In 2001, WHO published a global strategy to contain antimicrobial resistance.1WHO
WHO global strategy for containment of antimicrobial resistance. A year later, a workshop identified several crucial barriers to the implementation of the strategy (eg, underdeveloped health infrastructures and scarcity of valid data);2WHO
Implementation workshop on the WHO global strategy for containment of antimicrobial resistance. an action plan for continuing implementation of the strategy was therefore recommended. These challenges, many of which remain valid today, were discussed at the inaugural meeting of ReAct—an international network dedicated to the problem of antibiotic resistance—in 2005.3Antibiotic resistance–the faceless threat. A global action plan on antimicrobial resistance,4WHO
Global action plan on antimicrobial resistance. which spurred other political initiatives, was not adopted until 2015. Antibiotics are used more than any other class of antimicrobials, and in the political declaration on antimicrobial resistance in 2016,5UN General Assembly
Political declaration of the high-level meeting of the General Assembly on antimicrobial resistance. the UN General Assembly identified resistance to antibiotics as the greatest and most urgent global threat. This declaration was followed by the recommendations from the ad hoc UN Interagency Coordination Group (IACG) on Antimicrobial Resistance in 2019,6UN Interagency Coordination Group on Antimicrobial Resistance
No time to wait: securing the future from drug-resistant infections. and the formation of the One Health Global Leaders Group on antimicrobial resistance in 2020.7WHO
Global Leaders Group Terms of Reference. The issue of antimicrobial resistance has featured in several health-related international agendas, such as the Global Health Security Agenda, International Health Regulations, UN Sustainable Development Goals, health systems strengthening, primary health care, and universal health coverage.8Wernli D Haustein T Conly J Carmeli Y Kickbusch I Harbarth S A call for action: the application of The International Health Regulations to the global threat of antimicrobial resistance., 9van der Heijden M Sandgren A Pränting M et al.When the drugs don't work: antibiotic resistance as a global development problem., 10Bloom G Merrett GB Wilkinson A Lin V Paulin S Antimicrobial resistance and universal health coverage., 11The need to look at antibiotic resistance from a health systems perspective. However, the nature of antimicrobial resistance spanning diseases and sectors is a barrier to making a strong and sustained case, ultimately, to drive local impact. Substantial shortcomings remain in making investments, international collaboration, and collective action against antibiotic resistance proportionate to its global consequences.12Cars O Högberg LD Murray M et al.Meeting the challenge of antibiotic resistance., 13Laxminarayan R Van Boeckel T Frost I et al.The Lancet Infectious Diseases Commission on antimicrobial resistance: 6 years later.

The current COVID-19 pandemic has created a renewed awareness of the importance of infectious diseases, the speed at which health gains can be lost, and the need for resilient health systems. The pandemic offers opportunities to increase recognition that sustainable access to effective antibiotics is a fundamental component for both basic and specialised medicine, which is increasingly threatened by antibiotic resistance. However, when advancing action on antibiotic resistance, all stakeholders should reflect on the shortcomings of current messaging and advocacy, and move towards adapting and refocusing the message. Here, we have identified areas in which improvements could help reset the agenda on antibiotic resistance through a health systems perspective. A similar systems view is needed in the animal and environmental sectors with synergies sought between the three sectors in a One Health perspective.