{ "abstract": "Background\n\nThis paper builds on the other papers in this series to present high-level lessons learnt and considerations for the future of antimicrobial resistance (AMR) surveillance and its contribution to action on AMR in low- and middle-income countries.Methods\n\nParticipatory synthesis involved engagement with individuals who had worked within and alongside the Fleming Fund from a range of organizations and geographies, to scope and solidify lessons learnt and future considerations relevant to a wide range of donors, partners, and policy makers or implementors. Contributors were invited to join a Writing Group, which included individuals from academia, clinical sciences, applied public, animal, environment, and food sciences health, as well as senior scientists and administrators from 14 organizations. The synthesis was informed by contributions to 4 virtual workshops and 3 drafts of the manuscript. Authors read and commented on the drafts, several wrote and referenced sections, and all gave substantive feedback with their reactions to the draft conclusions as consensus was built.Results\n\nOver nearly 10 years, the Fleming Fund achieved significant improvements in AMR surveillance. Analysis of the barriers and enablers across settings and systems highlights key lessons for how surveillance is positioned, funded, used, and innovated upon. The success of future AMR surveillance and its sustainability relies on planning within resource constraints for a sharpened system that focuses the scope, frequency, and depth of data to inform action, technical, and architectural developments directions to streamline investment and financing that supports country-led sustainable approaches.Conclusions\n\nInvestment in AMR surveillance and broader AMR actions has yielded substantial progress. Expanded domestic public financing, large-scale private sector engagement, or enhanced multilateral support will be needed to ensure recent gains are sustained. Progress will require well-designed, targeted, and cost-effective investments to maintain current capacity while enabling further system strengthening.", "abstract_shown": true, "affiliations": [ "London School of Hygiene and Tropical Medicine, United Kingdom.", "Fleming Fund Technical Advisory Group.", "Institute of Development Studies, University of Sussex, United Kingdom.", "Itad Ltd, Independent Consultant, International House, Queens Road, Brighton, United Kingdom.", "Department of Antimicrobial Resistance, World Health Organization.", "Fleming Fund management agent, Mott MacDonald, London, United Kingdom.", "UK Health Security Agency.", "Animal and Plant Health Agency.", "Food and Agricultural Organization.", "College of Environmental and Life Sciences, Murdoch University, Australia.", "Veterinary Medicines Directorate.", "Department of Infectious Disease, Imperial College London, United Kingdom.", "Department of Infectious Diseases and Tropical Medicine, University of Heidelberg, Germany.", "Department of Infectious Diseases, North Bristol NHS Trust, Bristol, United Kingdom.", "Department of Pharmacy, Makerere University School of Health Sciences, Kampala, Uganda.", "Department of Women's and Children's Health, International Child Health and Migration, Uppsala University, SE-751 85 Uppsala, Sweden.", "Commonwealth Pharmacists Association.", "Foreign Commonwealth & Development Office, United Kingdom.", "Department of Health and Social Care, United Kingdom.", "Fleming Fund Expert Advisory Group, United Kingdom.", "Division of Infectious Diseases & Immunology, Faculty of Veterinary Medicine, Utrecht University, The Netherlands.", "Family Health and Infectious Diseases, East Central and Southern Africa Health Community, Arusha, Arusha, Tanzania.", "World Organization for Animal Health.", "Oxford Health Evaluations, Buckingham, United Kingdom." ], "article_type": "research article", "arxiv": null, "author_total": 33, "authors": [ { "affs": [ 0, 1 ], "name": "Clare I R Chandler", "orcid": "0000-0001-6499-7522" }, { "affs": [ 2, 3 ], "name": "Syed Abbas" }, { "affs": [ 1 ], "name": "Afreenish Amir" }, { "affs": [ 4 ], "name": "Sylvia Bertagnolio" }, { "affs": [ 5 ], "name": "Lillian Bibangamba" }, { "affs": [ 6 ], "name": "Colin Brown" }, { "affs": [ 3 ], "name": "Hannah Brown" }, { "affs": [ 7 ], "name": "Roderick M Card" }, { "affs": [ 5 ], "name": "Adrienne Chattoe-Brown" }, { "affs": [ 8 ], "name": "Rachel Dalton" }, { "affs": [ 3 ], "name": "Archie Drake" }, { "affs": [ 5, 9 ], "name": "Stanley Fenwick" }, { "affs": [ 10 ], "name": "Clare Gilbert" }, { "affs": [ 1, 6 ], "name": "Claire Gordon" }, { "affs": [ 3, 11, 12, 13 ], "name": "Ankur Gupta-Wright" }, { "affs": [ 5 ], "name": "Heidi Hopkins", "orcid": "0000-0003-1076-6758" }, { "affs": [ 8 ], "name": "Emmanuel Kabali" }, { "affs": [ 14, 15 ], "name": "Freddy Kitutu", "orcid": "0000-0003-2277-9572" }, { "affs": [ 5 ], "name": "Toby Leslie" }, { "affs": [ 3 ], "name": "Rebecca Maudling", "orcid": "0000-0002-8900-2138" }, { "affs": [ 16 ], "name": "Maxencia Nabiryo", "orcid": "0000-0002-8766-2802" }, { "affs": [ 17 ], "name": "Amy Potter" }, { "affs": [ 16 ], "name": "Helena Rosado", "orcid": "0009-0007-4601-6621" }, { "affs": [ 16 ], "name": "Victoria Rutter" }, { "affs": [ 18 ], "name": "Nandini Shetty" }, { "affs": [ 3 ], "name": "Tim Shorten", "orcid": "0009-0002-0792-660X" }, { "affs": [ 18 ], "name": "Milena von Und Zur Mühlen", "orcid": "0000-0002-7314-9346" }, { "affs": [ 19 ], "name": "Catriona Waddington" }, { "affs": [ 1, 20 ], "name": "Jaap A Wagenaar" }, { "affs": [ 3, 21 ], "name": "Evelyn Wesangula" }, { "affs": [ 3 ], "name": "Dan Whitaker" }, { "affs": [ 22 ], "name": "Javier Yugueros-Marcos" }, { "affs": [ 3, 23 ], "name": "Kate Macintyre", "orcid": "0009-0007-3946-8734" } ], "bibtex": "https://research.draconitic.com/paper/7sbb8jr0q9hjk.bib", "cited_by": 1, "doi": "10.1093/cid/ciag498", "fulltext_url": "https://europepmc.org/articles/PMC13679387", "id": "7sbb8jr0q9hjk", "issns": [ "1058-4838", "1537-6591" ], "landing_url": "https://europepmc.org/article/MED/42895840", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2402|Antibiotic Use and Resistance" ] ], "openalex": "W7222921207", "pdf_url": "https://europepmc.org/articles/PMC13679387?pdf=render", "pmcid": "PMC13679387", "pmid": "42895840", "published": "2026-10-01", "publisher": null, "ris": "https://research.draconitic.com/paper/7sbb8jr0q9hjk.ris", "sources": [ { "first_seen": "2026-10-30T12:19:37Z", "native_id": "MED:42895840", "source": "europepmc", "url": "https://europepmc.org/article/MED/42895840" } ], "subjects": [ { "field": "biology", "origin": "openalex:2402|Antibiotic Use and Resistance", "subfield": "microbiology" } ], "title": "Reflections for the Future of AMR Surveillance and AMR Action.", "title_text": "Reflections for the Future of AMR Surveillance and AMR Action.", "type": "peer-reviewed", "updated_at": "2026-10-30T12:19:37Z", "url": "https://research.draconitic.com/paper/7sbb8jr0q9hjk", "venue": "Clinical infectious diseases : an official publication of the Infectious Diseases Society of America", "versions": [] }