AMR Visionary Award (Grand Prize)
Team 13279: Emily O’Neill (Team lead, LSE Health, The London School of Economics and Political Science), Omar Galarraga (Brown University), Catrin Moore (City St George’s), and Irene Papanicolas (Brown University)
Antimicrobial Resistance (AMR) National Action Plans (NAPs) are the cornerstone of global health strategy, with 181 countries having adopted the World Health Organization-recommended plans since 2015. However, evidence of their effectiveness remains limited.
Our recent study (O’Neill et al., BMJ 2025) demonstrated that high-quality AMR NAPs successfully reduced the consumption of broad-spectrum Watch-class antibiotics and encouraged the consumption of narrower-spectrum Access-class antibiotics. High-quality AMR NAPs also enhanced health system resilience and improved antibiotic prescribing during the COVID-19 pandemic. Still, there is insufficient information on whether AMR NAPs decrease AMR rates.
This research will conduct the first rigorous evaluation of the impact of AMR NAPs on bacterial resistance using quasi-experimental methods. We will analyze ATLAS surveillance data from 59 countries that overlap with our original study, employing staggered difference-in-differences analyses to estimate the causal effects of AMR NAP adoption and quality, on resistance rates across WHO critical- and high-priority pathogens. While the WHO GLASS data is accessible, it covers only 2018 to 2023, which is insufficient for robust pre-treatment trend assessments required for causal inference. The ATLAS program’s longitudinal coverage will enable rigorous evaluation of policy effectiveness.
This work will inform public health practice by helping countries prioritize interventions with demonstrated impact on AMR. We will identify which pathogen-antibiotic combinations respond to policy interventions, enabling targeted public health strategies. Our work further seeks to strengthen health systems by linking our BMJ findings on antimicrobial consumption to resistance outcomes, validating the full AMR policy pathway and demonstrating how health system investments in AMR NAPs yield measurable population health benefits. Finally, our work will strengthen stewardship by quantifying which AMR NAP components (surveillance, regulation, education) reduce AMR the most, providing evidence-based guidance for optimizing stewardship programs globally.