A more comprehensive pandemic risk monitoring system, that tracks threats and preparedness in real time, is urgently needed says the WHO-hosted Global Preparedness Monitoring Board, in a report launched on the second day of the World Health Summit. This followed the release of a new World Health Organization data documenting the sharp global rise in drug-resistant bacterial infections. Day 2 of the Summit also featured a series of discussions on how to streamline global health institutions in the wake of massive cuts in donor aid.   

BERLIN – One in six laboratory-confirmed, common bacterial infections were resistant to antibiotic treatments in 2023, rising to 1 in 3 reported infections in WHO’s South-East Asia and Eastern Mediterranean Regions, according to a new World Health Organization (WHO) report published  Monday. 

Between 2018 and 2023, antibiotic resistance rose in over 40% of pathogen-antibiotic combinations monitored, with an average annual increase of 5–15%, according to the Global antibiotic resistance surveillance report 2025. 

The report, which highlights the growing threat of antibiotic resistance (AMR) to public health – also underlines the heightened pandemic risks from AMR, among other factors. Those risks are tackled in a second new report released Monday, “The New Face of Pandemic Preparedness” by the WHO-hosted Global Pandemic Monitoring Board, a group of political leaders, agency heads and experts, co-sponsored with the World Bank.

The GPMB recommends the establishment of a “comprehensive pandemic risk monitoring system that tracks threats, vulnerabilities and preparedness in real time, integrating health, social, economic and environmental data into clear signals for leaders.” 

Right now, for instance, while WHO monitors and reports publicly on antibiotic resistance trends in human health, its animal health counterpart, the World Organization for Animal Health has only just launched an Observatory to track drug resistance in livestock. Historically, however, the data collected by this non-UN, member-based organization has made use of different, and far less transparent reporting methods – leading to a major disconnect in terms of signals and risks. 

The report also recommends a global pandemic spending tracker for every country, with recommended benchmarks of $15 billion annually or 0.1-0.2% of GDP. And 0.5-1% of security and defense budgets.

AMR surveillance now includes data from 104 countries

The WHO report synthesizes data from the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS), to which 104 countries are now reporting. That represents a four-fold increase in country participation in GLASS since 2016, when only 25 countries were reporting data through the system. However nearly one-half of WHO’s member and observer states are still not yet reporting data. And about half of the reporting countries still lack the systems to generate reliable data, WHO said, in a press release. 

The new report presents, for the first time, resistance prevalence estimates across 22 antibiotics used to treat infections of the urinary and gastrointestinal tracts, the bloodstream and those used to treat gonorrhoea. It also looks at regional differences in resistance trends. Along with the soaring resistance in EMRO and SEARO regions, 1 in 5 lab confirmed infections in WHO’s Africa region are also antibiotic resistant.  

Globally, more than 40% of E. coli and over 55% of K. pneumoniae globally are now resistant to third-generation cephalosporins, the first-choice treatment for these infections. Altogether, the report covers 8 common bacterial pathogens – Acinetobacter spp., Escherichia coli, Klebsiella pneumoniae, Neisseria gonorrhoeae, non-typhoidal Salmonella spp., Shigella spp., Staphylococcus aureus and Streptococcus pneumoniae.

In the African Region, resistance to gram-negative bacteria, a growing problem worldwide, exceeds 70%. Among these, E. coli and K. pneumoniae are the leading drug-resistant gram-negative bacteria found in bloodstream infections. These are also among the most severe bacterial infections that often result in sepsis, organ failure, and death, WHO said.

Country participation in GLASS has increased over four-fold, from 25 countries in 2016 to 104 countries in 2023. However, 48% of countries did not report data to GLASS in 2023 and about half of the reporting countries still lacked the systems to generate reliable data. In fact, countries facing the largest challenges lacked the surveillance capacity to assess their antimicrobial resistance (AMR) situation. 

Greater emphasis on One Health 

The political declaration on AMR adopted at the United Nations General Assembly in 2024 committed countries to strengthening surveillance systems and addressing AMR through a ‘One Health’ approach coordinating across human health, animal health, and environmental sectors. However, massive animal industry resistance exists to transparent, and systematic reporting on AMR trends in livestock populations. Combined with that are financial incentives to veterinarians in low- and middle-income countries  – who earn much of their revenue from selling drugs to farmers.

Speaking at a WHS session Tuesday launching the GPMB report, former New Zealand Prime Minister Helen Clark who in 2021 co-chaired the “Independent Panel” that investigated the COVID-19 pandemic, lauded the “strong push for a prevention focus and a One Health approach” in the WHO pandemic agreement, approved in May. 

“But that actually calls for a lot more, a broader spectrum of collaboration than was business as usual before, at the multilateral level and within countries. And we really do have to get the agriculture and health ministry much closer together,” Clark said.

Creating new institutions while sunlighting others ? 

The new needs highlighted by the COVID pandemic contrast sharply with the budget pressures being faced by countries and agencies to retrench their budget and their spending. 

These and other challenges to global health governance and agency alignment were the focus of another WHS session Monday, on the ‘Shifting powers of global health governance.’ The discussion focused on the need for strategic reforms in global health governance, that could allow for the sunsetting of institutions that have filled their role – but even allow for their creation of new ones, should needs arise. 

“What we really do need is that we need clarity of mandate and that will not only save money, that will also eliminate the inefficiencies currently face,” said Paul Zubeil, deputy director of international health in the German Federal Ministry of Health.  “We actually need to have someone taking the lead and looking at that system and how we can make it lean. And of course, we need to talk also about sunsetting, and that’s very painful, because it involves people. It involves things that people have watched close to their hearts.”

Added Joy Phumaphi, executive secretary of the African Leaders Malaria Alliance (ALMA) and a former high level official at both the WHO and the World Bank, “Both the UN and the Bretton Woods institutions were crafted at a certain time and were designed for a certain global ecosystem… when most African countries were not even independent. And they need to be remodeled in order to suit the current global environment.

“They are really not helping us, the developing countries,” she said, referring to the vicious cycle of high interest rates, large debts and tough austerity measures that have trapped many low-income countries as a result of World Bank and International Monetary Fund policies. 

“I think that the starting point is, what does the country need?” said Wellcome CEO John Arne Røttingen. “It’s not a one size fits all.”

He said that development assistance had too often been managed similarly to humanitarian aid fostering excessive dependency on international institutions – inevitably followed by the shocks seen in recent months when that aid was abruptly withdrawn. 

“Of course, we know that there are fragile states, conflicts, states, countries with large populations due to migration that need extra support. And there, the international system probably needs just partly be involved in operations and humanitarian context and operational support. 

“[But] I think actually we have delivered some of global health almost as a humanitarian system…not in the most fragile countries only, but maybe up to 100 countries where we have delivered services from afar. And it means that when these politicians in high income countries make decisions to stop a program, the program is actually stopped a couple of days later on the ground. And that just indicates that level of verticalization and dependence that is not sustainable.” 

 ‘Neurotic and fearful’ about change

Engineering change, however, is extremely difficult because the multiple new global health institutions that were created are now “neurotic and fearful and frightened about their futures – and thus not good bedfellows,” observed Jeremy Farrar, WHO Assistant Director General and a former Wellcome CEO.  

Those not only include UN-affiliated institutions such as UNAIDS and UNITAID, as well as the Gates-funded Gavi, the Vaccine Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria, but also several dozen other smaller global partnerships and agencies in the global health galaxy – all funded one way or another by donor states, one other veteran diplomat observed. 

“No institution should think it’s there forever because, because that just brings complacency and arrogance and all of the things that go with it,” Farrar declared.

“But [that] is not a criticism of why those agencies were established,” he stressed. “They were established for a good reason. The question is not …why on earth did we set up the Global Fund or Gavi…in 2000.  The question is, what do we need for 2025 or 2050?  And it may or may not be, those organizations. 

“It’s not that we’re not saying they were rubbish and they should never have been established. They drove the world forward, and there are millions of people around the world now being vaccinated as a result of having Gavi. And we would not be where we are now with TB, HIV, and malaria, without the Global Fund. So let’s celebrate that success. But the thing now, in this more horizontal than vertical world…. when you have malaria and TB vaccines, is that Global Fund or is that Gavi? And how do you integrate those interventions into complex systems? 

“So it’s not that we should never have done them. We should. The question is, what do we need next?” 

Image Credits: E. Fletcher/Health Policy Watch, E Fletcher, https://www.who.int/publications/i/item/B09585O, 2025, WHO, 2025, WHO/GLASS , WHO , E. Fletcher/Health Policy Watch .