Evaluating Jordan's Antimicrobial Resistance National Action Plan (2018-2022) Implementation: Progress and Recommendations

BackgroundAntimicrobial resistance (AMR) is a pressing global public health challenge that requires coordinated multi-sectoral responses under the One Health framework. In line with the Global Action Plan (GAP) on AMR, Jordan developed its first National Action Plan (NAP) for 2018–2022 to guide national efforts. This study aimed to evaluate the implementation of Jordan’s AMR NAP 2018-2022, identify progress and challenges across its five strategic objectives, and suggest actionable recommendations for strengthening future AMR responses.MethodsA comprehensive end-term evaluation was conducted for the NAP 2018–2022 by the Jordan Center for Disease Control (Jordan CDC), utilizing a structured evaluation tool including sector-specific and multi-sectoral indicators aligned with the five objectives of the AMR NAP. Data were collected via national stakeholder workshop and follow-up electronic communications, with consensus-based completion by multi-sectoral working groups. Descriptive analysis was used to assess implementation across human, animal, food and environmental sectors, applying the One Health approach.ResultsThe evaluation revealed uneven implementation across sectors and NAP objectives, with notable achievements in the rational use of antimicrobials (69%), mainly in the human health sector, followed by infection prevention and control (IPC) efforts (63%), and surveillance-related activities (56%). Lower progress was reported for awareness activities (47%), while research and innovation activities were not implemented during 2018-2022. Although human health sector activities dominated, gaps persisted across the animal, food, and environmental sectors. Limited intersectoral coordination, the absence of a unified communication strategy, lack of dedicated funding, insufficient investment in human resources and laboratories, and the disruptions caused by the Coronavirus Disease 2019 (COVID-19) pandemic further constrained implementation. The findings underscore critical gaps in One Health surveillance integration, rational antimicrobial use in the food chain, and the need for robust AMR research governance.ConclusionsDespite progress in different areas, the overall implementation revealed significant challenges, particularly in research, multi-sectoral collaboration, and the One Health integration. Future action should prioritize a unified national AMR policy framework for strategic planning, emphasizing resource distribution, active participation of all relevant sectors, and institutionalizing systematic monitoring and evaluation to inform policymaking. Strengthening coordination between human, animal, and environmental sectors is essential to achieving a robust, One Health-aligned AMR response in Jordan.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-24073-5.

Antimicrobial resistance (AMR) is driven by inter-related dynamics in the human, animal, and environmental health sectors and 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. There is widespread consensus that the response to AMR requires multiple actions, including improving awareness and understanding of AMR, strengthening the knowledge and evidence based through surveillance and research, reducing the incidence of infection through effective sanitation, hygiene and infection prevention measures, optimising the use of antimicrobials in human and animal health and stimulating research and development (R&D) in novel antimicrobials and alternatives. International and national efforts to combat AMR have grown steadily over the last two decades. Two major landmark developments include the launch of the World Health Organisation (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. The European Commission also published a One Health action plan against antimicrobial resistance in 2017. However, despite progress at international level, there remains inconsistent progress and implementation of recommended policies to tackle AMR at national level. The UN Interagency Coordination Group on Antimicrobial Resistance (IACG) recently concluded that currently the greatest challenge in AMR is not designing a national action plan but implementing it. The contrasting cultures, behaviours and incentives of each sector and relevant stakeholders is what makes the successful implementation of AMR national action plans so challenging. The purpose of this workshop will be to discuss the evidence and thinking on the different facets of the complex problem of tackling AMR for academics and policy-makers. These discussions will be informed by a forthcoming book jointly published by the European Observatory on Health Systems and Policies and the Organisation for Economic Co-operation and Development titled 'Challenges in Tackling Antimicrobial Resistance: Economic and Policy Responses'. The workshop will focus on five key questions; How can implementation of AMR national action plans be strengthened? What is the evidence on the rise of AMR and its health and economic impact? How can AMR be most effectively addressed in community healthcare settings? How can the discovery of new antibiotics be reinvigorated to replace those rendered ineffective by resistance? Can more use be made of vaccines to tackle AMR? Key messages Antimicrobial resistance is a complex issue which requires actions across the human, animal, environmental health sectors taking a 'One Health' approach. Improving the quality of governance within antimicrobial resistance national action plans is an essential step to strengthening implementation.

IntroductionAntibiotic resistance (ABR) is a global issue that requires a One Health approach, addressing human, animal, and environmental health sectors together. The PRESAR network aims to reduce the emergence and spread of ABR in the Nile Valley, seeks to fill research gaps in ABR. This scoping review (ScR) focuses on mapping the existing literature and data on ABR in Egypt, Ethiopia, and Sudan, specifically examining the application of the One Health approach and reviewing the national action plans (NAPs) of these countries.MethodsThe ScR was conducted using the PCC framework (population, concept, and context) and incorporated relevant keywords and MeSH terms in: Medline, Scopus, and Web of Knowledge. Two reviewers per sector (animal, environment/agriculture, human) screened articles, including peer-reviewed studies published in English across all years. Studies on non-bacterial or mycobacterial infections, and systematic reviews, were excluded. Data such as infection type, sample source, and observed resistance were recorded. The NAPs were compared with the WHO Global Action Plan (GAP) to assess similarities and differences.ResultsThe review included 492 articles from Ethiopia, 331 from Egypt, and 31 from Sudan. Preliminary findings show that multidrug-resistant (MDR) S. aureus and K. pneumoniae dominate human infections, while Staphylococcus spp. and ESBL-producing Enterobacterales are more prevalent in animal and environmental sectors. There was large variability in diagnostic methodologies used across the sectors and countries, which in turn may lead to discrepancies in identification of bacteria at the species level and thereby inaccurate epidemiological data on prevalence and burden. While NAPs are generally aligned with the GAP, variations exist in areas like process ownership, research capacity, and funding.DiscussionThe review underscores the need for more research in non-human sectors and highlights the importance of One Health in tackling ABR. We strongly advocate for a unified and strategic approach among local stakeholders, scientists, and international agencies to prioritize and fund research, aiming for a sustainable reduction in antibiotic resistance.

Introduction: Antimicrobial resistance (AMR) remains a critical global health issue contributing to increased morbidity and mortality. Antimicrobial stewardship (AMS), surveillance, and infection prevention and control (IPC) programs have been established and implemented to mitigate this crisis. Alongside this, advancements in nanotechnology and artificial intelligence (AI) or machine learning have enhanced academic tone and readability in combating AMR. This study employed a comprehensive narrative review approach to provide detailed evidence of AMS programs initiated to address AMR across One-Health sectors (human, animal, plant, and environmental health). Methods: A comprehensive narrative review was conducted to assess the global implementation of AMS, surveillance, and IPC programs, nanotechnology, and AI aimed at curtailing the rising prevalence of AMR. We also focused on the impacts of these AMS programs across diverse populations and settings. Relevant literature published between January 1995 and June 2025 was extracted from PubMed, Google Scholar, and Scopus databases. Results: The findings of this review demonstrate that AMS, surveillance, and IPC programs have been successfully established and implemented in some hospitals, community pharmacies, academic institutions, communities, and animal health. These programs have significantly promoted the rational use of antimicrobials in the One Health sector, prevented infections, reduced the emergence of antibiotic-resistant bacteria, improved adherence to treatment guidelines, awareness and knowledge of AMR, and patient outcomes. Advancements in technology, including nanotechnology and AI/machine learning, have shown promise in enhancing AMS and surveillance programs aimed at combating AMR. However, there is a dearth of empirical data on AMS activities within the environmental and animal health sectors, pointing out a critical gap in the One Health approach to AMR mitigation. Conclusions: This review underscores the importance of developing and implementing AMS, surveillance, and IPC programs as effective strategies to combat AMR using a One Health approach. Consequently, the study found very little information regarding AMS activities in the animal and environmental health sectors despite global problems as climate change. Notably, this study emphasizes the importance of embracing nanotechnology and AI within the healthcare system as innovative tools to combat AMR. It further highlights the need to promote integrated AMS, IPC, and surveillance programs across the One Health continuum, leveraging all available strategies to effectively combat AMR.

The pandemic legacy of antimicrobial resistance in the USA

Mapping One Health antimicrobial resistance policy and implementation in Bangladesh: A scoping review

Antimicrobial resistance (AMR) is a well recognized threat to humanity in recent times. The severity of the issue is highlighted by WHO statistics showing that in 2023, one in six confirmed bacterial infections worldwide was resistant to standard antibiotics. Among the major reasons for this global rise in AMR are the inadequate diagnostic capabilities of low-income countries, inappropriate antibiotic use, and weak governance in both agricultural and human health sectors, where antimicrobial overuse remains a persistent problem.1,2 Additionally, pharmaceutical manufacturing effluents and untreated human sewage make significant contributions to the spread of resistance yet these sources receive little attention from regulatory authorities and researchers.3 To effectively address this issue, interventions must target not only human use of antimicrobials but also their use in animals and environmental sources. This integrated perspective is embodied in the One Health approach, which seeks to achieve a sustainable balance between human health, animal health and the ecosystem. Although the importance of the One Health approach is widely acknowledged, critical implementation gaps persist.4 Moving from rhetoric to tangible results requires three key strategic shifts. First, comprehensive surveillance of antimicrobial usage and resistance data across human, animal, food and environmental sectors must be ensured, with the integration of technology to detect emerging resistance patterns and transmission hotspots. Second, antimicrobial stewardship should be strengthened across all sectors. Third, research into diagnostics and alternative treatments, such as vaccines must be consistently supported.5 Pakistan developed its National Action Plan (NAP) in 2017 to combat antimicrobial resistance. Currently, NAP 2.0 is being implemented, focusing on improving awareness, optimizing antimicrobial use and investing in research for new vaccines and diagnostic tools. This National Action Plan aligns with the United Nations General Assembly Global Action Plan.6 In conclusion, the One Health approach, emphasizing integrated surveillance, stewardship, and awareness across human, animal, agricultural and environmental domains remains the only viable path forward.

PENICILLIN: A JOURNEY FROM A MAGIC BULLET TO A RESISTANT DRUG

Introduction The Field Epidemiology Training Program (FETP) in the ECOWAS region focuses on enhancing early detection and rapid response to disease outbreaks. Introducing the One Health curriculum in FETP is critical in addressing public health challenges by integrating human, animal, and environmental health sectors. The One Health Frontline Field Epidemiology Training Program (FETP) curriculum is designed to equip public health professionals with a multidisciplinary approach to address health challenges at the human-animal-environment interface. This regional approach strengthens multisectoral collaboration and ensures a transdisciplinary network of field epidemiologists who can coordinate and share data effectively across sectors. Methods A Joint CDC-WAHO training of trainers workshop on One Health FETP Frontline Curriculum was held from July 22 to 26, 2024, in Saly, Senegal. A teach-back method was employed, with participants presenting curriculum topics in PowerPoint, group discussions, and case studies. Mentors from 15 ECOWAS countries were trained to implement the curriculum. They engaged in exercises, multisectoral discussions, and field activity preparations. Feedback on the curriculum was collected daily to improve content and training delivery. Results The curriculum integrates epidemiology, veterinary medicine, and environmental health to foster a holistic understanding of disease prevention, detection, and response. A new field activity is the intersectoral site visits so that participants can see how other sectors conduct similar surveillance activities and multi-sectoral outbreak investigations. Sixty participants, including 36 mentors, from 15 ECOWAS countries attended the workshop. Participants represented human, animal, and environmental health sectors, with additional support from development partners like CDC, FAO, WHO, and USAID. The workshop successfully familiarized participants with One Health principles and how to apply them to surveillance, outbreak investigations, and data management. Feedback collected during the workshop highlighted the need for further adjustments in curriculum content and mentor training strategies to accommodate diverse regional needs. Conclusion The introduction of the One Health curriculum to the FETP Frontline training in the ECOWAS region successfully built One Health multisectoral collaboration and enhanced public health surveillance capacity. The workshop’s outcomes show a promising start toward improved detection, response, and management of zoonotic diseases. Future steps include cascading training at national levels, continued evaluation, and curriculum adaptation to local contexts.

IntroductionElectronic information systems (EIS) that implement a ‘One Health’ approach by integrating antimicrobial resistance (AMR) data across the human, animal and environmental health sectors, have been identified as a global...

BackgroundAntimicrobial resistance (AMR) is widely acknowledged as a global health problem, yet its extent is not well evaluated, especially in low-middle income countries. It is challenging to promote policies without focusing on healthcare systems at a local level, therefore a baseline assessment of the AMR occurrence is a priority. This study aimed to look at published papers relating to the availability of AMR data in Zambia as a means of establishing an overview of the situation, to help inform future decisions.MethodsPubMed, Cochrane Libraries, Medical Journal of Zambia and African Journals Online databases were searched from inception to April 2021 for articles published in English in accordance with the PRISMA guidelines. Retrieval and screening of article was done using a structured search protocol with strict inclusion/exclusion criteria.ResultsA total of 716 articles were retrieved, of which 25 articles met inclusion criteria for final analysis. AMR data was not available for six of the ten provinces of Zambia. Twenty-one different isolates from the human health, animal health and environmental health sectors were tested against 36 antimicrobial agents, across 13 classes of antibiotics. All the studies showed a degree of resistance to more than one class of antimicrobials. Majority of the studies focused on antibiotics, with only three studies (12%) highlighting antiretroviral resistance. Antitubercular drugs were addressed in only five studies (20%). No studies focused on antifungals. The most common organisms tested, across all three sectors, were Staphylococcus aureus, with a diverse range of resistance patterns found; followed by Escherichia coli with a high resistance rate found to cephalosporins (24–100%) and fluoroquinolones (20–100%).ConclusionsThis review highlights three important findings. Firstly, AMR is understudied in Zambia. Secondly, the level of resistance to commonly prescribed antibiotics is significant across the human, animal, and environmental sectors. Thirdly, this review suggests that improved standardization of antimicrobial susceptibility testing in Zambia could help to better delineate AMR patterns, allow comparisons across different locations and tracking of AMR evolution over time.

Antimicrobial resistance (AMR) is an intensifying global crisis arising from the unsustainable use and misuse of antimicrobials in human health, animal health, agrifood systems, and the environment that threatens the effective prevention and treatment of a range of diseases. With AMR already a leading cause of death globally, this mortality is projected to increase rapidly if urgent action is not taken to contain it. The AMR crisis has demanded multisectoral governance frameworks, spearheaded by the United Nations (UN) and the Quadripartite (comprised of WHO, FAO, WOAH, and UNEP) and implemented at all levels of government. Yet these mitigation efforts have been plagued by insufficient investment and vast coordination challenges across human, animal, and environmental health sectors within and between countries. Adopting a One Health approach, which recognises the interconnectedness of human, animal, and environmental health, guided by systems thinking and underpinned by global health law, is essential to transform global governance for responding to AMR as a complex systems challenge. This article examines the growing threat of AMR and the multisectoral drivers accelerating it, discusses the One Health approach and its application to AMR, and traces the evolution of global AMR governance leading to the establishment of Quadripartite cooperation and the initial, targeted codification of AMR-related obligations under the WHO Pandemic Agreement. To strengthen global AMR governance, this article offers recommendations for developing and implementing binding international law, applying a One Health approach underpinned by systems thinking in updates to WHO’s AMR Global Action Plan, and mobilising sustainable financing and new partnerships for antimicrobial innovation and AMR policy implementation.

Antimicrobial resistance (AMR) in bovine mastitis has become an increasing concern for public and veterinary health, compromising the effectiveness of conventional treatments and raising management costs. Mastitis is primarily caused by Staphylococcus aureus and Escherichia coli, pathogens that have shown increasing resistance to common antibiotics such as penicillin and tetracycline. The One Health approach, integrating human, animal, and environmental health sectors, emerges as an effective strategy to combat resistance and improve treatment efficacy. This study systematically reviewed articles published between 2020 and 2025, utilizing PubMed, BIREME and SciELO databases, aiming to assess how the One Health approach impacts AMR in mastitis and explore sustainable therapeutic alternatives. A total of 19 articles meeting the inclusion criteria were selected, addressing the prevalence of AMR in mastitis pathogens as well as the application of vaccines and phytotherapies as alternatives to antibiotic use. Results showed that resistance primarily increased due to excessive antibiotic use, while the One Health approach was found promising in controlling resistance by integrating veterinary, public health, and environmental practices. Additionally, sustainable alternatives such as vaccines and phytotherapies proved effective in reducing resistance without introducing new resistance issues. This study concludes that the implementation of the One Health approach, combined with sustainable alternatives, offers an effective model for controlling antimicrobial resistance in bovine mastitis. However, it is important to highlight the scarcity of in-depth studies on the long-term efficacy and viability of sustainable therapeutic alternatives. The lack of robust data limits the application of these solutions in the field and emphasizes the urgent need for new studies to confirm their effectiveness on a large scale. The implementation of public policies encouraging collaboration among human, animal, and environmental health sectors is also essential to optimize outcomes in managing antimicrobial resistance.

Background and Aim: Antimicrobial resistance (AMR) has emerged as one of the most critical global health challenges and poses significant threats to human, animal, and environmental health. Indonesia, like many other developing nations, is facing widespread AMR because of the overuse and misuse of antibiotics in humans, livestock, aquaculture, and agriculture. The interconnected nature of AMR requires a holistic approach to understand its prevalence, pathways, and impact. A One Health perspective, which integrates human, animal, and environmental health, is vital for comprehensively and effectively addressing AMR. This study is significant because it provides a detailed analysis of AMR in Indonesia and identifies critical resistance patterns across various bacterial species and antibiotics. This study highlights reservoirs of resistance, such as wastewater and food-producing animals, which serve as major pathways for the spread of resistant genes. Furthermore, this study examines the policy landscape in Indonesia, emphasizing the need for data-driven interventions and multi-sectoral collaboration. This study offers insights into AMR’s economic, health, and social implications and aligns with global and national AMR mitigation frameworks. The primary aim of this study was to evaluate the current state of AMR in Indonesia, focusing on the environmental, animal, and human health sectors. The One Health approach identifies key resistance patterns, transmission pathways, and contributing factors. In addition, the study proposes a research roadmap to guide future initiatives, emphasizing the development of rapid diagnostics, therapeutic innovations, and improved surveillance systems to combat the growing threat of AMR in Indonesia. Keywords: antibiotic resistance, antimicrobial resistance animals, antimicrobial resistance environment, antimicrobial resistance humans, antimicrobial resistance policy.

Integrating One Health governance in China: Assessing structural implementation and operational entry points