As global development aid contracts, low- and middle-income countries (LMICs) face growing pressure to fund and implement National Action Plans on antimicrobial resistance (AMR).
A new approach rooted in local ownership and equitable partnerships is emerging — led by LMICs, supported by innovation and collaboration.
From Colombia to Kyrgyzstan, country-driven models are proving that sustainable, effective AMR action is possible without donor dependency.
The moment calls for leadership, innovation and solidarity to transform crisis into catalyst.
World Antimicrobial Awareness Week (WAAW) 2025 will take place from November 18 to 24, 2025.
The global health and development financing landscape is undergoing a transformative shift. As traditional development assistance diminishes and economic pressures mount, low- and middle-income countries (LMIC) face a critical juncture in addressing antimicrobial resistance (AMR) — one of the most pressing yet significantly underfunded health threats of our time. Within this crisis lies an unprecedented opportunity to shape new pathways and governance mechanisms, grounded in local realities and led by countries, forging innovative partnerships and collaborations that transcend conventional donor-recipient dynamics.
The urgency of addressing AMR in the midst of current turbulent times cannot be overstated. Forecasts show that if we do not act now, AMR will cause 39.1 million deaths between 2025 and 2050, with an additional 169 million people dying from illnesses associated with AMR. AMR also has the potential to negatively impact economies worldwide, halt development and drive up poverty levels. Despite widespread development of National Action Plans (NAP) on AMR, only 29 per cent of 186 countries have costed or budgeted their NAPs and are monitoring their implementation.
Last year, Official Development Assistance (ODA) dropped by 7 per cent, and this year a decline of 17 per cent is expected as traditional donors pull back commitments. This contraction sends tremors throughout LMICs, compounded by an unprecedented global debt crisis that constrains national budgets precisely when they are needed most. Global government debt is projected to exceed 100 per cent of the world’s gross domestic product (GDP) by 2029 — its highest level since 1948 — heavily affecting LMICs at a time when conflict, migration, inequality and health vulnerability are on the rise. On top of this, there are cuts to multilateral organisations, further impacting the ability of LMICs to sustain essential health and development programmes. Public health institutions and governments are being asked to accomplish more with less. This convergence of crises demands a fundamental reframing of how we approach governance and financing for AMR across the One Health continuum.
While the current financing landscape presents genuine challenges, it also creates an imperative for change that has long been needed. For too long, LMICs have been overly reliant on a narrow base of wealthy donor countries and foundations, perpetuating dependency relationships that often prioritise donor agendas over national priorities.
A year after the Political Declaration on AMR was adopted, the global community stands at a crossroads between aspiration and action. The question is no longer whether AMR deserves attention, but rather how we ensure that commitments translate into measurable action and progress. The call for greater self-reliance and leadership in LMICs must be matched by innovation in the way countries structure governance and financing for action towards AMR, as well as in their approach to partnerships.
The International Centre for Antimicrobial Resistance Solutions (ICARS) provides funding and technical support to governments and research institutions in LMICs to implement AMR interventions. Working closely with local partners, ICARS supports the co-development of projects that are driven by national AMR priorities rather than donor agendas and broader global AMR objectives.
Examples of country research efforts illustrate such partnerships in practice: in Colombia, a partnership with Porkcolombia to improve colostrum management and vaccination and introduce antibiotic-free feed in pig farming has led to a 91 per cent reduction in antibiotic feed use, while improving piglet health outcomes. In Kyrgyzstan, a trial involving 1,204 children tested point-of-care diagnostics to guide antibiotic prescribing for acute respiratory tract infections, resulting in a 24 per cent reduction in antibiotic use with no difference in health outcomes — demonstrating that safe, scalable and effective approaches to stewardship in primary care are possible. Projects are designed for sustainable impact from the very start by including capacity-strengthening, behavioural change and economic components.
These LMIC-led projects demonstrate that effective AMR response and governance are not simply about replicating models from high-income countries. Rather, they require context-appropriate solutions that fit within existing national health system architectures, political and economic structures, and implementation capacities. A shift towards domestic ownership is not merely about filling a funding gap; it represents a fundamental reimagining of who drives the global health agenda, and whose priorities shape interventions on the ground.
The future of AMR action lies not in waiting for traditional financing streams to recover, but in actively building new models of cooperation grounded in shared challenges and mutual respect. LMICs face similar pressures from drug-resistant infections, comparable resource constraints and analogous governance challenges. These commonalities create natural foundations for collaboration, knowledge exchange and joint problem-solving.
Such collaboration can take many forms: regional surveillance networks that share data and coordinate responses; joint procurement mechanisms that increase bargaining power for quality-assured antimicrobials; technical cooperation that enables countries to learn directly from peers facing similar implementation challenges; and policy advocacy forums that amplify LMIC voices in shaping global AMR policy. At ICARS, we also see great value in bringing project partners from different countries and regions together to share learnings across borders.
Furthermore, AMR cannot be addressed in isolation. A truly horizontal approach must integrate AMR action with pandemic preparedness, health systems strengthening, agricultural and food production system reforms, universal health coverage expansion, primary healthcare delivery and climate action. These are not competing priorities but interconnected challenges requiring coordinated responses.
The current contraction of ODA financing, while painful, may ultimately prove catalytic if it accelerates the transition towards more equitable partnerships rooted in country ownership, solidarity and sustainable financing. The governance and financing frameworks we build today, whether at national, regional or global levels, will determine whether the world rises to meet the AMR challenge or watches decades of medical progress erode. Commitments have been made – now is the time to act. The moment demands leadership, innovation and, above all, partnership. LMICs have both the necessity and the opportunity to lead this transformation.
Theresa Hogenhaug is leading Partnerships, Advocacy and Global Government Relations at the International Centre for Antimicrobial Resistance Solutions (ICARS). Views expressed are the author’s own and don’t necessarily reflect those of Down To Earth