Accelerating the global AMR response in the context of global health financing crisis

2025-03-27

With global health funding under strain, the global health threat of antimicrobial resistance (AMR) faces significant challenges. As resources become more limited, ensuring AMR remains a priority is more critical than ever. Our latest article examines how the global health financing crisis impacts AMR efforts and highlights key strategies to sustain and accelerate progress.

Renewed funding commitments for AMR

At the UN High Level Meeting on AMR last year world leaders agreed that more financial investments are needed to accelerate the global AMR response. Member states called for enhanced Official Development Assistance (ODA) and committed to facilitate funding from international cooperation to support National Action Plan implementation with a target of achieving USD 100 million in catalytic funding.

However, at the very time when global actors in the AMR response are in the process of turning commitments into action, the global health financing landscape is facing the shock of dramatic reductions. This jeopardizes both existing efforts to address antibiotic resistance as well as opportunities to expand and accelerate much needed interventions.

Over the past decades the US has been the largest bilateral funder of development assistance for health. But with the arrival of the new Trump administration a series of executive orders were enacted that have decimated US’ support for global health. This includes the withdrawal of funds from WHO and a cancellation of US membership; interruption of all external communications from the Centers for Disease Control and prevention (CDC) and the National Institutes of Health (NIH); as well as the 90 day stop-work-order of USAID and freeze or cancellation of foreign aid. Fully 83% of USAID programs have been cancelled. All of this has disastrous consequences for millions of people, and severely affect the AMR response.

What do we know about the impact of US funding cuts?

In its briefing 17th of March 2025, the WHO reported on observations of the impact on health as a result of the US government’s freeze on foreign aid through USAID, CDC and other agencies, including the following examples:

• Suspension of funding has led to an immediate stop in HIV treatment, testing, and prevention in more than 50 countries; 27 countries experience crippling TB response breakdowns, with disruptions to diagnostics and treatment supply, human resource, data and surveillance systems, and vital community work deteriorating; Severe supply disruptions of malaria diagnostics, medicines and bed nets supply in hot-spot countries, which risk reversing 15 years of progress.
• Over 700 laboratories in WHO’s Global Measles and Rubella Network face imminent shut-down – at a time when measles is making a comeback, with 57 large or disruptive measles outbreaks last year.
• Polio eradication efforts, and the monitoring of emergence of diseases such as avian influenza and the response to disease outbreaks are also under threat, with reversal to progress in disease control, immunization rates, maternal and child health and emergency preparedness.
• More than 2,600 health facilities in 12 humanitarian crises have already suspended services at least partially, or will do very soon.

The impact of interruption of health interventions and various health systems functions risk having more widespread effects beyond the specific areas. Given how strategies to prevent and address antibiotic resistance are interconnected with other health interventions, the effect of the cuts is likely to be broad, but also more difficult to track.

According to the head of Africa CDC, Jean Kaseya, the aid cut will reverse two decades of health achievements in maternal, child health and infectious diseases, and could lead to entire health systems collapsing. This is at a time when disease outbreaks have increased by 41% in the past two years.

Many of these cuts in areas such as disease monitoring and outbreak response, will directly affect AMR surveillance and related activities in Lower and Middle Income Countries (LMIC).

Ripple effects can be expected through inappropriate use of antibiotics for children with fever due to reduced access to malaria tests, and increasing unnecessary use of antibiotics to treat infections as a result of the closing down of Water and Sanitation and Hygiene (WASH) initiatives.

AMR-specific programming is also in line for termination, according to a leaked list that includes cutting funding for “Antimicrobial Resistance within humanitarian contexts” in South Sudan, Sudan, Somalia, Syria and the Yemen region earmarked for termination.

Cuts are not only limited to human health programs. The FAO’s Global Health Security Programme USD 250 million USAID grant to support animal health and One health capabilities in over 30 countries was formally terminated in March despite having a measurable effect in reducing the use of certain antimicrobials, mitigating resistance development and helping to improve food security.

Nor will the damage be confined to health systems and delivery. The US has been a significant funder of civil society organisations’ work, as well as a wide array of academic research, all of which has been decimated by the cuts.

Understanding the full impact of these cuts will take a long time, but it is already abundantly clear that their impact is disastrous for people’s health.

A challenging funding climate

The current US cuts are not happening in a vacuum. After decades of steady increase in development assistance for health reached an all-time high in 2021, then declined by 23% between 2021 and 2023. The United States has long been the largest provider of development assistance for health, and even increased its contribution in response to COVID-19 in 2021-23. This reversal from the US could not have come at a worse time, with the funding situation deteriorating further as other donors are also reducing aid financing.

Belgium, the Netherlands, France and the UK have recently announced aid cuts in the order of 25-40% respectively Germany, Sweden and Finland have also made cuts in their aid budgets. These cuts together with the dramatic cuts by the US, will deal a catastrophic blow to a wide range of health programs in LMICs.
Domestic resources are still the main source of funding for health programs globally but development assistance for health is proportionally more important in lower income countries, and the aid cuts therefore have a bigger impact in those countries. There is no doubt more domestic resources must be allocated to health in LMICs. However, abruptly cutting aid is not the way to achieve this goal. Such policies should not be given a chance to be disguised as opportunities.

The fiscal space for countries to take on these costs themselves is highly constrained. Countries are now facing a high and growing cost of external debt, particularly as a result of loans taken during the COVID-19 pandemic. Recent figures show that billions of people live in countries that are forced to spend more money on interest paymen than on health. To make matters worse, inflation is putting additional pressure on governments as the prices of goods and services rise.

A way forward

So how can we move forward with resource mobilisation and acceleration of implementation of AMR interventions in this volatile financing landscape? Doing nothing is not an option. A range of actions should be explored, including:

• We must continue to make the case for investing in health, whether through development assistance or domestic resources. Investing in people’s health has a value of its own right, and apart from saving lives and preventing outbreaks, it makes sense economically and socially. A diverse set of funders need to re-prioritise health, including governments, philanthropies, development banks etc.
• Donors need to be reminded of their moral responsibility, and be called upon to resume disbursements. Unplanned and sudden closure of programming is hugely destructive. If donors decide to reduce their aid budgets they must act responsibly to allow for the transition of services and minimise the risk to people’s lives.
• There should be a recognition that development finance is broader than just aid, and whilst the disruptive cuts must be challenged, there are long overdue reforms needed in the global financial system, including aid. The debt burden of lower income countries must be addressed, including multilateral development banks reviewing lending conditions.
• For investment in health overall and for AMR interventions specifically, resources should be harnessed and allocated through a system-wide approach, where synergies are sought across interventions to seek the most efficient way of delivering fundamental health services in a way that is accessible to all.

All actors must come together to call for investments in health. Civil society has an important role to play, and not least communities, where the impact of funding cuts will ultimately be felt. We need to hear their stories. ReAct will do its share to advocate for expanded resources to the AMR response.