Addressing antimicrobial resistance in China: progress and challenges in translating political commitment into national action

Abstract

Background: In 2016, 14 department ministers collaboratively launched China's five-year National Action Plan (NAP) on antimicrobial resistance (AMR). The NAP sets out strategic objectives including diagnostic innovation, mandatory prescriptions for antibiotics in human and animal use, antimicrobial stewardship (AMS) in hospitals, and professional capacity building. We conducted an interim post-implementation analysis to assess the impact of the NAP and provide critical insights about where efforts should focus next. Methods and materials: We synthesized evidence from multiple sources, including 1) the World Health Organisation (WHO) global tripartite database of country progress in addressing AMR, 2) two national surveillance networks, China Antimicrobial Resistance Surveillance System (CARSS) and China Antimicrobial Surveillance Network (CHINET), collectively reporting cross-sectional and time-series data of AMR epidemiology, and 3) published literature and government documents. The analysis was validated by key strategic and operational policy makers in China, including the Chief Advisor of the National Consultative Expert Commission of AMR Containment, who also scored a 7-dimension framework to identify levers for future change. Results: Legislative enforcement in antibiotic use in paediatric patients and food-producing animals, and national surveillance with timely mandatory reporting and data accessibility highlighted the country's progress, reflected by the reduction in broad-spectrum antibiotic consumptions for surgical prophylaxis and among hospital inpatients; and decrease in total hospital resistance and methicillin-resistant Staphylococcus aureus (MRSA) incidence. Tailored training and research has been embedded in hospitals to guide clinical practice and minimise skill and knowledge gaps in healthcare professionals. However, areas for improvement remain. AMR is absent from the nation's wider public health agenda, including Healthy China 2030, which lacks any strategic measure to address AMR. Shortages of qualified general practitioners and low utilisation of nursing workforce hindered local implementation of top-level policy directive. Organisational regulation relies on administrative power rather than dedicated professional roles. Further, pharmaceutical industry continues incentivising prescription and over-the-counter sales. Low public awareness, driven by limited health literacy about anti-infective and anti-inflammatory drugs, remains a barrier to engaging patients and citizens to promote optimal AMS and infection prevention. Conclusion: Despite the progress, China faces challenges across health systems. A whole-health-economy approach is needed to involve wider stakeholders to achieve sustainable long-term benefit.