National Action Plans for Antimicrobial Resistance in the WHO Western Pacific Region: The Just Transitions Lens.

Antimicrobial resistance is one of the biggest global health threats, demanding urgent action. However, the threat of AMR and the ability to respond to it are far from evenly distributed. In many parts of the global South, where infectious diseases are more common, healthcare systems are weaker, and the social conditions that shape health are more precarious, the effects of AMR are felt more acutely. Because AMR arises within these unequal conditions, rapid action alone is insufficient; attention to how costs and benefits are distributed, who is prioritised, and whose voices are heard is essential to ensure that efforts do not inadvertently deepen existing inequalities. Hence, as the world prepares to tackle this "complex wicked problem," it needs to ensure that we not only make a quick transition but also a just one. The first step in ensuring a just AMR transition is examining the fairness of our current strategies. This study critically reviews the National Action Plans of the countries in the WHO Western Pacific Region to examine the extent to which ideas of justice are considered. Findings reveal that there are limited considerations for how the burden and benefits of actions are shared; decision-making is dominated by external and national actors within human health. Access to antibiotics is restricted across the spectrum without adequately expanding and strengthening alternatives. As NAPs undergo revision, there is a need to more consciously and explicitly integrate considerations of justice and equity to avoid unintended harm and ensure effective outcomes.