Inclusion of antimicrobial resistance in a pandemic agreement: why it matters and what comes next?

Background: Antimicrobial resistance (AMR), referred to as the "constant pandemic," exceeds malaria and HIV as a cause of mortality across low- and middle-income countries. As AMR has been included in the recently adopted world's first pandemic agreement, we assessed the implications going forward for addressing AMR and meeting the UN General Assembly AMR targets. Methods: A rapid literature review was conducted to synthesize policy perspectives and empirical literature using 3 databases (PubMed, Embase, and CABI-Global Health) for studies published from December 2021 to May 2025. Results: Of the 56 included studies, only 2 were empirical research. Inductive and deductive analyses using the Organization for Economic Co-operation and Development framework with a force-field analysis were used to identify drivers and factors that may impede AMR reduction via the pandemic agreement. Challenges include inequity, inadequate governance, and financing. Factors that may impede implementation of the agreement currently outweigh driving forces. Conclusion: While AMR is included in the pandemic agreement, assessing the merits and risks associated with doing so is important to inform the detail and implementation strategy of the agreement itself. There is consensus that strengthening governance frameworks, fostering equity, and ensuring fair access to health resources are imperative.