York University researchers are challenging how the world tackles antimicrobial resistance (AMR), calling for a more equitable and sustainable approach to surveillance and governance.
Published in the journal Social Science & Medicine, the research explores how AMR surveillance systems can better reflect the needs of vulnerable communities and under-resourced countries.
Led by Raphael Aguiar, postdoctoral research fellow at York’s Dahdaleh Institute for Global Health Research, the study draws on interviews with global experts from government, academia and international organizations.
The researchers argues that current AMR surveillance systems overlook the social, environmental and political factors that drive resistance.
“Antimicrobial resistance is not just a biomedical issue – it’s a social and environmental one,” says Aguiar. “We need to understand how power, poverty and urban development influence who gets sick and who gets access to treatment.”
Using a framework informed by Urban Political Ecology theory, the research team – including scholars from Montreal, Norway and Switzerland – show how urbanization, inequality and global development patterns shape risk and response related to AMR.
The study highlights that AMR disproportionately affects low- and middle-income countries, where limited resources and infrastructure make it harder to monitor and address this threat. It also points to ineffcient coordination between sectors – such as human health, animal health, agriculture and the environment – as a barrier to effective surveillance.
The authors advocate for a more inclusive and locally informed One Health approach to AMR. They recommend that future global strategies – such as the next WHO Global Action Plan on AMR – prioritize equity, gender responsiveness, community engagement and long-term support for under-represented sectors.
“To truly reduce antimicrobial resistance, we need to address deeper issues like unequal access to resources, gaps between rich and poor countries as well as the social and environmental factors that drive resistance,” says Roger Keil, co-author and professor emeritus at York’s Faculty of Environmental & Urban Change.
Focusing only on medical solutions isn’t enough, adds Arne Ruckert, co-author and director of research at the AMR Policy Accelerator, who states that surveillance systems should be tailored to the realities of different countries.
The study recommends policymakers and global health leaders embed equity into every stage of AMR surveillance – from data collection to policy development – and proposes a roadmap for more inclusive and effective governance.
“Without equity," adds Mary Wiktorowicz, co-author and professor at York's Faculty of Health, "AMR governance will continue to reproduce the same global inequalities that drive resistance in the first place.”