colombia’s delegate said.

The compromise text adopted Friday softens the language to “the promotion of knowledge sharing and the transfer of AMR-related technologies, respecting international and national rules in line therewith.” Reference to “international and national rules”, access advocates said, leaves open legal room for countries to pursue compulsory patents in a crisis.

Knowledge Ecology International (KEI), one of the civil society groups that lobbied hardest against the original draft, declared victory: “KEI is pleased that WHO negotiators eliminated problematic language on technology transfer in the global action plan on antimicrobial resistance,” the group said. “Governments have a responsibility to regulate industry, which can include mandates on sharing access to intellectual property rights, data, biological resources, and manufacturing know-how.”

Brazil thanked the secretariat “for holding consultations on the question of technology transfer,” adding that “for Brazil, meaningful tech transfer is essential for developing countries to achieve the global planning goals.”

European states and pharma push back

While European states, which host some of the world’s largest pharma firms, agreed to the compromise language, the UK delegation said it would continue to interpret the strategy as encouraging  “the promotion of voluntary, mutually agreed technology transfer to build trusted relationships.”

Germany echoed the line, telling the assembly that the plan’s reference to international rules “includes the key principle of voluntary technology transfer on mutually agreed terms.”

The pharmaceutical industry association IFPMA “broadly” supports the strategy, its delegate said, but called on governments to work with industry “firmly grounded in a collaborative approach, including prioritizing the principle of voluntary and mutually agreed terms for technology transfer.”

China was the only delegation to call for a more far-reaching approach. One of the world’s largest producer of generic health products, it urged WHO to “promote the building of a fair and reasonable technology transfer mechanism,” as well as a dedicated One Health financing window and uniform standards for environmental AMR surveillance.

The same fight over technology transfer is holding up adoption of the Pathogen Access and Benefit Sharing (PABS) annex to the WHO Pandemic Agreement. There, the sharing mechanism is far more pivotal to the entire agreement, which aims to set out rules to ensure more equitable access to vaccines, drugs and diagnostics in a global crisis, avoiding the inequalities seen during the COVID-199 pandemic.  Until the annex is settled, the entire agreement, which was approved by the World Health Assembly in 2025, cannot undergo ratification by member states. 

The conflict blind spot

The updated strategy is largely silent on AMR in war zones.

“Conflict-affected settings” appears only in passing lists in the plan, with no dedicated section, operational guidance or indicators, despite war zones being where collapsing health systems, broken supply chains, damaged water and sanitation systems and crowded displacement camps accelerate resistance fastest.

The UK flagged the gap in supporting adoption, calling for “explicit guidance on AMR in conflict settings.”

Several delegations from countries at war also noted the omission.

“Despite Russia’s full-scale war against Ukraine, our country continues to strengthen work in AMR and protect the effectiveness of antimicrobials,” the delegate said. “At the same time, war creates serious additional risks. This includes more infections, higher use of antimicrobials and even pressure on health systems.”

Sudan’s delegate, speaking three years into a civil war that has displaced more than 12 million people and collapsed much of the country’s health infrastructure, said the country could not deal with the crisis alone.

“Sudan faced one of the most severe humanitarian crises, in which antimicrobial resistance is rapidly escalating within a fragile and overstretched health system,” the Sudanese delegate said. “The ongoing war has severely disrupted the supply chain for medicine and laboratory agents and reduced access to qualified healthcare workers and microbiology services.”

Sudan, the delegate concluded, “cannot confront AMR alone while simultaneously responding to displacement, epidemics and healthcare system collapse.”

Over half of falsified medicines are antimicrobials

The AMR debate also overlapped with another issue on the WHA agenda this week: substandard and falsified medical products.

“The intersection of these two crises is where the danger lies,” the Maldives delegation told the assembly. “Weak regulatory systems and the infiltration of substandard antimicrobials directly accelerate the spread of resistant pathogens, threatening to unravel global health progress.”

A falsified antibiotic containing too little active ingredient kills off susceptible bacteria but leaves resistant strains to multiply, accelerating exactly the dynamic the global action plan is designed to slow.

“Over half of substandard products reported to WHO are antimicrobials. These contribute to creating new resistance,” Dr Yukiko Nakatani, WHO’s assistant director-general for health systems, access and data, told delegates.

Like AMR, falsified medicines hit poorer countries hardest. The WHO estimates 1 in 10 medical products in low- and middle-income countries is substandard or falsified, with Africa carrying a prevalence of 18.7%, nearly double the LMIC average. Globally, the WHO estimates substandard and falsified medicines kill over one million people every year.

In sub-Saharan Africa alone, 267,000 people die annually from falsified antimalarial drugs and 169,000 from fake antibiotics used to treat childhood pneumonia, according to a 2023 UN Office on Drugs and Crime report.

Chad’s delegate said the proliferation of falsified medical products and AMR represent “a double threat to public health and global health security, particularly in countries facing security, humanitarian, and persistent logistical issues.”

Nigeria flagged a vulnerability that has surfaced repeatedly in recent years: contaminated excipients, the inactive ingredients used to bind, dissolve or preserve active drugs. “We remain concerned about contaminated excipients and unsafe online sales,” Nigeria’s delegate said.

Ethiopia echoed the concern. “Incidents occurring across multiple regions demonstrate that no country is insulated, in that vulnerabilities in raw material supply chains translate directly into patient harm.”

Online markets and threats to generics

Online and informal markets came up repeatedly throughout the debate. France told the assembly that despite a secure legal supply chain, “we continue to see the circulation of illegal products online, for instance, and that is why we need to have intensified surveillance activities.”

Brazil, meanwhile, warned that the fight against falsified products must not come at the cost of legitimate generic medicines, which are critical to expanding access for low- and middle-income populations and form the backbone of treatment programs across the developing world.

“A critical challenge is eradicating falsified products without stifling legitimate, affordable, generic medicines,” Brazil’s delegate said. “A regulatory framework must be precise, risk proportionate, and globally harmonized, aggressively targeting illicit networks, while safeguarding streamlined pathways for quality-assured generics.”

No new strategy or resolution was adopted on the falsified medicines file. The Executive Board’s report on the issue was noted, with member states broadly endorsing a streamlined 2026-2027 work plan focused on regulatory strengthening, detection technologies and supply chain oversight.

AI and Sustainable Development Goals Crammed into final WHA hours in scramble to finish

Committee A wrapped up its business on Friday afternoon with the room noticeably emptier than at the start of the week, as national delegations began flying home from Geneva.

The last grouped agenda item, covering progress on the health-related Sustainable Development Goals and the harmonisation of digital health and artificial intelligence governance, drew no resolution. Member states “noted” the Director-General’s reports and closed the file.

Member states used the floor to confront the fact that the world is on course to miss every one of the 52 health-related SDG targets by 2030, according to a WHO report released earlier this week.

Once considered the most achievable of the SDGs, the health goals have been derailed by stalling progress on maternal mortality, flatlining childhood immunisation, a reversal in malaria gains, and what the WHO has called a “global health financing emergency”.

Nigeria put numbers to that emergency on the floor of the assembly. “Around 4.5 billion people still lack access to essential health services,” its delegate said. “In 2025 official development assistance fell by about 23%, the largest annual decline on record.”

AI’s expanding role in health care – governance is sparse

AI, despite its rapidly expanding role in healthcare and the concerns it poses around bias, privacy and equity, did not get much airtime. The discussion centred on the “harmonization” of governance frameworks that, in most of the world, do not yet exist.

The European Union’s AI Act remains the only substantive AI legislation in force anywhere, and even that is not health-specific.

Countries said they were taking steps to catch up. India has launched a national AI in health strategy. Russia has produced a code of ethics. Singapore passed a Health Information Bill in January and is using regulatory sandboxes. Indonesia has set up a Health AI committee.

Switzerland’s delegation announced it will host the Global AI Summit in Geneva in 2027, positioning the event as a “a concrete impetus for globally sustainable AI governance, which is also critical to global public health.”

In the final minutes of a committee that began a week ago, WHO Director-General Tedros Adhanom Ghebreyesus made an unscheduled appearance to weigh in on the digital health and AI debate.

“The future of health services is digital, whether we like it or not,” he told delegates, framing the funding crunch as a forcing function for digital transformation. “There is a crisis, unprecedented global challenges, and health financing emergency that demands actually to seize digital health and AI as opportunity.”

Colombia pushed back on the UN health chief’s crisis-as-opportunity framing, warning that without equity at the centre, digital transformation risked entrenching the very inequalities it promises to solve.

“The future of health cannot consist in replacing old-fashioned inequalities with digital inequalities,” its delegate said. “Innovation only makes sense when the benefits reach all people and communities.”

With that, the chair declared all business allocated to Committee A — and the final day of the World Health Assembly — closed.

Image Credits: X/WHO, Felix Sassmannshausen/HPW, Gale Julius Dada/MSF, WHO.