Today marks World One Health Day, which emphasises a transdisciplinary approach to addressing critical global health challenges. The One Health lens empowers advocates to develop strategies for navigating emerging infectious diseases, antimicrobial resistance (AMR), climate change, environmental pollution, and other interconnected issues. It highlights the need to address these challenges collectively to support one another.
A recent publication in Nature Reviews Microbiology from the Doherty Institute's National Centre for Antimicrobial Stewardship (NCAS), including Dr Rod James and Professor Karin Thursky, discusses the threats of AMR to human, animal, and environmental health through the One Health framework. The review examines the clinical, economic, sociocultural, and environmental drivers of antimicrobial use, highlighting the interconnectedness of these sectors. It provides practical, evidence-based solutions to implementing effective antimicrobial stewardship (AMS) programs to assist in combating this global threat.
Professor Karin Thursky, Infectious Diseases Physician and Director of the National Centre for Antimicrobial Stewardship, says the review also sheds light on the disparities between high-income and low-income settings, emphasising the inequity in addressing AMR globally.
“What we have demonstrated is that there is inequity in resources and ability to implement AMS globally. All countries should consider addressing the drivers for adoption as a key priority,” said Professor Karin Thursky.
Currently, no AMS model caters to the needs of all nations, health systems, and sectors. Poor translation from policy into practice, outdated guidelines, lack of access to high-quality antimicrobials and laboratory equipment exacerbate disparities, making it more challenging to address global health holistically.
Key recommendations from the authors were:
– Improve AMS through governance, sustained funding, surveillance, behavioural science and digital tools
– Measure what matters: implement interventions and report on appropriateness, not just volume of use
– Close the equity gap: Low- and middle-income countries (LMICs) need political commitment and long-term investment (transition funding from donor to domestic sources)
– Fund comparative-effectiveness and implementation research, and include LMICs, animal and environmental sectors in study design
– A One Health approach to AMS is required, include animal and environmental sectors, to end siloed programs with minimal funding outside human health
The World Health Organization Global antibiotic resistance surveillance report 2025, demonstrates that in 2023 globally, one in six laboratory-confirmed common bacterial infections in humans were resistant to antibiotics. This highlights the urgent need for a cross-sector framework to address AMR.
“The United Nations General Assembly advocates for member states to take urgent, accelerated action on AMR through a One Health approach, emphasising the optimisation of antimicrobial access and use. Here, we recognise and address implementation challenges, especially in low resource settings,” said Dr Rod James.
Despite the challenges, there is hope for improving AMS through effective policy-to-practice models, frameworks, guidance, and the utility of existing resources. However, political support and sustained funding for AMS are crucial to address inequity, strengthen health security, improve patient safety, enhance animal welfare, and maintain antimicrobial efficacy
Peer review: James R., Hardefeldt L.Y., Ierano C., Charani E., Dowson L., Elkins S., & Thursky K. Antimicrobial stewardship from a One Health perspective, Nature Reviews Microbiology, 2025. https://doi.org/10.1038/s41579-025-01233-3
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